Gavin Francis - Intensive Care: A GP, a Community & COVID-19

INTENSIVE CARE

ALSO BY GAVIN FRANCIS

True North

Empire Antarctica

Adventures in Human Being

Shapeshifters

Island Dreams

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A GP, A COMMUNITY & COVID-19

GAVIN FRANCIS

First published in Great Britain in 2021 by

Profile Books Ltd

29 Cloth Fair

London

EC1A 7JQ

www.profilebooks.co.uk

Published in association with Wellcome Collection

183 Euston Road

London NW1 2BE

www.wellcomecollection.org

Copyright Gavin Francis, 2021

The moral right of the author has been asserted.

All rights reserved. Without limiting the rights under copyright reserved above, no part of this publication may be reproduced, stored or introduced into a retrieval system, or transmitted, in any form or by any means (electronic, mechanical, photocopying, recording or otherwise), without the prior written permission of both the copyright owner and the publisher of this book.

A CIP catalogue record for this book is available from the British Library.

ISBN 9781788167321
eISBN 9781782838166

For carers of all kinds
(for the kindness of carers)

This book takes the reader into the coronavirus pandemic as seen beyond the walls of the hospital, out in the communities that I work with, and for, urban and rural.

Just as physicians must honour the privileged access they have to our bodies, they must honour the trust with which we share our stories. As a doctor who is also a writer, Ive spent a great deal of time deliberating over what can and cannot be said without betraying the confidence of my patients.

The reflections that follow are all grounded in events within my clinical experience, but the patients in them have been so disguised as to be unrecognisable any similarities that remain are coincidental. Protecting confidences is an essential part of what I do: confidence means with faith we are all patients sooner or later; we all want faith that well be heard, and that our privacy will be respected.

[I]t is my opinion, and I must leave it as a prescription, viz., that the best physic against the plague is to run away from it.

Daniel Defoe
A Journal of the Plague Year

At the Covid clinic car park the barrier points skywards: the requirement to pay is suspended, along with so many other rules in this strange, in-between world of coronavirus. The clinic doctors had told you to come alone. You walk to the door, breathless even at that brief exertion, then push a buzzer that will shortly be wiped with alcohol to decontaminate it from your touch. You wait, with your cough and your fever. The door opens; inside, a nurse in blue scrubs, face mask and visor helps you put on a face mask, then leads you down the red or dirty corridor (though it is decorated in pastel shades and looks freshly mopped) into a small clinic room with too-bright lights and wipe-down furniture. Youre gasping now for breath, have some pains in your chest, youre flushed and sweating, frightened by all youve heard and read of this virus, this pandemic. The millions downed by it, the lack of ventilators, the military drafted in to help, the global economic ruin.

A doctor comes in; she too is dressed in impersonal blue scrubs, a mask with a spray visor, a flimsy plastic apron and bare forearms ending in blue-gloved hands. She asks you a few questions how breathless you feel, how high your fever has been, when did your symptoms start, where you have been travelling. She puts a sensor on your finger to gauge the oxygen content of your blood, then slots a thermometer into your ear. You feel hungry for air, and notice her gaze on you, as she counts your breaths.

Your oxygen is too low, your breathing too fast; a wheel-chair is brought, a porter takes you to a lift. You still have your mask on and when, inside the lift, you ask the porter where youre going, his own mask makes it difficult to understand the response. The lift door opens, behind it more blue-suited figures dressed in masks, aprons and gloves. One approaches with a swab on a stick, but you cant make out clearly what is said. You feel swallowed by the hospital, by the virus, by this pandemic that has broken over the world.

This story begins on 31 December 2019 when the Chinese authorities alerted the World Health Organization (WHO) to a new and dangerous strain of viral pneumonia that had arisen in Wuhan, central China. That virus didnt yet have a name, though it had already been circulating for some months. As the world turned into a new year, midnight fireworks igniting in a band across the globe, the virus began its worldwide spread. The story of 2020 is the story of this virus, its transmission, its ramifications for global and local economies, for how we travel, how we deliver healthcare, and how we plan for the even more damaging epidemics that will come.

My ambition has been to chart the evolution of this modern epidemic as I saw it, as a GP and as a member of the communities I work with, and for, in Scotland. In fact, the story that I am telling has proven more complex, and its ramifications more extended, than I anticipated in the early weeks of the crisis. Back then my fear was of a deluge of infections and deaths caused by the virus. I didnt see that this would become not just an account of a pandemic infection, but of the sudden warping of an entire way of life, of all those lives which have been thrown out of kilter and whose trajectories were now so uncertain, and the care those people would need as a result. I didnt foresee how much the profession that I love would be bruised, transformed and reshaped to cope with the impact of the virus. This book is a contemporary history, an eyewitness account of the most intense months I have known in my twenty-year career, a hot take on the pandemic that speaks of the tragic consequences of measures taken against the virus as much as it tells stories of the virus itself.

Crisis is a Greek word which originally described the moment in the evolution of an illness on which everything hinges, when death and recovery are held, for a moment, in the balance. The slightest nudge towards one or the other may determine the outcome. In a hospital, the intensive care unit or intensive therapy unit (ICU or ITU) is where the sickest patients, those whose organs are failing and who will die without drastic and intense interventions, are looked after. Those units do extraordinary work, but over the months of this pandemic it has often seemed to me as if many other clinicians, scientists, carers and charity workers outside the ITU have been engaged in something comparably intense. It has frequently seemed as if society itself is on life support, and intensive measures, including huge efforts of selflessness, vision and compassion, have been required to sustain it. Care is something we do for others, but its also an emotional attitude of attentive compassion, of kindness, and delivering it can be a privilege as much as it can also be a burden and a responsibility. Id like to cast a modest spotlight on the care Ive seen delivered in the communities I work with a care that has often been delivered quietly, without headline news, in rural village streets, community clinics and communal city stairs. Its my hope that sharing some of those stories will help readers see more clearly what has been gained and lost so far through Covid-19, and what were still in danger of losing. Its only by learning from this pandemic that we can better protect ourselves for the next one.