Tuesday, 24 March 2020

Over The Top

I have consumed so much information in the past two weeks that whatever comes out of my head now is simply a mish-mash of other people's words, advice and opinions. I am no longer the master of my own thoughts. My consciousness is simply a stream of memes from fourteen different WhatsApp groups and my brain is no longer able to tell the difference between the Junior Infants Home-School-Mom-Drinks-Wine-To-Survive hilarity and the Learned-Colleague-Who-Knows-Their-Stuff-Says-We-Are-All-Doomed misery. 

A few phrases are lodged at the front of my brain (I have heard this being referred to as top-of-mind. Advertisers love when they can get their stuff to be Top of your Mind). Someone described the feeling in emergency departments around the country as being like the deep low tide sucking all the water from the land just before a tsunami hits. This then reminded me of William Wallace shouting HOLD! And someone else mentioned the final scene in Blackadder Goes Forth, when the lads go over the top(To save you having to follow the links, I can tell you that none of these scenarios end particularly well). 

These are the fears of the medical community, and they relate not just to the likelihood that our hospitals and clinics will soon be flooded with people, but that the staff working in those hospitals will be washed away, trampled over or blasted apart by the illness itself. We are aware that many of the people who have died from Covid19 around the world have been healthcare workers. We know that those who work closely with sick patients are more likely to get severe illness than those who work more peripherally in the hospital. We also know that wearing the correct personal protection equipment (PPE) can dramatically reduce the risk of becoming infected. 

Ideally, every encounter between a healthcare professional and a patient right now would be carried out in the correct PPE. Ideally, one would err on the side of caution to reduce the risks of transmission to an absolute minimum. This would protect both the patient and the caregiver and ensure that enough people are well enough to provide healthcare to the hordes that need it. So, ideally, we would wear the right gowns, masks and gloves for each interaction, and have enough left over to have a few spares in case we need a wee half way through our shift.

However, the world does not have enough gowns, masks or gloves apparently (according to at least ten of my fourteen WhatsApp groups). So we need to ration them. Now, no one is saying that we should just throw ourselves onto the pointy swords of the marauding virus. No one is telling us to go over the top with just a little stick to fend off the machine guns. No. They are suggesting that we wear a gown, goggles, gloves and fancy mask when we are forcibly suctioning secretions out of a moribund patient in ICU. It would be a good idea to wear the full kit while intubating a young man who is struggling to breathe. It would be wise to have most of it on while examining the chest of a middle-aged woman who is coughing and spluttering uncontrollably. 

But what about when someone is sitting there with one of those persistent shoulder-curling coughs, but is otherwise not too bad? Or a fella with a high temperature but not much else wrong with him? Surely there's no need to go wasting precious resources for that? Or how about the elderly lady who knows she is dying, and has chosen to stay at home? Will a night nurse or a GP go into her house to help her to die well, wearing a full hazmat suit? Or not wearing any protective gear at all?

Every coronavirus death that is announced is given a designation as being "erra fair enough" or "god that's awful" depending on the presence or absence of the infamous "underlying conditions". It is quite surreal to hear this dismissal of the value of life, based on the fact that the person might have had a drop of asthma or a bit of the old stage 4 cancer. I think I can see the logic; the softening of the blow, the minimisation of panic. But I am not sure that the family of a 57 year old victim who happened to use an inhaler or took some tablets for diabetes are able to accept that he was simply a sitting duck. 

And what about the healthcare workers who also happen to have an underlying condition, or are a little more senior in their years? Should they retreat to their cocoon, pull the blankets over their heads, and let their greatly under-supported colleagues stand in front of the rampaging virus with their diminishingly-pointy sticks? Or should they throw themselves out in front, given that they now have Expendable written across their foreheads and their deaths can be put in the "ah well" category?

Let's face it, none of us filled in that CAO form thinking jaysus do you know what, I'd love to die for my country. Some of us filled it in with dollar signs in our eyes, and there are very few dollars swishing around the hospital corridors these days. Most of us signed up with a vague Miss Universe aspiration of "helping others", but not really ever envisioning that we would have to risk our lives just to listen to someone's chest. Sure, there are the hero doctors like David Nott and those other MSF types but we all know they are a bit left-field, a bit out there. Not like the rest of us. I watched the documentary "For Sama" before all this Covid carry-on started, and I found it incredibly moving but so, so far away. Now I think of the film-maker's husband and his colleagues working in those horrendous conditions, and how their lives have been so dramatically changed in a short period of time. This is what lies ahead for us, too. We are being forced into the roles of heroes, warriors, patriots, martyrs. When really we just wanted a nice house with a garden and a feeling of being useful. 

So we are scared and worried, and ashamed and embarrassed by those feelings. We are willing to climb the ladder into No-Man's-Land, but we wish we were in a massive armoured tank and not just carrying a small stick. Some of us may want to point out that we have a dicky heart, or flat feet, so that we can be legitimately sent home from the Front. We may even consider going AWOL. But in the end, most of us will do what is asked and expected of us, and some of us will do a lot, lot more. 

We are all trying to think of cunning plans, but in the end we may just have to take out our diaries and simply write, "Bugger". 

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