Auckland GP Himali McInnes writes of dealing with a waiting room of patients in the time of Covid-19.
I work as a general practitioner in the busy Three Kings Accident and Medical clinic on Mt Albert Rd, with a robust, friendly and competent team of doctors, nurses and administration staff. General practice clinics, with public health colleagues and hospital staff (as detailed in Dr Eileen Merriman’s excellent essay at ReadingRoom), are part of the frontline response to Covid-19.
Right now our clinic waiting room is frenzied and pulsing with a primal sense of unease. It’s sometimes akin to a war zone. The enemy is invisible. We don’t yet have the weapons to fight it effectively. Even normally sanguine, happy-go-lucky staff look harried. We wonder how we’ll avoid getting sick and taking illness home to relatives or friends. We wonder how we’ll make the right decisions, and keep up with multiple daily updates.
Anxious patients turn up to be seen with mild symptoms of cough, sore throat, and “shortness of breath” – intriguing when objectively they’re not short of breath, and likely have the common cold. Dr Caitlyn Gill says the current situation is “a fascinating study in human response to mortality.” On the plus side, she says, “We’re not doing the dinner party for my Mum for her 83rd birthday. I hate cooking!”
The supply chain for essential protective gear is at times fickle. N95 masks come and then they go. A pharmacy assistant whispers in my ear, “Psst doc! Do you need hand sanitiser? We’ve got some now.” I burst out laughing, and thank her, but no, I have enough.
I don a bright yellow apron, gloves and mask to see a patient with a temperature of 40 degrees who is waiting in the car. My new jaundiced look clears the waiting room immediately. My colleague Dr Siobhan Latham can’t find one set of carpark patients – they’re shopping in Countdown instead of self-isolating in the vehicle.
There’s a sensation of working in quicksand. The rules change, sometimes daily, so at times we work out what’s best on the hoof. Dr Kate Farmer trawls hardware stores for masks, plastic boxes, outdoor shelters – anything to make carpark consults easier. She says, “I never thought I’d have to go to Bunnings to manage a clinically evolving situation. I’m incredibly proud of DIY Kiwis.” Actually Kate, you’re an Aussie, but a great one.
Everyone is working so, so hard. Sometimes we gently remind ourselves of this – if we can’t see how harried our public health colleagues are, it doesn’t mean they’re sitting around twiddling their thumbs. Social media vibrates with colleagues venting their fears and frustrations as well as asking for advice in an ever-shifting landscape.
I have a healthy work-life balance, and I rarely get anxious. It’s likely due to how easily small things distract me. I come home, drop my bag, and stick my fingers in the crumbly loam of my garden. I avoid eye contact with my fluff-bottomed chickens lest they chase me for snacks. I go for a run with my sweet sleek obedient Huntaway. I’m annoyingly happy. I’m a perpetual optimist who everyday clings to the belief she can get ready for work in five minutes or less, rather than the 15 minutes it actually takes.
Yet even I’m starting to feel a low level of worry about this pandemic. At first I was watchful and relatively unconcerned. Then I progressed to being very watchful, more concerned, and keen that we all work together swiftly and effectively, implementing as many measures as we can to halt the spread.
The most typical symptoms of the virus are fever, dry cough, and shortness of breath. Eighty per cent of cases will need little to no treatment. There’s more risk to older people and those with underlying medical conditions. Every winter my own lungs corset with the wheezy tightness of asthma. In spring they overreact to overgrown privet hedges. I don’t particularly want to find out what this virus might do to me.
There’s a test, but it’s only 70-80 percent sensitive, so false negatives can occur. Although the number of tests doctors perform per day has increased to 1500, we can’t and won’t test everyone, as it’ll be low yield and will overwhelm our labs. We have a finite stock of the reagent used to extract viral code from the swab samples – these are sourced from overseas, where supplies are dwindling, and are also used to detect other viruses such as flu.
Some pleas from those of us at the front line. If you’re only mildly unwell, please don’t come in. Whether you have Covid-19 or a cold, we can’t cure you. When waiting rooms are busy, older people with chest pain may wait quietly to be seen for an hour or more because they don’t want to be “too much of a bother”. Don’t be responsible for someone’s myocardium infarcting. However, if you are genuinely sick, seek help. Now.
Fifteen years ago, my family and I were vacationing in Sri Lanka. It was December 2004. We’d planned to travel south to visit the Yala National Park. In the end, we stayed in Colombo, because accommodation in Yala was fully booked. It saved our lives.
The Boxing Day tsunami became one of the deadliest natural disasters in recorded history. More than 200,000 people, including 35,000 in Sri Lanka, perished.
We watched with shock from our apartment balcony in Colombo as the ocean receded hundreds of metres, then thundered back towards us. There was utter pandemonium afterwards. No-one had a blueprint for such an event. By the time my husband and I got over our horror and emailed friends back home in New Zealand, a friend had placed us on the Missing Persons list. We hired a van, grabbed medical supplies from the Red Cross, and together with my sister-in-law doctor and our respective husbands, ran a makeshift clinic for a week to help survivors.
The global spread of Covid-19 feels like a tsunami in terms of reach and terror. This threat, however, moves via droplets and surfaces rather than water, and its timeline is more protracted. There’s likely to be a peak, then a serial wave-train of smaller peaks. But crucially, and in stark contrast to the unpreparedness of countries along the Indian Ocean coast in 2004, there’s much that can be done by authorities and the general public to slow down this viral tsunami.
Adaptability to changing circumstances is key, as is taking care of each other (especially vulnerable people), thinking and behaving systematically and sustainably, and being as courageous as we can. It’s at times like these that ancient words, penned by ancient hands, resonate with truth: “Love your neighbour as yourself.” Drop off supplies to an older person. Call up those who are isolated. Smile often and gorgeously.
Recognise that this, too, will pass. Tsunamis, episodes of intense personal grief, pandemics – most terrible things do not last forever. Anxiety is normal and to be expected, so allow yourself to feel scared. But don’t stay there. Limit looking at updates. Exercise, eat as healthily as possible. Newly available time is a precious gift, so embrace it, use it, delight in it. Hang out with creatures that don’t give two figs about pandemics, but might be interested in eating the figs instead.
Let’s dispense with some of our innate Noo Zild independence, and follow instructions. We have fewer than 180 intensive care beds in this country. We must limit and spread out cases, or we won’t cope. Some countries – Singapore, Hong Kong, Taiwan – adopt multi-prong approaches (social distancing, infection control, isolation of cases, tracking those in quarantine using apps). They move fast and they move as one. So far they’re on top of things. The places that are more laissez-faire in their approach are now tragically in medical meltdown. Madrilenians, Parisians, Athenians, and others in European cities sing songs of gratitude from their balconies for the medical staff and others who fight for them – and sometimes die for them – and this bring tears to my eyes.
Our Government is working hard to provide financial and other support to those with heart-breaking job losses. I’m not sure if Dr Ashley Bloomfield is getting much rest at the moment, but he and his team are doing a splendid job to coordinate and keep us as safe as possible.
Let’s strike the correct balance between fissile anxiety that disintegrates us, versus cavalier invincibility. Let’s do our part for our communities. Let’s keep as calm as possible and carry on. The whole world is in this together, and it will take a whole world approach to get us through.