In the war against the pandemic, healthcare workers around the world have found themselves at the forefront – doctors today are called heroes, but sometimes condemned for “allowing themselves” to get tired or burn out. Sofia Menshikova, oncologist at K31 City JSC, author of the telegram channel Oncology Fellow , is now working with COVID-19 in the infectious diseases hospital. She told us about the peculiarities of working in protective equipment, psychological stress, hate and support from others.
More recently, I worked as an oncologist in a clinic and was sure that the pandemic of the new coronavirus infection would not affect me . But in April we were informed that the clinic would be redesigned. Before that, we worked in two departments, while the remaining six floors were undergoing renovation. It was quickly completed, new employees were recruited, and we were offered a choice: to stay in the clinic, but to deal with patients with COVID-19, or to go to the state cancer center, where during the pandemic they allocated a department for our employees and patients. There was also a third option – to quit. I decided to stay at the repurposed clinic – I thought it would be an interesting experience; my family supported me, despite the fact that we knew that I would have to isolate myself from them.
Before the center opened, we went through very intensive trainings – both on the treatment of this new disease and on how to ensure our own safety. In April, an order from the Ministry of Health was issued, according to which any doctor can work with a new coronavirus infection – you only need to take a thirty-six-hour course (you can do it online). In our clinic we have clear treatment protocols, they were infectious disease and lung specialists – is a short squeeze of the Ministry of Health and the recommendations of all that has come up with the global medical community. After a month of this practice, I realized what things to pay attention to right away when you see a patient, how to choose the optimal treatment. And, of course, there is an opportunity to consult with specialist colleagues.
The clinic has four departments, each for fifty to sixty people. They were filled in sequentially – and completed in four days. When it was the turn of the department where I work , about sixty ambulances came to us in a day. There are five doctors in the department, but four at the same time work – that is, there are sixteen to twenty patients for each. This is a lot, considering that the experience is completely new for most of us. Many new people have come to work for us , some of them offer volunteer help. I have a bioinformatics friend, he is a doctor by education, but he has never practiced; in his usual job, he is engaged in genome sequencing, but unexpectedly got a job with us, and not as a doctor, but as a procedural nurse.
The standard working day of an infectious disease doctor is six hours, but it is impossible to have time to do all the work during this time, so we are overworking. True, in April we were paid for all processing, and now they have just officially transferred to one and a half rates. This is a big burden, but at least it is adequately paid for.
It happens that when I reach the last ward, someone gets worse in the first one.
I spend four to six hours in the “red” zone, and then I return to the clean zone to work with papers
When I arrive at work, first I go to the so-called clean zone and reviewing documentation of their patients, my purpose, to refresh them in memory. The fact is that in the “red” zone paper is prohibited, the entire document flow is electronic and there is nowhere to spy on – you need to keep in mind everything that is important to know about patients. After this preparation, they help me put on the protection, and I go to the “red” zone.
There you need to study all the appointments and notes of nurses, nurses, the doctor on duty who worked in my absence, look at the indicators that the nurses monitored: pressure, blood oxygen saturation, temperature. After that, I make a round of the wards, talk with my patients – it happens that when I get to the last ward, in the first someone gets worse, I need to go back there again. I adjust appointments, discuss difficult issues with colleagues. I spend four to six hours in the “red” zone , and then I return to the clean zone to work with papers.
Due to personal protective equipment, the work is physically difficult. It is hot in them, it is very difficult to breathe and talk normally , you sweat a lot. After a few hours, the mask and glasses are rubbed, the head begins to ache, and it already seems that you cannot understand anything . We have special employees who help to put it on, and then take it off when leaving the “red zone” . We call them “strippers”. It’s great that there is such a team, it saves a lot of time; since they have no contact with patients, they can afford some informal things – they draw muzzles on masks, write “Vasya’s stripper” on their clothes.
In my usual practice, I went to the reception in dresses, heels, styled my hair, did makeup, and now I wear crocs and surgical pajamas. When leaving the “red” zone, I take a shower every time . I had to cut my hair short to make it comfortable. At first, the face suffered a lot – many colleagues developed rashes, allergies, we wore plasters and patches. Now I’m used to it, I know which version of the mask to choose so that it does not rub.
Due to the means of protection, doctors are literally impersonal – patients do not see our faces. It is difficult to talk, you have to raise your voice to be heard, and turn your whole body yourself if someone speaks behind your back. Of PPE is very physically get tired – but to abandon them is impossible.
In oncological practice, I have become accustomed to a certain category of patients: they are usually calm, tuned in to treatment, and understand that they need my help. These are patients who collaborate with a doctor. Now the picture is completely different – we work like an ordinary emergency hospital for compulsory medical insurance, which means that people who are bad or hurt right now are brought to us. They are scared and it is not always easy to be polite – and it happens that a person is brought, for example, drunk and we are faced with outright rudeness.
These are patients who found themselves in an unexpected situation, suddenly fell ill, and they need to trust strangers – and without seeing the faces of these strangers, because we work in “spacesuits”. There are patients who are difficult to convince to follow the recommendations, it is easier for them to follow their habits: there were people who warmed themselves under three blankets (although this cannot be done at a temperature) or took pills given by relatives. There are those who, due to their upbringing or traditions, do not at all perceive a woman doctor as an authority. In general, now with many patients it takes time for grinding.
In the first few days, until our department was full, we helped others – in particular, the doctors of the emergency room, where the ambulances were traveling. The first time I went there, half an hour later I developed a panic attack and had to leave. This has never happened to me before . Of course, we are all under tremendous stress now: a lot of work in an unfamiliar environment, lack of contact with family, a disordered daily routine. Only a month passed in this mode, but at some point I stopped eating and sleeping normally ; I could return to the hotel by one in the morning, wash out without sleep, and by eight in the morning already go to work.
I recently read somewhere what employers should provide to doctors working with COVID-19. There are four items on the list: isolation (that is, the ability to live in a hotel), food, travel to and from work, and psychological support. I am very grateful to the clinic for the fact that we have all this. There are two psychiatrists on the staff who advise and prescribe treatment for both patients and doctors. I asked for help and was prescribed drugs to help me cope with anxiety and sleep better.
At the same time, for some reason, I am not afraid of contracting the new coronavirus . Maybe because my main specialty is rather difficult and some fears associated with illness and death, I have long gone through. The clinic regularly suffers some of the staff, but the new coronavirus almost none from anyone not found – it seems that doctors simply have a cold. PCR tests for the new coronavirus are done to us every week, all of my results were negative.
Only a month passed in this mode,
but at some point I stopped eating and sleeping normally; could return
to the hotel by one in the morning, wash out without sleep,
and by eight in the morning already go to work
It is difficult to live at a distance from the family. The husband stayed with his five-year-old son, a dog (we have a husky that requires long walks) and a cat – and the cat and the dog are not particularly friendly. The husband works remotely; we are greatly helped by friends who are engaged with the child online English, chess, so that dad can work more or less calmly. We call each other via video link, but not every day – sometimes I don’t have the strength to do it .
I encountered a hate on social networks when I began to tell that this work is very hard and that I might leave at some point. Readers became indignant, citing arguments that I am a doctor and liable for military service, which means that I should treat the current situation as a war. But I do not agree: in the country is not declared an emergency, no one obliges us to work with COVID-19, and it’s just a job, to which I agreed, because it’s interesting and well-paid. For some reason, this fact also hurts people: doctors are now called heroes, but the payment for their labor seems to neutralize this heroism or make the work less difficult and qualified. It is difficult to explain that the salary does not devalue my work and mental costs. I think many doctors are faced with this. Perhaps this is a public “Request for justice”: many people lishis income and have the doctors they grew up, and while doctors at us are associated with the state.
But there is also a backlash, and it is very encouraging. My colleague, also an oncologist, began to talk on social networks about our everyday life, about minor difficulties – for example, that we throw off and buy ourselves patches to protect our face from PPE, buy coffee. And it was very pleasant that our friends and even former patients began to offer their help – they send us coffee, plasters, and balloons so that patients can do breathing exercises. One former patient paid for a weekly delivery of food from a cafe. Of course, there is not in the fact that we are not able themselves to buy a shawarma or patches (can), but in the sense that our work is not indifferent to others, that about us remember and support us in this way express my gratitude. This is very motivating.
The clinic pays us for hotel accommodation and meals. There is a service bus, but it is not convenient for everyone in time, and now the employer is trying to negotiate with a taxi service, and for employees who travel by car – to make free parking throughout Moscow. We have a lot of administrative personnel who are involved in document management, so doctors do exactly the work of a doctor. I write only diaries and patient records , that is, what my medical knowledge is needed for, while other employees transfer the records where necessary, and I do not waste time and effort on this . I am happy with the working conditions and continue to consider this an interesting and important experience. I don’t know how long I’ll be enough, and I think that I have the right to leave at some point if I understand that I ca n’t withstand the load – physical or mental. I do n’t think anyone has the right to condemn for this.