For over 70 years my lucky corner of this lovely planet has enjoyed relative peace and prosperity. Despite this, we healthcare workers have rarely missed any opportunity to offer military metaphors. For example, we have long claimed to “be on the frontlines” even though there was previously minimal risk of personal harm. We have banged on about the “war on disease,” but likely did not fully believe our own propaganda. But in 2020—a year that shall live in infamy—and when it comes to combating this viral contagion, no analogy but “total war” now seems fit for task. Accordingly, numerous politicians are using this language too. After all, as in wartime, all activities are now cancelled unless vital to the effort, and industries are retooling for the fight. Finally, everyone knows why my “industry”, Intensive Care, matters. However, you may not yet understand what it’s like to be enrolled “in the unit”, and what you can do to help.
The covid outbreak is clearly worsening rapidly across North America. Western Canada, where I have worked for over 20 years, has already been hit and is preparing for numbers to substantially pick up in April and to surge in May. Like you, we healthcare workers are scared. Like older people, I have healthcare colleagues who worry that we are considered expendable, and those fears need to be heard and addressed. Regardless, I am reassured that at the bedside we have each other’s backs: which is a good job given the daily need to “buddy-check” protective equipment. Hyperbole aside, I truly have never been prouder of our staff. Moaning has been replaced with meaning, and many of us are surprisingly happy not being resigned to barracks. We have discovered a lot about our colleagues, and we know that most will run in and few will run off. We have a renewed sense of purpose, and we are seeing strength in each other. This is in stark contrast to more placid circumstances, when for reasons that now seem inexplicable, we constantly found ways to find fault or take umbrage. It’s now strangely liberating to focus on the bedside job and nothing but.
War turns the world upside down. And in a similar way, medicine has changed. And in some ways, for the better. Things that would have taken years in healthcare can now get greenlighted in a few days. Humour and common sense are returning to institutions that were previously, in my opinion at least, held back by excessive political-correctness and bureaucracy. Administration is now listening to clinicians, and just as shocking, clinicians are listening back. However, my new heroes aren’t doctors or nurses or administrators, but rather those in the logistics corps. They are those that sweep floors, make sandwiches, serve coffee, direct calls, help with security and bring in supplies. We healthcare workers were the regular troops: we signed up willingly years ago. These other members of the battle group may be less-eager conscripts, but there is no doubt that they are vital to morale. Please give these glorious folks a smile and ask them (albeit from a distance of two metres) how they are faring. Many of these everyday heroes look scared, so let’s make sure they don’t also feel invisible. I am rapidly learning names and I can’t wait for this to pass so I can offer a grateful hug.
If years of reading military history has taught me anything it’s that combat is preceded by denial. Let’s all tell any remaining virus-deniers (I have heard them called cov-idiots) that this is no joke. I know it’s hard to fathom but we must isolate to withstand this onslaught. Any disease that can kill 2% of all those it infects, and which is expected to infect at least 50% of the population, will be horrible: mathematically, economically, socially and medically. I would say “unprecedented” but that word usually just means our memory is too short. It is worth remembering that our grandparents and all those that share our noses and hair lines have experienced wars and pandemics. In fact, our genomes, microbiomes and immune systems are a record of every threat that was faced and beaten.
Healthcare workers will be massively challenged when we have to ventilate hundreds, when staff fall ill and die, and because of the constant fear of taking this infection home to loved ones. But how we behave on the “home front” will be just as important, so please don’t count yourself out. We are already low of blood so please donate, and food shelves are emptying so, I beg you, please don’t hoard. Please also be patient with the blood banks when you deposit, and food banks when you withdraw; it takes everyone time to switch to a war footing. We will all have to find a way to pull together even while being physically ordered apart. This is also social media’s first war. We need to learn when to tune in because we crave information and connection, but power down before we all lose our minds.
Those who have seen actual military service have been quick to remind us to not panic, to slow down, to prepare for a long campaign, and to have depth in the ranks. We need to unleash the incredible creativity and tenacity that exists throughout society, and is definitely not the sole preserve of doctors and nurses. Society should not be divided into healthcare workers and others, but rather those that find a way to help and those that don’t. We all have a part to play, so work out what you should do. In this regard it’s easy being a doctor: we just keep doing what we were trained to do.
Emotions can spread like viruses, so keep a check on yours. I was livid the day I discovered that hand sanitizer has been ripped off the hospital walls and masks had been stolen by the public. In keeping with the war theme, a colleague of mine suggested it was like guns being taken away from soldiers by the very people expecting to be defended. Please stop doing this STAT. Fortunately, I got my equanimity back courtesy of another wartime salve: the poem. This one is entitled “When this is over” by Laura Fannuci, and it is now posted in our Intensive Care Unit. As Fanucci beautifully points out, this battle is to regain the simple pleasures of life, rather than for any medals or glory. It is about becoming a better version of ourselves. There are so many lessons so let’s take this time of relative shut down to listen hard. For example, the economy matters, but it is not all that matters. We are all vulnerable, and none of us is truly a nihilist or an island. Life always has something to teach, and the offer of a cup of tea is always a good idea.
We healthcare workers are scared but, in some ways, we are also lucky. We have the best chance to relearn that human contact is lovely, that caring for others matters, and that finding humour in the everyday is glorious. These things should never have been taken for granted and your doctors and nurses were as guilty as anyone else. When this is over I sincerely hope we also win the peace and remain more like we always wanted to be.
Peter Brindley, Professor of Critical Care Medicine, Medical Ethics, Anesthesiology at University of Alberta, Canada.
Competing interests: None declared.