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"If not now, when? If not me, who?" 

Encounters by Residents at the Forefront of COVID-19


For the past three months, Singapore's healthcare force has been valiantly stepping up the fight against COVID-19, including our SingHealth Residents. How has life been for them since COVID-19 hit us? 

INSIGHT catches up with three SingHealth Residents, Dr Lim Mian Jie (Emergency Medicine), Dr Kennedy Ng (Medical Oncology) and Dr Amar Vaswani (Internal Medicine), who are working on the COVID-19 frontlines to hear about their experiences and what they have learned.


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Dr Lim Mian Jie, Emergency Medicine, SingHealth Residency


1. Tell us about your work and role in the SGH Emergency Department (ED) during COVID-19.

Every day in the ED is different for me. I could be rotated to work in various areas, such as the resuscitation area where we see patients with life-threatening illnesses, suffering from acute strokes or severe trauma; the critical care area where we see patients who are ill, but whose conditions are not life-threatening or the consultation area where we see patients who are not as seriously ill and are still mobile.

Lately, I have been assigned to the fever area, where I see patients with recent travel histories or patients who are also showing respiratory symptoms and/or fever. Beyond treating them, I also conduct swab tests for COVID-19, while wearing the full Personal Protective Equipment (PPE). 


2. We understand that you cared for the first locally transmitted COVID-19 case in Singapore. Tell us more about your experience. How did you feel after you found out?

Since we don't get confirmation if the patient is COVID-19 positive immediately, the whole experience came as a surprise to me. I won't deny that I did feel worried initially, but knowing that I was properly gowned and protected gave me great relief. I was thankful for the opportunity to have attended to the case and to do my part to contribute to the prevention of further community spread. This is definitely a moment in my medical career that I won't be forgetting anytime soon! 


3. We know that working in the frontline is not easy during this challenging time. What keeps you going during this COVID-19 period?

Before deciding to join Emergency Medicine, I was mentally prepared that one day, I might face challenging periods as a frontline healthcare staff during a health emergency like the one we have now. No matter how tough the situation gets, I will always remember my calling in Medicine. I will not back down, because this is more than just a job to me.

Although it has been a challenging time, I'm encouraged by everyone's efforts in battling against COVID-19 together. I would also like to say a big THANK YOU for all the warm gestures of support from our fellow healthcare colleagues, societies, schools and the public – they mean a lot to us and have kept us going in this fight together! 


4. What has been your biggest takeaway from the COVID-19 situation?

Even in times of great peace and stability, unforeseen situations can unfold very rapidly. It taught me the importance of appreciating each moment and what we have at present, because we never know what might happen next.




Dr Kennedy Ng, Medical Oncology, SingHealth Residency

 

1. Tell us about your work and your role during COVID-19.

I was working in the SGH isolation wards for five weeks earlier this year as a Senior Resident. I helped to manage and lead a team of Medical Officers (MOs) to care for the patients in the isolation Intensive Care Unit (ICU) and high dependency unit, as well as to respond to emergencies in the ward as the code blue team leader. The shifts were long and certainly hectic, but I had to press on.


2. Share one unforgettable/memorable moment from working in the isolation wards during COVID-19.

There was a case where we had to intubate a patient suspected with COVID-19, who needed oxygen support via a ventilator. This was our first intubation incident in the isolation ward. Intubation is a high-risk procedure and causes aerolisation of the patient's secretions, therefore increasing the risk of transmission if he did eventually test positive for COVID-19.

In the middle of the night, the entire team gathered outside the isolation room to prepare the necessary equipment and medication, and to make sure our PPE and the powered air-purifying respirators (PAPR) were working well. I was worried and I could sense the unspoken fear in my teammates, with thoughts like: What if we contracted the virus? What if we failed in performing the procedure since it's very difficult to see and handle equipment in the thick PPE?

When I decided to do Medicine after my national service, there were people who warned me of the risks involved in this profession such as being exposed to infections especially in a pandemic. I always understood it at a theoretical level, but this was the first time I found myself coming face-to-face with these risks in a very real way. Nonetheless, the intubation had to be done.

Thankfully, the process was a success, and eventually, the patient was confirmed not to have COVID-19. But I don't think any of us would forget that moment of fear and uncertainty. Looking back, I'm thankful for my team; that even in that moment of great personal risk, everyone was so willing to step forward and give their best.


3. What kept you going during this time?

To me, it is a privilege to be able to serve in this pandemic. When SARS happened, many of us junior doctors were still in school and we simply enjoyed the 'school holidays', not knowing the full danger or impact of SARS. We weathered through that crisis because many individuals stepped forward to serve fellow Singaporeans. Now, we realise how much our seniors in healthcare have contributed and sacrificed. I chose Medicine in the hope that I can do my part to serve others. I asked myself: If not now, then when? If not me, then who?

The encouragement from my wife, family, friends and colleagues were also invaluable. Initially, there was quite a bit of adjustment needed, since there were many unknowns about COVID-19. I deliberately reduced interactions with my family, friends and loved ones as I was worried that I would be infected and in turn, infect them. My wife was extremely understanding; both of us made the decision together for me to volunteer in the isolation ward. Her support meant a lot, especially since she was pregnant and due to deliver in early April. We decided to live apart to protect her and the baby, and this was probably the most difficult part of the entire five weeks. I'm also grateful for how my family and friends checked in on me regularly, and how my colleagues stepped in to cover my duties in a department with high clinical workload.

Finally, it's also knowing that I am part of an amazing team of self-sacrificing individuals. There are so many friends and healthcare colleagues who have stepped forward to help in different ways, for instance, the team at the emergency department, the nurses, the housekeepers who are all working tirelessly, the security team, the porters who transport the specimens from the wards to the laboratory and the laboratory staff who are working night and day to process the specimens. It's also inspiring to see how the different Ministries and Singaporeans from all walks of life have come together as we respond to the crisis. It's really like a team sport. In this case, we are fighting an unknown, unseen "enemy" and we are all doing our best to care for our patients and protect our country as one team.


4. What have been your biggest takeaways from the COVID-19 situation?

First, while adversity can sometimes bring out the worst in people, it also brings out the best. I've been inspired by the many sacrifices made by people from all walks of life. We've also seen creativity flourish when pushed to our limits – for example, using phone applications for contact tracing while maintaining privacy. Finally, we see the level of progress we can make when we put aside our differences and work as a team. With data-sharing across the world, countries were able to develop test kits rapidly for deployment.

Second, the crisis has presented unique opportunities for us to re-think and improve the way we work, play, learn and prioritise resources. The reliance on technology will increase as safe distancing measures are intensified. Companies are reorganising their workforces to be more adaptable, effective and efficient. During a crisis, when people are focused on the matter at hand, everyone is also more open to change. Whilst it has been and will continue to be a trying season for everyone, I can say with certainty that I am immensely proud to have been a part of this team, and thankful to call Singapore my home.



Dr Amar Vaswani, Internal Medicine, SingHealth Residency


1. Tell us about your work and your role during COVID-19.

I'm currently with the Medical Intensive Care Unit (MICU) in CGH. We attend to critically ill patients who require the highest level of care.

One of the challenges we faced in MICU during this period was high turnover of patients in the MICU, which required judicious bed management and a closer vigilance. I'm grateful to be part of a team that showed such adaptability in the rapidly evolving circumstances – there has indeed been a lot to learn in a time like this.

 

2. We understand that you cared for an ICU patient who was later tested to be positive for COVID-19. Share with us your experience.


This happened some months ago, when it was still early on in the COVID-19 outbreak in Singapore. We took care of a patient in the MICU, who was initially diagnosed with pneumonia. However, shortly after admitting this patient, screening guidelines were changed to include testing patients with pneumonias for COVID-19. This patient was eventually confirmed to be COVID-19 positive.


It came as a shock to many of us. But it was also a good reminder that as we continue to battle against the virus and learn more about it, we need to always be on our guard and constantly refine and review our processes.


3. What has been your biggest takeaway from the COVID-19 situation?

Despite all the disruptions, I think we still have a lot to be thankful for, especially when we compare the situation today with that of SARS thirteen years ago. Back then, communication was less readily available. Many of the processes and capabilities we take for granted today were put in place as a response to the lessons from SARS, for example, receiving constant updates on the COVID-19 situation, the use of more PPEs, etc.

When we view the situation from a different perspective, that as uncertain and evolving as the COVID-19 situation is, this pandemic is also an opportunity for us to better prepare ourselves for whatever the future holds.


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