Q & A session with Consultant Respiratory Physician Dr Martin Kelly

In this week's question and answer session with a member of our frontline services, we shine the spotlight on Dr Martin Kelly, who is a Consultant Respiratory Physician at Altnagelvin Area Hospital from Omagh.

How worried are you about the current situation?

I am appropriately concerned. We need to continue to take the coronavirus pandemic very seriously. Though the ‘lockdown’ has successfully ‘flattened the curve’, we anticipate ongoing cases of Covid-19 for at least many months. And yet, there have been many successes, too, and we must remember that.

What are the main challenges in the current situation?

We are working in a different environment from normal. We have had to adapt to new ways of working. The whole hospital had had to turn itself upside down and rearrange how to deliver care.

We are less able to care for our long term patients in the community, though there has been great assistance from specialist nurses and other doctors, who have delivered many telephone 'virtual' clinic visits. We worry about patients out there who may be sick but afraid to attend their GP or the hospital. Please do not be afraid. You must seek help, we will look after you.

We are especially concerned for possible lung cancer cases in the community. This disease is notorious for presenting late. Anyone who has worrying symptoms, such as a new or worsening cough for more than three weeks, who coughs up blood or has symptoms such as unexplained weight loss, especially if they are smokers/ex-smokers, must seek help. They need an urgent CXR and referral if necessary and the GPs will be able to help with that.

Within the hospital, the work to help redesign the layout and flow of patients in the hospital has been led by colleagues Dr. Rose Sharkey and Dr. Philip Gardiner, for which we are very grateful. This has been hard, challenging work.

Senior management have been very supportive.

It must be an emotional time for you and your family?

My wife is also a doctor here in hospital, in the oncology department. We both are very wary of bringing the illness into the house to our two teenage kids. But, we take precautions as are careful with hygiene. One has to remain calm in such situations and thankfully, we have been able to do that. It is stressful, I will admit, but the support from the majority of colleagues, as well as the public, has been extremely heartening.

How is your workload at the moment?

The workload is 'different'. We have adapted to the change by working more akin to our nursing staff, with longer days and some time off in between. We have had to step up and demonstrate leadership in the time of crisis. It has been perhaps challenging, but I hope that we as a team of doctors on the front line have done that.

Are you having to work extra days/hours?

So, yes, to an extent, we are doing more. The truth is, we have all just got on with it, done what is needed done, and not worried too much about time off! As already stated, we've been working longer hours. We have more routinely been working weekends (not that week days or weekends are much different anyhow now!). We have all forgone any leave. But, truth be told, we do what is needed. We are glad to be able to help and do our bit to care for people. We are in a privileged position, hopefully trusted by most of our patients, and we should always remember that.

What does your daily work day entail, and have your duties changed due to the current situation?

On a typical day, we all come to the ward at around 8.30am. There is a handover from the night staff, any issues discussed. Then, the patients on the ward are seen. As a consultant, I will see all the new patients and anyone who is very sick. By 12 midday, we will have everyone seen.

There is a team meeting with the senior nurses, to discuss management of the patients, and further plans. At lunchtime, there are often meetings to attend, which in this modern age, are often by video conference (even within the hospital - so as to minimize the footfall in other areas and possible intra-hospital transfer of infection).

In the afternoon, results of swabs start to come back and we will look at onward movement of patients. As new admissions come in, I will go to see them, often with a junior member of staff. Early review by the consultant is important, to facilitate prompt initiation of the appropriate care and refer on to intensive care if necessary. There may also be relatives to ring, especially if someone is very ill.

By 5pm, some of the junior doctors are getting home, and we will have a further review of the list of patients, known as a 'board round'. In the evening, it can be quite busy. Sicker patients from earlier in the day will need review. New admission need senior review. By 2100h, the night team have arrived, we have a handover, and then home (after a shower of course!).

There are times when it is less busy, so potential to get away earlier, but this is a pretty standard day.

What advice would you have for members of the public regarding staying safe and helping support the local health service at this time?

The public have coped remarkably well to date with this. We know this is hard. I spoke with a patient on the ward today who talked about feeling 'low' in mood. Though older, they would have been out to see their family and grandkids. We understand that.

The message is simple - continue to follow carefully the guidance from Department of Health. Stay at home unless journeys are vital, make sure to maintain social distancing and be meticulous with hand-hygiene, as instructed.

We will get through this, but to protect and save lives, we have to obey the rules.

Look at all those who have died and think of all the healthcare workers who have succumbed to this terrible illness. Do it for them, so as we can reduce the numbers in the future.

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