The Longest March: Reflections during the early pandemic

John Travers is a GP registrar, in clinical practice in Dublin. He is also leading research on interventions to reverse frailty and build resilience. He studied engineering and medicine at University College Dublin (UCD), a masters in business administration at Harvard and is completing a PhD at UCD. He has worked as a volunteer in East and West Africa, India and Europe.

Time has stopped. Familiar boundaries that normally mark its passage have dissolved. Gone are the opening and closing of shops, the relief of a weekend at the end of a week. Movie times, restaurant sittings and doctor’s appointments are all things of the past. In old time’s place is a new current that captivates and carries us along. A constant stream of news and information about the virus. The most anticipated punctuation of this new flow is the daily toll of infections and death.

What I hope will shine brighter in the memory are moments of humanity that pierce through the bleakness of lock down. Precious family moments. Rediscovering the simple pleasures like treasure hunts with my daughters in the park across the street, or feeling little arms clasped around my neck as I give pony back rides at home while isolating. Neighbours I haven’t seen for months stopping for a chat at a social distance as if we had all the time in the world. Strangers sharing kind smiles. People running marathons on twelve-foot balconies. Communities wrapping arms around those who need care and offering groceries and chats across the divide. We have seen the resilience of a nation in the face of uncertainty. A political leader suggests that when things are at their worst, we are at our best.

There are certain other moments that mark this passage through the lifetime of the virus for me. Some like a thud of realisation at the cusp of sleep. Some like stepping barefoot on shards of glass.

My Mum and Dad call to say they have coughs and temperatures. I hear the emotion in their voices. I am stunned at the possibility that they may have contracted the virus and be among the first in the country to do so. It is only days since the cogs of society stopped turning on the twelfth of March. The total number of infections in the country is less than one hundred but there is a national anxiety, bordering on panic. They had called their local GP surgery, where my Mum had visited five days earlier, to find it had been closed due to virus contamination.

Guidelines are changing daily and I realise I might already have missed an opportunity to get them in the lengthening queue for a test. I dash into my surgery early the next morning, St Patrick’s Day, to book a test on the secure referral system. The phone in reception rings repeatedly and echoes through the empty rooms before the line is diverted to the out-of-hours service covering for the holiday. It is the loneliest sound. Person after person waiting anxiously on the other end to tell of symptoms or seek reassurance.

Our surgery team hold an emergency meeting each morning. We discuss how to apply the ever-morphing guidelines and create a plan for the day. The phone is off the hook. We shift all our emphasis and instincts from seeing patients to telephone consultations. Call after call of telling patients we are there for them without the ability to lock eyes or grip a hand. The language of the body is lost.

I call an extraordinary meeting of the counselling not-for-profit I chair, MyMind.org. The board dials in and I urge an immediate move to online counselling and a stop to any face-to-face interactions. It has never been done before and would leap-frog the public health guidelines. There is resistance and I lament my inability to communicate the urgency better. I let the idea sink in. Within days the executive team make this the new reality. We lose a third of bookings overnight. We hold another meeting to go through emergency financial management for survival. Days later, the department of health selects us as the lead provider of online consultations to all frontline healthcare workers under stress and the general population suffering acute anxiety from social isolation, bereavement or loss of employment. Supporting mental health is the second front in this pandemic and we are privileged to help hold that line.

My parents test positive. My Mum recovers but my Dad’s fever burns on. I listen to his breathing intently at the end of a phone twice a day, like listening for static between musical phrases on a record. I bring over an oximeter. Our fingers graze on its exchange and the forbidden touch brings comfort and desolation. He declines auscultation of his lungs. I don’t pursue the offer, knowing that viral pneumonia or a cytokine storm would likely be silent. Rest, fluids and paracetamol remain the only treatment. The immune system does the rest and I pray it does not lose the run of itself and become a killer of my 80 year old father.

Stories trickle in from countries ahead of us on the infection curve that older people are being left on the heap as younger patients with a greater chance of survival are placed on scant ventilators. A video surfaces of corridors in a London hospital filled with body bags.

I ask for vital signs twice daily and despair that several are not settling. He is optimistic as ever but his body temperature rages for days. My finger hovers over a hospital transfer trigger, waiting for a change in breathing to pull it. I question if I am giving the right advice. Is the fear clutching my heart dulling my judgment? Most people start to feel a little better around days three or four after the onset of symptoms. He has not experienced any such reprieve. A small number may deteriorate around day seven and slip into a decline that leads to death around day twenty-one on average. The mortality rate for his age group is twenty percent. I do not sleep on the sixth night, or the seventh, or the eight. The fever breaks on the ninth day. I am filled with relief.

The surgery gets quieter as people stay home and the initial surge of anxious calls subside. Electronic prescriptions are a revelation. There is flexibility to get away slightly earlier in the day. I dash home to mind my two young daughters and give my wife, Lisa, the chance to do her work during normal hours. She has been getting up at six am and going to bed at two am, snatching time to fulfil the demands of her job. She is the hero. I cajole the girls away from her remote working station, going through more lollipops than a children’s party. We play in the spring sun at a local park. Every little thing is a wonder in their eyes. They ask why a duck does not move from its snugly nest, day after day. We wonder together. Has time stopped here too?

Just as things settle into a manageable rhythm, I get word that I am to be redeployed to a virus community assessment hub. GP registrars are redeployed without choice. I feel that leadership brings people along, but forcing people to do things buckles morale. Despite the loss of autonomy, I am glad to be able to work in a hub to which I would have freely signed up. I say a sudden farewell to the surgery team.

Lisa helps me shear my hair with a one blade after the girls are asleep. We have a long-needed belly laugh at the results. Patient numbers ramp up daily at the hub but we are never overwhelmed thankfully.

The team camaraderie is wonderful. Politics are gone. Hierarchy is gone. There is positive energy and a good will in every conversation. Laughter lives. We look out for each other. Yet the hub affects everyone, each in their own way. The gregarious nurse, full of chat and smiles, mentions in passing that she has not slept properly since starting here. The quiet doctor buries his head in his phone between PPE changes, seeking anything to distract him from the uncertainty of what the next patient will bring.

My colleague manages an arrest of an older man who came for assessment. She is entitled to pause and consider her ethical compass. She should don an appropriate mask for an aerosol generating procedure but none is to hand. A man lies unresponsive with no pulse. She does not think to do anything else but help him. ‘One and two and three…’ echoes down the long corridor. He comes back to life after four rounds of compressions. She waits for the possible tap of symptoms on her shoulder.

They tell us the transmission rate has fallen below one and that all the containment efforts are paying off. My parents rally strongly, as do their own caring GPs.

Some people suggest that things will never be the same again. They feel the new ways of living and working will stay embedded where they have sunk their teeth. I despair at the thought of endemic suspicion and distancing, people crossing the road when they see a child because they consider them a vector or judging an older person for taking a stroll with freedom because all they see is the label of vulnerability. Both ends of the age spectrum have suffered degradation. If there is change, I hope it is for greater attraction to the simple, rediscovered pleasures of life and an abandonment of unnecessary busying.

In truth though, I am not convinced major changes will stick. I see the tide rush back over the defences. I see ‘new norms’ disappear like the ocean smoothing footprints in the sand. I believe a certain human entropy will prevail. Things seek the most comfortable state of energy in which to reside, like a perfume’s scent easing its way to every corner of a room. People will fall back into old habits, not languidly but because they work. Industry may also induce us along, urging a return of shoulders to wheels of production. But entropy and industry are a small part of the story. I believe in the greater goodness of human nature: our ache for social connectedness, for human touch and warmth, for a little foolish sense of invincibility, bravery and pushing the boundaries of experience and excitement. Children will lead us back out to play and remind us of a simplicity that has always kept us grounded. We will take what we have learned and suffered and walk more firmly through challenges thrown our way, while more aware of our vulnerability. This makes us stronger.

I long for life to recover its beautiful rhythm. Will it happen? Only time will tell, when it begins again, and it will.

My daughters take me back to the park where we saw the nesting duck. The waiting has passed. Nature has nuzzled on its offspring without a care. Nothing has deflected its relentless surge. Warm sun falls in shafts through broad leaves onto the pond. Through its dappled prints swim mother duck and seven strong, brazen and unaffected ducklings. Life brims with promise in every stroke.

Featured photo by Ron on Unsplash