By Andrew Brown 25 March 2020
Between 30,000 and 70,000 people will die of the coronavirus in Britain this year, according to calculations released yesterday, and frontline health workers will be present for almost all these deaths. How will they bear the strain, and will their faith help them?
A Christian emergency nurse practitioner married to a doctor, is a Baptist. A fortnight ago, her hospital split the accident and emergency department so that there is now an isolated zone for patients who show symptoms of Covid-19, where nurses work in protective gear: gloves, aprons, masks and visors.
All elective surgery has been cancelled. Normal surgical areas are being converted into high-dependency areas and staff are being trained to use ventilators.
But all this activity will not be enough to absorb the coming crisis. “In the emergency department we might already make difficult decisions where escalation of treatment to an intensive care unit would not be appropriate with someone who is perhaps old and with underlying conditions,” she says. “We often have hard end-of-life decisions anyway. What is different about this is that there are going to be people that we meet, who might normally benefit from an intensive care treatment, but there won’t be enough beds.
“There are going to be some really hard decisions. If you come in with a road traffic accident, and would need an intensive care bed, and there might not be one because they are all taken up with Covid-19 patients . . .”
“[By the end of the pandemic] we will all know someone who has died, or someone who is close to someone who has died; and they won’t all be older folk with underlying conditions. There will be younger people, and it is going to be hard. My feeling is that if you have no faith at all, it is going to be very difficult.”
Even for those with faith, she says, it will be grim. “For western Christians this will be the first time we will be able to fully rely on God. It’s going to be a real outworking if I truly believe what I have said I believe for years and years. We are experiencing the kind of helplessness which is the natural state of most people in the world.”
Lindsay van Dijk has no religious faith: she is a humanist pastoral care provider – the equivalent of a chaplain – for an NHS trust in Buckinghamshire. Since last Friday, she is allowed at the bedsides of dying patients only, and then in protective gear. All others must get their pastoral support remotely.
“With humanism we trust in scientific methods. We trust in our medics and in our scientists, working round the clock. But in the end of the day our humanity binds us. This virus does not discriminate. The helpers need to look across dogmatic borders and to help the human race collectively.
“This is going to be a huge challenge. It’s going to take a lot out of all of us. Social distancing for human beings is going to be difficult. There is not much you can say in the way of advice to the healthcare workers, but to be that listening ear and show them compassion and kindness.”
Ms van Dijk is originally Dutch, and she took comfort from a speech that King Willem-Alexander of the Netherlands gave in the face of the pandemic. “He said, ‘We cannot stop the coronavirus. What we can do is stop the loneliness virus.’ Even if we can’t meet for a cup of coffee, we can still find ways to support each other.”
At Addenbrooke’s in Cambridge, one of the NHS’s flagship hospitals, there are very close ties with the research community. About a third of the doctors have an academic role. The Medical Research Council laboratory where the early work on sequencing the human genome was done stands almost opposite the out-patients’ entrance but now all the doctors doing laboratory work have been ordered to work full-time and hands-on with the NHS instead.
Rebecca Fitzgerald is the director of the MRC cancer unit there and she had to shut her lab down on Friday and report, like all the other academic staff, for unspecified medical duties this week.
She has no illusions about what lies ahead: “One of my former PhD students is now a consultant at Imperial College London and he says they are almost completely overwhelmed. Doctors like to be able to fix things, and the feeling of powerlessness is difficult for them.
“For people who are fairly new to medicine, making decisions about who one can help and who one can’t – this is overwhelming: I can never remember having to talk about [resources] in this kind of way,” Professor Fitzgerald says.
“For example, how do we manage chemotherapy which makes them more susceptible to infection. Will they get surgery? If we treat someone with chemo and the course ends, and then the operation is delayed . . .
“What about the new people waiting to get a diagnosis because all the endoscopy has been stopped? Even to be thinking to have these conversations is quite extraordinary.”
Yet these conversations will be unavoidable, and people must somehow be supported through them. One of the impacts of social distancing, Professor Fitzgerald says, is that it increases the strain on the staff. If even chaplaincy services are delivered digitally, where can the workers get the human warmth they need? How will they cope when the only physical contact they are allowed is with ill or dying people?
“I was thinking in the middle of the night. You would want some of the nearby cafés to produce an endless supply of Chelsea buns and coffee and have a common room where you can moan. It’s something that hospitals aren’t very good at. People keep going because they’re busy and busy and busy and then they go home to an empty flat and have a pot noodle. And they really need 15 minutes talking. It’s very hard to cope with anything when you’re exhausted.
“Of course it is basic humanity to meet people with their emotional needs wherever they are. But to somehow replenish yourself and to do it the next day, you have to draw on whatever you can. For me it’s faith.
“But of course the virus has indirect effects even on the practice of faith. One of the hard things for me is being deprived of the usual faith community in church and liturgy. A digital service doesn’t feel like a substitute or appeal particularly much. [But] I find music very helpful – and laughing is the other thing. We have to laugh. There’ll be a time to weep and a time to laugh.”
Her colleague Dr Alasdair Coles, a neuroscientist and theologian, is clear that the requirements of staff support can’t be outsourced. “The danger is that people say we need staff support and then look to other people to do it. There are people whose job it is, but they were overwhelmed before this started. They are going to be even more overwhelmed now. The chaplaincy volunteers are mostly too old and they have been sent home. We need to provide each other with support.
Over the past couple of years we have realised that chaplains aren’t really the best people to provide support to doctors because doctors are very tribal. So we have three former doctors who are providing support – tea, cakes and discussions.”
He sees some comfort in the situation: “If we follow the way the Italians do, there’ll be a greater sense of mission among the doctors, as a profession. There is definitely a greater sense of solidarity as a profession: that we’re all in this.”
Of course the great majority of healthcare workers are not doctors, or even nurses. The nurse practitioner says: “The whole system is held up by the cleaners, the IT support, the electricians, the people who work in the labs. Our cleaners have as much exposure risk as anyone. They are our lowest-paid people and under-recognised for the incredibly valuable work they do. They don’t qualify for NHS employee discounts, since they are employed by agencies.”
“The Christian faith teaches us that to be compassionate is costly,” says Dr Coles. The problem, as he sees it, is that a lack of compassion appears to many to have no costs at all.
“The vast majority of us will get [Covid-19] and for the vast majority it will be a trivial thing,” he says. “People are putting these two things together and saying that if I get it it’s trivial. But it is not trivial to those who are most exposed.
“In Italy a number of colleagues of mine are now dead because they sacrificed themselves. There’s a friend of mine on a ventilator in London, and my temperament is such that I have to make sense of that.”
“I wish I could tell you that I had seen Christians die differently from those without faith but that’s not true.”
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