Blair Bigham is a resident emergency doctor in Hamilton, Ontario.


From the Oxford Dictionary…

Fear: the bad feeling that you have when you are in danger or when a particular thing frightens you.

Danger: the possibility of something happening that will injure, harm or kill somebody, or damage or destroy something.

 

A week ago, I was scared. I’m an emergency medicine resident and despite having been on ambulances during both SARS and H1N1 as a paramedic, the coronavirus pandemic had terrified me.

Fear was everywhere; I could see it in my colleagues, in my patients, in my family. Fear was on Twitter, in the newspaper, and on signs hastily taped to the door of my favourite coffee shop. Fear is a very real emotion. It is not something we can easily escape.

But something has changed over the last week. Fear, somehow, has dissipated. Last night I went to work in the ICU, where we have nine confirmed or suspected COVID-19 cases. One of them needed to be intubated. But I wasn’t scared anymore. My mindset had changed. It wasn’t because there was no danger. The danger was still very real; this virus is dangerous. It jumps from human to human invisibly, sometimes before there are symptoms. Healthcare workers transmit it amongst each other. It is more clear than ever that healthcare workers on the front lines of this war are very much in danger. In China 3,300 healthcare workers were infected, in Italy over 30 doctors and nurses have died, and in New York City, the death of a healthy 48 year old registered nurse was reported Thursday. Yet, despite these devastating statistics, my mindset had shifted away from fear. Rather than focusing on fear, I’ve started to focus on danger.

What changed last night? The unknown became unmasked. Over the last week, I was involved in simulations of COVID19 care. I managed patients with COVID-19 in both the ER and ICU. I went to lectures, listened in on teleconferences and attended virtual grand rounds – all focused on the virus. This knowledge and experience gave me power. The virus, remarkable as it is, is not a mystery. We know how it works, we know how it kills, and we are getting to know the best ways to treat it. Trials are launching left, right and centre; public health heros are showing flattening curves; hospital managers once vilified are now clearly stepping up.

Last week, no one had their act together. The frontlines were confused; hospitals had different policies around who should wear a mask, who needed to self-isolate, and who could use their home CPAP. Those policies are now coalescing and being streamlined. The provinces, once far apart on containment rules, are now singing the same tune. The Prime Minister, love him or hate him, seems on top of things as he readies the military, begins to secure desperately needed masks and gowns, and throws money at the front lines. This week we’ve finally smartened up, stood up, and are marching in the same direction.

There are still many challenges. We need field hospitals, ventilators, simulation exercises, and more PPE. The situation is still rapidly developing, demanding constant changes to practice. But our tolerance for the daily change in guidance that once seemed like a bad joke is strengthened when that guidance is more consistent across the board. Our faith that we are doing the right thing increases. And rather than a cacophony of voices, we now sound like a choir.

This virus is dangerous. But we are professional soldiers on the front line of a war that threatens our friends, our society, and our very selves. We will not lose. We will fight this virus, and we will win.

Last night in the ICU, as I stared danger in the face, I felt informed, empowered, and committed. But last night, I didn’t feel afraid.