Still going to work

Adhisthana, July 2019

You may remember that one of my colleagues from work was stuck in India. She was there for two months all told, but finally managed to get a flight home. The plane was full - no social distancing, although everyone wore a face mask - and although health screening questions were asked at the Indian end, there were no checks or restrictions at all at Heathrow.

So we asked the Trust HR and Occupational Health Departments about self-isolation, given that travelling in a plane is notorious for spreading infections at the best of times. They advised that as long as she didn't have symptoms she could come straight back to work. This is surprising, to say the least, but all I could do was to stay as far away from her as possible - she came back on a Tuesday so we only had one day in the building together before I had the rest of the week at home. Her situation is slightly complicated by the fact that we were advised to record Covid-19 in the personnel system as the reason for her absence, which was taken to mean that she had been ill with the virus, and therefore would now be better... Luckily for all of us, she has experienced no symptoms.

In case anyone was wondering, none of us has been tested for virus or antibodies, nor has anyone suggested that we should be. This is reasonable as we have very little contact with the public, with patients visiting the centre only for the procedures that simply can't be done over the phone. We now keep the front door locked and we have a new doorbell and a perspex screen in front of the reception desk. When any stranger enters the building we all put on face masks and after they leave the receptionist wipes down all the surfaces they may have touched. If we have to be in the same room as the visitor we wear plastic aprons and gloves as well as face masks, and we ought to wear goggles or a visor too but those of us with glasses are omitting that inconvenience. So far we are not requiring the visitor to wear a face mask. We all work in separate rooms, and when we come together for lunch we sit 2 metres apart.

I have somehow escaped the order that has taken all Dietitian back to the main hospital to work on plans for the apocalypse. Fortunately the apocalypse has not come to pass, so there are a lot of Dietitians at a loose end - I have no idea how they are occupying themselves. Every fortnight I have a very busy Monday with the multidisciplinary clinic that used to allow people to see me and a nurse and a doctor all at the same visit. As a stopgap measure we are sharing out the telephone calls to patients between me, the doctor and two nurses, and it's working moderately well.

However, all the outpatient clinics for all the Dietetic services including mine have been cancelled except for one clinic for each service. That single clinic is filled with only the most urgent cases, so I have no means of booking follow ups for patients that I want and have time to see. I have resorted to keeping a separate diary - my own offline booking system - to get round the restriction.

On a Monday when I wasn't involved with the multidisciplinary clinic I was asked to do one of the sole bookable clinics for diabetes, and it was quite a challenge especially as I had one patient whose first language was not English. I worked hard that day, and it was just as hard to work out how to record what I had done and make plans to follow up that patient. There was no point putting them back into the general clinic because then it wouldn't be me following up, and it was too complicated to just pass the patient back and forth between different Dietitians. A little while later I got a call from the admin team querying how to record the follow up for the patient - the answer being "You tell me." It would have been perfectly straightforward if they hadn't cancelled all my clinics.

Most of the time, however, we are working less hard than before.

The local community is supporting their front-line workers by providing food, which has led to a situation becoming known in the Diabetes Centre as Pizzagate. Various local suppliers are sending food to the hospital - sandwiches, snacks, chocolate and pizza. These arrive at the management offices for distribution, but there are loud grumblings of inequity - the managers are accused of creaming the best off for themselves before distributing to the wards, and we in the Diabetes Centre receive nothing. I try hard to keep out of these discussions, not least because there is no way I can fit pizza into 1200 kcal/day, but it is getting as bad as back in the days when everyone was moaning about parking all the time.

The (first) peak in Covid-19 cases seems to have passed, and now the word from the top is all about how we re-start services. We are in a good situation at the moment - wards are so empty in our hospital that the opportunity is being taken to redecorate - and we have the chance to think about how we would like to do things differently. With this in mind I volunteered to send out a call to arms to our Diabetes doctors, asking them to contribute to a discussion. Not one has responded to me, but it seems they are thinking about it. I'm not holding my breath.