The beginning.

It looked like a war zone.

That was my first impression, when I walked in for my night shift. Not so much patients, they seem the expected amount for the night. But the setup. Make-shift dividers turning hallways into “spaced out assessment areas” as our ER’s best effort to keep anyone with respiratory symptoms separate from each other. The so-called “social distancing” phenomenon. It’s a compromise, of course. Physically our department only has one negative pressure room, and another so called “decontamination” room which I’m not sure what criteria qualified for the title. It’s likely still early in the Pandemic in our city. Globally sports leagues just cancelled their seasons. Sending a final wake up blow to the causal observers who up until that point had view this as a “China virus”, or just something from afar, or something that’s purely associated with travel. It is not. It is here. Likely circulating undetected for weeks to months. I welcome the shock wave to bring some senses to all people and all levels of government. I’ve seen efforts being stepped up to prepare. Too late, in my opinion, and not enough. Widespread recommendations that sounds nice on paper but likely written by people who has no clue how feasible it would be to carry out, especially at smaller sites like ours. So, the call was to attempt to isolate anyone who presents with respiratory symptoms. Impossible. So this military looking department is what we came up with at the very moment until the next, better idea.

These are stressful times indeed. I haven’t seen my parents in weeks, and actually didn’t even meet my brother who flew in to pick up his two daughters who had stayed in town longer due to the school closures in Hong Kong. I debated a lot over that decision. To my 4 year old niece, and to some extend my 9 year old one, this would seem harsh and suggest disinterest on my part to be with them. It is not. But being at the high risk position that I am, as front line medical staff, and with the elusive but highly contagious nature of this thing, I couldn’t risk it. I fear I am looking at many more weeks to possibly months of staying away from my parents in person. Thank goodness for FaceTime.

People are stressed at work too, as you can imagine. Which is ironic, because stress decreases our immune system, making us all more susceptible to fall ill. And that is what I am most fearful of. The incapacity of our health care system, and in particularly, our doctor group, with withstand anyone missing any work for any duration of time.

I’ve personally be recovered from a cold, which I’m quite over by now, but some persistent sinusitis symptoms and slight stirring of my post viral asthma kept me self-conscious with an occasional cough. I don’t believe I’ve been exposed yet to any positive Covid 19 patient, but of course one can never be sure. I’ve swabbed many, and fortunately all so far came back negative and most were consistent with the flu. I’ve always kept a mask on and almost never touches a patient without a pair of gloves. But what troubled me, and it’s something that’s plagued me for some time now in this profession, is the inability to “call in sick”.

My friends would ask, shockingly, “you can’t call in sick??”

My reply, usually, unimpressed, was that “well who’s going to replace me?”

Few other profession has this concept, I find. Most people have sick days, or even if they don’t, they lose earnings, but they just don’t show up. In the era of heightened awareness of communicable diseases, that is commendable. It should be encouraged. It should be the norm.

But doctors, particular smaller groups like those of us in our ER department, has never had the luxury of that. To miss a shift, we have to find our replacement. That you cannot obviously just find ANY replacement, because only those within your group are qualified to work on behalf of you. So, you only chance is to draw from your existing pool of colleagues, most are already overworked, stressed, or just unable to help because of their own scheduling obligations. It is a very unsettling feel. Knowing that no one is ever really there to save you. For such an intensely demanding job, when really you should always be top of your game, this is extremely ironic. If you need to miss a shift, you post it on your group’s schedule calendar, and hope that someone can do it. Very often, if given enough time, that does happen, thanks to my beautiful colleagues. But most of us who fall ill need to cancel in the last minute. And that, unfortunately, does not happen.

At the time of writing, I’ve just came off a night shift and is due for another one tonight, and I’ve posted these two shifts in hope that someone would relieve me so I can continue to nurse my asthmatic cough in peace. I don’t expect myself to be relieved.

I hope this virus change that culture. We have to have a new systems. For far too long, doctors come out of this difficult and harsh medical school journey and feel an obligation to be “toughened” enough to motor through most adversities. The very notion that “doctors get sick too” has actually gotten some interesting following on social media as if this is someone a foreign concept. But as we preach for the masses to no longer try to “be a hero and work through your sickness”, we should create ways to adhere to such similar advice. It is not yet possible, due to the way the employment structure is set up. But if there is anything this viral outbreak has taught us, is that there are lots of ways we are going to have to change in how we live. We have been too relaxed for too long. We should have seen this coming, and we did not prepare adequately for it.