it's the small things

Wed 25th March 2020:

I decide to get armed and repel the danger of coronavirus in my own way at work-there just doesn't seem to be the same sense of urgency in our department, and it hasn't helped that the measures we adopted (to take patient temperatures, clinic staff to wear basic protection in the way of scrubs, aprons, and simple surgical masks) are being refuted by a senior hospital matron.  I find this unaccepatable that our nursing staff have been told not to wear any protection "for fear of frightening patients".  I overrule what I am hearing from our precious nurses and tell them to continue and I will answer to whoever is suggesting otherwise.  On the contrary, all my patients  who have been attending for their surgery, (some in their own face masks, others we give one to), have expressed only gratitude that we are still running our service for their more urgent need.  And they have said how reassured they have been by our visible measures to confer protection of them and of ourselves.  These people fear this virus, not of seeing the donning of physical protection amongst staff which is what they have seen everywhere else on the news.  Physical examination and treatment of patients requires close proximity between clinicians (doctors, nurses, healthcare assistants) and patients.  Spacial distancing is impossible.  If I were a patient I would be acutely aware of how many people a clinician treating me would be coming across in a day, and I would want to have a decent barrier between us.  Some patients haven't attended their clinic appointments because of their concerns with exposure.  I can't really blame them. 

​I take things up a notch from my paper surgical facemask, and  borrow a visor usually used for UV phototherapy by our nurses (it makes me wonder even more why anyone would ever consider lying on an artificial sunbed when this visor is used to protect the nurses during controlled uv treatment of patients). I feel the safest today than ever before, but the FFP3 mask (of which we have only a few) is marking my face after wearing it for an hour, and with the visor on top (which makes me sound and feel like Darth  Vader in a sauna) makes for a heavy day’s operating. But it raises some smiles, even if people think I’m overreacting in my little dermatology dept. Granted we aren’t itu.  And my thoughts are very much with my colleagues up there. But there’s no risk worth taking right now I feel. Even in our dermatology department, and especially during facial surgery.  I wore a long sleeved high necked top under muy scrubs today as we don't have long sleeved gowns, and I feel even more guilty asking for these when others in the hospital need them. I keep a separate pen for my patients to sign their consent form, and I sanitise it afterwards.  The door handles are wiped down with each entry and exit into the op room.  I don't think I'm overreacting. Am I?? 

I go home tired today. And emotional for the first time. The impact of what’s going on is hitting me hard this week. I can’t help thinking about what is going on on the wards and itu and in A&E and in places we aren't hearing as much about like care homes.  I think about the fact that the dying and their relatives are not together, and that funerals can't even be attended in the usual way.  I think about the fact that patients with cancer are amongst the people who are being delayed or even denied their treatment. I cry when I get home as I think about the seriousness of this pandemic now, having been so calm and pragmatic and reassuring my colleagues as much as possible, when all along I’ve been slowly gaining a momentum of a background anxiety myself, and tonight it bubbled over. I wept on my own. 

My husband wanted to comfort me.  I said that I was finding it hard to verbalise what I was feeling right now, but confused, worried, sad, anxious, helpless in a situation out of our control, uncertain, guilty, and not believing what these covid patients, their worried families all at a distance, and cancer patients and other sick patients must be feeling.  I think of the devastation my family and I would have felt if I was told when i had my cancer diagnosis that I couldn’t get my treatment at that time, and how lucky I was to have access to such treatment. I then think of those who can’t afford it, can’t reach it, their illness too advanced to be given it, living in places which don’t have the science, technology or funding for it, whether here or in any other developed or underdeveloped country. And then I think that horrifyingly this must also be true for covid-19 right now.  And across the world. 

It's 4 weeks to the day since Ash Wednesday, when I gave up chocolate, cake, and sweet things for Lent.  It was a chocolate day today.  My husband and my friend, who both know me too well, give me permission to break my resolution early.. so I do.  My night is complete.