The patients I am most fearful for in the Covid-19 pandemic

Dr Zirva Khan reflects on how she was feeling as a GP prior to lockdown, a difficult encounter with a particular patient, and shares her concerns for the patients she is most fearful for in this pandemic

I am going to take you back to a week before lockdown, approximately Wednesday 15th March 2020 to be precise.

The world is locking down around us

For the last few weeks I have been getting really, really anxious about what is about to happen. The world is locking down around us. I am a GP and haven’t until now really realised what risk we have always put ourselves in. I adore shopping for “work” clothes and shoes; the sort that make me feel empowered but also allow me to be me. Now I wonder if my clothes will tolerate 60 degree washes, and if they don’t, is it time for scrubs? The last time I wore scrubs was when I did night shifts in hospital! I haven’t always washed my hands between seeing every patient, and now I am freaking out about who has touched my door handle and if it is sanitised or not!!

We are awaiting Government information and advice, but it is murder… literally this daily never-ending time bomb that we are closing our eyes to, hoping it will go away. And it’s not going away; it’s getting closer and closer… a lot closer than what we think!

A few private social media forums have recently been set up for doctors to talk to each other about how they will approach managing COVID with the daily information we are getting – I think this is adding to my anxiety; so many people are already ahead of the game, setting up policies, shutting their front doors. Now I am contemplating, “why did I never embark on partnership opportunities? Perhaps I could lead the way where I work???”

A scary encounter

My surgery starts, I’m working all day. Looking at my list is filling me with dread:a never-ending list of cough, fever, cold-like symptoms, lethargy… if you ever want a definition of heart sink, here it is! And it got better. Each patient that came would start the consultation by saying,  “You know with what’s going around I just wanted to make sure I’m ok and don’t have it”… heart sink, heart sink, heart sink!

If you want to know about my “protection”? I was the only one in the building with a surgical mask! Thankfully I had asked my husband to source me a few from his work the week before because of the rumours we have nothing. 

Here I am, in a fairly anxious/unnerved way, seeing all the patients that follow, not really sure what I’m being exposed to and how I can protect myself. What I am about to tell you however, put the whole situation of what was ahead into perspective.

Rarely do our incredibly experienced practice nurses come into our rooms shouting for us for help. I literally run to her room, and see this young child screaming and crying, with a high temperature. I don my mask, gloves, and apron, and naturally one would get close to show some care and compassion, however with “what’s going on” I can’t. I know nothing about this patient- about him personally or his medical file.

I’ve never met his mum who is with him either. I try to enquire about him and then he starts to vomit. I then step back further. Externally I appear incredibly cool and relaxed about it, but internally, if there is a more appropriate word to use, I was shitting myself!

Thankfully the father of the boy walks in, and I am able to take him to the side to explain the situation, whilst the mother was calming the boy down. It was a routine appointment for some vaccinations but clearly he wasn’t well. When I enquire further, it sounds like he has picked up a common viral bug causing throat upset, but what I didn’t realise was, he had significantly delayed speech and understanding due to autism.

And here we are, the nurse and I, in our pathetic version of personal protective equipment, which we now have to rely on to protect us against this silent enemy that my colleagues are shutting their doors to, trying to communicate to an autistic distressed child who just wants to go home and rest!

The situation turned around quite quickly when this became apparent to us; totally lightening the mood, with a bit of (distant) play, mum and dad singing, the nurse and I prancing in circles for him. He went home laughing and the parents were happy that their situation was managed.

After the family left we had a bit of a debrief.

The patients I am most fearful for

On one hand, my anxiety about COVID until our doors shut will remain, and all I can do is continue to update my colleagues about what’s happening in other places. But for patients? Especially patients like this little man we saw. He is the type of patient my fear really lies with. Where change and unfamiliar territory, paired with gazing eyes and intimidating overtowering adults, can be utterly overwhelming. The voices you could never understand before, and emotions you’ll never be able to read. How will I continue to help these patients that really need us?! I really hope I can, and I really hope they will communicate with us when they aren’t well, in whichever way they can.

That’s it for now! Unless you want to know about the 99+1 coughs that filled my surgery… 😉 

P.S. Mid way through my afternoon clinic we were given the heads up that the front doors will shut tomorrow. How this will work, I have no idea, but I’m ready for the daily challenges in the knowledge it is better for me and for our patients.

For more journal entries from doctors facing the pandemic, check out our Doctor Diaries.

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Zirva Khan

Dr Zirva Khan is a GP in the North Midlands, and a Mum of her 3 year old little man. She enjoys reaching out to people from under represented backgrounds, encouraging access to health and medicine. In her spare time she likes to spend time with family and friends, travel, and connect!