Diary of a (secondline) clinicianAll good things must come to an end, but so too must all bad things pass. We're not out of the woods yet but the recent relaxation in physical distancing restrictions around the country is certainly a good sign. As we slowly emerge into the light it seems odd to continue to dwell on the vagaries and foibles of humans subjected to a pandemic. So I'll be looking to the future, and you should do the same. But if you must re-visit the past, even if only out of nostalgia, then look no further than below for the full Oh Sweet Pandemic - Diary of a (secondline) clinician series:
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Diary of a (secondline) clinicianThe human psyche is a contrary thing, wanting one thing when it has another, valuing that which it can't have higher than that which is available in abundance. "Familiarity breeds contempt". "Absence makes the heart grow fonder". Two sides of the same coin that we are forever turning over in our minds. Some may scoff at this, dismissing it as stupidity. But it is based on a well-established heuristic. That which is scarce is more likely to hold greater value and thus worth acquiring. You could certainly pick a worse survival strategy. "Two sides of the same coin that we are forever turning over in our minds." So it is we find ourselves in an entirely predictable place. Public health physicians and health promotion organisations shout till they're blue in the face about the value of exercise but as soon as it becomes one of only 4 reasons for which one can leave their house (at least in the state of Victoria), suddenly its popularity skyrockets. I've never seen the Princes Park or the Maribyrnong River tracks more full then on weekends during COVID-19. Sure this is somewhat tongue-in-cheek and obviously has more to do with being able to get out of the house than any intrinsic appeal of exercise. But the point stands, restrict leaving the house and people will do anything to enjoy it, even if means having to exercise to avoid a $1,600 fine. So it shouldn't have really come as any surprise that people were protesting on the steps of State Parliament against the restrictions on freedoms imposed by COVID-19 physical distancing orders. In many ways it was the truest embodiment of the "prevention paradox", where an effective preventative measure means people don't see the consequences of whatever has been prevented and cease to see the value of the preventative measures themselves. This appears to be partly driving the reductions in vaccine uptake seen across the developed world. It has often been said that the greatest compliment that can be paid a public health physician is that they over-reacted. "I've never seen the Princes Park or the Maribyrnong River tracks more full then on weekends during COVID-19" When this existential threat is all said and done there will be those who rejoice then move on and those who lament that we have so soon forgotten the lesons we should have learned. Our society will change, how much for better or worse is as yet anyone's guess. But if we value our freedom any less once restrictions are lifted, it won't be public health physicians to blame. Diary of a (secondline) clinicianFor time immemorial humans have engaged in conspiracy thinking. There are numerous reasons why people believe in conspiracies, from wanting to make sense of the world, feel a sense of control, or just plain make money. Some are largely harmless, except for causing their believers to unnecessarily lighten their wallets. Others are incredibly harmful, with medical conspiracies in particular comprising the bulk of this category. "Some are largely harmless, except for causing their believers to unnecessarily lighten their wallets." In addition to the usual smattering of Facebook posts that make up my medical professional-dominated feed, often with an exasperated comment along the lines of "Can you believe this [expletive]?!" I was recently sent a video by a close friend. This turned out to be a two and a half hour diatribe from a US osteopath, whose original video was apparently banned from YouTube after amassing 9 million views, claiming variously that SARS-CoV-2 was developed in a Wuhan laboratory at the direction of Dr Fauci and Bill Gates, COVID-19 was essentially no worse than any other run-of-the-mill upper respiratory tract infection but exposure to 5G communications made it significantly more deadly, that lockdown measures were an attempt to keep us all inside while 5G was installed across the world, and finally when we all get vaccinated against SARS-CoV-2, the combination of this vaccine and 5G will kill us all. It is probably needless to say that this was presented with nothing more than anecdotal evidence "my friend called me up the other day and told me..." and faux surprised Dorthy Dixer questions from the interview host "But Iran doesn't have 5G does it?" with self-assured responses "Yes! Iran was actually competing to be a world leader in 5G!" (that may be but a quick Google reveals spectrum issues have even a 2021 Iranian 5G roll-out in doubt, although presumably that's not true and part of the conspiracy too). "This turned out to be a two and a half hour diatribe from a US osteopath, whose original video was apparently banned from YouTube after amassing 9 million views" Curiously I found myself understanding the appeal of listening to such a video. If you could suspend disbelief for a while and turn off the evidence-requiring piece of your frontal cortex for a while it was strangely reassuring to listen to someone so assured of the truth of what they were saying, making sense of the whole world for you. Yes of course this was all the fault of the Government and those people in positions of power. I was just a victim here. There's nothing I could have done to make this crisis better or worse, in fact I shouldn't suffer the economic consequences of physical distancing, I should go out and work my job, maybe doing my bit to expose the COVID-19 lie for what it really is to boot. Yes, alternate realities are seductive but like a good work of fiction, once disbelief is no longer suspended the whole edifice comes rapidly crumbling down. Diary of a (secondline) clinicianAs I've said on this blog before, there's been an effusive out-pouring of love both corporate and communal for healthcare workers, love to which I certainly don't feel I can lay claim to. Sure, healthcare workers work long hours, look after sick people at their most vulnerable, and ensure that society can continue to be productive; all true and things to which I can well attest. However, many other 'essential workers' as the government calls us collectively work just as hard, if not harder at the present time, ensuring our society doesn't fall apart. The supermarket workers I see tirelessly stacking shelves at all hours of the day, the teachers who now have to deliver both an in-person and a virtual curriculum concurrently to their split classrooms, and the tram drivers getting us all to where we need to be come easily to mind amongst the many possible examples. "However, many other 'essential workers' as the government calls us collectively work just as hard, if not harder at the present time" As I walked to work this week, passing three hospitals before getting to mine, I noticed a new set of heroes getting out and doing their bit for the war effort. Spotless has employed hundreds of people for whom other work is unfortunately no longer an option nor possible, to leave the safety and comfort of their homes and clean the streets. In our area with many public amenities this seems to mean quite literally disinfecting each and every public bench from one end of Flemington Road to the other, in addition to the usual rubbish collecting and minor maintenance. While I was unsure of the value of spraying what I can only assume was disinfectant of some sort over the footpath, these workers were undoubtedly leaving the city cleaner than before they came. "quite literally disinfecting each and every public bench from one end of Flemington Road to the other" So I am reminded each morning as I pass the team at various stages of their trip northwestwards of the many faces and roles that make our human community what it is, resilient to change and adversity. While healthcare workers may be the public lightning rod of the recognition of this at the current, we are just the tip of the iceberg, an iceberg that goes tens of professions and tens of thousands of people deep. Diary of a (secondline) clinicianAs has been widely reported, SARS-CoV-2, the virus that causes COVID-19, is stable on certain surfaces for up to several days. This is a significant cause for concern when it comes to controlling a virus that already causes an illness with a long asymptomatic transmissible time, making it even more likely to spread amongst individuals. Much attention is paid to cleaning of bed spaces and equipment to prevent cross-contamination between patients. Just as important is frequent hand-washing and changing of the personal protective equipment (PPE) worn by healthcare professionals. "This is a significant cause for concern when it comes to controlling a virus that already causes an illness with a long asymptomatic transmissible time" One thing previously only considered in the context of the operating theatre where scrubs are worn exclusively, or in the intensive care unit where visiting doctors must be bare below the elbows, is what healthcare professionals in other areas wear when not protected by PPE. Given the risk for SARS-CoV-2 to persist in droplets on the surface of one's clothes and be brought back home, potentially exposing one's family, it is now common practice amongst both doctors and nurses to change clothes more times during a day than in a Bollywood movie. Many health services suggest wearing a set of clothes to work, changing into a work set i.e. scrubs, then at the end of the day changing into another set, putting the work set into a plastic bag that you take home and wash immediately. The result of this is much changing and washing to be sure but a curious side-effect is the sudden seeming loss of the ability amongt patients to tell various health professionals apart. Nurses wear scrubs, allied health wear smart casual (pants if you're a physio), pharmacists and doctors wear semi-formal, the former distinguished by prominent purple pens and the latter by stethoscopes, or in the case of consultants, suit jackets. "it is now common practice amongst both doctors and nurses to change clothes more times during a day than in a Bollywood movie." So now that everyone's wearing scrubs, no one knows what anyone else's role is any more. Female doctors have it the worst. Already struggling with septagenarian and octagenarian patients suspicious that non-male doctors even exist, being mistaken for nurses is anecdotally now even more common. More than a few of my female medical colleagues have commented along the lines that they could be wearing a flashing neon sign above their head proclaiming their doctor role and still be asked to replace a bedpan. On the flip side some of my younger female nursing friends have reported occasionally being mistaken for an intern or resident doctor, always by other doctors rather than patients, which has apparently been quite flattering. As a male doctor still semi-formally dressed replet with stethoscope and yet to need to convert to scrub-wearing I'm in no danger for being mistaken as anything other than the secondline 100%-safe-from-COVID-19 clinician I currently am. This puts me firmly at the bottom of the current pandemic-ready hospital moral pecking order, a position I'm more than happy to inhabit for now. If I never need to wear scrubs this year it'll only be because our community has fought COVID-19 and won, and that is something truly worth celebrating. |
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May 2020
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