As the UK records its deadliest day so far, with 980 deaths in 24 hours surpassing the worst seen by Italy and Spain, a New Zealand doctor reports from the frontline of a London hospital.
It took eight painstaking months before I was allowed to work as a doctor in the UK. I became a troglodyte, holed up in my west London flat, diligently studying for the General Medical Council’s registration exams day after tedious day. I resented being shut indoors while the rest of the city went to work – self-isolation wasn’t considered cool back then.
The week I started my first hospital job was the week the lockdown began. Suddenly the entire population of London, along with a fifth of the world, was banished from the outside realm into their respective homes for the foreseeable future, while I was elevated to the godlike status of an NHS key worker. As a doctor I already had an inflated sense of self worth, but now I was being given special access to public transport, had a dedicated hour in the grocery store and was literally being clapped in the street. Never before had I experienced such a violent turning of the tables.
For the first few days on the job, the hospital, like the rest of the country, didn’t appear to regard the rapidly spreading virus as a matter of much importance. Clinical life proceeded as normal. The corridors and cafes still teemed with people; staff, visitors and patients all rubbing shoulders, unaware of what was about to unfold. But by Friday of the first week, the serious switch had been flipped, and the whole hospital was thrown into upheaval.
The atmosphere was tense, as if we were preparing for war. An infectious disease specialist prowled the halls, giving impromptu lectures to groups of scared staff, comparing the approaching situation to the 1918 Spanish flu pandemic. There was stunned silence as he prepared us for the worst, explaining how we stood to lose an entire generation of people. I felt a distinct pang of guilt that I hadn’t been taking the matter more seriously myself, though mostly I felt nervous. I had only been in the NHS for four days and had barely worked out how to log onto the computers. I felt woefully unequipped to face the new frontier.
The hospital was divided into “dirty” and “clean” wards in an attempt to sequester the infection, which required a mass reorganisation of patients and staff. All sense of the usual workplace hierarchy was obliterated as it became obvious that nobody really knew what to expect or what their roles were. The directions from management came in fragments and seemed to change by the hour. My cohort was assigned to the “dirty” ward for patients aged 70 and over. We were segregated from our “clean” colleagues for all hospital activities. I went home for the weekend with a growing sense of unease, expecting the worst upon my return.
To my surprise, when I returned on Monday the working environment had vastly improved. The hospital was suddenly much less chaotic. The novelty of the situation meant we developed immediate bonds with the nurses and therapists, making day-to-day tasks much easier to achieve. In addition, much of the administrative burden that makes up the bulk of a junior doctor’s role disappeared as the hospital suspended all non-urgent activities. We basked in the camaraderie and adoration from the public as we feasted on gifts of Krispy Kreme and cupcakes. I thought to myself: “this pandemic is going to be a doddle”.
That illusion faded fast. We are now in week three, and the situation on the ward is getting quite dire. An average of two patients are dying per day on our ward. It’s not that these are unexpected deaths – the patients are all elderly and frail – but the frequency is greater than what I’m used to. Difficult decisions about resuscitation are being made more rapidly than normal and are in part driven by a lack of available resources. We are at full capacity and several staff are off sick. Our PPE provisions keep being downgraded and are now well below WHO recommendations. We are tending to infectious patients in flimsy plastic aprons and breezy surgical masks while Johnny-on-the-street is walking around dressed like Darth fucking Vader.
Patients’ conditions often fluctuate wildly. One man on maximal oxygen therapy, who was sitting up in bed and chatting to us in the morning, was dead by the afternoon. The speed of his deterioration caught us all off guard. When another patient took a turn for the worse, I solemnly called her son advising him to come to the ward – a privilege we can currently grant only to the closest relatives of the imminently dying. By the time her son arrived, the patient had made a full U-turn and was sitting up in bed, happily eating a pottle of yogurt. Her son had questions about the expected course of the illness; I couldn’t provide any answers.
The daughter of another patient approached me in the hallway. Her elderly father had been hospitalised with the virus the previous week – he was in a critical condition and wasn’t expected to survive, so the focus shifted to keeping him comfortable. Active treatment, routine observations and labs were all ceased. It was now a week later, and his daughter had questions: what if Dad had recovered from the virus but wasn’t improving because he was barely getting any nutrition? How could we be sure if we’d stopped taking measurements? Was it possible that we had “given up” on her father too early due to the uncertainty regarding the nature of the virus? Again, I didn’t have a satisfactory answer.
In addition to the uncertainty regarding patient management, it’s unsettling to know that my paperwork is being used to inform the public. When completing a death certificate, I am legally required to list all conditions that could have contributed to the patient’s death. This goes to the deaths registry, which is then used to inform the daily Covid-19 death tolls. Problematically, as there is so little known about the virus, it isn’t always clear that Covid-19 directly caused death, but these are still included in statistics attributed to the virus, which I fear may be leading to widespread misinformation.
All we can do is keep moving forward. In the meantime, I only hope the lockdown helps ease some of the burden here. It certainly seems to be doing the trick back home.