Under the mask, not everyone is smiling.
Last week, I went on call for the wards for the first time in nearly two years. Just before people wonder how I managed to get such a good rota, let me explain that as part of my preparation for becoming President, and for eventually retiring, I reduced my NHS commitments to six PA’s, which meant I didn’t do on call. My amazing colleagues at Aberdeen Royal Infirmary have respected and supported me during that time and all through lockdown, for which I am extremely grateful. Like most units, however, it has been during the year after lockdown, when patients went back to their GPS, who in turn referred them on for specialist management, that the pressures have mounted. Coupled with this has been the unwanted recurrence of COVID in Scotland. Thankfully, because of the vaccines, the death rate has been low, but the pressure on beds has been high and has not fallen as rapidly as in the first wave. It has been challenging and it worries me that England, and the other devolved nations, will face similar problems to us as they move into winter.
Back to being on call and the wards. Some aspects had not changed. We have always run a 24 hour, 365 days per year, emergency endoscopy service and a seven-day per week inpatient endoscopy list. We have carried out daily consultant ward rounds, including weekends for nearly 15 years, so the overwhelming pressure of work and the difficulty of keeping up with the referrals, results, and the administrative “stuff” was familiar. The amount of general medicine sent to GI wards was noticeably higher. The need to wear a mask and sometimes a visor and the constant requirement to change aprons and gloves were also new. It made me wonder whether, if we had been this careful in the past, the spread of flu and Clostridium difficile might have been reduced. COVID has been a wake-up call for all of our practice.
Masks are necessary, but they have unexpected consequences. Under the mask, it’s not possible to tell if colleagues are smiling or distressed. The subtle non-verbal signals are lost, and we are tempted to conclude that under the mask everyone is smiling. It reminded me of the poem by Stevie Smith:
“Oh no, no, no, I was too cold always
(Still the dead one lay moaning)
I was much too far out all of my life and not waving, but drowning”
Stevie Smith, Collected Poems, 1972. Copyright Stevie Smith, and the New Directions Publishing Corporation.
It is not always possible to gauge the feelings of people even when we work closely with them, masks or not. This is why the workload census and app are important. Without information about our workload, we cannot lobby or push for a better work-life balance and this potentially affects us all. Unless we do something about it, the effects on the next generation, our trainees, and new consultant colleagues will be much more serious. Not to mention our nurses who have borne so much of the load over this crisis. We will have difficulties with recruitment and retention and ultimately with maintaining a service.
So, even if you feel particularly hard-pressed at the moment, or the thought of keeping a diary for two weeks seems yet another imposition, please do it. Register now.
If not for yourself, but for those who will follow us. Under the mask, not everyone is smiling. Some of our colleagues are not waving but drowning. Throw them a lifeline. Do the app.