The Other Side of the Fence
Updated: Dec 4, 2020
2nd December 2020
UK COVID Deaths – Daily 648 / 7-Day average 452
Total UK COVID Deaths within 28 days – 59,699
Total UK Deaths with COVID-19 on the death certificate – 69,752 (up to 20th Nov)
James Cook Hospital – Total COVID deaths – 353
All COVID cases within South Tees Hospitals Trust – 90
James Cook Critical Care
COVID cases – 13 (8 ventilated)
Non-COVID cases – 42 (12 ventilated)
The second national lockdown has now finished. The new, reinforced tier system comes into effect today, the day that it was announced that the Pfizer/BioNTech vaccine has been approved by the Medicines and Healthcare Products Regulatory Agency (MHRA). The vaccine will begin being distributed next week and top of The Joint Committee on Vaccination and Immunisation’s priority list are elderly residents in care homes and their carers. Second on the list are frontline healthcare workers although we may end up getting vaccinated first. As a result of the logistical problems of administering a vaccine that needs to be stored at -70 degrees, it will be delivered to hospitals first.
At James Cook Hospital, the numbers of COVID patients continue to decline. We are seeing increasing numbers of non-COVID Critical Care patients and have had to change our extra ICU/Female SAU/Surge HDU or whatever you want to call it, into a non-COVID ICU. We all realise that, as we move into winter, flexibility is the key to being able to meet the demand for ICU beds.
Unfortunately, Nicky has been experiencing medicine from the other side of the fence. Over two weeks ago, her father, Gordon was diagnosed with a lymphoma following his admission to hospital with kidney failure. Lymphomas are a type of cancer that arise from white blood cells called lymphocytes. Treatment usually involves chemotherapy and/or radiotherapy. He has been in Castle Hill Hospital in Hull having scans and biopsies and he received the results a few days ago.
Gordon has subsequently started his first round of chemotherapy and is just beginning to feel unwell as a result. He has asked me to convey his thanks to all the staff on the haematology ward at Castle Hill. It is a relief for us all to know that he is being well looked after; the lack of visiting makes the ordeal that he has to go through even harder. It’s only when you have spent any significant period of time in hospital that you will truly come to understand how important hospital visits are for patients.
His ordeal is also hard on Nicky’s Mum, Lesley. Like many families in similar situations, this is the longest period of time that the two of them have ever been apart and it is difficult to overestimate how much this adds to the fear and worry. Lesley has been struggling to cope with all the things that Gordon normally deals with and, as most of us know, trying to deal with unfamiliar paperwork and computer issues over the telephone is extremely frustrating.
The extra worry that the threat of COVID-19 brings at this time makes a bad situation much worse. Gordon’s immune system will be suppressed by the chemotherapy and so both he and Lesley will have to formally ‘shield’ as and when he is able to return home. No-one will be allowed to visit them. The isolation that this complete avoidance of face-to-face contact brings is far from welcome at a trying time like this.
The ramifications of having a close family member become seriously ill are keenly felt when you are a doctor. The normal family dynamic changes a little. You often feel that there is an expectation that you should be more objective and level-headed, perhaps even ‘stronger’, despite the anxiety that you may be feeling. Understandably, you are asked to be the interpreter or the medical ‘go-between’. Your job is to explain what is happening and why. On top of this, you will often be asked for your own medical opinion. There is perhaps an unintentional assumption that the situation may be easier for you to handle as, after all, this is your job. Any confusion and fear will be lessened because of your familiarity with the circumstances. Your medical knowledge will surely help you understand and deal with the situation better, right?
Well, no, to be honest, the exact opposite is often true. You are prone to remember all those similar cases that you have treated over the course of your career. It’s perhaps only natural that you only seem to remember the people who didn’t do well. Your fail to realise that there were many patients that you didn’t see; the ones who were diagnosed, treated and recovered without too much drama. I’m not saying that ignorance is bliss but sometimes too much knowledge can work against you. It’s a bit like sitting down in front of Google and ‘researching’ any given medical condition. It’s far from reassuring and more often than not, serves to scare you unnecessarily.
Of course, you may also be treating patients in your own hospital with similar, if not identical conditions every day. This can be hard and it can be difficult not to be constantly reminded of what your relative is going through.
The other relationship that is different is the doctor-relative relationship or, put more accurately, the doctor-doctor relationship. Doctors have a particular way of talking to one another. It often comes across as a bit too objective, a little too matter-of-fact. It’s not that we are necessarily lacking empathy; it’s just a protective mechanism to help prevent emotional burnout. To worry about each patient as if they were a member of your own family would make decision-making very difficult and make every bad outcome a personal catastrophe. You would not last long in the job. However, it’s very easy, when talking to a patient’s relative who happens to be a doctor, to forget that this is not one of your colleagues in front of you but a worried, anxious family member instead. They may be looking for more than detailed treatment protocols and outcome statistics; they may, like any other family member, be looking for reassurance and hope.