[Natalie Eggermont is a trained moral philosopher (a former student), an environmental activist, politician, and ER physician in West Flanders. This post first appeared in Dutch on March 26, 2020; the translation appears with permission.--ES]
The night shift in the ER. There is no certainty about how the crisis will develop. Keep on fighting. And let off steam together. About the shortage of material and excrutiating political choices.
I know this feeling. I sense the impending impact. Last year I had an accident in a MUG [that is, physician led ambulance].* In the middle of the night we flew through the intersection with screaming sirens. When I saw the other car coming from the right, I knew that a collision was inevitable. After the blow, everything went in slow motion for a few seconds. The airbags inflated, I braced myself. Waiting for things to come. Would we flip? Crushed against a post or facade? Disintegrate? Was this the end?
It is that feeling with which I crawl into the car for the night shift. I recognize it. Only this time it is painfully slow and the end is not yet in sight. The email I just received from management haunts me. We are seeing an exponential increase in patients and expect it to continue for at least two more weeks. "There are no objective reasons to think that doomsday scenarios like those in Italy, Spain and France can be avoided here." I'm trying to master that awkward feeling. The next few weeks are going to be hellish. On the radio, the presenter asks what people do at home against boredom.
In the meantime, the emergency room has been completely redesigned; the flow of “corona” and “non-corona” has been separated. During the handover - where the ten of us in the small kitchen try to keep 1.5 m apart - the last guidelines are listed again and we receive an update on the state of affairs in our hospital. The many questions are answered as best as possible.
Cannon fodder
It is also the time to let off some steam. Someone derides the cabinet-ministers and years of savings in health care: "And now they are clapping hypocritically for us!" The lack of mouth masks is also reviewed: "If we had bought two F-35s less, I would not be here with one mask per shift." Few fans of Maggie tonight.* Management had sent us the new guidelines from the federal government by email: you wear a mask for eight hours, "to prevent and/or limit shortages." According to scientific guidelines, they are no longer safe after four hours.
It is beyond shame. Are we suddenly jointly responsible for preventing shortages? Experts warned the government in 2009 (!) that in our country the stock of masks was “below average” and that “saving on these expenses was ethically unacceptable.” The various governments did nothing for ten years. Even worse: in 2018, Minister De Block decided to destroy and not replace 6 million high-quality mouth masks. Now caregivers, store clerks, home nurses, garbage collectors, cleaners, truck drivers, dockers… must risk their health due to guilty neglect on the part of the government. Just like during the Great War, ordinary people are used as cannon fodder in the fight against the enemy.
Health versus profit
Planned shortages and a sluggish policy. It does not only pertain to face masks. There is a patient in the suture-room, a work accident. "What kind of work are you doing," I ask, inspecting the wound in his palm. "I work in the metal industry." "In the metal industry, why aren't you at home?" I react surprised. "Is that essential work?"+ "Like hairdressers, for sure," he laughs wryly. "I'd rather be home, though."
I do not understand. We have no objective reasons to believe that we can avoid doomsday scenarios, hospital management says. We are short of protective equipment for our healthcare personnel. Then why are so many people still working to make things that we don't need now? That is asking for further spread of the virus. That will translate into deaths we could have avoided. When [medical ethicists at] universities develop guidelines on who should and should not be put on the ventilator and economists call to keep working as much as possible to mitigate the crisis (the economic one), I am caught in a nauseating mix of grief and anger . So I'm going to have to let patients go because some bosses don't want to close their businesses? Patients who may not have had a visit for days and cannot have a dignified funeral. And is that just being said and supported by our politicians without blinking? Now we know how coldly unfeeling our economic system makes its choices. In times of crisis, capitalism shows its true face.
The hidden consequences of social distancing
Back to our kitchen. It is suspiciously quiet in the ER. We fear that many people who should come are afraid to do so. We hear it every day: "My son, my daughter, our home nurse told me to come." People don't like to come to the hospital. Certainly not now. There is fear of corona. People know that no visitors are allowed. And above all, there is no social monitoring anymore. No son or daughter visiting [their aged parents] and sounding the alarm. No caregiver noticing that speaking has become more difficult. For example, there are now three patients on intensive care with severe inflammation and kidney failure who probably would have come earlier in other times. Two of them have since died. The many initiatives, including from city councils, to actively call up vulnerable people are heartwarming and much needed. If anyone ever tries to tell you again that man is a solitary and selfish being, think back to this time. We are thoroughly social beings.
Someone bursts into tears. I want to give her a hug but it is not allowed. Loneliness is beginning to weigh on us too, although we are never alone. People fear us because we come into contact with the virus every day. We all feel it. "You shouldn't give mom kisses or hugs anymore," said one husband. He also kept his distance, bed and bathroom were separated. However, it is the love and support of family that keeps us straight after a long shift.
I hope it doesn't get too hellish tonight. Because during the weekend there is no cleaning crew at night and every potentially infected box is one box less in anticipation of the first rays of the sun. We have to laugh notice that when the ambulance is called, I have to crawl into the trunk of the physician led ambulance, otherwise we are too close together.
We laugh, cry and fulminate at politics. We are concerned about the people. Each in their corner in the small kitchen. With a mouth mask that has to be usable double the duration. On the table are cakes, pralines and pots of apple sauce, made by people who give us a hope
Editor's notes:
*Eggermont uses MUG, the abbreviation medische urgentie groep, or medical emergency group, the car with nurse and physicians that accompanies an ambulance.
*This refers to Maggie De Block, Minister of Social Affairs and Public Health.
+Many European countries have a list of essential occupations/jobs (partially) exempted from the lockdown.
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