As we muddle through relaxing the UK lockdown, the overwhelming public mood seems to be one of fury ‘Today, working in an intensive care unit, I feel I live in two worlds.’ Had somebody asked me a year or so ago to imagine a pandemic, I would have predicted it to be an anxious time. But as we muddle through relaxing our lockdown, the overwhelming public mood seems to be one of anger. People seem to be angry for all sorts of reasons. Some are angry there aren’t enough rules, or that the rules aren’t going on for long enough. Others seem angry that there are any rules at all. Public anger is not regular. It comes in waves and pile-ons, stoked by frustration, resentment and fear. Amid this, in hospital beds across the world, lie sleeping patients with plastic tubes in their windpipes, machines breathing their breaths. In normal times, there’s usually something peaceful about an intensive care unit (ICU). The machines’ cacophony is regular, rhythmic, beating. It used to feel peculiar that a hospital’s sickest patients lay in its calmest ward. Today, working in the ICU, I feel like I live in two worlds. There’s the world inside a respirator mask, where everything is darker, voices are muffled and facial expressions are hidden. Meanwhile, the outside world mimics the old world, only the streets are more anxious and cities play at being closed. Amid all the public fury, I’ve surprised myself that I’ve not been angry. I imagined, if ever there was a time to hold an opinion on government policy, it would be during an international health emergency. Sometimes I wonder if my lack of anger means I don’t care enough; if I’ve been worn down by ventilators being turned off, patients dying, families asking for a final call. Perhaps emotions overwhelm and suffocate each other in such a situation, leaving no air for something as indulgent as anger. Perhaps my anger couldn’t compete with the humility of knowing that until early March, I and every doctor I knew had predicted that this virus posed little threat beyond a bad seasonal flu. Like my better judgment, perhaps my anger had lost. As a doctor you learn that patients die often; in the middle of the night, early in the morning, on bright summer afternoons and dark winter evenings. What I find most difficult about this crisis is how people die: alone, with their families distanced in some other world. Relatives wait at home, praying for patients to get better, safe from the virus but unprepared for the grief to come. I hear that funerals are similar. There is no social code for death in a pandemic. No ritualised hope that time will heal, no reassurance that your response is appropriate. As we obsess about viral transmission, I find myself wondering what risk a final goodbye is worth. Policy-makers have formulas to measure quality of life, to decide which treatments to commission with limited resources. But how to measure the value of a dignified death? I wonder how I would feel if it were my own family, if I would challenge the same rules we tell families now, if I would argue. The other day, the ICU phone rang. It was the daughter of a patient asking to speak to her mother one last time. I looked across to the bed and saw a woman lying peacefully, a plastic tube sitting in her windpipe, a machine ventilating her lungs. It wasn’t anger I felt, or despair. Medicine teaches you to focus on the practicalities, the things you can do or say, even when you know they will not work. Perhaps I will be angry one day. When I look back and see the number of deaths, when I read about the questionable behavioural science used to justify policy decisions. When I hear about retired healthcare workers who, were it not for precarious staffing levels, would have been enjoying hard-earned retirements but instead now lie in graves. I thought about anger when I watched a patient prepare to be intubated recently. For the previous days, he’d been breathing more than 40 breaths each minute. A breathing mask blew air into his face at a pressure equivalent to travelling at 80mph, through night and day. The respite breaks he’d taken, to sip water and eat small amounts of food, were no longer possible due to his deteriorating lung function. We faded behind the condensation that coated his breathing mask. He couldn’t see anything. We couldn’t see him cry. He wasn’t angry. He was scared to be put to sleep. He was terrified he might wake into a world where his family, who had also tested positive for the virus, would have met the same fate. When you are intubated, you are given a drug to sedate you, followed by another to relax your muscles, to allow a breathing tube to pass into your windpipe. When he was paralysed, his oxygen levels fell almost immediately. We cautiously watched as numbers dropped on a monitor. He still hasn’t woken. Working as a doctor, people treat me differently. My partner wonders if it’s safe to see me, I wonder when I’ll see my parents again, if I’ll endanger those I meet. My family and friends ask how I am doing. They ask, expectantly, if I’m angry. If I wish the protective equipment had been better, if the preparations should’ve been more robust. They wait for a coherent criticism of the announcement they’ve read in the news. I struggle. I’ve learned that anger betrays some naivety about this world. It necessitates a decided world, a clarity about what has happened, what will happen next and what is happening now. Maybe I have lost faith in such a world. Perhaps that faith will return. One day, it may reappear, with its busy streets, open cities and anger bestowed. But maybe not. Maybe it is lost forever. Source
