lockdown and preparing for war

 ​Monday 23rd March 2020:

Prime Minister Boris Johnson declares the uk in lockdown.  I couldn't see this 

To me, this now means war.  Yet I feel that we are being kept in the dark at my hospital-surely we should as staff be informed of the developing situation regarding our capacity for covid patients, our itu beds, how soon we will need to change what we are doing , or help out outside of our own departments (aka outside of our comfort zones)?  With everything escalating in the media, it feels entirely hidden from us at my hospital, and with scenes are we seeing, it can't just be happening everyhwhere else and not where I work!  Why the silence?

I wake up feeling anxious, not only for myself but for all my colleagues, doctors and nurses alike.  I feel compelled to write to our medical director to enquire about what the situation is with us.  I have a pang of guilt as his job is immense at the moment, and whilst we are regularly being updated on covid protocols, advice, including  that from the government, personal protective equipment, etc on our Trust internet, we have had no word of the actual or impending situation where we are, and that is becoming intolerable unnerving.  Will a button just be pressed and everyone runs into action? How will they tell us when and how we are needed? It feels wrong, and we feel uninformed. The anxiety levels in myself and my immediate colleagues is rising, particularly over the past week, and amongst our nurses is as sky high as their morale is rock bottom with the lack of information, and their own fears of working  on the wards-many of them left shift work on the wards to work in outpatients years ago, and this potential threat to their status quo is now raising enough of their concerns to resign if they are moved.  As a doctor I feel we need to keep our nurses informed, and support and encourage and protect them, but right now we have nothing to tell them, and that feels disabling. 

We don’t know how to manage patients with covid, we don’t want to take the virus home to our loved ones, we fear the changes it will bring to our familiar hectic working lives in ways that we all fear. And never did we think we would be facing a health war of this scale in our entire careers. We don’t have a means to be tested yet, and I’m convinced the lack of testing has led to too many medics continuing to work on the frontline in Italy and scores of them sacrificing their lives to care for the patients whose lives they are trying to save from the same disease that they too have ended up being buried with. Excruciatingly families can’t visit their dying relatives due to the risk of the virus upon them, and so many people are dying and grieving alone. This is heartbreaking.

With my manager’s support, I find my (written voice) and send the email to the man at the top:  

Dear Medical Director,

As a non-consultant doctor in dermatology, I would like to share my concerns with you, having shared them with my manager, about the current lack of information being conveyed to the clinical work force as to the existing situation at this hospital regarding numbers of covid cases/itu capcity etc, and whether things are escalating behind closed doors without updated information being given to the very people who are required to assist if things are becoming overwhelming without our knowledge.

I’m sure I speak for many when I express that I feel strongly that the trust have a duty to tell their soldiers the situation, which we have good reason to assume to be mounting, as at the moment everyone currently outside of the acute care situation is a sitting duck, and would appreciate clarity without wondering and thinking if or when we are reaching a tipping point here, and will be deployed outside of our specialities to manage these acute patients.

Whilst there may be a feeling at the top that keeping us informed may incite panic in the workforce, this is in my opinion very short sighted to think that panic will be the overwhelming response if we are told where we are in numbers today, and every day.  On the contrary-what we need to do right now is prepare, as individuals, as teams, and with time, however short now, to learn and educate ourselves if there is some undoubted certainty that we will all be called into battle.  If the emergency button is suddenly pressed, and we are called up at the final hour and without training or preparation, then this will be disastrous for patients and clinicians alike. And that is when you will see panic...

None of us have been tested, and whilst this is a vital intervention, without which we can all freely and hugely impact on our own and therefore our patients’ safety, I realise this is another battle we can’t overcome immediately as testing is not freely available.  

But I urge you-being kept in the dark is absolutely wrong in my opinion, and with the inside knowledge that things aren’t rosy in our locality, makes me even more sure of this, and if others were more aware of the current situation I’ve no doubt they would feel the same.

These may be the thoughts of a mere clinician at the bottom of the hospital food chain, but who still has a soldier mentality of wanting to do whatever it takes to enable a favourable outcome through this war.  Of course we all appreciate your invaluable ongoing considerations of everyone involved, and we know that you are also overwhelmed with all that is going on, it must be an impossible time for you.  But I ask you please not to minimise our professionalism and overriding duty of care which we are all continuing without question to embody, now as always, but see this as a personal plea on behalf of us all, for information to be given to your army who you will need to be prepared, and who are likely panicking more at the lack of information of the current situation.

Thank you, and I hope we can all have more transparency, as we work to prepare for the worst.

Yours sincerely,

Miss Sam Anthony

Although I also feel like signing it off as "little old me, in cushy old dermatology, and anyway who am I to reach out to the medical director when I have such a meek place in this profession, and with greatest of apologies for bothering you at this terrible time".  However my thoughts on the matter get me over that, and I feel he is the only person who could respond to this.  And I press send.  What's the worst that can happen I ask myself.  It's unlikely I will be sacked.  I may get thought of as an anxious worry-wort, someone stepping out of line and thinking I can weigh in with a moan to the upper eschilons of the hospital at a time when I should be quiet and get on with it, my colleagues may consider me to be interfering at a level not at all appropriate, I mean, I'm not even a Consultant, so what right do I have to tap in where Consultants have more authority to.  All questions I asked myself, but what really in the end did I have to lose even if all this did turn out to happen? Well I wasn't thinking of myself in this, I was thinking of my colleagues. 

The dear man takes a moment to acknowledge my email and replies:

Hi Samantha,
We are launching extensive comms today, in this very fast moving situation.
Apologise I can't give you a lengthy reply, but I'm really really busy.
Apologies that you feel out of the loop.
Best wishes,

I thank him greatly for his reply at what must be again an impossible time. All I can do is speak out for the workforce as I have seen and felt for myself first hand what people away from the frontline are feeling, and wondering if/when they will be called up to serve in this war.