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Gaye Cunnane is professor of rheumatology at St James’s Hospital, Dublin, and director of health and wellbeing at the Royal College of Physicians of Ireland.
The world is different now, and life in hospitals has altered almost beyond recognition. Sensory deprivation, an intriguing symptom of Covid19 in the form of anosmia (lack of smell) and dysguesia (altered taste), has, to some degree, also infiltrated staff experience.
The foyer and main corridors are much quieter - emptied of all but essential personnel. Colours are muted to the background greyness and the limited hue of hospital scrubs; individuality has been replaced by commonality -everyone is in this together. The place smells different too - there’s no getting away from the ubiquitous aroma of alcohol in the hand sanitizers, hand wipes, and the cleansing swabs we use incessantly for common surfaces and any other potentially tainted objects.
Perhaps the most difficult sensory loss is that of touch. We are keeping our physical distance, many meetings taking place while standing 2 meters apart. Of necessity, those meetings are brief, and frivolities shortened. On the wards, we review patients while wearing masks and gloves. Personal protective equipment (PPE) muffles the sounds we hear and softens our voices. Emotion can only really be expressed through our eyes and so, eye contact becomes more important than ever.
The telephone is now our main method of communicating with patients, including those who are in the hospital, but behind closed doors in isolation. Cancelled clinics also have given way to phone calls, which maintain the necessary contact with patients, but make clinical decision-making more challenging. In time, the roll-out of video calls will help, but will never replace the normal bedside consultation, which is the essence of both diagnosis and healing in medicine.
Working in the medical world, we are used to change. Even in “normal” times, every day is always different. Indeed, each patient with a particular illness has unique manifestations, influenced by their genetic and social environment. It makes our jobs fascinating, while the obligation to keep up with the scientific literature allows a fresh perspective in the face of diagnostic dilemmas. Adaptability is an innate part of our working lives.
However, this pandemic is something we did not anticipate or prepare for. We have had to learn a new disease, new vocabulary, new skills, and to pool our combined expertise and resources to deal with a tsunami of information and workload in a very short time-frame. It is a particular challenge for our young doctors and trainees who find themselves at the frontline of a situation also unfamiliar to their consultants and other healthcare professionals. This is an opportunity, like no other, to work together, to lower hierarchies, to share vulnerabilities and to find a common strength to tackle this problem with a sense of collaboration and hope.
We have felt the anticipatory anxiety, watching with horror the distressing scenes from Italy, the US, and many other countries, assuaging these feelings with a deliberate calmness, preparation and data gathering. We have used the opportunity, not only to get our medical centres ready, but also to put in place the psychological supports necessary to get through the next few months, when work may become overwhelming, when difficult decisions regarding life and death will have to be made, all the while trying to care for people with non-Covid19-related illnesses who also depend on us for their health and wellbeing. Accidents will still happen, cancers will still develop and urgent surgeries will continue to be required.
The Forum of Irish postgraduate medical and surgical training bodies - representing all Irish trainee doctors - has backed an initiative, in collaboration with the Psychological Society of Ireland, to provide dedicated support to doctors who find themselves struggling with the enormity of the Covid19 crisis. For many, each day will bring significant emotional trauma and it is important to resolve this skillfully and in a timely fashion. We need doctors to be healthy, both physically and mentally, throughout the long battle with this coronavirus and beyond.
Each of the medical training bodies has a dedicated area on their website for doctors to access, which includes practical information and latest data on Covid19, in addition to ways of finding support when they need it. We have made videos and podcasts that are regularly updated and disseminated. The fight against Covid19 is a global effort - it has emphasized the importance of collaboration rather than individualism. We want to make sure that none of our doctors feels alone.
What I miss most in this current climate is normal human contact, the essence of our everyday and medical world - the unmasked smile, the warmth of a handshake, the reassurance of a touch on the shoulder, the hug from a patient when a particular connection has been made. I also miss the easy camaraderie of staff meetings and teaching sessions, which by necessity have become brief and virtual. But, I also know that the common bonds that bring us together will be strengthened, not weakened by this experience.
