Social distance hurts our care for patients

OVER the last couple of months, I’ve heard colleagues discussing how Covid-19 has made it so much harder for doctors to care for their patients. In the Covid ward, nurses and doctors pinned photos of themselves to their gowns, so patients could see their faces.

I’ve been fortunate not to have to think about that too much myself through this pandemic, simply because I hadn’t been in that position.

Then last week, I had to tell a patient that they had a malignant brain tumour.

Ordinarily we would have that discussion with the patient in a family room. A relative or a friend might sit in on the discussion for support, making sure the patient doesn’t miss out on any scrap of detail. The nurse specialist is there for additional support and expertise. We would sit and talk face to face. We would answer questions. If a patient is upset, we might offer tissues or put an arm around them.

Last week I sat two metres from my patient to deliver this profound and life-changing news in a mask and at a safe social distance.

Family members were not allowed to be there because of the restrictions. Instead they listened on the phone which was on loudspeaker.

I realised that the simplest expression of compassion is found in the human touch, such as a hand on a shoulder. But that is no longer possible. Instead you find yourself repeating words into a crackling phone line, from a distance, because the family members at the other end of the line can’t quite catch what you’re saying.

Sometimes we forget the importance of that tactile gesture of empathy, especially in the often cold and clinical settings of a hospital. As doctors we are trained to deliver the information to patients in a dispassionate and nonemotional way. But at some human level you have to care for them as well. Otherwise, you wouldn’t be doing the job. And as humans we are not immune to the emotion that information might unleash and often we might carry that emotion with us for a while. Now physical distance is creating an emotional distance between ourselves and our patients.

We deal with death quite frequently in neurosurgery because of the nature of the speciality. I take that as part of my job. I look on it as a privilege to be involved in someone’s life at that time.

The British surgeon Henry Marsh starts off his autobiography with a quote from a French doctor, Rene Leriche. “Every surgeon carries within himself a small cemetery, where from time to time he goes to pray.” I thought of many colleagues in the intensive care professions who have been carrying their own personal cemeteries in the past few weeks.

I washed my hands in the changing room last Friday at the end of a long day and a long week. The hospital was busy. And not with Covid-19. We dealt with more trauma cases, certainly more than in the last six weeks — head injuries from falling over, accidents on the street, assaults. Perhaps it’s evidence of people pushing against the restrictions and moving around.

Walking past reception, I was cheered by the sign at reception to mark World Hand Hygiene Day: “During a time when the world needed everyone to stay apart, we were here, all hands working together.”

The words came back to me during my post-work ritual after I got home a short time later. I opened the front door and stood in the hallway and stripped off all my clothes. My wife Aoife held out a plastic bag to collect my wallet and my mobile phone.

I dashed upstairs to the shower, making sure not to touch anything on the way. While I showered and changed into clean clothes, Aoife wiped down my phone and wallet with disinfectant wipes. All across the city, hundreds of health workers were probably engaged in that same laborious ritual that unites us all — stripping and scrubbing to protect our loved ones from what we may have been exposed to all day.

All hands, working together.