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Bu haftanın sayısı Royal Melbourne Hastanesi’nde acil servis doktoru olan Amaali Loukange tarafından yazılmıştır.
Bölümümüzün en sevilen acil servis hekimlerinden biri iki hafta önce emekli oldu. Beklenenden daha erkendi ve Covid ve karantinanın artan duyguları göz önüne alındığında, haberler çoğumuzu ağlattı – özellikle de bazılarımız son birkaç haftayı onu kalmaya ikna etmeye çalışarak geçirdiği için. Richard, Avustralya’da uzman bir acil servis hekimi olarak eğitim alan ilk kişiydi ve Covid’in kariyerine son vermesi yanlış görünüyor. Ancak yaş ve komorbiditeler Covid risklerini artırdığında iş çok stresli, tecrit edici ve katlanılması zor hale geldi. Hikâyesi benzersiz değil ve Covid, sağlığımız ve iş gücümüz üzerinde acımasızca zarar verirken sağlık hizmetlerindeki disiplinler arasında kendini gösteriyor.
The personal protective equipment, the PPE, is tough. There are times when, with my glasses fogged up, the shield dripping with condensation, I feel like ripping it all off and screaming for air. During a resuscitation, the normally quiet and controlled room is now full of noise as everyone speaks 10 decibels louder just to be heard. Previously easy conversations with patients become fractious as I try to project through the PPE and my tone sharpens because it’s not my normal range. At the end of a shift, an eviscerating headache and sore muscles are now the norm.
The PPE traps us safe within a silo, unable to reach out, to share a joke with one another, to gossip in whispers. The camaraderie of emergency medicine is receding. We try to push the grief away for later and wonder whether this will be the norm for years to come.
Emergency departments are usually open spaces with clear lines of sight, but now our department at the Royal Melbourne Hospital is changing. Cubicles are enclosed with doors, whole areas are cordoned off to house Covid patients, and the department feels like it’s getting smaller even as the patient numbers increase exponentially. A sense of claustrophobia builds with each passing shift.
The strain on nursing staff is particularly acute. Before the pandemic, when visitors were allowed, family provided support, translation and context to the patient’s state. Now, with visitors severely restricted, the burden of caring falls mostly on our nurses. I walk into a cubicle and witness a young girl crying, struggling to bear the pain of a leukemia diagnosis — the nurse holds her close, substituting for the family not allowed into the department. I ask a nurse if she’s trying to find the pulse of a dying patient and she says in an undertone, “No, I’m just holding her hand.” The patient’s family did not want to come to the hospital for fear of Covid.
Then there is the disease itself. Thankfully, it is mostly easy to recognize — even without a Covid test. Its constellation of symptoms are obvious and specific: the chest pain like sharp little knives with each breath, the severe headache and muscle pains, the dehydration. Patients come in at first diagnosis because they feel like they’re dying. At least for the ones who present to my emergency department, it is definitely not just the flu.
From a purely medical perspective, Covid is fascinating. To be on the frontline, at a time when we are still discovering the nuances of treatment for a new disease, feels like a privilege. To be safe, treating these patients with adequate PPE and effective vaccination, in a hospital which pivots to stay just ahead of the disease, feels like a miracle. Every day I am thankful that the real surge in Covid infection is happening now and not in 2020.
At the moment, a majority of our patients are unvaccinated. Some of them were too young to be eligible, some don’t believe in the disease, and some are waiting for a better vaccine. Many don’t speak English and rely on their own communities for support. I feel that we have let them down. We haven’t integrated them enough to be able to reach them in a crisis.
For a lot of them, we are their only support now that they are ill. “They treat me like a leper!” a patient with Covid who had been isolating from her unvaccinated partner and children mournfully tells me. An unvaccinated woman calls me frantically about her son, whom I have just seen. “Please don’t send him home,” she pleads, “there’s no one to look after him.” I know she’s thinking of the young Covid-positive female in the news who died alone at home that day. To be able to help these patients at their most vulnerable, facing a disease which fills them with dread, is one of the silver linings of this pandemic.
Another is the black humor. Just as we are all closer to tears, the irreverent laughter is sometimes irrepressible. A patient almost walks into a Covid patient’s room, but, her hand at the door, she hesitates as the nurse shouts and lunges at her. The patient safely in her own room, we collapse into hysterics at the close call and the nurse’s reaction. Within a week the hospital changes its policy and provides N95 masks for all patients.
Now that Covid is finally here and we are on the edge of the precipice, the emotions run high. Behind us is the old way of emergency medicine, and ahead the unfamiliar and unknown.
In the end, we will adapt and find a new way of being. Before that time, we may lose a lot more than we gain. But against the backdrop of death suffered by the rest of the world, this seems like a small price to pay to finally defeat this disease which has plagued our existence for too long.
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Australia accelerates its plans to allow international travel.Travel bans will begin to lift in November for citizens and permanent residents, depending on vaccination rates.
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