The truth about the Second Wave

Dr Matt Morgan is a top Intensive Care consultant. Here, he tells uncancelled about the importance of honesty, and the power of ‘I don’t know’.

We need to move away from binary certainties  – the battle of the Professors of Hope vs the Doom mongers is not a helpful one. The truth is somewhere in between. It’s nuanced…

It’s Monday morning, coffee in one hand, phone in the other. As soon as the screen blinks to life, I am transported back to my life as an intensive care consultant at the peak of the pandemic in March.

Today my phone screen doesn’t show pictures of my kids or my dog, but endless WhatsApp messages from long forgotten groups, resuscitated by words of Chris Whitty and the expectation of Wave Two. Perhaps this is the best early warning system of what this winter in ICU may bring.

Working in ICU during Wave One was awful – for staff, for patient and for their families. But for many, it wasn’t one discrete wave. It was a long-lasting high tide that washed away parts of their lives that were stable, safe and secure.

Although my ICU hadn’t cared for a patient with Covid-19 for nearly two months, all the challenges remain. We still wear the uncomfortable PPE for long hours. We still can only let small numbers of family visit their loved ones. We still struggle as Covid-19 clouds the processes of care. Yet when I think about how Wave Two will be for individuals, perhaps the covid-19 cup is half full.

I recently wrote an open letter to the British Medical Journal. “If you become ill with Covid-19, we now have more tools to help keep you safe at home,” I said. “If you come to hospital, we have treatments that help you from needing our breathing machines. If you come to the Intensive Care Unit, we know which drugs may work and will help you survive. You are now more likely to survive with Covid-19 than ever before. Not everyone, but more than before. We also know illness doesn’t stop with Covid-19. We are also here if your heart needs us, or if your brain needs us, or if your cancer needs us.”

But these individual hopes need to be delivered by a healthcare system and also society. We are tired and thirsty. The summer is when the NHS normally takes a long deep breath in to recover from the calamity of another hard winter. Yet this summer we all held our breath. Now the winter lies ahead, the tide still very high.

The lowered rates of death today compared with March is great, but a small percentage of a very large number is still a very big number.

And so although the cup is still half full, we are all parched. We have already drunk half of the cold coffee to keep us going. It is also clear that easy answers are not coming easy. If there were policies that would definitely help, the whole world would be using them. Even if there are “right and wrong” answers, this will only become clear long into the future with the power of hindsight.

We need to move away from binary certainties  – the battle of the Professors of Hope vs the Doom mongers is not a helpful one. The truth is somewhere in between. It’s nuanced. Yet we seem to be arguing that nuance is either all good or all bad.

Uncertainty in medicine and science is strangely the very thing that motivates progress. Every answer starts with a question. Every question starts with “I don’t know”. Looking a patient or relative in the eye while saying “I don’t know” is hard. They’re difficult words to say. It’s hard to admit the limits of our knowledge, and sometimes it means hinting at the boundaries of medical understanding. Patients and families often expect doctors to have solid answers, or they assume that modern medicine can cure them. It can come as a surprise when we don’t, and can’t.

The public needs to hear this loud and clear from the governments and policy makers. Be open and honest about the impossible risks you are balancing. No lockdown – lots of Covid-19 deaths. Lockdown – lots of non-covid-19 deaths. Admit the uncertainty but also admit that in this uncertainty there remains hope for individuals and society through what we have already learnt about this disease.

Yet the word “I don’t know” also carry immense power: the power of hope, because there may be that chance to recover. They also carry the power to inspire people to strive for a better understanding of what’s not yet known. Even when these things don’t follow and hope is lost, perhaps honesty with yourself and those you care for is good in itself—although I’m not sure about that either. I don’t know.

So, we have a half-full cup. It is just not clear if we should quickly drink the other half before it goes cold or use it to help melt the winter ice that may lay ahead.

Photo credit: Sky News

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Matthew Morgan

Dr Matt Morgan is an intensive care doctor at University Hospital, Cardiff. His first book Critical (2019, Simon & Schuster) has been translated into four languages.

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