The Inevitable March of Time

For readers who don’t know me, I work as a paediatrician in a district hospital in Ireland. The views expressed here are my own.

At the beginning of March I was still writing. I had finished another draft of the novel that I’d been working on for seven years, had been up early in the mornings without fail for the previous four months to edit it. I was preparing a synopsis for the local Literary Festival novel competition, deadline April 13th. I had even boasted on my blog of discovering the three rules of novel writing.

Inspired by the 29th of February, I finished a short fiction ‘Leap Years’ on 2nd March. The prompt from the local writers’ group had been ‘I left it on the long finger’, which is an Irish way of saying ‘I kept putting it off.’

I had kept putting off thinking about coronavirus. I was looking forward to friends visiting from England at the end of March, and had booked a week off. We had planned an overnight trip to Cork together to visit Fota House and enjoy a dinner-bed-and-breakfast midweek deal at the Maldron in the city centre. I had also booked trips to Heidelberg and Brittany for the summer.

Ray, one of the writer’s group, had been the first to ask me about the epidemic:
‘What, as a doctor, would you advise?’

That had been around the end of January. The group of ten or so, sitting over mugs of tea and exercise books at the long table in Ray’s bookshop in the town, had turned curious faces to me. I hesitated. The outbreak was still confined to China. I said I didn’t know if it would affect us. In the past, SARS and MERS had been and gone without spreading to Europe. I still hoped that it might not reach us in Ireland.

But, with international air travel, everywhere is connected. Soon after that, cases started to be reported from Northern Italy; our first confirmed case in Ireland, on the 29th February, was a Dublin teenager who had been there during the mid-term break. I had attended a training session in the ED (Emergency Department) at the hospital: room 7, with a special ventilation system, had been set aside for COVID-19 patients, and in the anteroom outside it the doctors would don PPE: a closely fitting face mask, a long sleeved waterproof gown, and goggles. Working in the kit was going to be tricky, but removing it was harder as it had to be done without contaminating oneself with the virus particles which might adhere. Gloves off first, the first one grasped from the palm, then a finger run inside the wrist of the second. Hands to be sanitised at each step of removal. The gown untied from the back, hands inside the shoulders to loosen it and let it fall down the arms, grasping it from inside without touching the contaminated front. Goggles lifted forwards by the earpieces and put in a bin for disinfection. The mask last to be removed, outside the room now, straps released from the side or brought over the top of the head so that the outer surface was held clear of one’s clean clothing.

From reading the news I could see that we would soon be in lock-down and started to add a few extra items to my shopping, and to shop more often after work.

By the middle of March it had got busy at the hospital. There was very little testing available outside the hospital so everyone with cough and flu symptoms was turning up in the ED wanting to be tested. To reduce the number of staff using PPE our doctors were asked to do the nursing tasks while assessing the patient in room 7.

We realised that the paediatric doctor in the PPE could not be carrying the bleep for obstetric emergencies as it would take too long to de-gown. We were going to need extra doctors on duty for each shift. At the same time, a number of our team were off sick, self-isolating awaiting swabs, stuck abroad on holiday with no return flights, or back in the country from leave but quarantined for 14 days before they could return to work. We cancelled all our outpatient clinics to free doctors up to work in parallel shifts covering the respiratory assessments separately from other emergency admissions and from newborn care. I was going to be on call for part of each weekend for the rest of the month. We had not had any positive swabs as yet.

Online, the Chinese were publishing reports on their COVID-19 experience at great speed in the medical journals, as well as a textbook on treating the illness. The textbook revealed levels of PPE and ventilation equipment far greater than we have in Europe; the Chinese had learned from their previous experience of SARS and were arguably now world leaders in the field. The emerging evidence was that the illness was uncommon in children, did not always present with the typical symptoms of fever and cough, and that it was rare for them to develop severe illness. Our main worry was preventing cross infection in hospital and separating the infected ones from children with ordinary asthma, pneumonia. A wait of four days for swab results at that point was not helping. The worst of it was working with all the PPE and the fear of contamination. At that point a separate ward was set aside for assessing patients with suspected COVID-19 so that they would be streamed away from the ED.

The hospital management asked me to write a guideline to help select which children were to be sent to the COVID-19 area for assessment, on the basis of the severity of their symptoms. This was on the Friday of my on-call weekend and I was told the guideline was needed for the following Monday. All that I could conclude from reading the Chinese reports was that if the children had severe respiratory illness they were more likely to have something else; mild symptoms were no guarantee that the child was COVID-19 negative. Infected children could even present with diarrhoea and vomiting and without cough.

Fortunately the closure of our schools on 13th March was cutting our admission numbers. Leo Varadkar had announced social distancing measures on 12th March, speaking of the need to act in unity to save lives. I was grateful to have a Taoiseach who is a medical doctor: his sister is a paediatric neurologist.

By Patrick’s Day (17th March) I had cancelled my leave for the following week, and the hotel booking in Cork. I emailed my friends in England telling them not to come: ‘Unfortunately the UK government are now advising against non-essential foreign travel for its citizens. Travel from Northern Ireland to here is exempted but not from UK mainland. Really sorry about that but it’s probably for the best at present. Leo Varadkar was on TV this evening predicting that there will be thousands of cases here within the next 2 weeks. Stay safe and well, I am carrying over my cancelled leave and we will have our week together when things are better.’

I spent that morning sorting out a prescription for a neighbour, Gerry, with a fever and cough, who couldn’t get hold of his GP: Patrick’s Day is a public holiday in Ireland. Gerry, a construction worker and farmhand said on the phone that he felt breathless going up a flight of stairs. I told him to try to get a COVID-19 swab test. I put the antibiotics and paracetamol in a carrier bag, hung it on Gerry’s front door and waved at him through the window.

I felt unusually tired that day, headachy and hungover even though I hadn’t been drinking. It had been a busy weekend at work. Perhaps it was taking me a long time to recover. I rested at home in the sunroom, napping, reading news bulletins on my phone, and looking out of the window, across the field to Marianne and Tony’s house. When it grew dark I put our coloured lights on, switching them to green for solidarity. Every Patrick’s night Marianne and Tony would have thrown a party for the neighbours and we would have been in their ‘bar’ drinking and singing until the early hours, as one does in Ireland. Now the night was noiseless and no cars came along the lane.

‘Solidarity’ – it means something special here. In England, people associate it with the hard left; with trades unions ‘holding the country to ransom’; with dubious socialist movements in debt-ridden foreign countries. Here it evokes pride in the hard-won independence of the Irish nation; a love of community; a feeling of trust and fellowship with one’s neighbours. Adhering to self-isolation to spare others from the spread of coronavirus infection is an act of solidarity. In our community it was being taken seriously.

I seemed to spend the next few days at work still struggling to write evidence-based guidelines. How were we to tell which children were infected? Infected children might not have symptoms, but should we be swabbing them all when we might run out of swabs? The Chinese did, I argued: this is Ireland, my colleagues said. Every time I finished a draft there would be some new piece of strategy from Dublin that contradicted whatever I’d been working with and I had to produce a new version. It was worse than writing a novel. Eventually I flatly refused to produce any more drafts without a stiff gin-and-tonic. After that, it seemed to ease off.

By the 20th, thinking about the pandemic, reading medical publications, newspaper reports from around the world and Government guidance was absorbing too much mental energy. I was on call again for the weekend, so couldn’t go out for a walk or do the garden (also it was too cold outside). The ward was quiet but I couldn’t summon up the focus to work on my writing and sat in the study at home typing long rambling emails to my friends. Spring was coming to the garden, finches were mobbing the bird feeder, and heather, daffodils and rhododendrons were open, my alpines making gaudy clumps of colour on the dull stones of the rockery. Brittany Ferries stopped sailing from Ireland to France and I postponed our trip from May to September. I cancelled the hotel in Heidelberg, wondering if I would ever recoup the money I had spent on the flights, and for how long the airlines would still be in business; surely the era of budget air-travel was drawing to a close. Expatangie, fortunately safe and well under lock-down in Italy, suggested that I should write a journal for March as proposed by Bleda. When I looked back at my emails to my friends I could see I had enough material to write an account of the month.

On the 23rd, feeling the non-essential shops would soon be shut, I went to my favourite local garden centre for a sack of sunflower seeds for our bird-feeders. It would keep the finches going until the warmer weather, when they would fend for themselves. I had a quick trolley-dash and got assorted alpines, a clematis, runner bean seeds, broom plants in various colours, a dark red hebe and a variegated myrtle. The owners were expanding the business and in the middle of building an extension. Before the crisis began, the Irish economy had been doing well and people had been doing up their houses and gardens. Now only heaven knew what would happen. Indeed, the next day a further stage of lockdown was announced, with only essential shops open: groceries, pharmacy, hardware stores, fuel stations. Only essential workers were to go to work and everyone else to stay home.

My son, a software engineer, working from home in Manchester, was cheerful enough, socialising with his friends over the internet and only going out to buy food. I remembered how guilty I had felt when he was a teenager about letting him shut himself away in his bedroom to play computer games – when in fact I had been training and equipping him for adult life.

The bookshop crowd, deprived of their meetings around the long table, had been running a lively writing group via WhatsApp and it started to erupt with memes, poems and fiction. My head was full of medical papers on coronavirus from China and Italy and I couldn’t keep up with them, couldn’t see my way to writing a word. I was on-call almost every other day as we had got 2 consultants on-call each 24 hour period instead of one, and at the same time were 2 consultants short. We were expecting a surge in our admissions but didn’t know when. Dublin was maybe about 2 weeks behind London in the epidemic, and our quiet coastal town about 2 weeks behind Dublin. The adult side of our hospital was getting busier and they had one patient with COVID-19 on intensive care.

An Post issued every household 2 postcards to write and send for free to anyone in Ireland. Ours arrived on the 25th . On TV the CEO of An Post was interviewed and he said they had adopted an idea put forward by the unions. They were getting their postmen and postwomen to check on the welfare of elderly or vulnerable people on their rounds. They would also deliver their medicines and newspapers for free, tapping in to the community spirit here, particularly in rural areas.

My neighbour Gerry recovered without ever being tested for COVID-19; his GP spoke to him on the phone and told him he didn’t need a test.

In my area most people were respecting the social distancing measures. In Dublin however Simon Harris the Minister for Health was deliberately coughed at by two young people who filmed it on social media- apparently a popular prank. I’m glad I never got a job up there.

I finally had a weekend off on the 28th- 29th March: was second on call on the Saturday and didn’t get called in, Sunday was completely free. The lockdown had become more intense with people forbidden to go more than 2km from their homes for exercise, or to socialise with people not in their household. I braved the biting easterly winds that swept our hillside garden and planted out the trolley-dash plants. We’re fortunate to occupy about an acre; it’s poor rocky land but we don’t feel confined staying at home.

My partner mastered the breadmaking machine – the fresh bread was delicious. We had bought the bread-maker in preparation for the lockdown to reduce our dependence on the shops. Bread flour and yeast is easy to store and to quote Eve: ‘You just put in powder and water, press the button and after a few hours a loaf comes out.’ The supermarkets locally were well stocked – most of our fresh foods: meat, dairy, eggs, vegetables – are locally produced, but it was good to be able to shop less often to avoid the risk of infection.

On the 31st of March, I woke in the early hours unable to escape the feeling of being at the end of days. That when we emerged from this, the bookshops would be gone from the high streets; the china shops, the dress shops, the garden centres and all the little luxuries that I loved would be lost. Maybe someone I knew would have died of coronavirus – news reports of the deaths of doctors and nurses were sending a chill through my heart. I myself had had the occasional cough and sneeze over the last couple of weeks: not symptoms I would normally even notice, but now I considered my own mortality: my ashes to be strewn upon our rocky hillside. I would leave behind the broken ruins of capitalism; my worthless pensions. The Government would be devoid of income other than a slow trickle of death duties, while the rich persecuted the poor across the devastated land.

I read that they were equipping the ExCel Centre in London to be a vast hospital admitting thousands of patients. All the beds that had been stripped out of the capital’s hospitals over the last few decades to be restored at once. I hoped they would be able to staff them. I remembered in November 2007 attending a conference at the ExCel and hearing Gordon Brown, as Prime Minister, speaking with awkward passion about his ambition to make the NHS a world-class health service with facilities and services the equal of any other country. Now I supposed, it was happening, if not in a way that we could have foreseen.

In the morning, I watched from the kitchen window a blue tit trying to start a fight with its reflection in the wing mirror of my car. The birds had become fiercely territorial – probably nesting. The garden centre delivered a large order of pyracantha and cotoneaster while I was at work. My plan was that they would be covered in berries for the birds by the autumn. It was still cold for the time of year, below 10C most days but getting brighter, with the evenings lengthening. With the inevitable march of time, spring was coming. There was one more guidance document remaining to finish for the paediatric department, and after that I might get back to my novel. The deadline for the novel competition had been put off to May.

©ChateauxEnEspagne 2020

(Some names have been changed)