Pressing on and taking the fight to the virus.

If Covid-19 has taught me anything, it is that the quality and commitment of our team is second to none

Tap, tap, tap. The click of my keyboard is accompanied by the low hum from street noise outside. The occasional car passes. A door shuts. I hear the neighbour’s dog bark as a motorbike goes by. The quiet sounds of the neighbourhood. Noises I never normally hear. Throughout my childhood, in the countryside, through an open bedroom window, the sounds of the night accompanied me first to sleep, and then to the new day.

Until now, during my adult life in Dublin, the window has been shut. It’s safer that way. Now I keep the window open. Both of us are acute hospital consultants. If one of us is asymptomatic and shedding the virus, the load to the other will be less due to the fresh air. A small thing but one of a thousand ways my life has changed. Where once a shut window kept the danger out, now an open one shepherd’s the danger away.

The frontline of the battle against Covid-19 is in the community. It will be won there or lost there. We cannot lose so we must win it together. Life at the last line of defence is unrecognisable. Since I came back as a consultant and joined the IHCA our goal has been addressing capacity in the acute hospitals, the lack of beds, the lack of consultants, the unacceptable waiting times. Now all elective work is cancelled indefinitely as we battle to slow the virus. I find it hard, knowing the numbers waiting are climbing, knowing that many of them will get worse in the interval, that many may be in pain, that all will be worried. I worry about when this is over, will there be political will and money available to tackle the waiting lists with this level of determination so that we fix the problems in our health service? I must believe we will.

We are worried. I am worried. I know that Colm Henry our Chief Clinical Officer and the HSE procurement team are working hard to try to secure additional personal protective equipment. I also know many of our acute hospitals are critically short and staff are understandably very worried. GP friends have similar concerns. It is our ICU colleagues – doctors, nurses and physiotherapists – that are at the highest risk of serious illness because of their exposure to aerosol generating procedures in the sickest patients. Where supplies are limited, and with an evolving global pandemic that is likely, we must prioritise those at highest risk of severe infection. One of my ICU colleagues has spent his working life trying to get the government and department of health to address ICU capacity yet in the 10 years since the Prospectus report was published we had an actual decrease in ICU bed numbers, not the more than doubling recommended. In dark moments now I worry for him as he is in a high risk group himself. It seems ridiculously unfair that he and his family might pay the price for years of Government inaction. ICU consultant numbers are less than half what they should be. The workload for them in the coming months will be enormous. I make myself stop thinking about it or the fury leaps bile to the back of my throat. For us to win against Covid-19 all must work together collaboratively and so justified as they are, I must park my frustrations.

As a radiologist my clinical interactions, performing ultrasounds and fluoroscopy are low risk for aerosol generation; thus logically I know that I am at low risk for severe disease. Still, in rare moments of calm, it niggles at me. A healthy 21-year-old woman has died in the UK. My mother died when I was in my twenties. It felt too soon. A decade later, it still does. My children are very small, a toddler and her school going sister. I have so much living, loving and rearing to do with them yet. The thought that doing the job I love might take me from them is one I cannot contemplate. When it sneaks in, I ring my friend Laura. She is one of life’s radiators and within minutes I’m back focused on the many tasks at hand, the multitude of ways I can help. I push the worry away and focus my attention on what I can control: How I respond to the challenge ahead.

Avoidable deaths. That is what I focus on. We must minimise the avoidable deaths in patients and staff. In the IHCA we have settled on the twin tasks of leading the frontline delivery of care as care pathways in acute hospitals split into parallel Covid and non-Covid streams and ensuring that staff are safe at work. To get as many people through this as possible we need to keep healthcare workers protected, healthy and at work. In my own radiology department we have split into two teams that don’t overlap to try to avoid infecting each other. Some of our team are in self-isolation due to contact with confirmed cases. Despite the cancellation of elective outpatient work we are flat out, providing the normal emergency and inpatient care and the neurosurgical service is especially busy. Devising new care pathways and protocols keeps us busy. My hands are red raw from washing. Through small cracks the alcohol wash stings.

Physical distancing

Our normal multidisciplinary meetings cannot take place due to the risk of infecting each other. Quickly the tech literate organise alternatives and I find myself presenting MRIs from my MRI basement office sharing the screen back and forth with clinical colleagues. We try to minimise in person contact to limit transmission. Physical distancing quickly starts to feel like professional isolation. I realise for the first time, the extent to which those moments of connection as physicians where we discuss difficult cases together and share decision making usually sandwiched between brief pleasant social interactions weave together to form a critical part of the joy of work in a hospital. It surprises me just how much I miss them. From my pocket on the commute home I lose my trusty 100ml hand sanitiser and a limited edition MAC lipstick. It is a sign of the times that it is the hand sanitiser loss that irks me.

If Covid-19 has taught me anything, it is that the quality and commitment of our team is second to none. Everyone is giving this everything to try and get as many people as possible through this. Even though we are afraid for ourselves, we close our eyes, take a deep breath and push on to meet the challenge head on. In the National Maternity Hospital where I work the team have built a hospital within a hospital, going from one negative pressure adult room to twenty two and a delivery suite in under three weeks. What a tribute to the management team, our engineers and our in house construction. Incredible. Shane Higgins, Ronan Gavin, Mary Brosnan, Roger McMorrow: you inspire us all. In Children’s Health Ireland similarly the executive have made huge changes consolidating services to generate much needed adult capacity in Tallaght University Hospital and Beaumont Hospital while still ensuring that all our critical emergency and inpatient services including neurosurgery, oncology, cardiology continue delivering the highest quality of care. There is a real sense across the health service, for the first time I feel, of Team Ireland.

We have decided, as two acute hospital doctors, it’s too risky to visit my husband’s elderly parents for the duration of the outbreak. His brother is so relieved when we tell him. He hadn’t wanted to ask us to stay away but worried our presence could bring the virus with us. The kids miss their grandparents. We have a FaceTime just like we did from America on fellowship. The love and connection are there but we all miss the comfort of physical presence.

These are hard times. As medics we always push our own fears aside and put the patient first. We need to mind each other. We will falter at different times but, together, we will press on and take the fight to the virus. We must embrace aggressive contact tracing using the technology available to get ahead of the virus. Test, treat, track, repeat. The cold night air from my open window reminds me that I must sleep now. I miss my old life. I long for a normal work day, tea with the work wife Nuala and a weekend, which includes a play date with friends and our young families or a visit to Kerry. I feel grateful for so many small things that weave the tapestry of my normal life. Codladh sámh. We will fight for our patients and each other afresh tomorrow.