Martin Cermak

The anaesthesiology and resuscitation ward is not a place one would look twice.

We are all the more surprised when we come across a smiling and very positive doctor. "I guess it's some kind of defence, otherwise we'd go crazy here," he laughs. Martin Čermák has been working at Příbram Hospital since 2011 - and this is the story that brought him here.

I come from Mokrovrat in the Novoknín region. I went to high school in Dobris and I was already interested in natural sciences, biology and chemistry. I graduated from the first medical faculty, which was oriented in a general direction, so we had insight into all fields. The only job I found after school was in the internal medicine department at the Hospital of the Sisters of Charity of St. Charles Boromeo in Prague. I enjoyed that job, but I did it for a year practically for free.

The beginnings were difficult. When you come out of school as a doctor, you have a diploma and a lot of theoretical knowledge, but you don't really know how to treat people. You only become a doctor when you learn how to put things together. And that's what you learn your whole professional life.

Then a vacancy opened up in the A&E, and that's how I got into intensive care. I worked under Petřín for thirteen years, then I moved to Příbram and I've been here since 2011. Intensive medicine is the closest to my heart because I see the meaning in it. When you take care of a patient with a fifty-fifty chance of survival and the treatment works, the feeling is indescribable. There is a downside, of course, a lot of people die in intensive care because the conditions are often intractable and even with our treatment we can't work miracles. Then comes the difficult decision of who else to treat and who we are actually harming and only prolonging their suffering.

Unfortunately, we have a lot of such decisions to make. The scenario is often that the ambulance service brings us an unconscious patient. We don't know anything about him. We don't know what's wrong with him - that's what the medical textbook is all about. It's particularly difficult in young people if it's something sudden like an acute brain haemorrhage that cannot be operated on and it's clear that the patient is going to die. Then there is the social and ethical dimension to it: for example, knowing that the patient's organs can be given to another recipient and save someone else's life.

One has to be pretty emotionless. We are under pressure every day to make decisions about people's lives, and those decisions have to be the right ones, not only professionally but also ethically. We have to get away from that, but it's not always possible. It happens that my colleagues call me at home and need advice on something, and you still can't stop thinking about some things. I have to do something else to keep myself from going crazy - I have a family, children, I like music, I like watching movies, I like going out in nature. The kids are small, so I learn with them and play with them, and it's such a nice relaxation that you completely switch off.

The coronavirus started to be addressed in our country when we saw the first news from Italy. At the beginning of March, a crisis staff was set up, the hospital closed for visitors, planned operations were postponed and nobody really knew what would follow. We reserved beds for "covid" patients, ordered additional breathing machines and started to find protective equipment. Although fewer were needed at the beginning, we never felt that we had nothing to protect ourselves with.

When the first patient came to us, who was in a very serious condition and had the worst course of the disease, our ward began to operate in a completely different mode. Every time we went in to see him, we had to put on full protective gear - boots, gowns, and of course we had a respirator or a mask with a filter and three gloves. It was terribly difficult to work in that, and once I was in that mask for about two hours and I really thought I was going to pass out. But we had to protect ourselves because the absolute worst case scenario would have been if we all got infected from that patient. That would have been a meltdown for the hospital. and you can't ask a skin doctor to operate a ventilator.

We have several scenarios in place now, and we're still able to take care of any potential patients even if a second wave were to come. I just think it's going to be with less hysteria. But at the beginning, nobody really knew what was going to happen. Even I myself was afraid of getting infected or infecting someone. There's a lot of other things going on in your head, and you're suddenly afraid of things you wouldn't otherwise be.

We just expected it to be worse. I was surprised, for example, by the wave of solidarity from people. For example, we were dealing with how to communicate with the nurse who is locked inside the infection box. We thought that baby monitors would help - and one link on Facebook meant that we got about five of them. People also sent us coffee and snacks. So the Chief Medical Officer and I agreed that it wasn't so necessary to have any additional benefits, and we gave up the "covid" extras. We thought that was fine - and maybe the hospital will use them differently.

■ Text: Václav Bešt'ák, photo: Karolina Ketmanová