Fearful brainstorming.

There’s been a lot of gratitude lately towards us front line health workers.

I don’t quite feel like we deserve it.

Not yet, anyway.

With all the social distancing measures and the mass panic over the coronavirus, people have now became scared silly to even get near the ER. In a way, it goes to show how many “unnecessary ER visits” there were in the past. But some of us do fear that people aren’t coming when they should come, and when they do, they may be gravely ill. It’s all a fine balance. But for the time being, we will take the “calm before the storm”.

And since none of us are used to any sort of calm at work, it feels, somewhat, undeserved.

Especially when you see footages of the hardest hit places, and what our colleagues go through there.

But then I realize, maybe we do deserve some of this gratitude. For being here, for standing guard, for treating those who come, and for risking ourselves at the front line of this long battle.

Just yesterday, I realized that one of my most believed teacher at my old teaching hospital ER, fell ill from the COVID virus. Thankfully, it seems he should do okay. But the news almost brought tears to my eyes. In fact, I think it did a little.

Much of our struggle at the current stage is mental. I’m sure it’s on all my colleagues minds when they come to work, and when they go home to their family (those who don’t have the option of staying away for months, as I am doing). We know we are high risk in contracting it. We know not all “healthy young people” would do well routinely. I myself have mild asthma, so I do have some worries. We do the best we can, donning personal protection equipment. But every time you put on the equipment, it is a reminder of the risk that you are taking. And for that, yes perhaps the gratitude is deserved.

We are also frantically using this time to plan ahead. We have the benefit of seeing what other places go through when a surge hits. We have, fortunately, appeared to have acted in time to allow ourselves to try to prevent that same surge, while at the same time plan meticulously for it.

My department is smaller compared to some of the others in the city, meaning that we have less resources, and less physical space, to handle a surge of respiratory patients. We also have less staffing, should any number of us take a hit and have to be off work for weeks, to be able to absorb such blow. That bit really worries me.

And that is one of the biggest challenge of this outbreak, as I explain to my friends. Hospitals and ERs are not built for this. We have limited space, and limited staff, on good days. We cluster patients routinely, and we do not have the physical infrastructure to allow proper “social distancing” of our patients when they all come at the same time. My department has one negative pressure room. Upstairs, our ICU has 8 beds. They are always full.

There is also lots of planning from the personle side. We know this is essentially an ICU disease. So that means, the ER docs, the ICU docs, and all the nurses, have to have a game plan to all work seamlessly together. We’ve also spent a lot of time working out the kinks in our team-oriented attack, involving as well our anesthesiologists, as they are the usual del facto airway experts. When you bring a lot of bright people together, all capable of doing things their own way, you need to make a lot of rules so that we are all, when the chaos hits, doing things the SAME way.

So that’s what the last couple of weeks has been like. All of us, brainstorming and discussing and planning, on how we can literally transform our department on the spot to account for these expected needs. My best friend in the department, another Dr. T, has been taking this task to heart, and spent weeks mulling over options and physical space limitations and led the charge on this endeavour. I offered my usual critical eye and the occasional idea. Piece by piece, we are transforming our ED, for something that hopefully we would never need the full extend of.

Lots of anticipation. Lots of planning. Lots of fear. Lots of hoping.

And in all likelihood, this will be the new normal, for months to come, if we are lucky.

If not, for years.

For as stated in my last post, I am not aware that we have arrived at any endgame yet.

And so, the stalling tactics continues.