Sorry, Not Sorry | Covid-19

“So, this next consultation will also be done via phone.” Keyboard clacking sounds ensue. Then, “Even I have a 1 in 40 chance of dying.”

I’m mid-sentence making notes: “SCLC — paraneoplastic, LEMS, 40 dying–” Wait, that’s not what I was supposed to write down and wait what did she just say?

It’s March 12th, 2020: a bizarre Thursday with flip-flop weather that switched at a simple glance and the majority of this lung cancer clinic list being done over telephone. The respiratory consultant — a short-haired lady whose mind, I observed, had a certain zippiness that can knock you out for a second — had had her iPhone propped up behind the keyboard since I walked in. She was constantly refreshing worldometer’s Covid-19 statistics, fervently attending to every blaring BBC notification sound, and relapsing into solitary moments of a sighing & head-shaking combo as she checked the respiratory doctors’ WhatsApp group chat.

It was the first thing I asked about; of course it was. I’d walked in already on edge about this Covid-19 situation. I wasn’t feeling anxious up until two weeks beforehand — not when I couldn’t find hand sanitiser in Boots for the third weekend in a row; not when there were rumours swirling around about two confirmed and one suspected case in the trust I was practicing in. Maybe I didn’t want to admit that I had my doubts about not taking this seriously, but heck, I was still scoffing with friends in car-rides about how this was “just the flu 2.0”. It stemmed from this borderline prideful thinking that as future doctors, we have a duty and responsibility to prevent the spread of panic — but in retrospect, the horrendous cost we’re dealing with now is probably caused in part by that excessive downplaying attitude.

Perhaps it hit me hard after realising this wasn’t a blip — that this situation was not wavering. It was a consistent regression from what we knew and what would happen in the form of my Mum sending Line messages everyday in our family group chat (“Buy hand gel” “Keep some in stock” “Wear mask, take from hospital” “Buy Dettol”), a simple search for antiseptic spray and alcoholics wipes for electronic devices on Amazon Prime yielding “Out of stock” messages, the empty aisles of tissue paper and dried pasta — but most importantly, it was how light-heartedly everybody around me was taking it and laughing at those who were anxious. Thus, after much internal resistance, the palatable sense of worry suddenly got through to me because clearly, I wasn’t the only one worried if there were all the stock issues going on.

My concentration fluctuated drastically in the last two weeks before being shuttled off. I still risked clerking patients in the respiratory ward despite it being closed off due to a norovirus outbreak, brilliantly left my water bottle in one of the infected bays, put a cannula dressing on the wrong way in front of a consultant, lost a page filled with haematology notes somewhere in ED. Yeah, I was a bit of a mess — so, I made it a point to get into any respiratory clinic before the weekend, so at least I could hear what an expert in the field had to say. Luckily I was on a respiratory rotation.

“How worried should I be?” I remember asking. “Because I am, but people around me aren’t. So I don’t know if I should be.”

I remember her abruptly swivelling on her chair and looking directly at me. When unquestionable resolute, she replied, “You should be”, before turning back.

The entire clinic was a lot of her abruptly stopping to check something Covid-19-related and me immediately prompting her about it. I’d ask a Covid-19 question out of the blue that would’ve probably been deemed inappropriate manners in another setting, but she always answered without hesitation. After internally battling the two ends of putting on a face for my family to not worry, to getting my own worries immediately deflected by my colleagues, talking to her was…nice. Mildly cathartic, even.

As a sort of final assessment of how serious she felt about Covid 19, I remember saying, “Well, I guess I’ll be canceling my meeting at the library this weekend, do online grocery shopping, and freeze my gym membership.” At this point I wasn’t even sure I’d do those things. But her reaction: an approving nod, and a simple “That sounds very reasonable.”

That sort of cinched it for me, and I felt oddly lighter. It was a huge, ironic relief to meet somebody who felt as anxious (albeit much more knowledgeable and sensible), even more so as a freakin’ respiratory consultant. I felt I could justifiably worry.

Besides the racist floodgates that this pandemic has outrageously opened, looking back, it was a massive conflict in attitude. Me, at the beginning of February, thinking how ridiculous it was to buy a box of masks to send back to my family in Bangkok as per my Mum’s order, embarrassed to see predominantly Asians wearing masks on the street, and healthcare professionals laughing about how this was being blown out of proportion. Then me, experiencing a sudden turn in tide at the end of February, being scoffed at for sanitising my tuff box and my stethoscope, berated at when telling colleagues to “At least wear a mask if you’re coughing”, and being told repeatedly that I’m worrying way too much as people rolled their eyes at me. “Stop contributing to the panic, I’m not going to wear a mask, they don’t even help” to “We’re gonna be fine if we get it anyway, whatever” were common things being said.

It was hard to predict what was going to happen. Fast-forward to present day, numbers have sky-rocketed unbelievably high, healthcare systems are more than exhausted worldwide, and PPE is horrifyingly running out. No one had any way of knowing.

But, why wait? It was unnerving to see my surrounding colleagues blissfully at ease with everything as if life was completely fine, because that was what I was like before my wall ‘crumbled’. It was more unnerving that even after we were told to permanently go home and an official statement was made by Boris Johnson, some people were still going to concerts, clubbing, and traveling for the weekend, like “Oh, maybe I can catch the tail-end of the last bits of freedom”. On a more personal level, I was stunned that yet again, we were all medical students — but hey, we’re all human in the end.

I wholeheartedly agree that panic is bad, and like I said, we had no way of knowing how bad it’d be — but at that point, after a couple serious official statements were made, surely it’d be a bit daft to think you could go on with life normally. Okay, so wait until you get symptoms before deciding to self-isolate. Wait and hold out against wearing a mask because they’re not even that effective until WHO officially says you must. Wait until the number of deaths creeps up until you decide social isolation is convenient for you. But why should we sit tight twiddling fingers until an official statement is released, at which point, things are usually pretty dire?

This conflict in attitude is what made me question myself in those last two weeks. That because I was acting and worrying on my own accord, I was in the wrong. Medical school hasn’t said anything. The news hasn’t said anything about a mask. ScIeNcE hasn’t told me what to do yet!11!! I was using the “but we are medical students!” reasoning both ways — a duty to not spread panic? Yeah, but a duty to prevent the worst-case scenario is just as important. A tricky balance.

That’s something I’ll remember if there is another pandemic of sorts — it’s okay to sensibly worry. You’ll know you crossed the line if you start gulping down Dettol.

©TMK

I Wore A Heart Monitor For 24 Hours

Spoiler: I’m okay for now.

Approximately three weeks ago, I went for my regular health-checkup routine. There was nothing spectacularly negative about my results – my total cholesterol level increased compared to last year, but it was due to an elevation in good ol’ HDL; my TSH level was 1.960 uIU/mL, smack-bam in the middle of the hospital’s normal range; my hematocrit percentage, usually presented with a taunting “L”, was surprisingly normal for the first time in years. It’s safe to say, living on my own in Bristol the past year has made me much healthier on the micro scale.

Ah, but the results came with a little more excitement than anticipated.

Last year, my EKG result stated: “Sinus bradycardia with sinus arrhythmia; borderline prolonged QT interval; otherwise no pathological findings”. It wasn’t necessarily denial, but an unimpressive knowledge about ECG/EKG interpretation that allowed me to shrug nonchalantly about the situation. But this year, my EKG result stated: “Sinus bradycardia with junctional escape beat and bigeminy premature ventricular complexes”, and after having crammed an outrageous amount of information about various cardiovascular system abnormalities (I’m panicking as the phrase “Quick lids flecking at amiable dilettantes” scrolls across my vision), well, what can I say…I still shrugged nonchalantly about the situation.

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14/06/17 EKG Results (For You Keeners Out There)

A follow-up was required a couple weeks later. I was *this* close to napping face-down all day listening to the ironically motivational movie soundtracks of Rupert Gregson-Williams, but thankfully dragged my lazy bum off the bed due to post-exam hopelessness (I hope today all you IB kids got the results you wanted – remember, there’s always a pathway for you!). So there I was, in the doctor’s office – not to be worried about at all, she said. It’s common for people under 40, and it’s very rare for it to be serious. Two things would happen: I’d get an echocardiogram done, and then wear a Holter monitor for 24 hours.

I remember watching one of the demos talk about echocardiography during an anatomy session, and this image was put up:

echocardiogram
Source: http://www.cardiachealth.org/sites/default/files/2011/echocardiogram.jpg

Um. I mean, what a truly wondrous photo. Find a person who’ll look at you the same way the patient and sonographer look at each other, am I right? (I swear I learn in anatomy sessions).

Anyways, that didn’t happen in my case (painfully grateful); I faced away from the sonographer and counted the number of vertical stripes per coloured block on the wallpaper (seven, if you wanted to know), and there was barely any talking. Despite being half-nude and having this transducer basically kneading my left boob, it all felt incredibly systematic. I almost fell asleep. But by hearing sudden spitfire beatboxing by my heart, occasionally being asked to hold my breath, and catching a glimpse of the Doppler echocardiography’s explosion of pretty colours, I just managed to stay awake.

After swiping away the ultrasound gel, I was then suited up with the Holter monitor: five electrodes plastered on, and a little pouch that held the ambulatory device itself. It’s basically just a piece of tech that records heart activity continuously for 24 hours (or 48, depending on the doctor’s suspicions of the final diagnosis) – since ECG/EKGs are performed only within a short snapshot of time and abnormal heart rhythms/cardiac symptoms come and go, the monitors are pretty great for doctors to evaluate irregularities, severity and patterns over an extended period.

I left the hospital feeling like an amateur espionage agent (watch out Agent Cody Banks!1!!). Here are a couple of images to show the Holter monitor itself and where the electrodes were placed – the former displays a countdown of the exact amount of time I had left of the 24 hours, and shut down once it reached zero; it was like a microcosm of every dystopian novel ever. 

So comes the next day, after having slept as still as a log (subconsciously afraid I’ll roll onto the Holter monitor and suffer the pricey consequences), and they go analyse the data. Here are my results in brief.

Echocardiography Summary: function and anatomy normal albeit mild tricuspid regurgitation (TR). Seeing the real-time videos of my heart beating made me oddly vulnerable – I mean, if you think about it, nobody will ever have the privilege to set eyes on your beating heart (with the exception of those lucky enough to partake in open heart surgery). I’d feel more naked posting a snippet of the echocardiogram than a revealing swimsuit photo of myself.

Holter Monitor Summary: The doctor said if I had 10% or more ventricular ectopic beats in the total number of heartbeats in the 24 hours, I would be sent for treatment. If it was 5% or below, I’d be alright. Luckily, I only had 4.1% – whilst she did appease my mother by stating there was nothing to worry about (“All you need to hear is that her heart is completely normal”), she turned to me and asked me to be more aware of my body. That is, if my palpitations become more frequent or if the tight squeezes I feel in my chest increase in severity, I am to go back to see her.

“How many hours of sleep do you get?” she asked in the middle of history-taking.

“Well, 7 hours on average, now that it’s summer.” I think back to how my heart rate was only 48BPM just before the appointment; that armchair was really quite comfortable…

With a small smile, she casually said, “Ah, wonderful – when you get to clinical years of medical school, you won’t get nearly as much!”

Honestly, I really like this doctor.

Anyways, I got this incredibly exciting full report with an hour-by-hour analysis (I can sense what a funky, wild Friday night I’ll be having).

You can see how the number of PVCs vary during various times of the day; a few examples of the activities I was engaged in included:

8:00PM = delicious dinner at MK with the family + a McDonalds cone (the simple pleasures of life)

10:00AM = extremely fervent Kyle Landry piano-playing; I even got a cramp in my left hand (watch this space for a cover…)

3:00PM = serious car talks in traffic

It’s extraordinary to actually see the direct play between the physical environment and the electrical activity of my heart – the times with high PVC frequencies correlated with some form of intense emotion; “Strike fear into the hearts of your enemies” “With a sinking heart” “Eat your heart out” idioms suddenly became exceptionally reasonable to me. It should be blatantly obvious that everything you do cascades upon your inner mechanics, but I previously could only resonate so much so as if watching a devastating BBC News segment from the comfort of my own home. It just further highlighted the stark opposition of medicine being both routine practice and blindly grasping in the dark.

At the end of the day, the treatment literally stated “reassurance” – drink lots of water, sleep for a minimum of 6 hours per day, no caffeine, stress less. Such basic courses of action to take, and yet so subconsciously overlooked by the generation of today. Anyways, I think as a medical student, having the opportunity to personally experience particular examinations/procedures you see portrayed via cringe-worthy stock photo compilations in lectures provokes the same level of excitement you have as you are about to watch one of the most anticipated block-buster films of the year (I am at this very minute on the way to watch Spider-Man Homecoming). And that’s probably the very reason I documented it all…I guess I’m just young at heart.

©TMK