The Good and the Bad of Volunteering for Covid Duty

How does one describe the end of a working experience? There is a mixture of happiness that it happened, sadness that it's over and regret that you couldn't have done more while you were there. Having worked in both government and private hospitals for prolonged periods, I can definitely say that I prefer working in government hospitals for a number of reasons. As an MBBS doctor, you'll definitely be doing more good in a government hospital - can help more people and you'll learn a lot more by seeing more cases and having better followup (people always tend to come back). And you don't have to worry about creating profit for the hospital (something that doesn't come naturally to me).

 So when Covid cases started shooting up in Trivandrum last year, I had felt an inherent desire to help out. And as always, I tend to overestimate exactly how much I can help out in the need, which is a recipe for disappointment. Like all things in life, the past few months have had many good and bad moments. And countless life lessons as well.

 

The Good - Finally understanding the importance of field staff 

Life was a simpler time when I had worked in the past. I'd go to casualty, do my shift and then leave. Things were different now. We had to actively cover hard to reach areas. If we were to convince people with poor educational backgrounds to get tested and follow Covid protocols, being a doctor just isn't good enough. This is where people like ASHA workers and other field staff come into play. 

As doctors, we appear as outsiders to many people. They simply won't be as comfortable talking to us as they would be to someone from the same area. This makes public health interventions impossible to implement without field staff there to bridge this gap.

Sure, we all learn this in 3rd year PSM but it is only when we see it firsthand that we truly appreciate what a special thing it is that these people do. In fact, they are probably underutilised. There are so many misconceptions about common diseases out there and the best way to tackle them are through these staff.

The Bad - Data Entry

The database for Covid patients at present is absolutely superb in many aspects. It is comprehensive, reliable and most importantly, it imparts a sense of responsibility for what we do that was often lacking in many aspects in the government setup before Covid.

But this comes at a price. Data uploading is one of the worst aspects of working in America as a doctor and now I definitely have an idea why. My default setting since 2017 has always been to be a workaholic but this has been the only time since then that I've actually felt close to being burnt out. 

While working PPE suits a lot of the time may have something to do with that, I feel more compelled to blame the stresses that come with making sure the data entered is correct. A single wrong result can result in a scandal (and I know this the hard way). Often data entry can only be done at home after a long shift, meaning I basically had no life other than work. This type of burnout has a lot of consequences that I'll get into later on.

The electronic medical record is the future. It is only going to get more complicated in the future. This will come with obvious benefits - more accountability, easier access to past medical history and no more trying to decode shitty handwriting (mine included). But during implementation, there must also be some consideration given to how the extra workload is to be distributed. Unfortunately, I expect that this responsibility will be distributed unevenly among providers leading to more burnout. 

The Good - Appreciating other staff who stepped up to contribute

As a doctor, it is kind of my job to do my bit in crises like Covid. It's a lot different for people who are not directly involved with the healthcare system. Covid stigma in the middle of last year wasn't anything like it is now. Many people were genuinely afraid, often to an irrational extent. To volunteer and help out in that sort of climate is really commendable. 

There are too many people that I've come across to mention them all individually but a few need special appreciation. The cleaning staff we had at our testing centre was truly one of a kind. She would do everything - registration (not as easy as it sounds since they are 17 different categories you need to know), data uploading (essential before sending RTPCR samples for testing), cleaning the test area in PPE and making sure different stock are maintained. I'm pretty sure I would have gone nuts doing everything if she wasn't around. 

Having had brief postings at Covid centres, I got to meet several college going kids who volunteered to help out. The incredible dedication that they showed at that time was truly heart-warming. Transforming a school into a makeshift hospital would never have been possible without them. These guys are really underappreciated I feel. With youth like this, the future of the city does appear quite bright. 

The Bad - Hotel Management

As I've mentioned before on this blog, some of the stuff we have to do in a Covid centre really doesn't seem like something a doctor should be doing. I've grown to appreciate these centres much more than I used to at first because in certain areas, you simply don't have the facilities to safely home quarantine and such people need to go somewhere. 

With that being said, you can't escape the feeling that being posted there is a monumental waste of any expertise you have. Most people have no/mild symptoms. The vast majority of the complaints you are likely to hear are going to be concerning the food, something that I as a doctor have no direct control over. In fact, I even had an incident where a newspaper published a report suggesting that I told a patient that they had vomiting because of the food (I didn't say that and the patient actually had vomiting before she came to the centre but who cares about facts, eh?). 

There are many reasons why this may happen - the food may actually be poor (may happen occasionally over the course of many months but might be the first day for the patient), the patient had unrealistic expectations (5 star hotel treatment) or sometimes people just take out the frustration of their predicament in this way. Whatever it may be, it just seems a whole load of bullshit that we shouldn't really have to deal with. I mean we have more than enough shit to deal with in our usual jobs, having to deal with this crap is definitely something that I will not miss one bit.

The Good - Understanding Politicians

 

The interaction between doctors and politicians is more than ever before thanks to Covid. Like it or not, it  is as much a political issue as it is a health issue. Regardless of whether their political ways appeal to you or not, you do end up needing their up getting things done from a public health point of view.

The relationship between politicians and government hospital exists in a very balanced equilibrium of both sides trying to shit on each whenever the chance presents but at the same time understanding that they will always need each other in one way or another moving forward. As with other things in life, there are many things one can learn from politicians than we can make use of in the hospital.

Managing expectations is one thing - promising the moon is not going to sound great to most people who can see through the ruse and will also piss off the rest once it eventually doesn't happen. People appreciate more those who make it clear what they can and cannot do. Everything is in the delivery of how you present this information - making sure that they still know that you will do everything that can be done for them. Such qualities will definitely come in handy if you plan to go into the administrative side of the hospital and will also help once you start leading teams.

The Bad - Being more prone to diagnostic errors

Covid duty seems important at all but really, the more important part of my work schedule comes when I have to take treatment decisions alone in the casualty. Unfortunately, I'm pretty sure the pandemic has made my diagnostic skills worse than it was pre-Covid. 

The common consensus when I joined was that patient interaction was to be kept to a minimum. Now, I  know bad advise when I hear it so I didn't take it that seriously but it did have a subconscious effect. I really did not want to get Covid because of my over-exuberance and give it to other staff. This meant that I was not doing the physical exam anywhere near as thoroughly as I once did. 

As with most bad habits in medicine, it took me a while (4-5 months to be precise) to figure out that I was doing a shitty job. I realised I needed to make a more conscious effort to be more meticulous in my exam.

Often having to do casualty duty right after Covid duty often meant I was not in the right frame of mind to show as much compassion as I used to. I know this is not a problem for a lot of a doctors out there but I made a promise to myself years ago that I wouldn't be one of those doctors who talks shit to people for no reason. But sometimes we can't be our best selves.

The Good - Forcing me to develop ways to fix my defects

There is pretty good chance that the feeling of burnout that I felt was something that was inevitable in our line of work. It would happen sooner or later. Once I accepted that  my performance standards were not as it should be, I tried to find new ways to fix this.

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I tried things like making sure I got enough sleep during the afternoon before night shifts, meditation and exercise. These things did help somewhat and I could find myself getting back on the right track. Slowly and a little late in the day I guess. Being self aware of my issues definitely helped because after you start working for a couple of years, you really don't get much negative feedback (unless you really piss someone off personally). 

These life lessons will definitely come in handy in the future.

The Bad - Stagnation

After a while, Covid duty doesn't really allow you to learn many new things. Sure, it forces you to stay upto date with the latest medical knowledge but I'd already been doing that even before the pandemic. At my age, your career needs to move forward. I need more training and acquire more skills if I'm to help more people. As you may have inferred from the above, I've had to strive to just get back to my baseline level of competency.

A government job is obviously nice and all. It does provide some degree of stability. But it isn't the end goal that I see for myself in my career. And that is why I left in the end. 

When I joined, I had this illusion that I could simultaneously achieve my post-graduate goals while working. This may have been feasible if circumstances were like it used to be back before Covid, but that's not the case now. You can only do so much entrance prep when you feel tired after coming back home from work.

The Good - Little moments of kindness

Although the thing that occupies my mind the most are the good things  I'd planned but couldn't quite accomplish, I did manage to do a lot of good things for some people. Being more financially stable than I'd ever been earlier, I helped a lot of patients with financial difficulties receive adequate care - in terms of ambulance transport, medications or investigations. 

I really don't think of these things a lot and I doubt that most people appreciate this that much. But I just don't feel comfortable seeing patients receive substandard care purely because they don't have enough money. 

It doesn't matter that most won't think much of this. We may do precious little for someone but they may end up extremely grateful. On the contrary, we may move mountains for someone who ends up complaining about us. That's a part of medicine we just have to accept. 

I had hoped to do something more meaningful on a large scale but unfortunately that idea never came to fruition. Not yet anyway.

The Bad - You are not indispensable

With cases in India at a very low level and the vaccination drive in motion, the end of the pandemic is in sight. That means those hired for Covid duty are likely to be cut sooner rather than later. As much as we'd like to believe otherwise, the work we've put in will likely be reduced to just fables that we'll tell our kids years later. 

This does not particularly bother me since this was always on the cards from the outset. The powers that be will let us go once this ceases to be as big a public health problem as it was. What does bother me unfortunately is the nagging feel that we are being taken for granted by those in the hospital who don't have to do what we do. 

 

It didn't used to be this way. All we had to do was put a shift in. But now shifts never seemed to end even when you got home, unlike for others. Doing extra work never bothered me pre-Covid. But now, being asked to do back-to-back shifts just so someone else can get a few days off just pisses me off. Some people can't appreciate the difficulty of something you'll never have to do I guess. 

Again, this contributes to the general pissed-off mood that I find myself in a lot of shifts. You can try to laugh it off but the problem is that when you work harder than you probably need to, you just take everything so personally. And that's why I need a break to recharge.

Conclusion

If someone asked me if  I would do it all again if I went back in time 6 months, my answer would still be yes. Important things like this are meant to be hard. Some day, this nightmare will end and all our lives will get back to normal.