I CHOOSE ME

  “Communicate unto the other person that which you would want him to communicate unto you if your positions were reversed.”Aaron Goldman

 Who would have thought that in the year 2020 a new virus would be added to the emerging and reemerging infections list? Well, maybe the epidemiologists, because that is primarily their role. Right? We have had to have a crash course on how to actively live within the pandemic and so far I must applaud us all for really giving our best version of what we think actively living is. For a long time, many of us had never fully appreciated how rapidly our emotions can fluctuate. From being vibrant one minute to experiencing grappling fear of the unknown the next minute. I am sure we can each give scenarios related to this. 

 Most recently I was handling a patient whom now in retrospect I should have handled with greater precaution. In this context, precautionary measures should have included full protective gear for at that particular time a lot was unknown. I had admitted an elderly male with underlying preexisting conditions who had acutely gone into pulmonary edema, therefore, had dyspnea, severe hypotension, and a deteriorating neurological function. A cardiopulmonary arrest was a sure outcome if no rapid intervention was done. He had already been initiated on oxygen supplementation via a non-rebreather mask at 15L/min, he had an ongoing Norepinephrine infusion running peripherally from the transferring unit and he had received stat doses of Lasix and Albumin. However, more needed to be done as he could no longer sustain enough respiratory effort. Urgent invasive intubation was done. Yes, we had the basic gown, surgical mask, and gloves but with the risk of exposure to aerosols, we had forgotten to wear a shield and the N95. Why? tensions ran high and the team leader shouting orders didn't aid much. A lot of mistakes were made in terms of our personal safety. Luckily, the patient was now adequately ventilating, and oxygenating. By this time his blood pressures were sustained. Later on, we had a debrief and the errors were discussed and it was noted that we need to improve on effective communication as this will encourage situational awareness which encourages the maintenance of personal safety at all times. We could have done better but I choose not to dwell on the what-ifs but rather what was the root cause of the problem.

 Heading home that day I managed to take a walk which allowed me to think through the day's activities. I realized all sense had gone out of the window because I could not imagine losing my patient. Adrenaline is a valuable thing as it makes the impossible workable but with it ushers a lot of illogical thinking. I felt obliged to help and this for a minute made me forget about myself. I am sure some of you may get this and some of you may not which is great as it generates a diverse audience for these conversations.

 A study done in Florida USA showed that often communication has been identified to vary by specialty, especially during a simulated operative emergency. This same study showed the effect of directed communication in eliciting a response depends on the clinical status of the patient. To read more on this follow the link operative team communication. In light of this pandemic, we do not have the luxury of this because we can not continue losing more health workers. We need to deliberately take steps to protect ourselves to continue providing care to all those who need us. Globally, as of June 23th 2020, the World Health Organization reported on more than 10 000 health workers in 40 African countries being infected with the covid 19 virus click here for more information W.H.O Africa. They further stated that inadequate access to personal protective equipment or weak infection prevention and control measures raise the risk of health worker infections. Coming to a realization of all this made me angry about myself for allowing it to happen. Currently, I am lucky enough to work for an organization that offers all protective gear yet I did not take advantage of this. Daily I am reminded that there is a group of my fellow colleagues who do not have this opportunity. I was angry because I contributed to the statistics that generate nosocomial infections. Wondering how? What if my patient had a highly infectious disease and I developed it after this exposure. Handling other immunocompromised patients would mean that they are at risk too. However, reflection reminded me of why situational awareness is key and why we need to work harder at working safely. We need to protect our families, ourselves, and our patients.

In conclusion, within healthcare, it is important to always be aware of the many reasons something can go wrong but at this time it is very crucial to do your best while playing your role accordingly. Simple ways we can achieve this is by holding each other accountable when errors are noted being made, be unanimously vocal. Vouch for what is right regardless of the situation we need to remember to take a few minutes in any medical/surgical emergency and make ourselves aware of the situation at hand.

“Doing what's right is never easy. You think you're right, but you lose track of what you were trying to do all along, and then there's blood and screaming and death. Doing a bad thing for a good end just sours the good.”Janice Hardy,