Psychiatrists In Pandemics

I wrote this piece for a competition entitled ‘The psychiatrist’s role in responding to global disasters’. It was run by a society of psychiatrists. I don’t think they liked it much.

The ludicrous proposition

Psychiatrists have no role in global disasters.

“Wait, wait!” you cry in outrage.

Hear me out.

The world needs more than psychiatrists

Many eons ago, dinosaurs decided to drop dead, and the way was paved for Homo sapiens to take over the earth. And that was exactly what humankind did. They put animals in zoos, traded financial instruments, made television shows, flew to other countries, and generally enjoyed their man-made creations – like sausage rolls and drive-in cinemas.

But with that luxury came an inevitable risk: the danger of losing everything. Because of the advent of civilisation, things which didn’t matter before started to become vitally important. The fragile entity of the economy, social fears, world politics, technological dependence – all of these became concepts that can be threatened by global disasters (World Economic Forum 2020).

Wealth can be protective against adverse outcomes, yes, but the strong risk of adverse outcome is still there (Brookings 2017; Scientific American 2017; The Guardian 2020). A severe enough disaster can affect basically everyone (United Nations 2020).

Thus, when a global disaster strikes, what the world needs isn’t psychiatrists; it’s resolution, co-operation, and community.

In emergencies, we can’t limit ourselves to a single role to achieve the most reparation. We need to be flexible and versatile. We need to revert to generalists to do the most good. We need to be ready to do whatever our training allows us to contribute, even if that doesn’t refer to the specialised skills trained many years for. We need to prepare for a step in humility, and we need to offer whatever basics the world most requires of us.

If the majority of the world is dying of an infectious disease, maybe you don’t need a psychiatrist right that second. But you do need a doctor generally when physical health is the most pressing issue.

Or maybe it’s something that can’t simply be cured that instant. Then perhaps you need a human, or a friend to help talk to you or bring you a hot meal, if emotional support is the thing required at the time (Purdue University 2018).

Neither of these situations calls singularly for a psychiatrist as the only prescription. They require a doctor – or simply a very helpful human.

That’s why psychiatrists specifically don’t have a role in global disasters. But doctors generally do. And especially in those times, doctors are human and need to be human first (PR Newswire 2011).

The burden of global disasters

Disasters are bad. Pretty bad. By definition, it’s in the name. And if something bad turns global, it’s sure to be even worse.

There are the pandemics – Black Death, Spanish flu, HIV/AIDS, and now COVID-19 (National Center for Biotechnology Information 2017). There are the natural disasters – of which there are around 400 annually (Brookings 2010), with the potential to leave people trapped in gruelling conditions for days (Direct Relief 2019). There are the human-created dilemmas – terrorism, war, and others.

Each of these seems different on the surface, but they all have some grave things in common: significant death and injury, world chaos, a huge burden on healthcare workers, and depletion of the workforce.

Negative consequences range from economic devaluation to social anxiety to illness and injury to death, for which the stories can be jarring. During the COVID-19 pandemic, one woman described her experience of tragic loss. She woke up to find that her fiancé, who tested positive for COVID-19, was not next to her. Logically, she fathomed he must have been downstairs. However, something was unsettling; they had a parrot that typically squawked in conversation whenever someone was near it. But the parrot that day was completely silent. That was how she realised that her fiancé was dead at home downstairs (CBS News 2020).

We haven’t yet figured out how to revive people from the dead – and there are many reasons why we probably wouldn’t want to – so what we need is prevention over cure. Simply put, people need more healthcare in these moments to prevent deterioration. However, a significant proportion of people can’t afford to pay for healthcare even in normal times (The New York Times 2020).

Yet, it would be naïve to think that a global disaster doesn’t involve a massive shake-up to every industry – and health is no exception.

Especially, especially, if the global disaster is of such proportions that it disrupts the healthcare workforce. Speaking historically, with pandemics such as influenza or COVID-19, that’s a huge concern and probably even an inevitability (National Center for Biotechnology Information 2007).

When the world is short on medical staff, there’s a clear solution: source more.

Why psychiatrists should be doctors and doctors should be humans

Remember that psychiatrists aren’t just psychiatrists; they’re doctors.

There are certain times, such as global disasters, where it’s very important to be a doctor first and a specialist second. It’s only in this way that we can do what world healthcare needs holistically. It’s not about resorting to what we trained most recently in because that’s what we feel comfortable doing, as we can offer more by stepping out of that comfort zone – while remaining within the realm of our certified qualifications, of course. It’s not about choosing what we can charge the most for; the focus is what the patient needs the most.

Now, psychiatrists are important – it’s not much fun if your brain is running through depression or your mind is addled by psychosis – but we have to step back and remember what it’s all for. You train as a psychiatrist because you enjoy being a doctor and you have a specific interest in addressing pathologies of the mind. You take up that specialty because it’s the area you feel you have a knack for and can do the most good in.

But why do you become a doctor? Because you want to help people. Because you find health fascinating. Because you realise that a life lived with serious ailments and maladies is not really a life well lived at all – or at least one with a handicap better resolved as much as it can be.

So you become a psychiatrist because you want to be a mind doctor, and you became a doctor because you want to help people. You want to help people because you want to do some real good for the world, because you want to contribute to that idea of the greater good.

So really, if you can help the world a bit, that’s your mission accomplished. It isn’t about being a psychiatrist; it’s about doing good for others. Psychiatry is just the vessel you use to achieve that.

Which means, if some unprecedented situation arises like a huge pandemic or a massive tidal wave that demolishes half the city, you’re best to revert to your basic aims: helping people and doing the most good. If people around you are starving or succumbing to infection, maybe your priority doesn’t change – doing that good – but maybe your method does.

Emergency department doctors act as miniature specialists across many fields. If the patient enters with chest pain, they switch on cardiology mode. If it’s abdominal pain, they warp to gastroenterology thinking. In times of crisis, this is a model we need to emulate. It reflects the ability to be versatile and adapt to whatever the patient most pressingly needs.

Global disasters ruin life as we know it, which calls for adept generalists. That’s particularly when we need more than psychiatrists specifically; we need doctors generally.

Conclusion

Aesop wrote of a conversation between the Oak and the Reeds.

The Oak, haughty about its ability to stand upright and rigid no matter what, criticised the Reeds for unfailingly swaying with the breeze. Unruffled, the Reeds declared their intention to continue bending pliantly with the wind. Later that day, a hurricane struck and ripped the Oak out of the ground (Library of Congress n.d.).

Versatility is rewarded; inflexibility is destroyed.

Psychiatrists have no role in global disasters. Doctors do.

References

  1. World Economic Forum 2020, COVID-19: What are the biggest risks to society in the next 18 months?, accessed 2 August 2020, <https://www.weforum.org/agenda/2020/07/covid19-future-economic-societal-geopolitical-risks/>.
  2. Brookings 2017, Pandemics and the poor, accessed 2 August 2020, <https://www.brookings.edu/blog/future-development/2017/06/19/pandemics-and-the-poor/>.
  3. Scientific American 2017, Natural Disasters by Location: Rich Leave and Poor Get Poorer, accessed 2 August 2020, <https://www.scientificamerican.com/article/natural-disasters-by-location-rich-leave-and-poor-get-poorer/>.
  4. The Guardian 2020, We’re about to learn a terrible lesson from coronavirus: inequality kills, accessed 2 August 2020,<https://www.theguardian.com/commentisfree/2020/mar/14/coronavirus-outbreak-inequality-austerity-pandemic>.
  5. United Nations 2020, The Social Impact of COVID-19, accessed 2 August 2020, <https://www.un.org/development/desa/dspd/2020/04/social-impact-of-covid-19/>.
  6. Purdue University 2018, A little help from your friends is key to natural disaster recovery, study suggests, Science X Network, accessed 2 August 2020, <https://phys.org/news/2018-10-friends-key-natural-disaster-recovery.html>.
  7. PR Newswire 2011, Loss: What to Say After the Flood, Earthquake, or Disaster from Grief Expert Aurora Winter, accessed 2 August 2020, <https://www.prnewswire.com/news-releases/loss-what-to-say-after-the-flood-earthquake-or-disaster-from-grief-expert-aurora-winter-121990828.html>.
  8. National Center for Biotechnology Information 2017, Pandemics: Risks, Impacts, and Mitigation, U.S. National Library of Medicine, accessed 2 August 2020, <https://www.ncbi.nlm.nih.gov/books/NBK525302/>.
  9. Brookings 2010, Natural Disasters, Conflict, and Human Rights: Tracing the Connections, accessed 2 August 2020, <https://www.brookings.edu/on-the-record/natural-disasters-conflict-and-human-rights-tracing-the-connections/>.
  10. Direct Relief 2019, 10 Disasters That Changed the World, accessed 2 August 2020, <https://www.directrelief.org/2019/12/10-disasters-that-changed-the-world/>.
  11. CBS News 2020, Coronavirus: The hidden pain and sorrow of dying at home, accessed 2 August 2020, <https://www.cbsnews.com/news/coronavirus-pain-and-sorrow-of-dying-at-home-60-minutes-2020-04-26/>.
  12. The New York Times 2020, As Coronavirus Deepens Inequality, Inequality Worsens Its Spread, accessed 2 August 2020, <https://www.nytimes.com/2020/03/15/world/europe/coronavirus-inequality.html>.
  13. National Center for Biotechnology Information 2007, Can the Health-Care System Meet the Challenge of Pandemic Flu? Planning, Ethical, and Workforce Considerations, U.S. National Library of Medicine, accessed 2 August 2020, <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1936949/>.
  14. Library of Congress n.d., The Oak & the Reeds, accessed 2 August 2020, <http://www.read.gov/aesop/011.html>.

Podcast 033: General Meowdicine With Dr Cat

You know the best April Fool’s joke? It’s where you pull the prank on April 10 instead of April 1, because then no one’s expecting it.

Thank you to all the fans, supporters and listeners of How To Win Friends & Influenza. The podcast has been what it is because of you. May your medications be therapeutially potent and your auscultations highly accurate.

Keep on doctoring, only in the most ethical of ways!

Podcast

About the guest speaker

Mewtwo is a Professor of Kitten and feline specialist working in Sydney, Australia.

Mewtwo enjoys eating, sleeping, chasing string, scratching people and generally being rather annoying.

Music credits

Piano solos by Mewtwo the cat.

Athletic Salt Intake

Athletes lose extra salt because they sweat profusely, more than a normal citizen. In such cases, they need a higher sodium intake than the usual recommendations.

Sometimes salt can be serviceable, not just delicious!

References

  1. Valentine, V. 2007, ‘The Importance of Salt in the Athlete’s Diet’, Current Sports Medicine Reports, vol. 6, issue 4, pp. 237-240, https://journals.lww.com/acsm-csmr/fulltext/2007/08000/the_importance_of_salt_in_the_athlete_s_diet.9.aspx.

Of Mice And Men Inoculating Mice With Viruses

In an experiment involving the ever-unfortunate mice, the following steps occurred:

  • Mice inoculated with influenza virus
  • Th17 cells activated and migrate to respiratory and gastrointestinal systems
    • Both respiratory and gastrointestinal tracts have mucosa, so they are similar in a way
  • Th17 cells produce cytokines IL-17A and IFN-γ
    • These cytokines mess with intestinal bacteria
    • Results in less Lacto-, more Entero-
  • Intestinal injury

References

  1. Racaniello, V. (2014). How influenza virus infection might lead to gastrointestinal symptoms. [online] virology blog. Available at: http://www.virology.ws/2014/12/10/how-influenza-virus-infection-might-lead-to-gastrointestinal-symptoms/ [Accessed 5 Feb. 2020].

Podcast 032: Rheumatology With Dr Allan Sturgess

Some people light up joints and some people light up when they hear about joints. Although these are theoretically not mutually exclusive, rheumatologists tend to form the latter group.

In this episode, Dr Allan talks about rheumatology, interesting diseases in the specialty and what it’s like to win an award shaped like a foot.

Podcast

About the guest speaker

Dr Allan Sturgess is an Associate Professor of Rheumatology and specialist working in Sydney, Australia. He is the Department Head at St George Hospital.

Dr Allan enjoys hiking, reading and generally being rather awesome.

Music credits

Opening and closing blips by Lily Chen.

U Waves

The U wave is a smaller structure after the T wave that resembles a second T wave, kind of like Baby Mario, M&M’s Minis or Pichu. It’s best seen in V2 and V3.

Prominent U waves are most commonly found in:

  • Bradycardia
  • Hypokalaemia

Inverted U waves are abnormal and point to cardiac disease.

References

  1. Burns, E. (2019). U Wave. [online] Life in the Fast Lane. Available at: https://litfl.com/u-wave-ecg-library/ [Accessed 29 Jan. 2020].

Pulsus Paradoxus

It’s normal for blood pressure to drop when breathing in.

When you breathe in, the negative intrathoracic pressure increases. That basically means the extra force of all the air you’re leeching from the atmosphere pushes on the insides of the body, squishing the important bits of the cardiovascular system. So, the blood flow gushing out to the rest of the body is reduced a bit, referring to the cardiac output emitting from the left side of the heart. Note that venous return to the right side of the heart increases with inspiration.

A drop in SBP<10 is normal during inspiration. When it’s greater than this, it’s pulsus paradoxus. That can happen in things like:

  • croup
    • inflammatory reaction to parainfluenza virus
    • results in airway obstruction, mainly in children because they have smaller airways
    • airway obstruction means even bigger negative intrathoracic pressures
    • this increases left ventricular afterload, which is the force the heart has to push blood against
  • cardiac tamponade
    • heart is compressed
    • leads to reduced cardiac output

References

  1. Olfa Hamzaoui, Xavier Monnet, Jean-Louis Teboul, Pulsus paradoxus
  2. Van Dam MN, Fitzgerald BM. Pulsus Paradoxus. [Updated 2019 Jun 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2019 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK482292/

The Sad Evils Of Smoked Salmon

Smoked seafood has, unfortunately, been cast into the same category as preserved meats. These traitors have been linked with an increased risk of malignancy. Shun them all!

On the plus side, chicken is still in season(ing). As long as you’re not a greedy pig about it. Moderation, which basically means not over-gorging, is the key to success. That is, health.

References

  1. Egan, S. (2019). Do Lox and Other Smoked Fish Increase Cancer Risk?. Retrieved 29 August 2019, from https://www.nytimes.com/2019/07/26/well/eat/does-lox-and-other-smoked-fish-increase-cancer-risk.html
  2. Meat, Poultry, and Fish: Picking Healthy Proteins. (2017). Retrieved 29 August 2019, from https://www.heart.org/en/healthy-living/healthy-eating/eat-smart/nutrition-basics/meat-poultry-and-fish-picking-healthy-proteins

Podcast 031: Vascular Surgery With Dr Gabrielle McMullin

Blood vessels are needed to keep the liquid of life pumping throughout our bodies. Bad vessels lead to bad flow, which is undoubtedly a bad thing.

In this episode, Dr Gabrielle talks about vascular surgery, rather interesting stories and workplace injustice.

Podcast

About the guest speaker

Dr Gabrielle McMullin is a consultant vascular and endovascular surgeon with a long list of letters adorning her name: MB BCh BAO FRCSEd FRACS MCh. She is a specialist at The Sutherland and St George Hospitals in Sydney, as well as a mentor for women in surgery.

Dr Gabrielle was born in Uganda, attended school in Hong Kong and studied medicine at Trinity College in Dublin. She then worked in numerous countries, including Ireland, New Zealand, Papua New Guinea, Hong Kong, England and Australia, where she has lived for 25 years. It has been a fascinating journey.

Dr Gabrielle spends what is left of her spare time with her husband and 2 children.

Music credits

Opening and closing auditory experiences by Rupert Keller.