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When ‘Do no harm’ becomes ‘Do the best you can’

Everything I learned in nursing school has been abandoned in favor of rationing, creativity, and the need to adapt to this new reality
A view of the corridor outside the intensive care unit of the hospital of Brescia, Italy, Thursday, March 19, 2020. (Claudio Furlan/ LaPresse via AP)
A view of the corridor outside the intensive care unit of the hospital of Brescia, Italy, Thursday, March 19, 2020. (Claudio Furlan/ LaPresse via AP)

When nurses and doctors, who are working in conditions we never even thought fathomable back when we were studying how to decide which precautions should apply, see you going to synagogue, the park, the beach, it makes us feel powerless to stop this pandemic. All the armchair epidemiologists (who knew there were so many?), with their theories and advice, causing average people to think that this is no big deal, and therefore ignore the isolation and social distancing measures, make us feel like our putting ourselves in harm’s way is for naught.

* * *

October 17, 2004. I and the incoming class of Hebrew University School of Nursing are sitting in an auditorium (that no longer exists) listening to the dean (who has since retired) welcome us to the world of nursing. “You have chosen the noblest of professions. Your reward will not likely be financial, and there may be a time you will be called to risk your lives.” The new students sitting around me listened intently, and I believe we all felt that charge to go out and do good in the world.

From the earliest of times, medical professionals have placed themselves in harm’s way in order to tend to the medical needs of others. We have always known this, and we all chose our calling despite these risks. Over the years, putting ourselves in harm’s way has had different meanings, but now it is different.

We are trying to keep our healthcare services from crumbling, and we are doing so despite the fact that we do not have the supplies we need to use best practices to protect ourselves for very long.

In nursing school, I remember being tested on how to correctly glove up, suit up, and wear personal protective equipment (PPE). We had to be able to correctly identify which situations required airborne precautions (those N95 masks you see people wearing all over, usually incorrectly), which required droplet precautions, and when contact precautions were sufficient. I crammed, along with my classmates, so I could remember how to best protect myself and my patients, so we could all practice that very basic tenet of medicine: “First, Do No Harm.”

Now we are having to abandon some of those precautions because we are in a war, and in wartime, you simply do the best you can.

I am seeing nurses in the US, that wealthy first world country, sewing their own masks out of cloth. I am seeing nurses teach others how to use one ventilator on two or four patients. Essentially, all that information we learned in nursing school has been abandoned in favor of rationing, creativity, and a nurse’s unique ability to adapt daily to the new reality. “First, do no harm” has very quickly become: “Do the best you can.”

I am in contact with nurses all over the world, and it seems one thing is common. Each country seems to think that their comrades elsewhere have access to better supplies, more equipment, different conditions. I watch the US nurses be horrified by orders that our European colleagues have already accepted as normal. If I take a “macro” view and watch these conversations from above, one thing is abundantly clear: we are all in this together.

We are all in this together. We, the medical staff on the front lines. We, the medical administrators having to make difficult decisions every hour. We, our neighbors and acquaintances who need to just stay home. We understand the economic burden that staying home places on you, we really do. I am also a student, somehow trying to complete an MBA in biomedical management, so I speak with a very tiny understanding of the economy, as well as the healthcare system.

We are in this together. The economic outfall affects us, too. I have had to send staff home because people are simply not coming to Terem (we are here, open, ready to serve you, and unlikely to be more dangerous than the park or the beachfront in Tel Aviv, due to our abundant precautions). We also have spouses who have been temporarily laid off. Our incomes are also decreasing. No one is getting extra pay for working in extra crazy conditions. We all signed up for this on the day we decided to became healthcare providers, whether as nurses, doctors, paramedics, or pharmacists.

We are in this together. Taking social distancing seriously means this will be over quicker. Not going out means your neighbor can get back to their job as a wedding coordinator more quickly. Skipping synagogue now means we will hopefully be able to celebrate in the future together.

We all drink from the same well. That’s the meaning of public health. We don’t get to choose who drinks from our well, and unfortunately we don’t control who spits in it. Please remember, we are all in this together. We healthcare professionals remember it every minute.

About the Author
Noa Hirsch Choritz is an emergency and OBGYN nurse, and the regional director of Terem Emergency Medical clinics. She is currently completing an MBA in biomed at Hebrew University.
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