‘Goggles that fit snugly are always the first to go’

Springsteen in the air and a deep dive for the duckbill masks

ANOTHER week, another piece of the Covid-19 architecture is dismantled at Beaumont Hospital.

I cycled into work last week, turned the corner down by the emergency department where I park my bike: the tent was gone.

It was erected outside the emergency department so that ambulances could decant Covid-19 patients for triage by teams of doctors. It was where patients would be separated into the sick, the very sick and the dying; those with a chance of survival for treatment, and palliative care for those who were not going to make it.

It’s the kind of medicine usually reserved for disaster zones and war, not a suburban north Dublin hospital. Thankfully the tent was never used.

The numbers of seriously ill Covid-19 patients has been falling. The seriously ill patients are all now cohorted into one intensive care ward, rather than three at the start of the pandemic.

We are back at prepandemic levels of activity in the neurosurgery department. We are getting possibly more referrals from all over the country than we did before Covid-19.

Our team is short-staffed because restrictions meant that registrars who come to us from the US as part of their training programme were recalled to their home hospital in St Louis, Missouri.

The hospital is getting back to business. And yet …

Over the past couple of weeks, I have noticed a tension building, a slight tonal shift, like tightening a string on a guitar.

At our morning meetings, some of us have been getting snappy with each other. I’ve been ratty. Colleagues have been ratty. There have been a few rows.

We’re working harder than ever. But it’s not just the workload. In theatre, the anaesthetist and I were positioning a patient on a bed ahead of surgery so that we could secure the head for the operation. She was in full PPE — the anaesthetist places a tube into the patient’s throat, a very highrisk procedure in terms of Covid-19.

“I’m sick of it,” she said. “What, the PPE?” I asked. “Everything. All of it. Everything is taking so much longer. The intubation time, the downtime for cleaning the theatres…”

Later upstairs, someone in the office said: “I just wish we could return to normal.”

We’re not returning to normal and we won’t be for a very long time. We’ve lost so many everyday habits and routines, like the simple act of pulling a chair up to a crowded table in the canteen to join a riotous discussion or a bit of gossip.

It makes me wonder if the frustration, the rattiness, the sniping at our morning meetings, is Covid-19 stress finally breaking out. Maybe we’re experiencing a collective dawning realisation that this is the way it’s going to be.

Just as well that as neurosurgeons we learn stillness and fine movement during our training.

We have to be calm in theatre.

When we operate to examine the brain, the surgeon will often sit in a specially designed chair with rests for their forearms to minimise their movement. When you are examining the brain under a microscope, the slightest movement becomes magnified.

Music helps. One surgeon in Beaumont likes to play heavy Seventies rock while he works, like Led Zeppelin and Rory Gallagher. His taste doesn’t always go down well, especially with the staff who prefer pop.

Personally, I find Bruce Springsteen is always a popular choice. Who doesn’t like a blast of

Bruce? Sometimes lyrics can be distracting, and then electronic music gently pulsing in the background works.

At least we haven’t lost the music.

And striking evidence has emerged that we are adapting to our new Covid circumstances: we are developing crushes on our PPE.

We have discovered that we each have our favourite bits. Before theatre, we make a dive for masks and goggles. Cries often ring out —“no, I want the white one” or “oh no, there are no pink masks today”.

As for the goggles, the smaller, snug-fitting ones are always the first to go. People who wear glasses like the ones that look like swimming goggles. I find they fog up. I am partial to the yellow duckbill mask though. It’s got a nice tight fit around the face.

You know, I think we’ll get through this.