How to be EPIC (in the time of COVID)

Evolution is afoot. It‘s entirely possible you will have noticed a bit of an alteration in the world around us. A pandemic – the downwind effect of a miniscule strand of RNA and its lollypop studded shell, this savage little virus that took a wrong turn out of a market somewhere – has uprooted everything we know.

So too our role. A few years ago I wrote a piece on How to Be EPIC. Well, we’ve had a makeover. Where we used to dress like obedient socialists, now we are wrapped in layers, rendering us even more carbon-copied, anonymous and sweaty than ever before.

Like most hospitals, we’ve divided our ED into two streams. Dirty/clean, COVID suspect/non. Ours is called ARIZe. This makes it sound somewhat like a resurrection, or the denouement of a Joel Osteen TV segment, but really it just stands for Acute Respiratory Infection Zone. And, of course, a stream needs a leader.  Sound the horns, unfurl the standards, may I introduce you to our updated EPIC, the APIC – the ARIZe Physician in Charge. I voted for calling us APHIDS, after scurrying little sap-suckers, but, as is wearyingly routine, my suggestion was overruled.

We are not attractive. Covered from head to toe in PPE, our gowns are bile yellow and made from poly-synthetic material designed to prevent the ingress of foul liquids and humours, but also not let them out. Our mouths are enclosed in beaks, our eyes shielded with fog-fancying plastic. No jewelry, no distinguishing features. Hair in the worst bun our unhairdressered hair can form, and shoes so ugly that even they are embarrassed to go out in public. Ugly shoes are hose-downable, is the sorry mantra we now live by. I still wear mascara, but that is because I am vain. We will probably discover the coronavirus is attracted to cheap Maybelline products and I will be the first against the wall.

We have been issued radios, to wear around our waists like truckers, as putting phones up to our ear is a Bad Idea (also near impossible among the strata of PPE.) I am immature and like to say ‘niner’ a lot into my radio, which has amused absolutely nobody. There is a pattern here.

We are connoisseurs of alcohol hand-wash. Like sanitiser somelliers, we can distinguish between the fine Aquim gel, and the bootlegged fluid delivered round the back of the hospital in unmarked trucks. My own hands are cracked and flaking, Cinderella hands before she got rescued. No amount of moisturiser and the wallops of steroid cream will transform them, fairytale style.

As bosses we have not adapted well to some things. We cannot type efficiently into the wipeable keyboards, and it takes me half a day to type, with a single gloved finger, a typo-sodden letter to a GP. We complain about compromises to patient care – ‘oh I remember the days pre-Bipap,’ we moan, ‘and we used rotating tourniquets for pulmonary oedema.’ The trainees roll their eyes, and we listen to our crusty selves, wishing this were not true. We fumble taking bloods, forgetting the correct order to fill the bottles and which are the right bags to place them in. We are consultants! What are we doing venesecting like peasants again? (working, is the answer, we know). The hierarchy is now so flat we are mistaken for RMOs again, only with wrinkles and creaking joints and a junkie’s reliance on coffee.

But I digress. What complaints! What a whine! We, of course, are fortunate beyond measure, working in a public hospital, down the dowdy, unfashionable end of the world. A gob-smackingly obedient and sparse population has seen our curve not so much flatten, but die in the ass. Our COVID numbers, as this goes to print, are in single figures. Not happy to celebrate though, we all mooch around with survivor’s guilt, glued to news of our northern brothers and sisters, and wait for the flares. We study, like mad, the daily accretion of knowledge, the coinage of terms, the innovative, novel trails being blazed by those who are swimming in the floodwaters of presentations elsewhere, so we will be able to do it just right, when we need to. Because although we may be unattractive, and slow, and torn from the known soil by our complacent roots, we have, in the wake of a tiny sequence of ribonucleic acids, discovered what it means to live in the very now. Nobody can predict the future; it may be horrifying, or it may rise like a beautiful dawn, so all we have is the best we can be today. A bit sweaty, hard of hearing, lines across our cheeks like buried worms, dehydrated and flaky, but in possession of a deep, unending well of love and gratitude for what we have, on this shift, in this place, in this world, among these people. You. Our critical care family, our patients, our own loved ones.  A Physician In Company. That’s what we are now, and long may that last, long after the coronavirus has perished.

‘How to…’ An Instruction manual for those in Critical Care

• How to be EPIC
• How to be The Shop Floor Clinician
• How to Read an ECG
• How to be Kind
• How to be EPIC (in the time of COVID)
• How to be a FALCON