LOCKDOWN: A PHYSICIAN WHO HAD COVID 19

Vol 9 #3

Rita Rigg MB, BCh, MRCGP, Dip Fam Medicine

Rita Rigg is a General Practitioner in the NHS.

She is working at the COVID Triage Hub, in the Edinburgh (Lothian) region of Scotland.

For more on her story go to “Rita’s Story- Common Thread, NHS Voices in a Time of Crisis” on Vimeo:

https://vimeo.com/462508817?ref=em-share

On a personal level, reflecting on the situation, overwhelms me. Where do I start? Thinking about it stirs up a mixture of emotions, feelings and thoughts, exhaustion, feeling drowned, difficult, stimulating, frightening, refreshing, rewarding, exciting, tragic, helpless, desperately sad, thought-provoking, kind, gentle, compassionate.

We have never before experienced anything like this, a situation that infiltrates every aspect of our lives:  our health, our occupations, our activities, our well- being, physically and mentally, and has shaped and continues to shape our outlook on life. Until the beginning of 2020 we had lived with certainty, a sense of control and power, believing we had the means to overcome any enemies and conquer all. We were not used to uncertainty, powerlessness, lack of control, vulnerability, rarely were we unable to “fix” things, to being forced to stay in our shrunken new worlds, a world we thought was ours to explore as and when we wished.

We were used to carefully planning every day, week, month, and year. How much did we take for granted: hugs, meeting friends, touch, travel. We rarely allowed spontaneity and freedom and reflection to enter our rushed busy lives. There was little time to sit and ponder and admire and appreciate and notice -the beauty around, the changing colour of the seasons that came and went, little time to listen to the birdsong, the quiet, stillness, to  inhale and fill our lungs with precious fresh air.  It was during lockdown when we were almost forced to pay attention to all this treasure around us, in the quietness and stillness, sensing the close touch of nature, listening to its sounds and admiring its beauty, that I suddenly realised why I had so loved my experience of life in the Western Isles.

There are many who have suffered greatly throughout these months, who have lost family members or close friends either from Covid or from other causes. Loved ones have been left behind to mourn and grieve alone without the comfort of closeness, touch, hugs, consolation. I share with her permission one such tale, that of a close friend of ours who suffered great worry and loss. 2 sons and her husband were all admitted to hospital whilst she was isolating at home, also suffering from Covid, isolating in her own terror and fear for the lives of her family members. Every one of them had previously been well. All the hospitalised family members required oxygen treatment. Her husband and one of her sons received escalated treatment, then admission to ICU and both were ventilated for many weeks, both required renal dialysis, specialist intervention and additional life supportive measures. Every system in their bodies were ravaged, attacked and shut down. After 10 weeks her husband sadly died. His funeral was one of the most poignant, heart-rending farewells I have ever had to attend. Her son eventually recovered. His first question to his Mum was “How is Dad?”. His father had passed away while this son had been in a coma.

“A SITUATION THAT INFILTRATES EVERY ASPECT OF OUR LIVES”

This young man just 30, with his whole life lying ahead of him, suffered a stroke whilst being ventilated. In addition he has been left with severe post Covid sequelae.  How on earth does one recover from that nightmare? This friend is a woman of strong faith and I believe that that has enabled her to cope, with such courage and grace and fortitude. And there are literally hundreds of stories like this repeated all over the world.

What of all the collateral damage? Lives are being, and will continue to be, affected indirectly by Covid 19 as more and more lose jobs, lose their daily support systems and are forced into poverty or deeper into already existing poverty. There are many worried as to where the next penny will be coming from. Mental illness is a massive problem. Usual support networks and support workers, essential lifeline contacts were severed, when they were needed more than ever. People felt lost, abandoned.   With all schools closed for 4 + months it was very hard for many single parents living in flats, with children with difficult problems, to home school.

“AS ELSEWHERE IN THE WORLD IT IS THE POOREST WHO ARE HIT THE HARDEST”

In India , where Covid 19 is rampant, an immediate lockdown was enforced with no prior notice at the start of the pandemic. This resulted in a mass exodus of daily wage workers back to their villages. Their income consequently disappeared over night. They had no money to buy food. Public transport stopped overnight so that families had to walk hundreds of miles to reach home.

As elsewhere in the world it is the poorest who are hit the hardest. Food is scarce and food supply chains have been cut, making what is available too expensive for most to afford. 6 million have been infected and 100,000 +have died from Covid19. Both these figures are believed to be significant underestimates. The sick suffering from other diseases cannot reach hospitals as there is no public transport available. The indirect deaths from starvation and collateral damage can hardly be counted. It is predicted that when the pandemic has passed whole sectors of society will be tipped into poverty and that begging in the streets will increase dramatically.

I keep in regular contact with my family, based in Calcutta and Mumbai. They thank goodness have kept well and experience a kindness that is touching. My nephew had to curtail his medical school studies in China and has not been able to return. He has now managed to transfer studies to India. My cousin a surgeon in Calcutta and in the thick of it, often working 24/7 explained to me that the situation in health is dire there. There is no direction from the government, little supply of essential PPE which when worn becomes intolerable to bear for more than an hour or so, due to the high temperatures of 40+ at times. And in the midst of this pandemic there was a severe cyclone in July causing massive destruction of homes and crops.  All this serves to remind us that this is a global problem and we will need to find a global solution.

Once I had more or less fully recovered from suspected Covid19 I returned to work. Aware of the impact the pandemic was having on the NHS and feeling restless and impatient that I was not able to contribute for a while, at a crucial time when the pandemic was growing uncontrolled and reaching its peak. Appeals were being made for doctors to return to work, I was keen to resume in whatever capacity was required. I was anxious, frightened and had lost confidence. Would I have kept sufficiently up to date, whilst I was sick, with the constantly, rapidly changing new guidelines, advice, protocols, in spite of my almost continuous reading watching webinars and participating in online education about Covid?

I had been away from work for three weeks whilst ill and in those three weeks the world of general practice had been turned upside down. I hardly recognised the place when I did return. All doors were locked, closed to the public, there was no-one around. Inside the building it looked bare, there were no pictures on the walls, shelves were empty, no medical journals, no magazines, no leaflets, nothing that could potentially harbour the virus. The waiting room was empty. Patients invisible, to whom were we now providing a service, and how? I even had to dress differently. It felt as though I was going in to work in my pyjamas, wearing scrubs and trainers, which I had to wash every day on my return home.

I was nervous about face-to-face consultations. Logically I should have immunity. However this disease seems to follow no logic I did a few more locums. These were all good experiences, allowing me a sense of belonging and support as a part of the practices. I was grateful to be included and invited to their daily “huddles”. These were instigated to improve team morale and I found them enormously useful in this time of extreme pressure. There was uncertainty and an understanding that we had to quickly put changes into place.

As I felt stronger and more able I slowly got my confidence back. I felt able to commit to more regular work . I volunteered to be a part of the newly established and rapidly set up Covid Triage hub. I have since discovered that ours is one of the few health board areas, certainly, in Scotland that has such a facility available. The Hub is located in an NHS building with open plan office layout. The individual workstations have 2 metre distance spacing and are made up of personnel including administrative staff and clinicians. There are between 1 and 3 clinicians, mostly doctors, on duty at the same time. The Hub is the central and first point of call for the population of Lothian (800,000+) for anyone who has, or thinks they may have symptoms of, Covid. It is a telephone advice service and operates from 0800 to midnight every day.

Patients who would normally phone their GP or,, the out- of -hours service are directed to us instead. The call is put through to one of the clinicians, of whom I am one. We speak to the patients and advise on how to manage their symptoms.. We guide them on the testing available and on the self-isolation rules.

We also direct them on how to claim financial or other help they may need. The symptoms that may indicate a worsening of the condition and would prompt the need for a medical review are explained.. If they do have worrying symptoms , like shortness of breath or chest pain, we then make arrangements for them to be seen at the dedicated assessment Hubs for Covid or send them directly into hospital if their symptoms warrant this.

The condition can rapidly deteriorate within hours. It is therefore important to stress the need to call us back if the symptoms get worse. Day 7 to 10 are the most crucial and when complications and deterioration could happen. It is essential for those living alone to have a ‘buddy’, someone who will regularly keep in contact by phone 3 times a day until at least Day 10 has passed. The NHS will provide such a buddy if there is no one else who can do it.

Working through this time has been an extraordinary experience. The disease has required learning in every field of medicine.. There are weekly meetings, at times three a week , to keep us updated as more is learnt. .  We have had volumes to read and digest, zoom and team meetings, webinars, podcasts, interactive and lecture style to attend, watch and listen to. The learning has been phenomenal, stimulating, comprehensive.

At times the volumes seem insurmountable and we can feel swamped by it. Almost daily, something new is discovered The rapid rate of change that has occurred in this last six months is beyond belief and imagination – the equivalent of 2 or 3 years medical school study, all crammed into these months.  The collaboration and kindness amongst colleagues from all the disciplines, as we all try to understand the condition and each other, and how we all work and help and cooperate with each other, has been unprecedented.

“COMPASSION EMPATHY AND TIME TO LISTEN”

The stories we hear from patients range from cruel and heart-breaking experiences to uplifting wonderful tales of kindness. As we are available to all patients and they have easy access to us, we are able to offer a lifesaving ear as they unload all their worries, anxieties, tears, and mental health crisess That offer of listening does not require any expensive drugs, it does not require any complicated investigations or highly skilled surgical intervention. All that is required to help and heal is compassion, empathy, and time to listen. And the time can often be as short as 10 minutes.

I don’t remember such sincere repeated expressions of gratitude from patients at any other time in my career. So, learning point number 1 and maybe the one I shall never forget,  is that the power of listening. has the greatest impact on care and benefit to the patient: Never underestimate its value!  And all of us can do it

 “We can make our minds so like still water that beings gather about us that they may see, it may be, their own images, and so live for a moment with a clearer, perhaps even with a fiercer life because of our quiet.” .   WB Yeats

And of course in St Benedict’s Rule “Listen with the ear of the heart”.

In the 40+ years that I have been practising, change has come about, very gradually and step-by-step, but never at this accelerated rate. T. In one fell swoop, as Covid demanded it, we have had to change:  change the way we consult, the way we prescribe, the risks we take, (much higher than previously), and the responsibility we carry as a result.

Consultations that are face to face are very few and far between, taking much longer having first to clean the room, then don the PPE in order, and then again clean the room. The actual encounter is given the minimal time possible so as not to expose the patient nor the clinician to unnecessary risk. Being masked immediately creates a barrier to communication.

Working at the Covid Hub I have treasured the camaraderie enormously, meeting new colleagues I would never have had the opportunity to meet otherwise, across the whole spectrum of ages and backgrounds. The situation has cemented us and formed a bond whereby we affirm each other recognising and sharing the same anxieties and concerns. We may otherwise feel that we are alone in this and even to the point that we fear that we may be going mad. Sharing with peers who are going through the same dilemmas and anxieties when no other person can, is therapeutic. I am immensely grateful for that and feel very lucky to have been given this opportunity.  We have even formed the Covid Girls Golf and meet once a month to play a round, always finished off with a snack and drink at the 19th!  The standard of golf is variable and inconsequential!!

“UTTER EXHAUSTION………..YOUR CHEST FEELS CONSTRICTED “

My experience from having had the illness myself has proved to be an asset in my dealings with patients who are now experiencing the same symptoms. It allows me to truly empathise, understanding that sense of utter exhaustion, that your chest feels as though it is being constricted by a tight band ,  preventing the freedom of taking a deep breath feeling lonely in your isolation, feelings that those who have the virus are now expressing with worry and fear. It is good to be able to confidently reassure them that you know exactly what it is like for them.

As for the future no one really knows the long-term effects. I feel I have now fully recovered, and I am grateful for that. Subconsciously however there is a niggling anxiety that something lingers in my system that may be reignited at any time.

I do 5-6 hour shifts at the hub, sometimes amounting to 30, exceptionally 36, hours a week. There has been a steady demand although some four weeks ago when our schools returned we experienced a huge surge.  We were expecting and prepared for this but not quite to such a level. It seems however that the governments were taken by total surprise!  We have since escalated our service once more. We expect the winter to be pretty tough and demand will be relentless.

“WE EXPECT THE WINTER TO BE PRETTY TOUGH AND DEMAND WILL BE RELENTLESS” 

For the 6 months ahead we remind ourselves of what we realised at the start: that this is a marathon, not a sprint. At this point in time it seems we have ‘hit the wall’. The winter will be hard, unimaginably hard, and we will need each other more than ever.

Perhaps in our vulnerability and helplessness we may look to the Patron Saint of Doctors and graciously ask, St Luke, pray for us.