A few months ago, I came home late from working at the “covid-coalface,” and fell into a fitful, grumpy, sleep. I was sick to the back teeth with work, specifically with too many patients, too few beds, and too much red-tape. All these existential concerns evaporated when I awoke suddenly at 2am. It was not my pager but, rather, severe chest pain, worse with inspiration. I subsequently transitioned from cantankerous ICU practitioner to grateful emergency room (ER) patient. As we contemplate a post-covid world (fingers crossed), it is worth sharing what I learnt during my literal wake up call.
Without revealing too much, I am familiar with chronic pain. I have an autoimmune condition, and this traitorous ailment flairs-up whenever, wherever, and however it pleases. Occam’s razor (aka diagnostic parsimony) suggests that any new pain will be the old pain in a sneaky new guise. Regardless, this pain had reached 11…on a 10-point scale. Like many people, I needed relief first, and diagnosis second. Anyone with a passing medical knowledge would want to rule out a lung clot. Anyone who had seen me sporting a bathing suit, would also expedite an ECG. Regardless, within a few hours, I had been poked, prodded, and scanned. Junior doctors were dragged from their beds, and chins were scratched. Mercifully the symptoms abated. I made it to morning rounds, weary, and presuming that Occam had struck again.
But not so fast. After all, pain is a funny old thing; even if there’s nothing funny about it. My peripheral pain fibres may have been screaming, but it was still ultimately my brain “deciding” to what extent to turn physical symptoms into psychological distress. This complex mind-body conversation works in reverse too. It is why depression can be felt as shoulder pain, why chronic body pain can make us mentally inconsolable, and why symptoms usually worsen when we are scared, worn out, or under threat. As mentioned, I experience plenty of pain: sometimes I whine, and sometimes I show enough stoicism to make Ancient Greeks blush. I will never know how much of that night’s pain was body versus brain, and it ultimately doesn’t matter. Importantly though, days later, while dropping off thank-you-chocolates, the ER staff told me that large numbers of healthcare staff have been turning up, like me, with non-specific complaints. I don’t know whether to add these cases to that bulging dossier called “mental health issues during covid,” but clearly this pandemic has taken its toll on the medical staff.
The ER staff took a thorough look under the bonnet, but the best thing I received was a dose of old-fashioned caring. All around me all patients were receiving the same. During these witching hours, I witnessed nothing but considerate nurses, engaged doctors, polite porters, and humorous techs. These were consummate professionals in flow, and despite 18-months of a grinding pandemic. I write this not because colleagues may read this, but because gratitude matters. Moreover, gratitude was the one thing the staff were definitely not receiving enough of. Additionally, the staff where I live (Alberta Canada) have been giving their all despite well publicized plans for post-pandemic pay cuts. That might seem okay if all you do is gulp your way through financial reports. However, it seems appallingly ungrateful— and frankly indecent— to anyone who has witnessed the ER on a Saturday night, or my ICU during the covid pandemic.
Healthcare is far from perfect, and I understand the need for prudence and accountability. Regardless, my night of fear and loathing in the ER was a stark reminder that the problem is not whether frontliners care: they really do. They are also—in my unhumble opinion—increasingly administered to death by an excessively large officer class. Frontliners have also endured overconfident windbag presenters— such as myself— arguing that medicine need look no farther than high reliability industries such as aviation. There are certainly lessons to be learnt, but checklists are ultimately no replacement for a human being pushing their computer aside, looking you in the eye, holding your hand, and simply giving a damn. Instead of being pilots or conductors, we likely just need to be free to be what we were when we entered the job: caring conscientious humans who can problem-solve. However, if I’m pushed to offer an updated analogy then we staff could aspire to be like a temporary family for our patients. As such, we should make the hospital more like a welcoming home: no small accomplishment at 3am.
Sure, some families can be dysfunctional, but the best ones make the effort, and show that care is a verb not just a noun. Moreover, the best families rely on common-sense, effort, humour, and give-and-take; not on mandates, edicts, protocol-binders, or tortuous emails. Importantly, families look out for each other. As such, if the bean counters and bureaucrats are going to attack my work-family, then I’m going to push back. Not only are we being threatened with pay cuts, but the job has lost much of its joy. More and more it feels like “care-by-committee,” and too many words, but not enough communication. The clinical staff knew what to do for me at 3am, not only because they are well trained, but because they are decent people who excel at thinking on their feet. The ER hummed despite the utter absence of the clipboard brigade.
The woes of the world have been catalogued by smarter people than me. I can only comment on what it has been like as a healthcare worker in a pandemic. I am sticking around, but fear many will quit, and I fully understand why. It is especially upsetting because I believe that most simply want to be part of a family, and free to connect as humans. Instead, it feels like this job is increasingly about worshipping computers and displacing people. It feels like wellness and mindfulness are vacuous buzzwords. Humour was once our safety valve, but now feels like a terrifying mine-field. Straight talk is needed, but is dangerous. Too often, it feels like our system is too big to empower individuals and too entrenched to make the necessary changes. What I know for sure is that my work family cared for me when I needed help. I am grateful, and duty-bound to speak up in return.
Peter Brindley, Department of Critical Care Medicine, Department of Anesthesiology and Pain Medicine, and the Dosseter Ethics Centre, University of Alberta, Edmonton, Canada. Scholar, Peter Wall Institute for Advanced Studies. Twitter @docpgb
Competing interests: none declared.