Excitement at leading the Emergency Department during a pandemic soon turned to despair when his staff started falling ill. Associate Professor Kenneth Tan brings you on his emotional roller coaster, and shares the burden of a leader.
I will not forget the day when we heard of the virus that came from Wuhan. We were told to get ready and start pre-screening measures and prepare our isolation facility. At first, we thought that this was going to be similar to MERS-CoV, where we screened and moved suspects into our fever zone.
Going to my first Command Centre meeting for the Wuhan virus, my initial feelings were a mix of excitement and pride, because we were finally going to show the world what our Emergency Department (ED) was all about. I was going to be the Head of Department during this pandemic and the ED would do very well.
Everything changed on the day we detected the first case in Singapore – it dawned on me that this was very different. The first few days were some of the most challenging ones of my young headship. We were flooded with a lot of tourists who came to see us. Usually, we would have 10 to 15 patients a day in our fever zone. After the first case, the situation exploded. Every day, there would be 50 to 60 patients – tourists or returning Singaporeans – with features worrying for the novel infection. We really couldn’t cope, be it in terms of space or manpower. We spoke to senior management and they gave us part of the Ambulatory Surgery Centre (ASC), a facility adjacent to ours.
Together with non-suspect cases, we began hitting about 400 cases per day. As the department became crowded and the wait time lengthened, the nurses struggled to separate those with and without worrying clinical features. With long queues, people turned hostile. It didn't help that many of the tourists turned up with luggage in tow.
As I walked the ground and saw our young doctors and nurses go into these fever zones, I could tell that they were so scared. We didn’t know what was going on. With SARS, we could identify who had it, based simply on fever, and isolate them straightaway. However, this virus was different – fever was not a consistent sign.
The weight on my shoulders
One incident caused me to break down. The junior doctor who saw the first COVID-19 patient had a very high fever the next day and had to be admitted to the Isolation Ward (IW). I couldn’t visit him – that was the rule. My world crashed. I feared, not for myself, but for his life, his family – he was newly married. I called him, and he told me, “I am very scared. I can’t see my family. I can’t see my wife, I don’t know what’s going on …”
I had an overwhelming sense of helplessness because there was nothing I could do. As more junior doctors and nurses were admitted for fever, I had sleepless nights, fearing the worst.
A difficult decision was made to go into segregated groups to reduce the chance of cross-infection. Leave was cancelled, and those who usually spent only a portion of their time doing clinical work, such as clinician-scientists, all came back to work full-time. Prof Anantha, often regarded as the “Father of Emergency Medicine” in Singapore, also threw himself into the fray, working the full 12-hour shift.