This is the second set of the three. To read the first set, please visit https://bit.ly/3eVu768.
Anxiety and apprehension have been prevailing themes in the upheavals brought about by this pandemic. Indeed, how do our juniors feel as they graduate in this very unique academic year and enter the wards as newly minted house officers? To find out, we invited three Duke-NUS Medical School graduates to share their concerns. And to address those concerns, we felt there would be no better group of doctors than our seniors – those who battled with SARS 17 years ago. We were interested to hear what the seniors, with the wisdom of experience and hindsight, would have to say to this new cohort. Thus, we have paired one senior with each junior for this special series, and will be featuring their insights in the coming months.
TURNING FEAR INTO HOPE AND TRUST
Sneha Sharma
"No, please no," I say as the news falls on my ear.
My vice dean, a tiny square floating among other important squares, is trying his best to provide sympathies to the student body – a mere 60 of us – over Zoom. I mute them all.
"Are they really sending us back into wards, despite knowing full well the dangers of the new virus? Should I start writing my obituary?" I think.
My mind wanders to my parents, my 18-year-old not-so-little little brother, and Goldilock (the house goldfish).
"Am I going back to learn from patients or to support understaffed medical teams? Who am I? What is my role?" I deliberate.
I open my mouth to ask these questions but quickly close it again knowing that primed administrative responses could hardly provide the consolation I needed. As a cohort, the graduating class of Duke-NUS Medical School was obligated to join wards as students.
I enter the hospital for the first time in two months. Everything is exactly the way I had left it pre-COVID-19 – the smell of mixed vegetable rice, pancakes and kopi (dialect for coffee) mixed with a certain alcoholic cleanliness, the buzz of chaotic early morning nursing handovers, the scramble as people fight for computers to finish typing their notes and the usual chatter humming in the background.
How is the hospital playing the same rhythm as pre-COVID-19, when more than 700 patients (double the usual number) walk in through its doors every day? I learn quickly that this rhythm had the same melody but a different harmony.
COVID-19 wards had been separated from non-COVID-19 wards, and people working in either place had been isolated from each other to keep infections among healthcare workers at bay. Doctors were now asked to wear surgical masks at all times and N95 masks when entering high risk areas. Coffee rounds – traditionally a time when seniors bought juniors coffee and the team united as one to discuss important changes to patient management – had been banned. People ate lunch in isolation or at least one metre apart from their colleagues.
I learn that despite these small sacrifices, life in the hospital went on relentlessly. Doctors, nurses, allied health professionals and others knew the tune they had to play to not compromise patient care. Instead of gathering for coffee, people gathered on their phones to discuss important changes.
Everything in the hospital was the same, I think. I have nothing to fear.
One day, I look across my ward at the acute respiratory infection ward. The doors open and a band of doctors emerge from the COVID-19 ward post shift; yellow gowns, green masks, transparent face shields and yellow gloves – their strict personal protective equipment ensuring that no part of their body is exposed to the outside world. I jump in fear. Four years and yet I was unprepared for this moment. Unaccustomed to them, they look like aliens to me. One of them turns around to say hello and I run back to my haven of safety.
The new normal is easy to talk about but difficult to implement. I go into the hospital every day looking to play its tune. "Everything is normal", I repeat to myself; yet the differences are present in every aspect of working life. The fear that a new patient will slip through the A&E department and inadvertently spread COVID-19 to the medical team, the stress looking at the ever-increasing AE list and the constant feeling of being dirty with the virus – the list of ways that life has changed post COVID-19 is endless.
Fear of the virus is ingrained in every healthcare professional's mind as they start their daily work. But as the days roll on, another feeling has emerged – one of hope and trust. Hope that by following appropriate precautions we will remain safe, and trust that every member of the community will do their part for us to overcome this virus together. One thing is clear – as a community we are all relying on each other like never before.
The SARS Warriors
Lim Hong Huay
20 January 2020. "No, please… not again!" Waves of unbridled fear crashed on me as I watched, with horror, the news reports of an escalating coronavirus epidemic in Wuhan. Something inside me knew this would be worse than SARS. The deep pains from 17 years ago surfaced without warning. As I retreated into the comforting solace of my room, flashes of the past came flooding back.
15 March 2003. Flight SQ25 landed with a confident thud on the tarmac at Frankfurt am Main Airport as the morning sun peeked over the horizon. A couple of ambulances were already waiting on the apron with sirens blaring as the plane taxied in. I looked across the rows of seats separating the three of us from the rest of the passengers and watched them leave the plane in a confused hush. With a pounding heart, I turned to my mom, who was running a low-grade fever and said, "Don't be alarmed mom, the medical team will come in with 'space suits' to take us to the hospital." She forced a grin and replied with a quiver, "Don't worry about me, I have seen these on TV." I hugged her tightly. On my other side, my husband hacked a few coughs and leaned back into his seat in exhaustion. I had never seen him like this before.
Everybody including the crew got off, except the three of us sitting in the last rows of the plane. Soon, the thudding steps approaching broke the unnerving silence. Despite all psychological preparation, I froze as personnel in Biosafety Level 4 (BSL 4) suits marched down the aisle towards us. Pictures of the Holocaust flashed through my mind and I kicked myself for being ridiculous. We were asked to step off the plane one at a time into individual ambulances waiting at the bottom of the stairs. We were to take nothing with us. No bags, no handphones, no passports. As the sharp winter breeze hit me at the top of the stairs, I felt naked despite my thick winterwear. When the ambulance door swung open, my jaw dropped. I had never seen an ambulance like that in my entire medical career. The seats and equipment were all stripped off, and the bare walls, ceiling and floor were sealed with plastic sheets. I sat on the ambulance floor, sliding uncontrollably and frantically grappling the plastic sheets to stabilize myself as the ambulance sped towards the Hospital at Goethe-Universit at Frankfurt am Main. "I can do this, I can do this, it's gonna be ok, everything will be fine again. what is going on!" my mind screamed.
16 March to 2 April 2003. Everything that happened after that seemed a lifetime away. My husband fell dangerously ill with SARS, then myself. He had cared for the SARS index patient in Singapore. My mum was surprisingly spared. I still remember the horrific air hunger, as if I were drowning on dry land. And the writhing pain from multiple unsuccessful stabs for arterial blood gas because the nurse had sweat dripping into his eyes and accurate palpation was near impossible through the BSL 4 suit. Thankfully, with the loving care from the hospital staff, we miraculously recovered. I still reminisce about the German cold cuts and frankfurters from the hospital kitchen to this day.
Outside our BSL 4 isolation unit, the epidemic was raging on in different parts of the world, including Singapore. Mortality from SARS was reportedly 50% at first. When news from Singapore came, we heard heart-wrenching stories of colleagues succumbing. Families were torn apart and friends suffering. For the first time in my life, I knelt and desperately claimed the promises in Psalms 91 for ourselves and Singapore.
3 April to May 2003. On 3 April, we were finally allowed to return to Singapore. On 9 April, Hoe Nam and I reported at Tan Tock Seng Hospital, the designated SARS hospital, to support the medical and epidemiological team. I was 17 weeks pregnant then. Little was known about protective immunity after SARS-COV infection. I was worried that we would be re-infected again and my baby would suffer. Despite the experience at Frankfurt, it was sobering to walk through the hauntingly quiet lobbies, food court and corridors that previously bustled with visitors, shoppers, diners, patients and medical personnel. As we met up with the rest of the "SARS doctors" team, we knew we had reported at the front line for war again. The difference was that we were not alone this time. We were fighting together as a team. Was I frightened? Yes, of course. As I watched my determined husband and colleagues pick up their gear and walk towards the wards, I asked myself, "If not us, then who?"
We are the SARS warriors.
26 June 2020.The setting sun threw a glorious pink into the evening sky. Joggers huffed past me and children giggled as they zoomed towards the nearby playground on scooters. Many paused on the Bukit Chermin boardwalk to catch the picturesque scene over breaking waves on their phones. It was a week into Phase 2 post-circuit breaker. I have dreamt of this day for months. As I strolled on with my mask faithfully donned, I gave thanks that Singapore has risen from the ashes like a phoenix, yet again.
"True courage is not the absence of fear, but the willingness to proceed in spite of it." – Anonymous