As soon as the Pandemic was declared in March, I closed down my clinic and readied myself to be summoned for duty. But nothing happened- life continued like a vacation for me, while my colleagues from other faculties sweated it out in the hospitals. I had been messaging them and reaching out to tell them I was available to consult- through phone, in person- whatever way they thought necessary - for patients and colleagues. But people did not reach out and patients all preferred tele-consultation. I dont mean I just wanted to go to hospital anyhow- but I want to say that I recognised that I could not avoid going to hospital.
One reason that I was ready to work in hospital was 'survivor's guilt'. I felt that I was letting down my colleagues while they had to bear the entire burden of the disaster. Second reason was my thinking that Psychiatry is very important and legitimate part of medicine and that like everyone else, we needed to be an 'active' part of the pandemic response. My nature is to be deeply involved in anything that's happening around me. I felt rather left out of the Pandemic party because I was at home mostly and my Psychiatry consultations were also down to a trickle.
I have often heard mental health professionals complain that the gap in treatment is because our non- Psychiatry colleagues fail to refer patients. This is mainly due to their inability to suspect and diagnose mental health issues. I could not see how this ability would be developed overnight due to Pandemic. Thus if we mental health people really believed that we should reach out to all those who need our help, we would need to go out there and find them ourselves. I saw that mental health professionals were talking a lot about the expected increase in need for support and intervention due to the Pandemic. Webinars, helplines and tele- consultations were being publicised on every available medium. My personal thinking is that all this is fine for Psychologists and counselors. Psychiatrists being medical professionals have to show up,learn and implement the medical interventions where patients are. I also felt that one could make a reasonable contribution to any COVID unit, if one tried. The real role of a Psychiatrist is that of a doctor. Its ironical that we complain about Psychiatric interventions being neglected but are not showing up on site to handle them when the need arises.
I had never been comfortable with tele-consulting and after seeing few patients through video calling, I was convinced that it is a very inadequate method for evaluation. Maybe the patients felt better by talking through the video call (that is to be determined by asking them); but I was never happy with the evaluation. I was disturbed by the thought of completely abandoning hospital visits for fear of infection. I felt that we need to be ready to don the PPE and visit patient for evaluation if the situation so demanded. A blanket withdrawal from 'in person' consultation is not feasible. In the initial days of lockdown I had suffered sleep disturbance and anxiety and I dont consider myself as invincible; so I also wanted to remain in touch with hospital to avoid developing a phobia.
In January this year, I was reflecting on the fact that my work had become very routine and dull. I wanted to inject some excitement into it by taking up a few months of regular general medicine work. I love the energy of hospital wards and enjoy the intellectual stimulation of solving a medical problem.The Pandemic seemed a perfect chance to get this plan going.
The complications of the 1918 Flu pandemic had lasted for decades. I estimate that it could be similar with COVID 19. It is a completely new disease. I needed to learn everything I could about it. I dont like to become an armchair expert. The correct way to learn in medicine is one the job- means by managing patients under supervision. I was looking for an opportunity to work on a COVID unit so that I could actually watch personally how the disease appears and evolves at every stage in a good number of patients. I wanted a chance to witness its physiology first hand. I wanted to be able to understand what every patient went through during the disease phase. I did not want to settle for the poorer option- of my frontline colleagues selecting only a few for my evaluation (maybe missing some). I wanted to experience myself, what kind of emotional and physiological difficulties patients were going through. I wanted to be able to formulate a plan of intervention- most importantly I wanted to be able to decide for myself where the threshold for Psychiatric intervention should be. I wanted to become an expert on COVID related neuropsychiatric disorders.
Very Ambitious indeed!
I didn't have any illusions about my limitations and risks. As I have a limited hours medical practice, I was not sure of my physical or mental endurance for long hours. Having functioned independently, I was also doubtful of my ability to blend in with a team of younger folks. Its been 15 years since I left hospital quarters and my tolerance for that ambience and food was also doubtful. And the practical aspect of how my family of four would adjust with me suddenly 'going on the frontline' and missing in action at home. But these concerns could be tested only when the time came and not in advance. My fear of infection was reduced by my thinking that I could learn to manage the risk like my colleagues working on the front-line. I had no real concerns about it beyond confirming the availability of good quality and quantity of PPE and meticulously studying the precautions.
With all this on my mind and a great eagerness in my heart I kept waiting. But the call did not yet come.
Frankly then, I became quite desperate and volunteered myself to work on the COVID unit. I am much relieved that I was accepted without much fuss. And my learning journey began....
One reason that I was ready to work in hospital was 'survivor's guilt'. I felt that I was letting down my colleagues while they had to bear the entire burden of the disaster. Second reason was my thinking that Psychiatry is very important and legitimate part of medicine and that like everyone else, we needed to be an 'active' part of the pandemic response. My nature is to be deeply involved in anything that's happening around me. I felt rather left out of the Pandemic party because I was at home mostly and my Psychiatry consultations were also down to a trickle.
I have often heard mental health professionals complain that the gap in treatment is because our non- Psychiatry colleagues fail to refer patients. This is mainly due to their inability to suspect and diagnose mental health issues. I could not see how this ability would be developed overnight due to Pandemic. Thus if we mental health people really believed that we should reach out to all those who need our help, we would need to go out there and find them ourselves. I saw that mental health professionals were talking a lot about the expected increase in need for support and intervention due to the Pandemic. Webinars, helplines and tele- consultations were being publicised on every available medium. My personal thinking is that all this is fine for Psychologists and counselors. Psychiatrists being medical professionals have to show up,learn and implement the medical interventions where patients are. I also felt that one could make a reasonable contribution to any COVID unit, if one tried. The real role of a Psychiatrist is that of a doctor. Its ironical that we complain about Psychiatric interventions being neglected but are not showing up on site to handle them when the need arises.
I had never been comfortable with tele-consulting and after seeing few patients through video calling, I was convinced that it is a very inadequate method for evaluation. Maybe the patients felt better by talking through the video call (that is to be determined by asking them); but I was never happy with the evaluation. I was disturbed by the thought of completely abandoning hospital visits for fear of infection. I felt that we need to be ready to don the PPE and visit patient for evaluation if the situation so demanded. A blanket withdrawal from 'in person' consultation is not feasible. In the initial days of lockdown I had suffered sleep disturbance and anxiety and I dont consider myself as invincible; so I also wanted to remain in touch with hospital to avoid developing a phobia.
In January this year, I was reflecting on the fact that my work had become very routine and dull. I wanted to inject some excitement into it by taking up a few months of regular general medicine work. I love the energy of hospital wards and enjoy the intellectual stimulation of solving a medical problem.The Pandemic seemed a perfect chance to get this plan going.
The complications of the 1918 Flu pandemic had lasted for decades. I estimate that it could be similar with COVID 19. It is a completely new disease. I needed to learn everything I could about it. I dont like to become an armchair expert. The correct way to learn in medicine is one the job- means by managing patients under supervision. I was looking for an opportunity to work on a COVID unit so that I could actually watch personally how the disease appears and evolves at every stage in a good number of patients. I wanted a chance to witness its physiology first hand. I wanted to be able to understand what every patient went through during the disease phase. I did not want to settle for the poorer option- of my frontline colleagues selecting only a few for my evaluation (maybe missing some). I wanted to experience myself, what kind of emotional and physiological difficulties patients were going through. I wanted to be able to formulate a plan of intervention- most importantly I wanted to be able to decide for myself where the threshold for Psychiatric intervention should be. I wanted to become an expert on COVID related neuropsychiatric disorders.
Very Ambitious indeed!
I didn't have any illusions about my limitations and risks. As I have a limited hours medical practice, I was not sure of my physical or mental endurance for long hours. Having functioned independently, I was also doubtful of my ability to blend in with a team of younger folks. Its been 15 years since I left hospital quarters and my tolerance for that ambience and food was also doubtful. And the practical aspect of how my family of four would adjust with me suddenly 'going on the frontline' and missing in action at home. But these concerns could be tested only when the time came and not in advance. My fear of infection was reduced by my thinking that I could learn to manage the risk like my colleagues working on the front-line. I had no real concerns about it beyond confirming the availability of good quality and quantity of PPE and meticulously studying the precautions.
With all this on my mind and a great eagerness in my heart I kept waiting. But the call did not yet come.
Frankly then, I became quite desperate and volunteered myself to work on the COVID unit. I am much relieved that I was accepted without much fuss. And my learning journey began....
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