I turned up for work at Beaumont Hospital towards the end of last week, taking my usual route to the changing rooms - the ones beside the operating theatre which had been turned into a Covid-19 intensive care unit to prepare for the surge.
I was stopped in my tracks. The doors that had been closed were wide open, the Covid-19 signs were gone and there was not a space suit to be seen.
“Where’s the Covid-19 intensive care unit?” was not a question I thought I’d be asking anytime soon.
Something is afoot. I am almost afraid to say it but I think there is a sense of cautious optimism abroad — cautious being the operative word. People are whispering it. Are things getting better? Has the surge passed?
Maybe it’s too soon to say. There are still Covid-19 patients in the intensive care unit but my critical care colleagues there tell me numbers are falling. The extra ICU ward is no longer needed and its original function as a recovery area for patients after theatre has been restored. The vast majority of patients who had been through ICU recovered well — the mortality rate was around 5pc, which compares well internationally.
Another colleague, a microbiologist, told me how easily Covid-19 spreads in open wards. Most hospitals have six-bed rooms. If the virus comes in on one patient, scientists can predict the length of time it will take to reach the other five — if no precautions are taken to prevent its spread.
The same applies in nursing homes. As a medical student, I worked as a healthcare assistant in a public nursing home which had 20-bed wards and communal living areas. It was exactly the type of environment the virus would flourish in.
How clusters of infection have multiplied is of enormous concern, for the residents and their families and the health workers struggling now to contain the spread. It is clear they have not had enough PPE supplies.
I was struck though by some commentary I’ve read, about residents being left to die in these facilities.
The reality is a little more nuanced. The majority of nursing home residents will be in their 80s and 90s and a high proportion will have dementia, along with other medical conditions. Emergency departments can be incredibly upsetting and disorientating environments for the patient, emotionally and physically. They need to be in familiar surroundings, in a familiar environment and among familiar faces. Once they lose that familiarity and contact, their health may decline, and it can be challenging to care for them.
As clinicians we look at the patient holistically. It may not be in that patient’s overall best interest to be admitted to hospital, even when Covid-19 is suspected. We make similar decisions in neurosurgery, where the risks associated with surgery and hospital admission often outweigh the benefits. Doctors in all areas have to make decisions like this, and always in consultation with the patient’s family.
I cling to cautious optimism that we can all return to normal life. But there have been some extraordinary moments in this pandemic. I cycled home from Beaumont last Saturday night. I had forgotten about the Shine a Light campaign for health workers until someone mentioned it to me before I’d left. As I cycled through the gates, I noticed candles in the windows of the houses right across the road. As I continued, I realised they were shining from every house I passed. Not just candles, but Christmas lights and lights wrapped around trees in front gardens, and lots of people, standing in their doorways or sitting out front.
Light after light, in house after house; it was like a great warm wave of national solidarity. That’s when it hit me. It’s not just us on this frontline, it’s not just people who work in hospitals or in care homes or in doctors’ surgeries. It is also the patients we treat, their families and the people confined to their homes.
When I turned on to my road, one of the residents had put a big banner in his front garden that said: “Thank you to all frontline workers.”
He was on his doorstep as I cycled past. “Thanks Doc,” he shouted. “Cheers, no problem,” I shouted back.
I really shouldn’t say this but I was, almost, moved to tears.
John Duddy is a specialist registrar in neurosurgery in Beaumont Hospital in Dublin.
In conversation with Maeve Sheehan