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‘You’ll be working on the Covid ward’: the impossible choices facing healthcare workers | Ranjana Srivastava

One morning, a text arrives. “We are very short of doctors. Can you help?”

In ordinary times, this question would be unnecessary. Medical rosters in large city hospitals rarely contain gaping holes. The prospect of additional income, the attraction of a different work experience, the need to impress and an inability to say no all play a part. But by and large, doctors help because they want to help. More than 2,000 years ago, the physician Hippocrates remarked that wherever there is a love of medicine, there is a love of humanity and this is still true.

During the first lockdown of the pandemic, the response from my home state, Victoria, was lauded. There were so few cases that an overprepared and underutilised medical workforce watched the global tragedy with a sense of reprieve and disappointment. An intensive care physician memorably compared the occasion to “the bride getting all dressed up for a groom that never arrived”. Then, cases rose and our sense of safety was suddenly stolen. Another lockdown curbed individual freedoms and imposed a nightly curfew, things we thought happened elsewhere.

When I receive the text, things are worsening in residential care, where inadequate governance and miscommunication have wreaked havoc on vulnerable residents. Responding to public anger, the government has moved residents to private hospitals devoid of elective procedures. But the assumptions about staffing aren’t bearing out. As healthcare workers steadily contract infections, many are furloughed and others are forced to limit exposure.

A colleague advises that I could really help the especially frail patients with multiple illnesses who require difficult conversations regarding extent of management, holistic care, and engagement with relatives. The ward rounds are said to be easy for someone with my expertise, and from experience, I’d agree.

And then, almost as an afterthought, I ask,

“What’s the testing procedure?”

“Ah, you’ll be working on the Covid ward.”

I haven’t even exhaled when I hear: “All 25 patients are confirmed positive. Some are asymptomatic and others are very unwell.”

I have never felt unsafe at work. Even in dicey areas, the hospital has stood as a beacon of safety and reassurance; even offenders have a grudging respect for staff. When we’re tragically harmed, we freeze but overall, we come to work far more concerned for the lives of others than our own.

Until now. Of all the changes the pandemic has brought, the most difficult has been the introduction of impossible new calculations for healthcare workers. What is the price of my own life? What is my duty of care to patients who have a contagious and incurable illness? When is it OK to step back?

On the surface, being personally cautious during a pandemic makes sense but for people hardwired to help, the psychological distress of standing back from the frontline is greater than the physical cost of going in. So like many others, I decide to go in because no matter where they are, patients are patients. Fortunately, there is no shortage of protection and I am familiar with it. As I go to find my husband, I am thinking only about how to juggle my existing public hospital commitments to fit in more work.

“I might help out at the private hospital,” I venture, and his expression says it all.

He’s a doctor, too and I should acknowledge his worries, but really, I just want his assent, via guilt if necessary. Instead, he maintains that we are already working and exposed, why assume significantly additional risk.

Sure enough, the kids hear this and hold an emergency summit on the staircase.

“She’s going to see a whole ward of Covid patients!”

“No way!”

“Seriously?”

“What does Dad think?”

And then, the declaration that their dad didn’t make out of respect but about which they feel no compunction.

“Well, that’s a bit selfish, isn’t it? What about us?”

A frisson of interest changes into an avalanche of concerns. I’d blindfold all the disapproving eyes if I could, but it finally hits me that this habit of doctors to assume that their work is so sacrosanct as to be above all consideration has finally met its match in the pandemic. Doctors have never needed an excuse to miss life’s most important moments. We’re quick to remind our families that our patients come first and expect them to adjust, which they mostly do. But suddenly, those niceties have vanished and pats on the back are replaced with squabbles. The same families that sent us proudly into work are begging us to stay home.

“It’s not your hill to die on,” a relative tells my colleague. An intern’s mother cries unstoppably with worry. A wife bans her physiotherapist husband from working extra shifts. A nurse with a large mortgage forgoes the extra income and stays home. A single doctor parent cuts back her hours. A nurse prioritises her ailing grandfather. And I decide that I cannot antagonise or jeopardise my family. They are my rock.

Sometimes, these decisions feel sensible and sometimes, grievously difficult. No matter what we do, we end up second-guessing ourselves but perhaps this prolonged saga is the corrective we need to realise that we are not superhuman and won’t save our patients by working double shifts and sleeping less. The pandemic will be tamed not by the work of a few “heroes” but the efforts of an entire society. The opposite of valour is not weakness.

But truth be told, I am still smarting at my family’s reaction when another text arrives, this time from my own hospital.

“Just wondering how you feel about some extra shifts.”

Covid numbers are low but quarantined doctors need replacing and the load must be shared. Some patients might be positive, but most aren’t. Among controversies, this barely raises a yawn in my family. They will adapt as they typically do, by pretending I was always rostered. But before there’s more debate, I pick up the keys and am out of the door.

Read the original article at The Guardian

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