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Reflections from an emergency department junior doctor: the Covid legacy

O’Rourke, Sara Caterina Maria

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European Journal of Emergency Medicine: August 2020 - Volume 27 - Issue 4 - p 235-236
doi: 10.1097/MEJ.0000000000000729
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The world held its breath. Coronavirus disease 2019 (Covid-19), this feared and self-propelling entity, continues to make headway.

For many, the physical and emotional momentum can feel difficult to maintain. Uncertainty and conscious restraint are exhausting, and we are not immune to this as an emergency department (ED). Yet, as the promise of some restoration of normality begins to rumour, so it is important to consider the numerous important learning points brought to light by this experience.

Certainly, the ED has changed in many ways. Physically, as has been the case at many hospitals, the capacity to host and care for patients severely affected by the virus has been rapidly expanded. While some health boards have seen entire hospitals spring from the ground, for us, there has been the constant construction, extension and adaptation of clinical areas to cater for more complex and invasive procedures.

For staff, a similar period of rapid growth and psychological development has been necessary. All those providing care for patients have undergone clinical retraining and reorientation to new protocols, new equipment and new challenges. This has often taken place in an anxious and accelerated fashion to maintain our clinical work and standards in parallel with the latest public health advice.

The demands of the virus call on our public responsibility as healthcare professionals to provide a service. In this regard, our vocation and training grants us the ability to continue working and contributing to society at a time when so many individuals, families and businesses are struggling. We are fortunate that, ultimately, what drives most of us to do what we do, today as ever before, is an innate duty of care.

Nevertheless, with discussions and disagreements regarding national and international government policy, it has been impossible to completely shield ourselves from concerns around our work and our safety. Of course, there is a sense that exploring unchartered territory, and accepting its unforeseen risks, falls within the duties of working in healthcare. Yet, drawing on this sense of duty can both bond and harm a society.

It is important to remember this when talking about the NHS. Almost overnight, it seems the public have largely readjusted their perspective of universal healthcare. Often misused and chronically underfunded, the crisis has – if briefly – reignited an appreciation of the health service. The duty to protect the nation’s health has been rightfully shared with the public. Patients everywhere have been encouraged to reconsider the urgency of their problems and to be resourceful in seeking solutions.

Public favour and public introspection have changed the ED. Indeed, it is thanks to many patients choosing to stay at home that the attention and resources available to combat the pandemic have in many ways been successful. For us, the way we provide healthcare has positively shifted. The simple object of having time to spend getting to know a patient, of bringing them a glass of water or a hot drink, is a treasure we have only rediscovered in recent times. Staff wellbeing has also taken pole position on many departmental agendas, with simple yet effective changes going a long way to combating stress and improving job satisfaction.

The devastation caused by the pandemic is evident and likely underestimated. Its effects will colour public policy and the movement of people for a long time to come. Crucially, however, I wonder what role this experience has had to play in restoring an element of balance to how the public perceive and use emergency services. Furthermore, I wonder whether the staff who have cared for the public during this pandemic will in turn receive the care they deserve in the workplace. It is my hope that things will be positively, and indelibly, transformed.

Fig. 1
Fig. 1:
‘Organised Chaos’ – an illustration of the emergency department at the height of the Coronavirus pandemic, produced by the author.

Acknowledgements

Conflicts of interest

There are no conflicts of interest.

Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.