Chapter One: A whole new world
Who would have thought, a year ago, that today we would be walking around in masks; we’d need permits to be out of our houses after 9pm, international travel would be banned and that the only alcohol we’d be allowed to buy would be in the form of hand sanitizers? It sounds crazy right? Like something out of a dystopian novel or a war-time memoir.
Even more so, if you had told me when I graduated from medical school, that in five years I would be working in a converted-warehouse, ‘examining’ patients without really touching them that much or that I wouldn’t be able to recognize my colleagues without their PPE on, I would have laughed at you.
But indeed, here we are. At the beginning of this month I started working at a Covid-19 Intermediate Care Facility in Cape Town, or a ‘field hospital’ as they are commonly known. It is a warehouse converted into a 336 bed hospital, complete with high-flow oxygen devices, a pharmacy, mobile x-rays and a mini-laboratory. In true South African fashion, our opening date was delayed multiple times due to a number of reasons (knowing the details of these reasons is far above my pay-grade), but never-the-less I am so impressed with what the Western Cape health department managed to achieve in such a short time.
At the moment, we have around 100 patients but that number is steadily increasing. The type of patients we have is varied. Intermediate care means we serve as a relief for the bigger and more acute hospitals in the Cape Town metro. They send us healthy-ish patients who just need a few days of oxygen and not-so-healthy ones who have been discharged from ICU and High Care. We have received quite a few patients who sound very stable on their referral letters but end up needing double-barrel oxygen when they arrive, or even intubation. We also get patients who are for palliation – they are not expected to survive, don’t qualify for ICU and we try to allow them to pass as comfortably as possible. We don’t have the capacity to ventilate patients long term, so we also stabilize and send patients back to the bigger hospitals if they do qualify for ICU.
It’s a mixed bag and we have our hands full – adjusting oxygen, trying to control blood sugars, managing fears and expectations (our patients’, as well as our own), learning a huge amount and trying not to get sick ourselves.
I think I can speak for my colleagues when I say that we are also doing a lot more “social work” than most of us are used to. Patients are not allowed visitors at all, so keeping families updated and in touch with their sick loved ones is a big part of the job. The fear and psychological impact of this pandemic is massive. We have tablets that allow us to set up calls between patients and their family members, sometimes getting involved ourselves. Again, if you had told me five years ago that I would be video calling my patients’ families with them I wouldn’t have believed you. I have never been that good at managing the social aspects of illness. The difficult phone calls and demanding families have always been someone else’s problem, but this pandemic has changed my views substantially. Establishing communication between patients and loved ones is sometimes the only thing you can do that will make any sort of difference.
In terms of protecting ourselves, we have to don PPE before entering the “dirty” area and doff before going on breaks. We aren’t allowed any food or drinks into the ward – a doctor without their travel mug of coffee is a strange sight; phones get wrapped in cling wrap; hands are washed a little bit obsessively and people don’t refer to me as “die dokter met die krulle” anymore because I’m always wearing a buff on my head. One unexpected challenge is identifying who is a nurse, a doctor, or a clerk etc. The other day I mistakenly asked a porter to check a patient’s blood sugar for me – definitely not in his scope of practice!
In general, but especially in medicine, the world has become a very strange place. One thing I have realized in these first few weeks of working however, is that the world outside of hospitals is moving on and adjusting to this new normal – almost too much so. We are becoming complacent. And before this job, I think I was too. But I am now seeing that this pandemic is still very real and it is not going anywhere anytime soon. I am writing “Not for CPR or ICU” on patients’ charts who are younger than my parents and seeing people my own age debilitated by a lack of oxygen. I have to plead with you not to forget that the threat is ever-present, and it is here to stay. Nobody thinks that they will ever end up in one of these facilities, until it actually happens.
The world in general is a very different place than it was six months ago, but even more so inside hospitals. The way we practice medicine has changed dramatically, and we are having to unlearn so much of what we were taught before.
I have three months left of this contract. This journey has only begun and I know that a lot of difficult moments lie ahead, but I also know that there is so much to learn and so much opportunity to make this difficult time a little easier for my patients and their families, and for that I am excited!