Covid 19: The Front Line

It is often said that a career in medicine isn’t so much a job as a way of life. As full-time critical care doctors, we are used to having to fit our expeditions and adventures in the mountains and the wild places of the world around very different but no less arduous challenges in our hospitals. Our days are spent caring for some of the sickest patients, those whose fragile grip on life is weakening. We’re used to long hours, tough decisions, high stakes. We never really expected anything like the coronavirus pandemic though, something that would throw us into the frontline in the fight against a global emergency that is truly unprecedented in modern times.

As a Specialist Emergency Physician in New Zealand, Richard has been preparing as best he can to face an onslaught he hopes will never come. In a country that, for now at least, seems to have escaped the tragedies seen in so many other places, his role has been one of planning, training, redesigning and repurposing.
 
Gareth had no sooner started his one year secondment in Cardiff than he found himself deep in the trenches of that frontline working for the NHS. As a Specialist Anaesthetist at The University Hospital of Wales he has been at the forefront of Britain’s response to the global pandemic. His role has been to lead an intubation team, placing the sickest of the sick on ventilators to assist their breathing. Only half of those patients survive.
 
At the peak of the crisis we were being called to intubate and ventilate patients every couple of hours. Many of these patients were young and days before had been well. All were utterly terrified. We would sit with them, hold their hands, reassure them that we would do our very best to keep them alive, we would help them call their families. These are difficult conversations to be had behind a mask, visor and goggles. Gloved hands are a barrier and remove any chance of emotional contact. In these moments we are acutely aware that this may be the last conversation this person may has with anyone, ever. It takes an emotional and psychological toll on us all on the frontline. Yes, we are doctors and yes we have cared for dying patients before but never so many, never so often.
 

There are many parallels to be drawn between polar exploration and frontline medicine. The need to perform at your best in high-stress, high-stakes environments day after day is undoubtedly the most important. Over years of working as critical care doctors and exploring the remote corners of the world it has become clear that taking care of yourself is the highest priority. Helping a team mate in trouble in a storm before putting your gloves on can result in frostbite, serious injury and evacuation. Attending a COVID-19 cardiac arrest before donning your PPE will result in exposure, self-isolation and at worst serious illness. In both cases you cease to be an effective member of the team and it can be weeks to months before you are able to return.

 
It is not just the physical protection we need but mental resilience and emotional strength. Gone are the days of just soldiering on. We are a team, on the ice as in our hospitals, and it is our colleagues and team mates that we rely on for help and who we support in return by offering a kind word or taking a moment to listen. If there is a positive that comes out of this then it is the camaraderie within the hospital that is truly touching.
 
The crisis has brought out the best in our communities in the UK, Australia and New Zealand. In Cardiff and across the UK the support our health services has seen has made me proud and quite emotional. Cycling home from work on a Thursday evening along streets lined with people clapping for the NHS and all our essential workers, staring out the Intensive Care Unit window through my PPE goggles and visor and seeing the flashing lights and hearing the tooting of horns – a tribute from our colleagues in the Police and Fire Services. There are meals in the tea room every day sent in from families across Cardiff. There are rainbows painted by the children on every door. They have become a symbol of hope for better times ahead.

Through all of this we think constantly of Antarctica; it’s endless white ice strangely similar to the clinical white corridors and beds of our wards and trauma bays. Yet it offers the strongest possible contrast; a world of ultimate self-isolation where the bleep of monitors and the wail of alarms is a distant memory and the polar wind is our only company.