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"I do not consider myself a prophet or a virologist, I am a simple ER worker"

12 October 2020

He follows the photographer’s request calmly and firmly, picks up the phone every five minutes, answers his colleague’s questions who knocks urgently on his door. He behaves similarly when making serious decisions in the case of patients, or when expressing his professional opinion in a video, sometimes in a post. I could also put it this way: he is an ever-present. This unquestionable, solid, authoritative physician and human presence received the Albert Szent-Györgyi Special Award for Persistence (Szent-Györgyi Albert Helytállás különdíj), which dr. Kanizsai, Péter László, associate professor, head of the Clinical Center Department of Emergency Medicine received on 16 September as one of the most dedicated professionals in his profession; I could get an insight into his life on a rainy weekday.

 

 

Written by Rita Schweier

 

 

- In such a special, unprecedented situation like the one we are in now, one might appreciate it differently if they get an award and they presumably place it elsewhere in their life story. Am I right?

- That is right. There was an email that someone nominated me for this award but then it got overlooked in the pile of e-mails and I was very surprised when I got the call that I won. For me, this is especially heart-warming because it is a recognition given by a professional team based on patient votes, as well as positive feedback that I am possibly doing my job well and we are on the right track.

- You emphasized that this persistence would not have been possible without your team, which suggests that your team is great.

- Emergency care is teamwork, but the same is true for other types of care, the age of lone heroes is over. In the past, not just a single person was standing his or her ground either, perhaps there was only less spotlight for those working with him or her. 21st century medicine is characterized by an increasing team-like role, and I like working in a team a lot. This is no small challenge though because we are very different in many ways, but when I see my colleagues being aware of what the next step will be and acting accordingly in the fullest natural way possible, it is amazing. This does not only expand my comfort zone, but also improves the patient’s sense of security, which is a very important aspect in acute care.

- I know you as someone who is evaluating constantly and critically, and that applies to yourself as well as your surroundings. In retrospect, how do you see your performance in the spring?

- We did not really know what we were facing then, we still do not know. There is a virus that has been proven to be very resistant, there is no vaccine against it, and is spreading like wildfire. In the beginning, we knew even less about it than we do now. There was great uncertainty, although this has not changed much because 25 per cent of the scientific publications about COVID have already been withdrawn. In any case, we built a system that we operated. We had a drastic drop in the number of cases from mid-March to the end of the month but after that we treated patients whose condition worsened because there was no specialised care or admission to hospital wards. Based on our summaries, the previous year's number of patients returned from April, and it increased further from May. I think we stood our ground. We did not send anyone away, moreover, we organized the important medical examinations. It felt good that my colleagues were also partners in this and they were thinking correctly and responsibly.

- You also played a major role in the establishment and operation of the Coronavirus Care Center (KEK).

- The technical specialists deserve a lot of respect for performing a minor miracle very quickly when establishing the center. The difficulty during this period was caused by the fact that a part of my staff had to be transferred to KEK, but my colleague and deputy director dr. Ernő Bóna solved this excellently. At that time, it was not the workload but the psychological preparedness that affected us, as we believed that even thousands of patients could arrive. We continued to work in the background, trying to select those who came to us in a way that infected patients were admitted to KEK immediately.

Today, the situation has improved a lot with the installation of new CT equipment and new radiological devices, as we have not only received monitors and ventilators, but the Clinical Center has also managed to purchase a smart machine capable of performing a rapid test in seventy minutes. Its disadvantage is that such a test is very expensive, therefore it is only used in the case of patients admitted to the intensive care unit, but it is a big thing that it exists because we do not have to wait for 16 and 24 hours for the PCR test to be completed.

- This is also important because, according to the current protocol, those who experience severe symptoms are admitted to your department first.

- Yes, and they are transferred to the Coronavirus Care Center only if it is necessary. It is important to know that the patients should not come to the emergency department, but to the CR department set up at the former burn surgery department, located directly next to the ambulance entrance, separately. Of course, my colleagues work there as well, based on different regulations. There is an airlock, and they treat suspicious or confirmed positive patients there. Our goal is for these patients to be transferred to KEK as soon as possible where wards have been opened if they require placement or intensive care. So, we do not cure coronavirus patients.

Szekszárd has been designated as the regional epidemiological hospital by the authorities, but capacities are finite and logistically it is not always possible for a seriously ill patient to get transferred there. The protocol also states that the patients may be transferred to another unit if they are in transportable condition. As high-level providers, we need to be prepared that patients will not be transferred anywhere. Each decision is made in this regard with the interests of the patients in mind.

- What exactly happens to patients with symptoms of the virus when they come here?

- They go through a pre-triage - triage is the sorting activity - during which they fill out the questionnaire prepared according to the current protocol. If it is suspected that they may be infected with COVID, we will not take them to the emergency room, but they are transferred through another route, a so-called bypass to the COVID department. Here we perform triage, examine them, draw their blood, send them to X-ray and CT examinations, and then decide based on the tests if they really are suspicious. If it is confirmed, we transfer them to KEK, if not, we send them home. The patient can be taken home either by the ambulance service or by a family member living in the same household, the latter of course immediately gets quarantined together with the patient. Samples are taken from patients who need to be admitted to the ward and are suspected of being infected with COVID but do not require COVID care. These include patients with stroke, myocardial infarction, or gastrointestinal bleeding. Samples are taken from them in all cases because they can only be added to wards with a negative test result. They stay at our department until the result arrives. For those in the intensive care unit, we use the rapid test. An enlargement process is currently underway to accommodate pending patients. The site of this will be the old emergency department.

- What do you do if a patient needs an emergency surgery but has a positive test?

- We are prepared for this as well, we have a so-called COVID operating room in the COVID department, which has airlock ventilation technology. My colleagues put on protective gowns and perform the surgery. Even neurosurgical interventions can be performed here, which means that practically anything can be done in this operating room. We even have a maternity ward to provide care for COVID positive women in labour.

- People could read your call for volunteers, doctors, nurses, administrators, patient attendants in case the situation got worse.

- It is a typical emergency room aspect so that we do not have to solve it last minute if maybe five of my nurses cannot work because they caught the disease, we should have someone to replace them with in such cases. I just met our volunteers this morning, fortunately many people applied. They are mostly medical students, but there are also graduated doctors among them. We can work with them after two or three occasions of training. Their employment is important, especially in auxiliary nursing tasks. The biggest and most pleasant surprise for me was that there were also volunteers from the spring contingent who already know exactly what they have to do. I will also ask for their help in training and administration. It feels really good to see these enthusiastic young people here again.

- There have been several information videos recorded with you since the outbreak and you find it important as a professional as well as a private individual to keep people informed in many places, forums. Is this also part of the persistence, some kind of moral duty?

- I do not consider myself a prophet or a virologist, I am a simple ER worker. Our profession is not that complicated since we do not perform brain surgeries. What is important to us is that the patient has an airway, heartbeat, their nervous system works, they do not become hypothermic- we focus on such simple things. Nevertheless, I feel it is my duty and task to raise my voice. It is called public notification, this is the preventive role of emergency care, strange as it may seem.

Emergency is a very bad term because it is only urgent to see a doctor for those who feel sick. Those who come to us because they cut off a finger will certainly not be taken care of immediately unless there is purulent drainage. Many people are complaining about us calling ourselves emergency department, and of course they are right but this is what our department is called everywhere in the world.

Emergency does have a preventive role, a poster about stroke as well as a slide show or a spoken word. For me it is important to inform people, not just members of my family or friends. I like to tell briefly and clearly in these messages that it is necessary to use a mask, to keep your distance, wash your hands, and do not believe the virus deniers.

- All this is important also because autumn is here, people suffering from respiratory diseases and then the flu are coming.

- Moreover, the symptoms of influenza are very similar to those of the coronavirus, although the loss of the sense of smell and taste is not that expressive in the former, but it is present. I expect a major breakthrough from the machine we are likely to purchase in the near future, this is a simple PCR machine that can differentiate between influenza A, B and SARS-CoV-2 in twenty minutes. The supplier company does not have enough reagents to start with yet, but we are really looking forward to it and hopefully we can get it by December. This machine will make our job a lot easier. Such a machine already operates in Budapest, and it is planned that each university emergency department will receive one.

- Have you been tested?

- Yes, several times, and luckily all my tests have been negative so far. I am afraid of getting infected mainly because I cannot work then even though I am needed here, not to mention that no one likes to be quarantined. Several articles have been published about the fact that social isolation itself appears as an independent cause of death during pandemics. The number of suicides will increase and certain diseases will become more prevalent in humans. 

- In situations like this, it is really measured what kind of leader someone is, and how they can motivate their employees despite the difficulties.

- Fortunately, my colleagues are sensible people and understand the tasks. It matters a lot that we have enough equipment: masks, plastic aprons, coveralls in case we have to work with coronavirus patients. Having a comprehensive vision of what will happen if it ends, whether we will receive as much support as we do now, and whether people will understand the role of emergency would also be great things to motivate my colleagues. Not a day goes by without someone coming to us saying they would like a CT exam because they heard that here, at the emergency department, everything is done in one day. They are difficult to handle.

I can motivate my colleagues by being among them and doing my job, and in the meantime, we try to communicate in a way that does not hurt anyone. If someone makes a mistake, they can safely admit it, I do not reprimand them, I do not fire them and hurt them, but I try to learn from it too because that gives me feedback on what we still need to improve.

- However, during the spring period, we could also see how much people love you. You received a lot of support from people, and even delicious snacks more than once, which could provide strength and motivation for your fight.

- It really meant a lot to us. Unfortunately, voices denying the virus have intensified by now, which - as is the Hungarian custom - are manifested more than once in extreme reasoning and hatred, and I am very sorry about that. I do not want to get into that, I am not arguing. Sometimes a leader is also forced to take legal action to avoid people hurting his colleagues, unfortunately it has happened recently.

- Your phone rings every five minutes, you are constantly getting emails, people knock on your door - how can you return so calmly to the sentence that was interrupted in our conversation and maintain your composure?

- That is how I am put together. I love challenges, I do not collapse under the weight of tasks, and I am a “hurray” optimistic person. I get up every morning thinking that this day can bring something good too. I believe that life is beautiful and these beauties can be found in the little things. When everything turns upside down, I remind myself that I have three healthy sons. They are the present and the future, and they are worth fighting for. It was my father who did his thing without saying a word, it seems to be a family heirloom. If there is a task, it must be done, after which we can relax. As long as there is something to do, it comes first.