A taste of COVID-19 culture change in the ED

It wasn’t long until you couldn’t escape the knowledge of Covid-19 even if you lived under a rock, and in Far North Queensland, in the last town before the end of the road, there were plenty of us that lived under rocks.

In the Emergency Department (ED) of the Cairns Hospital, we were on the frontline. Before the news of Covid-19 became unavoidable, ED had been busy, ramped daily, especially after the rain. But now it was empty, fewer patients to see than doctors rostered on.  Sure, we were putting ourselves at higher risk being on the frontline but I came to work to flee the risk of losing my mind in the boredom of isolation. I came to work to escape the Covid discussions, as the outside world seemed to be more overwhelmed than the doctors. In hospital the general air of distress was silent whereas in the community it was loud, inescapable on the news, radio and social media.

The locals scolded each other for coming closer than 1.5 meters or not sanitising their hands. Or worse, if they knew you were the doctor, which let’s face it, when you live in a rural town everyone knows you’re the doctor, they’d come to ask you questions, get updates.

At work the buzz was quieter, controlled, because we’re doctors, we have to appear in control. The locals became afraid to come to ED. With no patients to see, we turned to each other to help pass the long quiet shifts. You found yourself having pandemic discussions with doctors and nurses you ordinarily would never speak to unless to ask advice or delegate a job.

I can remember a consultant came up to the circle of doctors of varying ranks that I’d found myself in. She began talking to us as though we were old friends about her children and the conversation she’d had with her husband about what to do if she gets infected. But while the department was quiet and controlled, the baseline anxiety hovered on the floor like mist that was inescapable.

Consultants seemed to be fragile, unhinging their usual put-together disposition. It was the waiting game, the torment of the possible. The department was in no way equipped for a pandemic. Makeshift ‘Covid rooms’ were designated with nothing but a curtain separating them. But the glory of being rural is we had the luxury of time to prepare.

Respiratory and infectious disease consultants came to collaborate with ED consultants. Every day they would ‘check in’ with the frontline, to bounce back ideas on pathways for management of proposed scenarios, scenarios that never came.

If this kind collaboration had occurred in the past it was never visible to the eyes of the juniors looking up. The collaboration was refreshing. Before it always felt like ED against them. Covid seemed to bring a shift in the culture of hospital medicine. At work you sought to connect with your colleagues and check in. You appreciated the personal exchanges. Because on the outside you were socially distanced; the two cafés were closed; the restaurants only did take away; and you were alone except for your household, which you were lucky to not despise for their fixation on our pending doom. Work became a break from the outside world.

There has long been pressure for a social change within the culture of medicine. Covid gave us a taste of how it could be different. Now that 2020 is over, now that the patient load has creeped back up, we can still remember to check in with our colleagues.