Diary of a (secondline) clinicianThe situation we find ourselves in is certainly one outside all of our experiences, insofar as no moment any of us experience is ever the same as any that has ever come before it or will ever yet come. But when faced with adversity we will always seek to use euphemism to normalise the experience and provide comfort, while still not detracting from the trying nature of the situation. In this regard this time is not unlike any other. For your contemplation and amusement I have compiled the definitive list of all adjectives I have heard to describe the current times. The rules are simple:
Within these bounds it's all fair game:
Which one's your favourite?
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Diary of a (secondline) clinicianThere has been something of an arms race lately amongst businesses in instituting social distancing measures. For a few weeks now the Australian federal government's restrictions have been stable and clear: stay 1.5m apart from others as much as possible and indoor spaces should allow no more than 1 individual per 4 square metres of floor space. This offers a lot of room for variation in implementation. From supermarkets putting stickers on the ground to indicate where to stand while waiting and using clickers to keep track of how many people are in the store, to stores having compulsory hand hygiene stations at the entrances for use on entry and exit. A particularly amusing example is the kebab store I walk past on the way to and from work. Restaurants only being allowed to sell take-away meals at this time, most have roped off, upturned, or simply removed their in-restaurant patron furniture. Not so this kebab store, which has instead used the tables and benches to make a, admittedly rather artistic, barricade around the bain marie and counter. To pay and receive your food you must lean over a table, reach out and tap your card on the EFTPOS machine held through a gap in the almost roof-high table wall, then collect your food as it is meekly proferred through a similar aperture. "most [restaurants] have roped off, upturned, or simply removed their in-restaurant patron furniture" You would think there would be a consequence to increased waiting, people getting fed up and irritated. Curiously, long lines to enter the grocery store may actually increase the mental estimation of the value of waiting. It's no surprise that people are very bad at apportioning value. You can take an item from a budget store, and sell it for double the price in a higher-end retailer with similar purchasing behaviour. In fact, chains such as Aldi in much of the world and Trader Joe's in the US have centred entire businesses around doing exactly the opposite. So it is that certain queues can increase the perceived value/quality of the store/restaurant/ticket that is being lined up for. "You can take an item from a budget store, and sell it for double the price in a higher-end retailer with similar purchasing behaviour" I am interested as to what the weight of driving forces behind many of these corporate decisions were. Was it an effort to scream safety to their customers in order to continue attracting them? Was it staff demanding they be kept safe and the human resources / legal teams working out the best way to avoid WorkCover claims? Or other forces of which I am unaware. Regardless, as with so many things COVID-19, it will be most intriguing to see which new elements of the way do life go once the threat is over and which remain. Diary of a (secondline) clinicianOne of the many ways in which organisations have attempted to slow the spread of COVID-19 is by preventing the entry of the people with active fevers from entering certain buildings. This is largely achieved through checking the temperatures of all who enter, barring entry to those who fail the thermometer's test. Of course there's a lot to say that this may be ineffective, due to the significant presymptomatic and asymptomatic transmission of SARS-CoV-2, the virus that has caused us so much pain these last few months. But this is not what I'm interested in today. "This is achieved by checking the temperatures of all who enter, barring entry to those who fail the thermometer's test." My hospital has been no exception to this, closing all but two entrances and stationing a nurse and security guard at each armed with infrared forehead thermometers, cool demeanours, and eerily identical small-talk repertoire: "Staff or visitor?" "Staff" [waving my tag] [reading the thermometer] "All clear, have a lovely day!" "You too!" Of course this bottleneck to entry meant lines of up to 30 people during peak hour waiting to be scanned to get in. It was a rare day indeed when I didn't overhear someone nearby in the line (spaced by social distancing markers on the ground 1.5m apart of course) make a joke about needing Aldi checkout operators (the German supermarket chain renowned for its ruthlessly efficient checkout system). "a nurse and security guard at each [entrance] armed with infrared forehead thermometers, cool demeanours, and eerily identical small-talk repertoire" This was, until one day two weeks ago, when despite arriving at work at my usual time there was almost no one in line. The reason became clear when I had to choose between two thermometer armed nurses (I chose the one on the Right because just like the right main bronchus she was more directly in line with my path, I daren't say whether either of the other two comparative features of the Right vs. Left main bronchi were present). What a great idea I thought, double staffing at peak times to manage demand, who could have thought such a thing possible in a public hospital? "despite arriving to work at my usual time there was almost no one in line" So imagine my surprise when last week my traversal of the hospital entrance was as unimpeded as a Livian's travel to contiguous Spain. A questioning glance at the lobby now devoid of nurses and manned by a lone security guard was met with a gesture upwards and a muffled phrase through his facemask "Infrared mate". Now this was technology! Sure Singapore's Changi airport's been doing it for at least 10 years from what I remember of transits through it, but even so, unencumbered entry and protection from febrile people couldn't be any better than this. It wasn't until the third day of this that I overheard a nurse at the visitor registration bay, at which of course I'd never had to stop, mention that her colleague had picked up some screening shifts at The Austin, a nearby tertiary hospital, because "we had no work for her anymore". And there it was, in the space of a few weeks we'd recapitulated hundreds of years of human history. A new market identified, technology invented to service it that requires labour, rural to urban migration to provide the labour, boosting productivity, then further technological advancements that disrupt the industry and obviate the need for labour at all. Or perhaps I was reading too much into things, a fever dream. Maybe those infrared thermometers need checking... Diary of a (secondline) clinicianIt is a truth universally acknowledged in the internet age that an event noted by at least two people will soon become a meme. And I don't mean a meme in the true definitional sense, but the sense that language purists hate us all for, some mash-up of an over-used picture with heading text that commits all sort of type-setting and often a few grammar sins. So when the greatest existential threat to modern life as we know it came along, the memes virtually wrote themselves. "some mash-up of an over-used picture with heading text that commits all sort of type-setting and often a few grammar sins" Memes about not being able to leave the house, memes about world leaders, memes about bats and pangolins, memes conflating virology and beer-brewing, and yes, innumerable memes about toilet paper. You would think then that these memes served some purpose, pushed us towards some common goal. And yet you don't have to look far to find people decrying the viral spread of these memes as something about which to be very concerned. Reports of racism and discrimination in memes is of course disturbing and even a pandemic is no excuse for hate of any form towards our fellow man. Beyond this, even seemingly harmless memes are denounced as 'making light of something that kills people' or as 'mocking those who've lost their lives' "You would think then that these memes served some purpose, pushed us towards some common goal." But as one of my favourite childhood authors described, we are very good at rapidly making the extraordinary seem ordinary, in order to deal with it. Human cerebral adaptation, better known as just getting on with things is one of the remarkable features of human imagination that set us apart from other mammals. Thus memes, offensive as they may be to some, could be conceived as a way of normalising the COVID-19 pandemic in order to cope with it. If it's something we can make light of using internet culture in the same way we seem to make light of everything these days, then it's something we can deal with, and no longer the imminent existential threat that stuns us all into inaction. Discussions about the balance between speech freedom and the risk of being offended aside, COVID-19 memes are likely a sign of the human race adapting to and dealing with the set of circumstances few of us have previously found ourselves in. Whatever else you may say about humans, we're rather good at adapting. Diary of a (secondline) clinicianA novel threat requires a co-ordinated response, of that there is no doubt. As we face such a threat it is more important than ever that we ensure our actions are optimal, as a medical profession, health system, and society. And as every high school student on a leadership or team-building course knows, the key is communication (...and teamwork, sometimes leadership, occasionally initiative). "As we face such a threat it is more important than ever that we ensure our actions are optimal, as a medical profession, health system, and society." In times gone by this would be achieved through large plenary lectures, "getting all the right people in the room" and hashing things out the old-fashioned way. However, the current imperative for social distancing, giving rise to increased familiarity with teleconferencing, has meant it's all too easy to set up a Zoom or Webex and let people know about it. It seems that the old adage holds true, if you build it, they will come. And in the present climate of hunger for any information on all things COVID-19, come they do, usually in droves. The problem is separating the wheat from the chaff. When you receive an invitation to Royal Tertiary's Grand Round at which the Health Minister is speaking of course you want to tune in. But then St. Excellence is describing their early experience with plexibox intubation straight after, and you can't miss that. During that talk your inbox pings with the medical school's roundtable on changing to a virtual curriculum, and as a clinical educator you'd better attend. As soon as that's done it's the inter-hospital COVID morbidity and mortality meeting, and oh look, it's 6 p.m. It's some irony that I've attended more meetings per week during a time when we can't meet than in typical months during which we could! "The problem is separating the wheat from the chaff." However, unlike in other more heavily bureaucratised health sytems *cough* America *cough*, these meetings are largely of our own making as clinicians. So it is the usual grievance of "just let me do my job" is a small voice amidst the louder cries of "tell me everything". Perhaps it's because our country's health systems 'ain't seen nothing yet', perhaps our bureaucrats are better at getting out of the way in a crisis. Unending meetings won't solve the pandemic, but enough of the right ones just may give us a fighting chance of coming out the other end bruised to be sure but unbroken. |
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