Medical trainee
London, UK
This essay is part of our new series, Flattened By the Curve, which features the voices of doctors, nurses, healthcare workers, and others on the front lines against COVID-19. For information on how to submit, click here.
Week One
I’m from New Zealand, so it took eight painstaking months before I was allowed to work as a doctor in the UK. I became a troglodyte, holed up in a dingy flat in West London, diligently studying for the General Medical Council’s registration exams day upon tedious day. I resented being shut indoors while the rest of the city went to work — self-isolation wasn’t in vogue back then. Occasionally I would entertain myself by peeking out through the shutters and hissing at passing groups of local schoolchildren. The sight of my monstrous eyes, grey and cloudy from lack of exposure to the sunlight, would strike fear into their youthful hearts and bring joy to mine in turn.
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, were banished from the outside realm into their respective homes for the foreseeable future, while I was elevated to the godlike status of an NHS worker. My services were in dire need and were recognized with a dedicated hour in the grocery store, hand-painted rainbows with messages of gratitude in windows, and special access to public transport. 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. The corridors and cafés still teemed with people; staff, visitors, and patients all rubbing shoulders, unaware of what was about to unfold. I was working in the adult assessment unit and was encouraged by my consultant to discharge an elderly, comorbid patient with a cough. She had been swabbed the previous day and we were awaiting the result, though the consultant felt the chances of her having the virus were low. Thankfully I didn’t risk sending her home because the next day her test came back as positive. She was a sincere, proud woman and when I revealed this fact to her she vehemently denied it, proclaiming it all to be a hoax and insisting she didn’t want to be a guinea pig for the NHS. I joked that in a way we were all guinea pigs, an insight she apparently didn’t appreciate.
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 to enter a war zone. An infectious disease specialist traversed 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. We were warned that we would never experience an event like this again in our lifetimes, and 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 three days and had barely worked out how to log onto the computers. I felt woefully unequipped to face this new frontier.
We were told the hospital would be divided into “dirty” and “clean” wards in an attempt to sequester the infection. This required a mass reorganization of patients and staff, and there was concern that some patients might be lost in the fray. A few of the other junior MDs and I spent that first day completely bewildered, following an equally bewildered consultant from ward to ward, in an attempt to ensure all of the medical patients were accounted for, had adequate management plans, and were moving to the correct location. All sense of the usual workplace hierarchy was obliterated as it became obvious nobody really knew what to expect or what their roles were. The directions from management came in fragmented murmurs and changed by the hour.
We were given new rosters: twelve-hour shifts, three days on, three days off, alternating between two sets of day shifts and two sets of night shifts. This was actually a vast improvement over the rosters I was used to back in New Zealand. My cohort was assigned to the “dirty” ward for patients aged 70 and over. The connotations made it feel like we were working in a leper colony in the 1800s. Handover was to be held in a large lecture theater twice a day, and we were to enter via a separate door marked RED ENTRANCE, presumably written with the blood of a freshly slaughtered spring lamb. We had separate areas to eat and socialize socially isolate. I wondered how long until I’d be required to wear a crimson T-shirt emblazoned with the phrase UNCLEAN: AVOID AT ALL COSTS. I went home for the weekend with a growing sense of unease, expecting the worst upon my return.
Much to my surprise, the working environment had vastly improved when I returned on Monday. The hospital was suddenly much quieter and calmer. We were now only responsible for the patients on our assigned ward — a stark contrast to the usual system whereby ward rounds are reconnaissance missions that have us patrolling the entire hospital grounds and nearby parks and recreation areas in search of our patients. The novelty of the situation meant we developed an immediate bond with the nurses and therapists, making day-to-day tasks much easier to achieve. In addition, much of the administrative burden that makes up a bulk of the junior doctor role disappeared as the hospital suspended all non-urgent activities. We had sixteen patients on a ward that could accommodate thirty-two, staffed with four junior doctors and two consultants. This pandemic was going to be a doddle. We basked in the camaraderie and adoration from the public as we feasted on gifts of Krispy Kreme and cupcakes. Finally we had arrived in the promised lands of medicine: this was what being a doctor was supposed to feel like.
The most problematic part of that first week, in fact, was that it became a lot harder to avoid beggars on the tube. It was suddenly much more difficult to stare down at my phone and pretend I hadn’t heard their pleas when I was the only other person on the carriage. After I patted my pockets and apologized for not having any coins, one cheeky bastard asked if he could get off at my stop and follow me to a cash machine, to which I agreed out of pure awkwardness. My final attempt to get rid of him was to explain that I was an unclean doctor and could potentially be infectious. This didn’t deter him, and I eventually ended up handing over £20 out of sheer embarrassment. Damn it.
Week Two
It’s amazing how quickly being regarded as an essential worker goes to one’s head. As a doctor I already had an inflated sense of self-worth, but now people were literally applauding me in the street. Not only that, but the BBC had started filming a documentary at the hospital, so I basically felt like a celebrity. It was exhilarating. I felt like I could storm into a Tesco at any given moment, proudly brandishing my staff ID badge while proclaiming, “It is I — the NHS worker! Move aside, peasants. I require sustenance to fuel my vital work.”
I did have the wind taken out of my sails briefly with the realization that my new special status was also awarded to supermarket workers and bin men. I mean, there are key workers, but then there’s key workers. Surely there needs to be some sort of tiered system implemented so the public knows to whom they should bow down the deepest? Even more troubling was that there were now volunteers trying to muscle their way into the front lines like scoundrels. There’s only so much praise to go around, goddamn it! I was leaving work one evening after a hectic shift and actually caught myself thinking, “Why am I getting the tube? People should be lining up to give me a ride home.” It was at this point I realized it might be time for an ego check.
But it wasn’t just my ego that had jumped up several notches: scores of health workers across the country had suddenly become fully-fledged journalists with a flair for the dramatic. Every twelve minutes, news sites would publish another article written by a heroic front-line worker documenting life in the trenches. My favourite was by an A&E doctor in London who was bordering on martyrdom when he declared to the public that, “If we get sick when you get sick, we can’t help you. That’s our biggest concern. We don’t care about ourselves.” He then went full David Brent by following it up with the line, “I’m usually seen as ice-cool, but I’m full of dread and foreboding.”
Jokes aside, the situation on the ward was getting quite dire by this point. We were now at full capacity. Our PPE provisions kept being downgraded, and were now well below WHO recommendations. We were tending to infectious patients in flimsy plastic aprons and breezy surgical masks, while Johnny-on-the-street was walking around dressed like Darth Vader. As supplies continued to dwindle I feared that we’d have to resort to holding an A4 sheet of paper in front of our faces when examining patients before long.
Uncertainty about the virus permeated the hospital as patients’ conditions fluctuated wildly. An average of two patients were dying per day on our ward. One man on maximal oxygen therapy, who was sitting up in bed and asking us how sick he was in the morning, was dead by the afternoon. The speed of his deterioration caught us all off guard. Another patient took a turn for the worse, so I solemnly called her son advising him to come into the ward — a privilege we were granting 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, joyfully eating from a pottle of yogurt, and making me look like a right pillock. The son had questions about the expected course of the illness, but 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 when he arrived and wasn’t expected to survive, so the focus shifted to keeping him comfortable. Active treatment, routine observations and labs were all ceased. However, 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.
This day ended with the death of another of our patients. The rigmarole of writing up a death certificate always feels sterile and grim, but especially now, as I knew the information was being used to update the daily death totals which were being consumed by the public like sports statistics. When completing a death certificate, I am legally required to list all conditions that could have contributed to the patient’s death. Problematically, as there is so little known about the virus, it isn’t always clear that COVID-19 directly caused death. This particular patient had died from aspiration pneumonia, which is frequently fatal, but he had also been infected with the virus. It was impossible to know which illness was directly responsible for this patient’s demise so I included both of them in the ‘main cause of death’ category. I couldn’t help but think that this decision was driven in part by public attention surrounding COVID-19. I went home that night with a heavy heart hoping for a better day when I returned, but I arrived on the ward the following morning just as two more patients passed away. I had a distinct feeling I’d be eating a lot more Krispy Kreme before this pandemic was over.
Nic is a doctor who trained in New Zealand but now lives and works in London.