Fellows on the frontline: France
03 June 2020
ANZCA fellow FANZCA Dr Kasia Tanguy reports from the COVID-19 frontline in France where she has been living for over a decade.
Since 2009, I’ve been living and working in a large private hospital in sunny Nice on the Côte d’Azur, France, where we have prepared for a disaster that many believe will never reach us. To date we have had “only” 860 deaths, which pales into insignificance alongside the chaos that befell Paris and the northeast.
My curiosity was initially piqued in late February when COVID-19 began to saturate the Italian health system. I followed our numbers closely, which appeared to be lagging by about 10 days. At the same time, the French media was reassuring us that it was nothing more than a bad flu season.
My ANZCA training pushed me towards “preparation”, instituting protocols and running drills. But officially there was no formally recognised problem, and waiting for official guidance precluded us from initiating any individual protocols. I had trouble accepting this perceived inertia and was frustrated that my suggestions and input were rejected seemingly on the basis that I was overseas trained.
Dr Kasia Tanguy, second from left.
As our elective workload stopped and I had nothing better to do - I studied - even harder than for the primary exam. An old adage from my days as a trainee was “prepare for the worst and hope for the best” - and I did. My senses were heightened, the adrenaline was running, sleep was difficult and I occasionally felt overwhelmed.
By late March we still had no protocols in place. Other French regions were inundated by catastrophic numbers of patients. We had emails from them making us feel like the apocalypse was inevitable. I felt panicked and lacked confidence. We had very few masks due to theft and delivery issues − the same for hydro alcoholic solutions. Our local response appeared lacking. So, I reached out to ANZCA and the next day I had a call that changed my perceptions.
It was reassuring to talk out my fears with an ANZCA colleague - not only for my physical health or that of my husband’s, but for my ability to rise to the occasion. It was most disconcerting to be at odds with some of my colleagues. I missed the camaraderie. I missed having my husband in a good mood. I missed being in control of my life and destiny.
Our plastic surgery unit was converted into a COVID ward and intensive care unit (ICU), though the latter was never used. By comparison, for a period of 36 hours, Paris had only 10 ICU beds remaining for a catchment area of 12 million people. Our COVID ward was filled up by a revolving patient load - several of whom were triaged as not potential ICU candidates - a hard choice for French doctors where do not resuscitate orders or advanced health directives do not exist as we normally resuscitate everyone.
Very little general work was done. A 14 year old lost his testicle due to late presentation of a torsion and another patient came in with a haemoglobin of 5g/dl due to a bleeding ulcer. The myocardial infarct waited for 15 days with chest pains before presenting and getting his stent. The on-calls were eerily quiet.
In the meantime, my brother in law Jean Michel was being transferred all over Paris, like a jumping Lima bean. Aged 57 and previously fit and well, he tested positive for SARS CoV-2 only in the last of his four tests. Communicating with his doctors was difficult as they were often too busy to speak. At first he simply had the classic symptoms of fever and fatigue. A week later he was transferred to hospital in the middle of the night and after five days he had an emergency intubation and the search was on for a ventilator. Then came the tracheostomy. One night we didn't even know where he was, following yet another transfer. Thankfully he is now recovering, and is very slowly on the mend.
Ready access to personal protective equipment has been problematic and it was hard to justify asking for the precious P2 mask - if the anaesthetist wanted one, then everyone else wanted one. And so for the most part we did without - it seems that in my hospital we got away with it. No health care workers (HCWs) are known to have become COVID positive.
The community has come together. Artists have 3D printed face shields for us to use as protection. At 8pm every night there is music and clapping in support of HCWs and I run errands in my spare time for the elderly couple two floors down. The green grocer puts a punnet of raspberries aside for me. Somewhere in the last eight weeks of confinement we’ve gotten used to the fear, and have learned to live with it. Every day new jokes arise and for everything that’s lost, something new is found. For me it’s been a rekindling of old friendships and becoming more independent.
It appears increasingly likely that COVID is a reality that’s not going to magically disappear and that we will need to learn to function with it. At the same time, patients are scared of hospitals and thus are staying away. Diseases have not stopped, so it’s time to go back to the general business of doctoring. The economy is a shambles.
Compared to February, I’m a much more relaxed individual - I am wary and respectful of COVID but it no longer scares the living daylights out of me. I am also ready for practice guidelines to change again. Being flexible appears to be part and parcel of new life post COVID.
My husband teases me that COVID will become my new sub-specialty. Our marriage has pretty much survived lockdown - some others didn’t - domestic violence and mental health issues have been real problems. I’ve given up trying to predict what might happen. I accept we are heading into unchartered territories - some of it is frightening but it’s invigorating as well.
I don’t believe it has ever been as interesting to be an anaesthetist. As for the long term - I hope to come back to Australia - dealing with disaster preparation as a foreigner has made me long for the order and the sense of belonging to my Australian home.