Interview with Bavarian COVID-physician Dr Thomas Parnitzke
by Dr Andrzej Turkanik
The following is an interview held on 14th of May 2020 and contains the professional and personal reflections of Dr Thomas Parnitzke on the COVID-crisis in Bavaria. It shows how Dr Parnitzke personally dealt with the medical intricacies and challenges of this new disease. The Interview was held in German and has been transcribed by Simon Wieser and translated into English by Stefanie Knecht.
This interview is part of the podcast series #Rethink, initiated by the Quo Vadis Institute in lieu of the COVID19-crisis. Rethink aims to challenge its audience and participants to do just that: rethink the approach to the world around us. The first three instalments of the podcast focused on healthcare professionals as well, and discussed the practical and ethical challenges with which physicians and nurses are currently confronted. During this interview, Dr Parnitzke was interviewed by QVI’s Director, Dr Andrzej Turkanik.
Dr Parnitzke is a senior physician at the hospital “InnKlinikum Mühldorf,” located in Bavaria, Germany. He is a senior anaesthesiologist, the chief of the hospital’s blood depot and medication provision, an intensive care consultant, and senior specialist in emergency medicine, hygiene, and transfusions. Bavaria is Germany’s largest federal state and also the state most heavily affected by COVID. As the “InnKlinikum” has four locations, the Mühldorf-location was selected to house all those suffering from COVID-19 and needing inpatient care. As a hygienist, Dr Parnitzke has been an integral part of the leadership of, and a frontline carer in, the newly dubbed “Corona-house.”
Dr Parnitzke, can you explain the job of a hygienist?
A hospital’s hygienist is responsible for ensuring that the rules and regulations with regards to hygiene are kept. It is the hygienist who recommends procedures and makes sure these are followed. Hygienists are supported by a team of trained hygiene specialists in order to cover the broad spectrum of responsibilities. These range from keeping the storage area of the hospital hygienic, which in our case houses the ventilation system, to monitoring the cellar, which is where the hospital’s water access point is located. Hygienists are responsible for keeping all of these operations running smoothly and hygienically. One of the most important ways of making that happen is to monitor the behaviour of the entire hospital’s staff. Of course, the overarching goal of a hygienist is to prevent cross-contamination and new infections of patients within the hospital.
I assume that the current COVID-crisis has made your job more crucial than ever…
Exactly. We are extremely overwhelmed and challenged at the moment.
We will dig deeper into those challenges in a moment, but I’m wondering how one becomes a hospital’s hygienist. What is your backstory?
Well, I’m not the youngest anymore… and I’ve had a long, winding professional journey. I started as a nurse, decided to study medicine, specialised in anaesthesiology and was very involved in the emergency department—even became head of the ER—and then decided to take on more roles in the hospital. I became a hygienist because I realised that I wanted to do something different in the last years before retirement. I wanted to commit myself to one last learning curve before my medical career ended and hospital hygiene seemed like the perfect venue. In order to become a hygienist, I absolved a two-year training programme parallel to my regular commitments, which familiarises you with the hospital’s hygiene protocol. And while I was in the training programme, I thought being a hospital’s hygienist would be a calm job, an ideal one before retirement. And I could not have been more wrong… but I also couldn’t have expected the current situation. No one could have expected it… no medical professional currently has ever experienced a pandemic. And what we are currently doing is partially only troubleshooting: a daily reaction to new challenges. It is a very difficult situation.
Many are comparing the pandemic to a war… during which some are fighting on the frontlines, and the rest is encouraged to stay at home. What do you think about the comparison? And how should individuals who aren’t directly confronted with the virus and its effects think about the pandemic?
First off, I need to state that it is our war. It affects all of us, even those who aren’t directly involved and who experience the virus as merely a theoretical possibility—as abstract. Many must be saying, “I don’t know anyone with COVID. No one in my family or wider community has had the virus…” Indeed, there are regions in Germany and Austria with very few cases, where people do not need to fear the virus. But it nevertheless affects us all, and there are different roles in this war. Some will be involved in operations and logistics—these are at the affected locations and deal with the direct ramifications of the illness. But others are also involved: they are required to put into practice regulations that will keep this pandemic in check, that will prevent the infection from spreading. What does that look like? Following government regulations, staying at home, so that those most at risk can be protected.
As a medic in a hospital, you are used to seeing suffering. Is this situation different from your previous experience?
What is different, is the illness. I had never expected that with my decades of experience in the medical profession that I would still have to learn so much… every day, I learn something new about this virus. This new information ranges from possibilities of infection to the core of the disease. We are experiencing COVID as a chameleon disease. There are new symptoms, new syndromes, we hadn’t previously encountered. We first met COVID as a pulmonary disease. In the meantime, we know that it is also a disease of the blood vessels, a blood clotting disease, a neurological disease, a cardiovascular disease… because when the blood vessels are affected, all internal organs are affected. And every day brings new information, some of which is quite shocking. The German public health institute, Robert Koch Institut (RKI), observes the infection daily and prescribes regulations for its containment. We had days when they changed those regulations twice a day. And you can imagine how that affects a hospital’s activities in a dramatic way… it was a constant challenge for our staff to change new habits and protocols short notice. For example, at first it was clear that the virus is a droplet infection, and then all of a sudden there was the hypothesis that it was an infection by projection of aerosol: the act of speaking is enough to project the smallest of droplets, which can linger in a room for hours. All of these findings remain unclassified. We don’t even know which ones are most relevant. We saw cases when only one individual of a whole household had the virus—asymptomatic and highly infectious. We called them “Super Spreaders”. They infect not only one other person, but 5-10 other individuals. In other households only one person becomes infected, and the others don’t. We have no explanation for this. So, not only the general population is left in the dark.
In addition to having to adapt to ever-changing regulations, what kind of challenges are individual medical practitioners encountering?
The RKI announced that a substantial portion of COVID-cases will have strong symptoms. Around 20% of COVID-positive individuals will need a hospital stay. 5% of those will need to be on the ICU. We initially assumed that COVID was like severe pneumonia, so-called Acute Respiratory Distress Syndrome (ARDS). And it is ARDS, but it is also different from what we typically have experienced, and there are now doubts whether we should be treating COVID in the same way as typical ARDS: with respiratory machines. These days we actually believe that certain patients should not receive intensive respiratory support. Another extreme challenge is the protective equipment all frontline workers must wear—a personal armour, if you will. We are talking about waterproof aprons and overalls, head coverings, FFB2 masks, glasses, two pairs of gloves… working in such conditions is extremely burdensome. We had expected this challenge more than others, as we had read the reports from China, but not the extent of its effects on the personnel was clear to us. And of course, then there is the issue that at any point you yourself can be infected. Huge challenges.
We’ve also heard about equipment running out for patients, for staff… ethical dilemmas arising. How do you deal with this kind of pressure? How do you make those difficult decisions?
I think every single medical professional will have to find a solution that works for them personally. My solution was in fact that I began every day with an intense time of silence and meditation. It was essential for me that I didn’t just stumble into the day, but that it was intentional: taking time to listen, as a Christian reading Scripture and praying. It was important to deal with the situations that had affected me. For years I’ve had issues sleeping due to stressful situations and night shifts. And there’s one story I’d like to tell: at the very beginning of the pandemic I watched a YouTube video of a personal trainer, also a Christian, telling his story. He retold the story from the New Testament that takes place in the middle of the sea of Galilee, and an intense storm that threatened to sink the boat carrying Jesus and his disciplines. And while his disciples were fighting the storm, Jesus was sleeping despite the chaos. The personal trainer told the story of when his child got heavily injured in an accident, and the only way that it could sleep is when he was sleeping beside it. He had this realization: that there is always a place next to Jesus you can lie your head down. This has become a mantra of sorts for me—it’s what I intentionally envision every evening. “Jesus, I lay my head down next to you.” And this COVID-crisis therefore has also had a spiritual element for me: I have been given sleep. Sometimes I still wake up in the middle of the night, but then I can come back to that place. Amidst the chaos, the storm, can I come to that place, become still, and sleep. That has been crucial in helping me overcome the daily challenges. Another element is exercise. Before the crisis I was doing intense physical workouts, something that wasn’t possible after COVID hit. However, I realised that once a week I need to go for a run in nature—5, 8, 10 kilometres—it has been both freeing and helpful for my mental balance. So those two aspects taken together have been my saving grace.
In a previous interview on 28th of March, when asked how people can manage, you answered, “Those who can pray, should pray.” What did you mean by that?
Exactly that. I was speaking to the Christians in my country, because I believe that this is also a challenge for the church. It’s our duty to pray for the world, for the people around us. COVID hit us hard here in Bavaria, and there were many who were anxious and afraid—even colleagues of mine. I believe it is our duty as Christians to pray for the situation, and for people in our communities. I personally found my duty to be praying for the hospital staff—and to ask for God’s protection.
Thank you for sharing such personal thoughts about your faith! How would you encourage younger physicians, especially those with less experience in the field, to overcome the hardships they’re facing?
I currently also teach at a nursing training school intensive care, pain management, and palliative medicine. At the end of a lecture I would show an official death certificate with my own personal information. What I was trying to say to my students was that regardless of whether you are a nurse, doctor, or surgeon, you will be best equipped for your job if you have dealt with the idea of your own death. You need to have answers for yourself. I have witnessed medics without answers—and they have difficulties interacting with gravely ill and dying patients. I don’t have an issue sharing what my personal faith is—even though I would never want to make anyone else feel uncomfortable—and I often simply point towards the centuries-long, Christian tradition of dealing with death. And I challenge my students to engage with that tradition. Who is this God? Who is this Jesus? Is it possible that he is present in our lives? That’s my personal answer, but I think young physicians need to see that these answers to life and death questions can be highly clarifying. They will give your life, your actions, and your career purpose. And I personally believe in a compassionate God who cares about and for every single individual. It’s my purpose to follow Him.
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