Thread by @Medic_Russell, Well. That was a strange set of nights. Eerily quiet mixed with [...]

Well. That was a strange set of nights. Eerily quiet mixed with some incredibly unwell patients and challenging situations.

Lots of reflecting and debriefing between the team, both regarding individual cases and the whole situation/our feelings.

Some things that came out:

1) Sleep - nobody is sleeping well at the moment. We’re all waking up multiple times a night/early in the morning. Loads of us are having endless work-related dreams. I keep having dreams about doing something wrong or having to manage impossible situations at work.

2) That “something’s coming” feeling - you know the one before an exam or an interview where something’s coming and you’ve prepped but you’re worrying about all the possibilities? That’s where we’re all at. Even while the ED is quiet the overall feeling is “is today the day?”

3) The plan feels like it’s in place (ish). Our ED underwent a lot of rapid changes and everyone felt like they didn’t know what was happening. We’ve been static plan-wise for a week or so now and we’re getting used to the new set up. That’s helped a lot.

4) Our frequent attenders. Every ED gets a lot of patients who attend weekly/monthly or even more frequently! Usually if they don’t attend for a while we get hopeful their chronic illnesses or social situations have turned a corner. Now if we haven’t seen them in a while

we’re worried something has happened. I think we’re all dreading seeing those we’ve developed closer clinician-patient relationships with get more unwell during this time.

5) The “you doing ok?” question is vital. It’s becoming a new skill to tell emotions by eyes and foreheads alone in the masks, but asking each other how we’re doing has revealed anxieties that it turns out we all have and we can all deal with together. Check up on each other.

6) Difficult conversations. We’re all used to having resuscitation/escalation planning conversations. Most are done as a hypothetical situation and sometimes it has to be done ‘in the heat of battle’.

Multiple times per shift over the weekend we had to have that conversations

with people/families of people who we thought were imminently dying. To a degree there seemed to be acceptance/understanding given the press coverage, but these are always challenging and emotional conversations to have. A lot of us have felt emotionally drained by this.

7) Social isolation is rough. Usually after a weekend like this we’d debrief over breakfast and talk it all through. Instead we just said goodbye to each other and went off to stay in our own houses until the next shift. In our job the after work drink/breakfast is *vital*

to helping everyone go home more comfortable with the events of the shift and process things. The social isolation is going to make this whole process really hard.

8) Everyone feels like they’re not doing their best. Be it their clinical work, keeping up with guidelines, or even their home life (looking after kids, keeping older relatives’ cupboards stocked). Once we talked we realised we all felt we were doing badly and

we all felt everyone else was doing an incredible job. Turns out we’re all doing just as well as each other, and it’s more important than ever to ensure we’re telling colleagues when we think they’ve done something well. The small wins/compliments are important.

9) Our specialty colleagues. In our department we’ve been so lucky to have specialty colleagues whose default stance is “yes of course how can I help”. On one night I was maxed out and a hand injury came in; I’m sure I could have sorted it but I needed a cognitive offload

I phoned plastics (who do hands in our place) and asked if they were free to help. Not even the slightest question; asked for an X-ray to be ordered and they were there minutes later to sort it out. I can’t thank them enough if it was just the break I needed.

10) It feels inhumane. We all got into our jobs because we want to help and care for others. Normally if someone’s dying we make a point of closing the curtain in their room and sitting with them (if they don’t have family) so they’re not alone. Now the curtains are gone

because we need the cubicles to be deep cleaned quickly and often family haven’t come with. We can’t sit and hold hands. We can’t give that level or comforting and care we’re so used. It feels horrible to watch through the cubicle window and not be able to offer that humanity.

11) “When this is over”. We know the worst is yet to come, but there’s going to be a light at the end of the tunnel. I think we’ve found it helpful to talk about what we’re doing to do when lockdown’s over; a holiday, the theatre, a pub trip. We need something to look forward to.

12) Prehospital pastoral care. I’ve found my prehospital colleagues have been hit hardest by this, and being someone at the handover desk to talk to after getting the patient into their cubicle has been vital. Just having someone to offload to is key for us and

I think a lot of the solo responders are struggling without having someone to talk to. Anyone who’s in ED please look after your friends in green; we’ve got a wide and sprawling team to help with this, they don’t as much.

13) Hydration. We’re awful at going for a glass of water at the best of times, now put a face mask and doffing and 85 hand washes between you and that glass of water and it almost never happens. Then add in the PPE sweat. No wonder we keep having headaches! Keep hydrated!

I think I’m running out of salient points/getting tired. I think that was an offload for me so if you read it thank you. If it resonates with your experience please share (here or DMs). If you’re prepping than hopefully there’s some insight to help! x

Actually one final point - “the new normal”. I’ve said this a lot this weekend. We all have. But it’s not normal. It should never be normal. And it’s really important to remind ourselves about that; these are exceptional circumstances and we have to act exceptionally in them.

How lovely to see the response to this after a nap. Mostly it’s been great to see a general vibe of “that’s exactly how we’re feeling too”.

#MedTwitter is going to be a key social tool for us to share our experiences in the coming.

Look after each other. Always here to chat

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Sure!

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