Hazel McHaffie

pandemic

Three months and counting

Milestones are useful hinges for reflection: three months ago this week the first Covid-19 death was reported in the UK. Since then, as per the official statistics yesterday, in this country there have been a further 39,727 deaths recorded where the deceased had a positive test for the virus. Say that again slowly – THIRTY-NINE THOUSAND SEVEN HUNDRED AND TWENTY SEVEN DEATHS. Not to mention the legion of unconfirmed cases. These are indeed unprecedented and calamitous times, so it seems fitting to consider something quite different here. Not a book; not a scientific paper; not even a film. But a newspaper article.

A beautifully written article in the Review section of the Guardian on Saturday, and one of the most sobering and moving pieces I’ve read in the proliferation of writings about this devastating disease. I wasn’t surprised to find that, before going to medical school, the author, Dr Rachel Clarke, was a current affairs journalist and documentary maker.

Her usual habitat is palliative care medicine in a hospice, but during this crisis she’s been working with patients dying of coronavirus. Politicians and journalists speak ‘loftily, from afar, an Olympian perspective’, she writes, and listening to them can feel like ‘a mathematical abstraction, an intellectual exercise played out in curves and peaks and troughs and modelling‘. But where she is, in a hospital, dealing with real people caught up in this horror, ‘the pandemic is a matter of flesh and blood.‘ And she is utterly appalled by the gloss the politicians have been putting on the devastation and loss.

Used as she is to comforting, hugging, being up close and personal, the very execution of her job now cuts her to the quick.
‘In PPE, everything is sticky and stifling. Voices are muffled and smiles obscured. Sweat starts to trickle into your underwear. Even breathing takes more effort. Behind our masks, we strain to hear each other speak and are forced to second guess our colleagues’ expressions. Being protected entails being dehumanised.’
Approaching relatives of the dying is immensely painful and counter-intuitive.
‘I am a doctor with neither name nor a face. My hospital badge is hidden from view and my eyes – the only part of my face still visible – are obscured by a layer of Perspex. So much for the healing presence of the bedside physician. I scarcely look human … Everything about this is wrong.’

She illustrates her experiences poignantly with reference to a single encounter with an 89-year-old man slowing drowning in his own secretions. His sons, bewildered and afraid, enter the other-worldly scene only for the last farewell. Her own emotions plummet as she watches helplessly, unable to offer the human warmth that is her instinctive response. Neither she nor they, want this elderly gentleman to be a mere statistic – a number reported in the next day’s death toll. He is so much more than that.

Dr Clarke and her colleagues at the frontline know for sure that the soundbites trotted out at the central podium in Downing Street each day have not been borne out by the reality in the Covid wards or the care homes. Social isolation, PPE, testing, lockdown – the deficiencies and delays and shortfalls have appalled them; the article captures the discordance perfectly.  Once lockdown was established, and the quarantined population were trying to manage its fears using ‘the unconventional strategies of baking bread and stockpiling toilet rolls’, the medical staff were reeling. Fearlessly, urgently, frenetically, they threw themselves into delivering high-quality pandemic medicine. They could only look on in disbelief as staff were obliged to fashion PPE out of plastic bags, patients were sent into care homes without tests to establish their Covid status, and restrictions were being lifted in the absence of the necessary infrastructure for proper testing and tracing.

The country may be letting its collective breath out cautiously as the numbers decrease, but they are still battling this deadly enemy. They feel sick as the politicians declare the success of their strategies; they know at first hand the stupendous costs of delay and deficiency, the real tragedy of thousands upon thousands of deaths and bereavements. They were, they still are, there, ‘up close with this dreadful disease‘,  seeing ‘the way it suffocates the life from you‘. For them political judgements ‘were grotesque‘. They themselves are ‘exhausted, stunned – shellshocked, even‘. Clarke’s verdict? The loss of so many vulnerable citizens is ‘entirely and inexcusably wrong … no one is expendable‘.

I certainly don’t envy any of the people who must make these decisions, but putting a spin on the devastation, peddling untruths and half statistics, making false promises, doesn’t engender trust or confidence. And as Dr Clarke says, ‘The point of our response to corona virus is not to flatten curves, ramp up headlines, protect the NHS or invent mathematically nonsensical equations: it is to prevent unnecessary dying’. And there you have it. The heart of the matter. Summed up by someone at the very kernel of this global catastrophe.

She’s the author of Dear Life, paperback version due out in September this year. It’s top of my wish list.

NB. To be fair, First Minister Nicola Sturgeon, in her daily updates for Scotland, always stresses the tragedy of every single death.

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Unprecedented times

We’re repeatedly reminded that we are living in unprecedented times, the normal rules of engagement don’t apply. And indeed nobody can be unaffected by the restrictions, embargoes and uncertainties caused by the Covid-19 pandemic. They have the capacity for making us look more closely at what really is important in life.

Maybe it’s that sense, or maybe it’s because we’re being reminded every day of the frailty of human life, but I have this week broken the habit of a lifetime … swift intake of breath … yes, it’s true. And that is …? I have abandoned a book a mere one third of the way in. Me!! Someone who prides herself on always … ALWAYS … giving a book the benefit of the doubt until the very last page! As I say, normal rules of engagement don’t apply right now.

With all this extra time at home, and an unusually empty diary, it seemed like a good idea to delve into the terrible hardships endured by Jewish partisans trapped behind enemy lines in occupied Russia during the last years of WW2. The unimaginable hardships they endured before and during their time in the ‘republic of the marshes’ – gut-wrenching deprivation, torture, imprisonment, starvation – that would surely put our present situation into context. So I duly settled down with Primo Levi‘s modern classic, If Not Now, When?

OK. There are some lyrical passages … the story comes from the heart and Levi’s own lived experience (among other things he was a holocaust survivor) … but oh dear … I struggled to maintain concentration. And it’s hard to pinpoint exactly why.  Is it because there’s so much going on in real life right now that’s taking up brain space? Is it because dark novels aren’t what we need when today’s news is full of grim statistics and dire predictions? Is it because our present emphasis on people coming together feels so much more edifying that a tale of nations and people in conflict? Or is it the book itself? Would it have defied me in more normal times? I don’t know.

Suffice to say that I believe I’d have persevered at any other time – on principle, if nothing else! But not now. Life feels too short, and I have plenty of other books calling me.

But not as many as I had last week. Because, in a spirit of community support, I’ve set up a bookcase at the end of our driveway, and each day I put a selection of books, DVDs and CDs out, with a notice inviting anyone to help themselves by way of distraction for lockdown.

And passers by are availing themselves of the opportunity every day; some leaving a little message, or throwing an appreciative message across the road at the Thursday clapping for the NHS and key workers. We’ve even had someone expressing interest in having the bookcase when this is all over!! And last night someone asked if her friends could add books and jigsaws to the shelves. Brilliant. I’m delighted that people are finding the time to read, that books still appeal. And there’s an added bonus: I’m freeing up space on my own shelves at the same time. If not now, when? It’s an ill wind …

Stay safe, everyone.

 

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Decisions in a time of coronavirus

Week 2 of the lockdown because of Covid-19 and I am reflecting back on an extraordinary seven days. Unprecedented. Grave. Frightening. But one of the most unexpected developments has been a positive one, closely connected to my professional interests: people have been thinking and talking about the ethics around end of life care, and specifically about Advance Directives, teasing out the kind of interventions or treatments they would wish to avoid.

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I wrote my own living will years ago, and have revisited it periodically just to be certain it reflects my sustained wishes. It does. My husband and children have known about the documents and their contents ever since I drafted them, but suddenly these matters seem much more urgent and relevant. There’s a greatly increased possibility that I might become seriously ill soon; that I or they might be called upon to decide whether it’s appropriate or not to accept aggressive or invasive treatment. That it might be futile. So, this week I sent copies of my Advance Directive to refresh their memories as to the detail. If they’re called upon to represent my views, they will know precisely what to say.

However, more importantly, this crisis has prompted other people I know to think about their own mortality and how they feel about these issues, for the first time. Sobering stuff. But so right.

At the very least we all need to have the conversation with our nearest and dearest; better still record our decisions, have them officially witnessed, make the documents known and available.

And the questions even for hardened ethicists have been widened and thrown into stark relief by developments during this pandemic:
what if our hospitals are already full, and I can’t be admitted if I succumb to the virus?
what if being admitted to hospital means I risk dying alone?
what if I live alone and I contract the illness?
what if I fall outside the criteria for treatment?
what if the medics deem me to be highly unlikely to survive?
what if it’s a choice of me versus another patient?
what happens if no-one can attend a funeral?
… and so on …
This public health catastrophe and its horrific statistics has brought us face to face with undreamed-of dilemmas confronting our society in the spring of 2020. Now.

The time has never been more urgent for a weighing up of the risks and benefits, and an analysis of our beliefs and values. For having the conversation. It’s personal. It’s real. It’s not going away.

What will you choose?

 

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