A year ago, the World Health Organisation declared COVID-19 a pandemic. A lot has changed in the world since then. Perhaps no field has had to deal directly with change, as much as healthcare.
I was working in plastic surgery at the time, finishing up my stint in the burns unit. I remember how we initially had light-hearted operating room chit-chat about the Coronavirus. They remained light-hearted until the first case was announced in Ireland on the 29th of February and shortly after, the first death. The light-hearted conversations turned serious and with that, the impending disruption to everyday life. I was due to present at a conference in Limerick on the 13th of March. On the 12th of March, the Irish government announced its first set of restrictions. Schools were closed, and mass gatherings were banned. This was early 2020, and virtual conferences were not commonplace, so there went my conference presentation.
It was quite frightening as we watched the situation in Italy unfold. It felt like only a matter of time before the number of critically ill cases in Ireland reached similar proportions. Thankfully, we never got to that stage.
For a while, we were still trying to figure out if masks were helpful or not. It was funny and sad at the same time because in the initial stages, hospitals were running out of mask supplies so it really was futile trying to answer that. We dilly-dallied around the issue before eventually deciding that masks were a good thing. A full lockdown was being considered by the Irish government and indeed governments around the world as public health officials tried to stem the initial tide.
The first lockdown
So by March 27th, Ireland went into a full lockdown as the virus continued to run rampage. On the bright side, my 30 minute commute to work was cut in half. Even more, I could now find parking when I arrived work. Our elective theatre lists were cancelled and non-essential service was scaled back. This had significant ramifications on the health care service. Patients were scared of presenting to hospital and anecdotal evidence suggested a significant increase in delayed hospital presentations. Research studies would later confirm this, as well as the devastating consequences. Another significant consequence of cancelling non-essential services was that we were further prolonging the already long hospital waiting lists. I tried not to think too much about all of that.
Despite the initial challenges COVID-19 posed, I was impressed at how proactive the plastic surgery service was in devising ways we could continue to provide urgent care for patients. We quickly adopted the technology at our disposal. We incorporated telehealth into our outpatient service, our departmental teaching was done over the now essential Zoom platform and we initiated urgent see and treat clinics for skin cancers. As a whole, this served to make us more efficient, while limiting clinician and patient exposure. It was a huge credit to the dedication of the medical and allied healthcare staff.
The pandemic also had a detrimental impact on medical training. Reduced patient exposure affected training and learning opportunities. This was a necessary sacrifice, but not one without consequences. While I am unsure what the impact will be going forward, it will be important for us to support training doctors. We also, have been one of the casualties of this pandemic mentally and professionally.
Deployment to the ICU
In April, I was deployed to the Intensive Care Unit on proning duties (COVID patients were placed in prone position for 16 hours a day, apparently this helps reduce dead space ventilation, but check with your local anaesthetist). Looking back, seeing all those patients on ventilators, it was then that COVID became very real to me.
The preparatory routine was: wash hands, mask up, gown up, gloves, visors -I could say this in my sleep by the end of the day. Enter ICU. Ignore the fear. Prep patient. Prone patient. Repeat. It may sound straightforward, but proning comatose patients, with all sorts attached to them, requires a good team and a lot of coordination. There were usually over 20 intubated patients to prone/unprone in our ICU daily. On the days I was not on proning duties, I was back working with my plastics team, which was always a breath of fresh air and certainly less morbid.
The summer respite
Summer approached and it seemed like we were finally getting to grips. The weather was so good that we started to witness anti-mask and anti-lockdown protests. Numbers had started dropping, the government lifted some restrictions and it seemed like normality would soon return. If there was any doubt, 5 pm traffic was back in full force. I had chicken wings indoors at Wishbone for the first time in a while; it seemed like a novelty. We even had a changeover team dinner before I started my new rotation in Otolaryngology. Farrier and Draper, I remember because that would be my last sit-in dining experience until Christmas.
Return to Lockdown and Vaccine rollout
By September, the cases started rising again and by October we were back in lockdown. We have stayed in some form of restrictions since, albeit a brief respite over the Christmas holiday. This time around, although fatigued, I think we were better prepared. There were also much welcome vaccine rumours. I attended and presented at my first virtual conference in January. I also got my first dose of the much talked about Pfizer vaccine. The vaccine seemed to herald some sort of new dawn. The sceptic in me thinks the COVID vaccine will become an annual ritual rather than a permanent solution. Who knows? For now it is a sign of progress. My hope is that the government rolls out the vaccine efficiently and equitably.
In all, the COVID 19 pandemic has caused immeasurable disruption and loss, but it has also provided opportunities for us to be innovative. On a personal level it has been a time for reflection and growth. In the midst of it all, I experienced the immense joy of being accepted on the Radiology Training Programme. I have also been lucky enough to have family and friends to lean on for support. The world has changed dramatically and so has healthcare. Medicine is an evidence and research driven field, but the systems in which we practice medicine can sometimes be inflexible. In my opinion, this pandemic helped us make necessary changes to how things were traditionally done. It is now up to us to continue to create innovate solutions to the problems we face and keep moving forward.
Interesting read. your experience and training along with the new normal with go a long way.
“Enter ICU. Ignore the fear. Prep patient. Prone patient. Repeat.” 👏🏾👏🏾👏🏾