Senior Registrar in the general medicine
department in a Western Australian hospital
If anybody had asked me about my life 2 months ago, I would have said it was amazing. I have a lovely family, a wonderful 2-year old daughter who makes me laugh everyday, a fulfilling career and a marriage that to this day, I thank God for. But most of all were the plans that I had for the future. Zara had just started French school and her weekly sports class; I was enjoying my last year of speciality training and I had holidays booked.
And then, in an instant, things changed. COVID-19, the pandemic that had trailblazed through China, was suddenly, very much at our doorstep. Funnily enough, the first sign of the havoc was in the supermarkets. The toilet paper crisis still to this day amuses me. I witnessed usually rational adults stampede their way to the much-coveted loo aisle at 7 am in the morning. However, this hoarding soon spread to rice, pasta, baking supplies, canned food and baby supplies and I got worried. I am in the hospital from 7am and get back home at 5pm most days, missing the shops opening hours. I soon realised other doctors also had the same issue and were worried about how to get basic supplies.
Weekends became a trek through various shops to stock up on essentials. We were now faced with the possibility that if things worsened quickly, that I may need to leave home and stay in a hotel close to the hospital, as my colleagues were doing in the Eastern states. I became fixated on stocking up on nappies and formula and cooking and freezing in bulk. Then we heard that schools and day cares were faced with imminent closure and more panic and worrying ensued. In the absence of family with us, my husband and I decided that we would have to take turns staying at home. That was my cue to now shop for craft supplies and books for Zara. We even bought a rabbit, whom we aptly named Covi, in the eventuality of her not having any social contact for a long time. All my spare time now went into hunting for babysitters so I would not have to miss work. I now do not know whether my Mother will be able to fly over in July as planned.
Being the Senior Registrar in the general medicine department in a Western Australian hospital carries a lot of responsibilities. I step in to cover consultants when they are on leave, supervise junior doctors, oversee the education roster and have a lot of non-clinical responsibilities within the hospital and the Royal Australasian College of Physicians as the chair of the WA trainee committee. Over the past 2 months, so much change has happened in the hospital that I am still trying to keep afloat. Every day, new policies, new infrastructure and new rostering alterations are proposed.
My general medicine ward has been converted to the official COVID ward. We, however, call it the cohort ward, so as not to scare patients and not to stigmatise them. The ward underwent an emergency makeover. Carpets were ripped in favour of vinyl flooring as they are easier to disinfect; new doors with large see-through window panes installed so we can talk to the patient from outside; the reception desk shielded with glass to minimise contact and the main doors sealed so as to create a one-way traffic system within the ward. Our ICU has expanded its capacity from 20 beds to 30 beds. We took over some beds on the surgical ward as elective surgeries were cancelled. Our rosters were altered and the WA Chief Medical Officer has issued a degree for doctors to be grounded in their current hospitals to minimise transmission risk.
All teaching sessions and practical sessions were cancelled while we come to grips with social distancing and in favour of Personal Protective Equipment don and doff techniques sessions. Weekly infectious diseases and respiratory medicine updates are being provided regarding therapeutics, transmission risk and management of patients with COVID. All of it serves to heighten the stress which is now palpable within the hospital. An emergency COVID clinic opened up in the hospital and all our staff are now tense and ready for the worst.
Our community testing guidelines in WA has relaxed to the extent that now anybody with fever or any respiratory symptoms can be tested. This means that any patients presenting to emergency with the above, is being sent to the cohort ward. A COVID test has implications for patients which are often forgotten. Whilst they are awaiting results, they cannot have any visitors or certain treatments such as high flow oxygen or non-invasive ventilation for fear of aerosoling the virus. Patients on the cohort ward do not receive visitors generally. Catering staff do not go in and only one nurse is assigned to them. Sometimes, the only interaction they have is medical or nursing staff talking to them through the window. PPE is scarce and so, we minimise entering the room unless absolutely necessary. Worse of all, is the alterations to cardiac resuscitation policies. We can no longer instinctively just perform CPR. Goals of care will be determined on admission and in the event of a cardiac arrest, we take the time to put our PPE on first and then go in, thereby potentially foregoing the valuable first minutes that could determine patient survival.
Thankfully, my hospital has not been overwhelmed and the heart-wrenching scenario unfolding in Europe and the USA has not been replicated here though winter is yet to come. Treating COVID-19 patients is nevertheless still stressful. While examining my patient, I also opportunistically insert his new cannula and send off his bloods. Since I am there, I give him his food and administer him his medications so the nurse will not have to go in. He tells me how his family is also being quarantined at home but that he feels lonely and alienated and is scared of dying alone in the hospital without being able to say goodbye. It is gut-wrenching to witness and I comfort him as best as I can. It brings to light how lucky we all are to be able to hold our loved ones close.
Before I leave for home, I have a shower in the hospital and discard my scrubs. I change my clothes and shoes and disinfect my car. I take care not to bring anything I might have touched into my home and go straight in for another shower as soon as I arrive. Before I embrace my family, I disinfect my hands again, just in case. The COVID pandemic has drastically changed all our lives. It is safe to say, it has altered the world we live in. Through the daily dread of somehow acquiring it, I nevertheless choose to focus on and be grateful for the things that all too often can be taken for granted; health and family. And while I will not be setting foot on home soil in 3 weeks as planned, I keep my motherland in my thoughts everyday and hope that Mauritians will all rally in the fight against COVID.