Shaneika Farrell, Physician Associate, Emergency Medicine
"No one could ever have predicted that the Class of 2020 would start their careers on the cusp of a virus that brought even the best healthcare systems in the world to its knees.
We entered into the field in an unprecedented and unparalleled time. A defining global health crisis! To those who have on-looked....carers, medical staff, nurses and all essential workers have been given a new found appreciation of what they do and the sacrifices that they make as they have stood at the helm of the Coronavirus and continue to do so throughout the public health crisis we face.
And so a little about my journey. My name is Shaneika and my background is in Human Physiology from the University of Liverpool. I have been passionate about medicine and wellbeing from I was very young and have had many personal influences to follow this path. After a completing a research project on Pre-term Labour at Liverpool Women’s Hospital, I volunteered at an acute medical Orphanage in Hyderabad, India. It was here, that I knew I wanted to become more involved in the clinical aspect of medicine and so I applied for the Physician Associate Studies Programme at RCSI.
In 24 fast paced months, the PA programme covers hundreds of medical pathologies. As a student you gain a thorough insight into the most common medical diagnosis’ in a systems based learning approach from head to toe. We were taught by leading clinicians of their field and spent 15 months on clinical rotation accumulating clinical hours with rotations through the various specialities of medicine and surgery. COVID-19 was not in my textbooks or my final exam!
It was 31 December 2019 before the first reported case. A pneumonia of unknown cause detected in Wuhan, China reported to the WHO. The outbreak was declared a Public Health Emergency of International Concern on 30 January 2020 and on 11 February 2020, WHO announced a name for the new coronavirus disease: COVID-19. The situation was declared a global pandemic 11 March 2020.
COVID-19 has since been in our daily language. It’s profound impact on our lifestyles and how things are done in our working lives is something we will not forget anytime soon. It has also perhaps inspired a whole leaving cert population to pursue paths in science and medicine which they may not have even considered before and it is my hope even a future PA after reading this piece.
Going back to Mid- March 2020. I had just received my exam results and got the news that I was a qualified Physician Associate. 2 years of perseverance, determination and a lot of hard work. I was starting to begin job applications when reports of the healthcare system in Italy facing COVID-19 were starting to come through. The virus had arrived in Europe! News depicted a surge of coronavirus cases in one region, leading to an overwhelmed health system. ICU was at capacity and cases were crippling medical staff. The World Health Organisation did daily updates on the emerging situation and efforts of trying to contain it.
Quickly, Ireland started to role out her rapid response. Our Taoiseach made a landmark speech and our daily lives were brought to a halt with a lockdown imposed. This was everyone’s responsibility to play part. Our businesses, retail, education and hospitality sectors started to shut down. You could no longer visit places of worship and hospitals and nursing homes too closed their doors for the protection of patients, residents and the public. These were all measures taken to help “flatten the curve.” I think the real gravity of the situation for Irish people was apparent with pictures and videos broadcast of a dormant Dublin on Patrick’s Day March 17th. This was very real and in our midst. Celebrations were cancelled elsewhere around the world, as leaders came together in the collective message of the best way to to slow the spread of the virus was to practice hand and respiratory hygiene and observe physical distancing when interacting socially with others.
So we did, our lives had to adapt and most people heeded advice. Mass public gatherings were not allowed, travel limits were enforced, beauty spots were shut, markers were drawn on the ground of a 2m distance. Initially there was panic buying of essentials but eventually as we became more accustomed to this way of life and a period of restriction placed on bulk buying of those items, we overcame this. Maximum numbers of patrons into places were implemented and standing in a queue became the new normal to enter anywhere. You would sanitise your hands and follow a one way system, workers stood behind a Perspex screen. We came together as we stayed apart on applications like Zoom. Working from home, socialising from home, limiting our journeys out unless they were absolutely essential. At the time of initial implementation, we thought this would be a temporary measure. The initial timeline given was 3 weeks and then it was renewed for a further 3 weeks. Each day we awaited the latest breakdown of cases and the R ‘reproduction’ value but we had to wait to see if our efforts could flatten the curve. It has now been 10 weeks and we have most recently started a pathway to recovery. It is a phased process and guided by Public Health who review the situation on a weekly basis and make recommendations.
I started my role as a Medical Physician Associate in Our Lady’s Hospital Navan on 23 March 2020. I had completed my Emergency Medicine rotation and then elective placement there just a few short months ago. I loved the team and was thrilled to be asked to stay. The hospital even hired 2 others in my class to be Surgical Physician Associates too! I was proud that the staff and hospital’s first experience of a student Physician Associate was a positive one. That in my time spent there I could prove our potential and that they were interested in pioneering this role in their hospital model. This is really proof that you should take every rotation as a potential job opportunity!!
With the emergence of COVID-19 however hospitals had changed up and down the country. The Emergency Department I had come to know had now been divided into 3 separate streams. A Respiratory, Non-Respiratory and Minor Injuries. Signs, cordons and masks had become the new-normal. Seats in the waiting room were brought apart. For medical staff we now wore scrubs as our uniform and covered our stethoscopes with a clear barrier film. Personal Protective Equipment (PPE) was also an essential part of carrying out our job and so you would don and doff multiple times on a ward round. I spent my first week on the COVID/ ICU Isolation ward. Elective Orthopaedic surgeries have been temporarily suspended in the face of COVID-19 and it’s infection risk. These wards have been repurposed with staff redeployed to care for patients with COVID-19. So my first week learning didn’t feel as overwhelming because we were all learning. There was such a real sense of camaraderie. Nursing, Administration, consultants, NCHD’s, we were ALL learning.
The hospital has also been split up into zones based on a traffic light system to reduce infection. Each colour has advice on appropriate measures which should be taken by staff with regards to correct PPE and staff should not cross zones of one colour into another for patient and staff safety and also infection control purposes. When I arrived there was an emergency roster in place to provide best cover. My colleagues joined me after two weeks, so we then became a team of 3 Physician Associates and could work out a schedule with our Consultant in how we could provide best cover with our scope of practice. It was decided that the areas the role could provide most benefit in were the COVID/ICU Isolation ward, Medical Assessment Unit, Emergency Department and on the General wards. Each area has its own set of tasks but almost every area will involve the skills of carrying out physical exams, procedural skills like taking bloods, writing patient notes and completing discharge summaries.
For me, I have gained so much experience in these 10 weeks. We have had to work longer hours and perhaps there hasn’t been as much opportunity to gently become accustomed to working life and transition from student but I have learnt on my feet every day and I am grateful for that. I feel it has been a privilege to go to work and be able to care for people at their most vulnerable. I am lucky that I have been able to communicate with others at work. Personally I think those who have heeded government advice to “cocoon” and “shield” are our real hero’s and I thank them from the front line for their sacrifice. I know it has been an isolating and difficult time. One thing I have also really learnt is that taking is a history is so much more than just information, you are there to listen, every patient has a story to tell!!
I am extremely proud though that I have been present as a Physician Associate on the frontline. That we have been given the opportunity to pioneer our profession and truly represent our practice as competent generalists throughout this crisis. So far our feedback has been really encouraging and we have all been accepted with open arms as valuable members to the team.
I officially graduate on 18 June 2020 although our graduation will be held virtually. It might perhaps be one of the first graduations done in this way but perhaps signals the beginning of something new and maybe this will be the normal! A mark in history. As a small class you become very close with your peers, so this is a moment I’d always anticipated in sharing together and with those who have taught and encouraged us throughout our journey. However, I know that there will be a time when we will come together again, safer times and we will all have even more to celebrate about!
I look forward to what else my career holds and am committed to continuing to learn! With thanks to all the torchbearers before me and may I now be one for the future."
Take care and Stay Safe,