Covid cat

Jill McIlraith

I was eight when I learnt two things: how to tie a reef knot and that I should never sing in public. The right-over-left-and-left-over-right knot sequence had a symmetrical simplicity that stuck with me and was the most useful thing Brownies taught me. Not singing in public was a lesson learnt when another girl and I were persuaded to sing Galway Bay for the end of the year Brownie concert, because “everyone had to do something.” The silence after the first few bars encouraged us, until we realised the audience was too appalled even to snigger. We ploughed on, determined not to stop even as the shuffling got louder. We got polite applause, but were not too young to realise it was less from appreciation of our singing than from gratitude that we were done. But despite the muted response, I felt dogged satisfaction that we had not given up. We had stood side by side supporting each other and had stuck it out to our final flat note.

Ten years later, when I was an exchange student in Arizona, the music teacher insisted I join the school’s a capella choir on the premise that all exchange students did so. I explained why I should be exempt, but he insisted on an audition. Three bars into Edelweiss, he stopped and muttered, “I see what you mean.” I remember telling him not to worry, there were lots of other things I could do and I would concentrate on those.

And 2020, like no other year, has shown us how to rely on our strengths and adaptability, standing side by side, undaunted, while fearsome eddies swirl around. Those of us who work in general practice are used to days not turning out as planned, but none of us foresaw that we’d be spending blustery afternoons wrapped in flapping PPE among the road cones of car park Covid clinics. We looked as alien as we felt in those first few weeks of the Covid response level 4 lockdown, caught in the spotlight and wondering if we were up to it. It seems quaint now to look at the practice’s 2020 diary with its days blocked out for leave and travel. Patients were similarly thrown off track, but often much more seriously, their plans evaporating with job losses, home schooling demands and the seeping anxiety that comes with planet-wide uncertainty.

How to cope with so much uncertainty and change? Could we keep everyone safe and care for our patients? Overnight, we had to change to a completely new way of practising: phone and video consultations, triaging patients into red and green streams, keeping up with who we were supposed to be swabbing that day and who didn’t qualify. How could we meet the expectations of patients, Ministry of Health, DHB, PHO and our families, while not going batty ourselves?  And were we going to be financially and emotionally robust enough to still be there for patients by the end of 2020?

We needed to work together with the sort of resilience, togetherness and grace under pressure that I had glimpsed as a hopeless eight-year-old singer.

In our South Dunedin practice we set about building on what we had learnt after the 2015 floods, although that crisis at least had an end point that wasn’t dependent on vaccine development, or muddied by conspiracy theories and nutty Trumpian advice. Regular quick meetings to keep up with rapid changes, humour and creative problem solving became the manure that nurtured our mental health. We started a Covid Log to share the wacky and wonderful interactions that peppered each day, making us smile as a counter-balance to the uncertainty. There was no shortage of anecdotes. Early on, one of the doctors made it into the Log by reminding a colleague not to forget to lick the door when they left. This brought the immediate riposte: “I thought we weren’t supposed to be doing that right now.”

The local pharmacist merited an entry for phoning to ask if we wanted a patient’s laxatives “packed or loose.” And we smiled over the straight-faced discharge note from an emergency department colleague regarding a patient who had wanted him to do something about her self-administered lockdown Mohawk haircut. After documenting all her vital signs and describing the haircut, he commented that “I can find no medical problem that I can deal with.”

Saturday morning drive-through ‘flu clinics during lockdown brought taxis, mobility scooters, house buses, wheelchairs, dog-walkers and drop-ins, as well as those who dressed up, pearls and all, for their precious five-minute interaction. We quickly perfected our traffic management skills – it’s amazing how effective a mask, face shield, clip board and hi-viz vest can be in getting people to follow instructions.

A sleek tabby cat, promptly named Covid Cat, decided it was a good time to explore the quiet neighbourhood. He kept us company on our weekend clinics, waiting at the back door and strutting down the corridor, owning it, as only cats can. He was glossy and energetic, and purred with the attention we humans provided. We only briefly debated whether he could be a coronavirus carrier before deciding the risk was low enough to be worth taking. In a pandemic, you have to take your cuddles where you can find them.

Some patients felt we needed caring for, and brought gifts. Based on the premise that if cream improved cooking, alcohol would do the same for a pandemic, one brought us a large bottle of Grand Marnier “to help things along.” Others stuck to more traditional gifts of shortbread, ginger crunch, slabs of Whittaker’s chocolate and a cooked sausage. Everyone in the practice bubble put on weight.

The nurses, always our stars, dealt with more than a  hundred phone calls every day, sorting out every kind of problem, including gently explaining to a patient that a negative Covid swab did not mean it was Ebola instead, as he feared, and reassuring another that it was okay to take medication after the seal was broken, as long as the patient themselves broke the seal and, yes, it was also safe to ignore the written-in-bold instructions not to take “if seal is broken.” There were sad stories, such as some agitated older patients who could not understand why they couldn’t visit family in rest homes or why they couldn’t make their daily visit to the pub. One man brought in a letter from his wife’s rest home to ask us if it was “legit” that they had “locked her up” and what could we do about it.

Staff also had their ups and downs. One delivered a healthy baby girl, while two lost family members (not to Covid); another took a month’s leave to look after elderly relatives and to teach them how to do on-line banking, grocery shopping, Skype and Zoom. Two staff members went ahead with their planned retirement (only for one to be persuaded back months later), and orientations for a new doctor and a receptionist were rushed through during the first week of lockdown. As long as they knew where the fire exits, tea room and toilets were, that seemed sufficient in midst of the turmoil.

Telephone and video consultations extended our skills, as when we tried to convince an active, itchy seven-year-old boy to stand still in front of his mother’s iPad so his rash could be seen.  On this one, we gave up and saw him in person; ditto for the man with the painful thrombosed haemorrhoids. Video consultations at home had mad moments such as a live mouse proudly brought in by a cat and dropped at a colleague’s feet. There was an abrupt and apologetic end to the consultation while feline and rodent were dispatched outside.

In the midst of this, there were the usual things to deal with: heart attacks; palliative care patients needing home visits; anxious, lonely patients who wanted to talk; a suicide; an insomniac wanting sedatives to counter multiple cups of coffee. On the bright side, there was less snot-and-grot, with fewer chest infections and exacerbations of COPD (chronic obstructive pulmonary disease). There were also fewer sports injuries and accidents, and a reduction in paper forms as agencies moved things on-line or extended expiry dates. Clinical staff took to wearing scrubs and vowed never to go back to ordinary clothes, as it was the closest they could get to coming to work in pyjamas. We ran a competition for who would see the most pregnancies post-lockdown with the winning doctor awarded a Sheela Na Gig.

Everyone stopped saying, “when this is over” and came to accept that disruption and new ways of working were here to stay. Some became amateur historians of previous pandemics – John Barry’s opus, The Great Influenza, about the 1918-1920 flu epidemic revealed just how far we had come in knowing a virus was the cause and how naïve we were to think it couldn’t happen again.  We noted the irony of Trump blaming this pandemic on China when the 1918 flu had started in America on a Kansas pig farm. Others found escape with amazing anatomically-based embroideries (brains, bones and wombs), Zoom salsa dance classes or planting thousands of native trees – never have so many reef knots been tied, protecting each precious plant from spring winds.

By the end of 2020, all had had different experiences but could acknowledge that facing adversity was better when you stood alongside others and drew on your individual strengths. Our general practice will never field a choir of good singers but we built on what we are good at and took our joy where we found it. This includes stroking Covid Cat who still occasionally graces us with his presence, tail held high and looking as healthy and as undaunted as ever.

---

Jill McIlraith is a New Zealand-based general practitioner who wanted to be policewoman or a vet, but who instead worked as journalist and then went to medical school as a mature student. Writing and animals continue to be a source of comfort and sanity.

Read more by Jill McIlraith on Corpus:

• First on the scene: the Westdene Dam bus disaster
• Waves from a storm: thoughts on suicide
• Miraculous Maisie