Dr. Constantin Jabarin, physician executive at Allscripts, describes working on the COVID-19 frontline and his experiences of treating patients during this time of crisis…
As an executive physician at Allscripts and working emergency department specialist, I see the true impact of COVID-19 first-hand. I’d like to reflect on what life is like on the COVID-19 frontline, and how Allscripts is also playing its part in tackling the coronavirus pandemic.
I am writing this after doing an increasing number of additional shifts in the emergency department of the district general hospital in which I normally work a couple of weekends per month. Right now, I am working every weekend because that is where the needs are.
So, how is life behind the mask?
Well, I should start with what life used to be like. I used to arrive for my shift wearing my greens and step out with my personal stethoscope around my neck.
Now, I arrive in my normal clothes. I get changed into my greens and use the stethoscopes left in each cubicle. These stethoscopes are of the uncomfortable plastic variety that you see in the many TV medical dramas (and hurt your ears).
Over my greens, I wear a plastic waterproof gown, which is made from non-breathable material. I put on my mask and shape the top to fit around my nose. From that moment on, I am breathing filtered air. It is hot, almost suffocating, but it will keep me safe. I also wear a face shield.
Finally, I put on tight gloves, which go over the sleeves of my gown, sealing me in. The last piece of Personal protective equipment (PPE) is a (rather flimsy) plastic apron which I put on to enter each cubicle and take off and bin before I leave; a necessary step in order to minimise the transfer of the virus between patients.
This is my world for eight to 10 hours at a time
I enter the area known as the RAZ, the Respiratory Assessment Zone. I log onto the system and pick up my first patient.
At my hospital, as in many other emergency departments in the UK, the long queues of patients with minor ailments has long gone.
The patients we are seeing now are the very sick and the injured. Any patients who have had a cough, temperature, or anything else suspicious, are seen in the RAZ by someone dressed like me, which must be disconcerting for them.
I see the patient, I examine the patient, I answer their questions. Then comes the “doffing PPE” experience. I rip off my plastic apron, bunch it in my gloved hand, and at the same time take off the glove, wrapping the apron inside. I take off the second glove wrap it around the first and put both in the bin. I wash my hands and walk out of the cubicle.
I repeat this process over and over again; each time I go into and out of a cubicle. In between, I go to the desk, log-on and write my notes. I look up results and I request investigations. Using my computer, I am able to read about my patient, look at their previous notes, their letters, their blood results, and build up a picture of a person who is scared, confused and ill.
We have a break to eat mid-shift only after we reverse the whole PPE-donning process. We repeat it to go back into the department afterwards. This is now the current front line of medicine.
Safe but desperately sad
My feelings about all this can be summarised in two words. The first word, a good one, is “safe.” I feel safe and protected breathing my filtered air, covered from head to toe, with kit that is mostly in-date (although the masks have been brought back out of retirement with new expiry dates!).
The second word, a much less good one, is “sad.” I feel sad that all the patients can see of me is my eyes behind glasses and a piece of plastic. They cannot see me smile to try and cheer them up, they cannot see me looking sad when I break bad news to them or their relatives.
A lot of the patients we are seeing are older and hard of hearing; they cannot read my lips to help with the understanding and comprehension of what I am saying. I cannot hold their hand to provide them with the contact they need.
Of course, the biggest sadness comes from seeing so much death. Big numbers are relayed each night on the news, but most people hear them with some detachment. In ED, there is no such option. I also see the effect that all this is having on some of my colleagues who are finding it harder and harder to cope as each day ends.
Everybody has a part to play at this time
As a doctor, I know I am making a difference. As a clinical advisor, I know Allscripts is also playing part. I was recently asked this by a sales colleague: “How can we approach our customers without sounding apathetic and insensitive? Why would they want to hear from us at a time like this when what they are trying to do is just keep things going?”
My response was that now is precisely the moment that we should be looking to offer help; to put forward solutions that can make a difference; to offer support.
We may be able to offer the solution that saves time for clinicians who need to capture key information. We may be able to offer trusts an option to streamline key processes, minimising the time their clinical staff spend on their computer keyboards.
We may be able to offer them a solution that works on a tablet that can be encased in a cover that can be easily cleaned to the stringent standards necessary to help stop the spread of the virus.
We have opportunities to help, and in helping we may make the lives of our clinical colleagues a little easier. That can be worth as much as being the person who holds the hand of a patient who is sick and scared.
We are all in this together, and I am very proud to be working both for a world class healthcare systems supplier and as a practising doctor in these difficult and unprecedented times.
About the author
Dr. Constantin Jabarin has 23 years of clinical experience, is a graduate of the University of Wales College of Medicine and continues to practice as an Emergency Medicine Physician at a senior level. He also has extensive experience in Clinical IT, working as a Director for DocCom (later known as Careflow), System C, and as CCIO for The Great Western Hospital, Swindon, during which time he oversaw the initial steps of the paper-light process rolling out digital across the hospital. Constantin strongly believes in the importance of presenting a flowing clinical solution that works for all clinical users, in addition to supporting non-clinical leads. Dr. Jabarin also has a large amount of experience running his own pre-hospital events company, where over the years has acted as Chief Medical Officer of Castle Combe Racing Circuit, Medical Director of the Bath Half Marathon and Cardiff Half Marathon, as well as being a trackside doctor at the British Grand Prix at Silverstone. He now continues to support Festivals by providing medical support as a Doctor at Glastonbury, Reading and Womad.