Wales Arts Review brings you a firsthand account of life on the ward as a junior doctor during COVID-19. The COVID Diary of a Junior Doctor unpicks the daily trials and emotional toll at the front line of the NHS during April and May, at the peak of the crisis, and questions a narrative that views medical professionals as heroes, risking their lives to save others. The experiences of our anonymous Junior Doctor strongly argues that the risk to lives was a result of a lack of preparation and fast movement by those in the highest positions of authority.
Monday 13th April
As a junior doctor in a training post, I am a resource to be redistributed. Along with many of my colleagues around the country, I have been moved from my day job onto an emergency rota, covering the adult medical wards – patients with COVID-19, and those unfortunate enough to end up in hospital for other reasons at this time.
What was strange was that they probably overdid it, redeploying too many of us. So after preparing myself for what I thought was going to be like a kind of warzone, I spent the first ten days of redeployment reading novels in my back garden. My ward hadn’t even been opened. And it still hasn’t been yet. We are starting to think that the curve in my city might be less dramatic, flatter, longer; a prolonged period of major disruption but not the catastrophic onslaught that we initially feared.
Finally, after several days of unseasonal sunshine, existing in a peaceful parallel universe: my first day on the wards.
I report to the Medical Workforce, who are doing a shambolic job of coordinating where the juniors go every day. They tell me to go to the fourth floor, to a ward that has been designated ‘clean’ as it has no patients with confirmed or suspected COVID. In our hospital, the management have made the practical and somewhat symbolic decision of putting COVID patients on the upper floors first, the plan being that as we get more COVID positive patients, wards lower down in the hospital will become COVID wards too. At the moment, the fifth and sixth floors are designated COVID floors. I arrive on floor 4, currently still ‘clean’.
On the ward I meet my new consultant, Dr B. His team is composed of a mishmash of specialists who, like me, have been redeployed from their usual roles. Dr B is a neurologist in his usual life; there’s also a surgical registrar and an SHO (senior house officer) who normally works in dermatology. They were meant to have another team member, but she never showed up – a mystery of the hastily thrown together emergency rota. So they greet me, an unexpected pair of extra hands, with enthusiasm.
Although I’ve never worked on this ward before, everything about it is familiar. The patients, the nurses, the blood results and discharge planning. Everyone is wearing masks and aprons (we don’t have the long-sleeved gowns that the WHO recommends), and there is a lot of delicious free food donated by local businesses, but other than that, it doesn’t feel that different from any other day. I start to think that, as I’ve been sent to a non-COVID ward, I may have escaped the worst of it, and that I can quietly get on with my job and feel like I’m helping without being stuck in the thick of it.
That feeling changes when a nurse asks me to urgently review a patient whose oxygen saturations, which should be around 98-100% in a healthy person, have suddenly dropped to 75%. It’s Mrs P, a 50 year old admitted with what we think is a bacterial pneumonia, and who has tested negative for COVID. We start her on oxygen and order a chest X-Ray. It comes back looking terrible – signs of widespread lung damage that we have learned are typical for COVID-19. Not the lungs of a healthy person, nor the lungs or a 50 year old with ‘normal’ pneumonia. We repeat the COVID swab, suspicious, given the 30% false negative rate. What else could this be? What else sends a previously healthy 50 year old into crashing respiratory failure? We spend most of the day with her, watching her slowly deteriorate. We come in the next day to find she was admitted to ITU overnight and is on a ventilator.
Tuesday 14th April
They’ve allowed the final year medical students to qualify a few months early to help out with the crisis. The rota coordinator calls them ‘newborns’.
They arrive in freshly laundered scrubs, looking clean and rosy cheeked. They’ve been given more training than we have on how to treat COVID patients. They had a whole tutorial on how to turn a patient ‘prone’, or onto their fronts. For reasons that we don’t fully understand yet, some patients with COVID seem to do better when lying face down – something to do with ventilation to the bases of their lungs, maybe. The medical students tell us that the proper technique requires 6 people and a ‘proning sheet’. We’ve never heard of a ‘proning sheet’.
We have another patient on our clean ward today who probably has COVID. An elderly man who suddenly develops an impressive temperature of 39.3 degrees Celsius. His repeat test comes back negative too. It feels absurd to base any sort of decision on this result given the false negative rate, and he is moved to a COVID ward too. I later learned that his third test came back positive.
As soon as these patients are moved from our ward, they become the responsibility of another team – not our concern any more. Except that I have started looking at the hospital computer system a couple of times a day to check up on the people we have sent to other wards. Checking they’re still alive.
Saturday 18th April
I’ve been thinking a lot about the way the media has framed the role of healthcare workers in the UK within the context of this pandemic. We are being called ‘heroes’, lauded for our bravery, our selfless dedication to the cause, our sense of vocation. The military language is a bit alarming; apparently we are ‘risking our lives’ on the ‘front line’. Every Thursday evening, people take to the streets to give us a round of applause. Being an NHS employee in this country at the moment brings a strange sense of celebrity. You get discounts in shops, free stuff and you can skip the supermarket queues if you flash your hospital ID.
It’s so nice that people are grateful, and I know that this comes from the heart for a lot of my friends and family, but there is something I find troubling in it too. I don’t particularly want to be a hero. I certainly don’t want to risk my life. I don’t remember that ever being part of the deal. We don’t have enough PPE because the UK missed several opportunities to buy it. Our Prime Minister didn’t act quickly enough to lock down and slow the spread of the virus. If healthcare professionals are dying (they are), then it’s not because they’re noble heroes who have made a selfless sacrifice; these people did not ‘give’ their lives. They have died, partly because this is a situation that nobody could have fully anticipated or prepared for, yes; but also partly because their government has failed to protect them while they do their jobs.
On top of that, the government has been systematically cutting funding to the NHS over the last ten years. The same politicians who voted against a pay rise for nurses, who cut bursaries for nursing students and who introduced a new contract for junior doctors (which was so unpopular that it led to the biggest strikes in living memory) are the ones who are so cynically putting us on a pedestal now. The NHS has been abused by the same people who now applaud it. It’s a convenient diversion tactic away from the enormous mistakes made by the government in the run-up to this crisis against a backdrop of chronic underfunding of public services.
So, I’d rather not be called a hero. (Apart from anything else, I find it faintly embarrassing when I’ve spent the majority of the last few weeks sunbathing in the garden). It’s rhetoric that (deliberately, probably) misses the point entirely. If healthcare workers (or supermarket workers, bus drivers or rubbish collectors) die, these are tragic, preventable deaths. They should not be swept under the carpet in some waffling, sentimental ideology of duty and sacrifice. It should provoke anger and fury as if this really was a warzone and we were being sent in without guns or helmets, or whatever soldiers have.
Saturday 9th May
There is an elderly man on our ward who is in because he fell down the stairs at his home and broke his arm. He lives alone, and normally his three daughters help him around the house, keeping him company as much as they can. Since the lockdown started they haven’t been able to visit, although they have still been delivering his shopping and calling him on the phone. On the ward round he starts to cry. He tells me that last year, his wife died, followed by his closest friend. This happened in the space of a few weeks. He says he’s never been able to get over it. I remark that this probably isn’t something you simply ‘get over’. He says that at Christmas, he had a ‘breakdown’. He doesn’t tell me exactly what happened. He is from a generation that rarely talks about its mental health, and when it does, it does so exclusively in euphemisms: breakdown, my nerves, a bit fragile. At home, a community mental health nurse has been visiting him several times a week. Things were getting better, but then the lockdown started and he hasn’t been able to see his daughters. The mental health nurse cut down her visits in line with the new rules on social distancing. He doesn’t want to leave hospital, and is scared of going back to his house where he feels so lonely. Here at least there are people to talk to.
We’ve started seeing a lot of patients with mental health problems. Mainly, it’s people who have taken overdoses and require a medical ‘all clear’ before the psychiatry team will see them. I bump into one of the psychiatrists on the ward; she says she had very little work for the first few weeks of the lockdown. Now, she has never been busier. The mental health effects of this crisis are insidious, but two months in, the strain is starting to show. Later that evening, walking home from my shift, I call my friend, an ENT surgeon in another city. She tells me a horrific story about a patient she saw on call. He had paranoid schizophrenia and had developed an obsessive delusional belief about coronavirus contaminating him through his ears and eyes. Tormented by his thoughts, he cut off his own ears and attempted to gouge out his eyes.
Monday 11th May
A manager comes to visit our ward. She is looking for patients to send to the new field hospital. Whenever I hear the expression ‘field hospital’, I imagine a scene from the First World War, soldiers with amputated limbs and nurses dressed like Florence Nightingale. Our field hospital has actually been built in a sports stadium, the pride and joy of our city, and patients will be looked after in what would usually be the hospitality boxes. I worked there as a student, serving drinks to fans (the tips were good).
I ask the managerial person what kind of patients they are looking for. ‘Patients with COVID,’ she says, (we don’t have any – as soon as someone tests positive they are sent to a COVID ward) ‘but nobody who is too unwell with their COVID’ (the field hospital doesn’t have an Intensive Care Unit, or a particularly reliable oxygen supply). She doesn’t want anybody who is too well with their COVID, either – they should be going home to self-isolate. Nobody with complex mobility or self-care needs (they don’t have the facilities to cope with these kinds of patients). Nobody who is elderly and confused, with a tendency to wander (it’s not safe in the new hospital – too easy to get lost).
I remark that these criteria seem to exclude most of the patients in the hospital. I ask why we are even sending anyone to the field hospital, when we, the main hospital, still have plenty of empty beds. The manager gives me a bit of a look and says that she doesn’t think we should be sending anyone there either. It’s not as well equipped as the main hospital, but the executives have spent a lot of money on it and there’s been a lot of publicity, so they are under a lot of pressure to show that it’s a big success. So far, they’ve identified five suitable patients, but she needs to find more. I suggest she tries the sixth floor.
It’s so disappointing to me that even in these times, the people at the top of the hospital management system seem to prioritise getting the right publicity above the welfare of our patients. I think it’s brilliant that they responded so quickly to develop the field hospital: had the situation in this part of the country been as bad as we had feared, it would have been an indispensable resource. But it wasn’t.
There are similar field hospitals in other UK cities that have barely been used. If media reaction really is so important, why not sell this as a success story? ‘See how prepared we were? Our Health Service was ready, and it was never overwhelmed’. Instead, we seem to have decided to use our patients as pawns in a bizarre political game, shifting them from place to place to comply with an imaginary scenario.
Monday 18th May
This week I’m ‘on take’, which means I’m based on the Medical Assessment Unit, seeing patients who have been referred to the medical team by A&E or their GPs. I’ve been allocated to the Clean Team, so I don’t see any suspected COVID patients – they don’t want the same staff working in both ‘clean’ and ‘dirty’ areas, running the risk of spreading the infection to more areas of the hospital. The regular team on the Medical Assessment Unit tell me it’s been eerily quiet – the ‘usual’ medical patients (people with heart attacks, strokes, kidney infections, falls) just haven’t been coming in. But the lockdown has been going on for a few months now, and it’s slowly but surely starting to get busy again.
I see a lady in her sixties, referred by her GP because her husband is worried about her. He says that she’s been a bit muddled for a few weeks, has been forgetting things and is sleeping a lot in the daytime. I call the patient in and she’s friendly, charming, and completely lucid; a retired school teacher. She sings the praises of the hospital, the kindness of the staff, how hard we are all working, the wonderful nursing student who brought her a glass of water. She convincingly dismisses her husband’s concerns (he isn’t there to contradict her, as we can’t allow relatives to come in at the moment). He’s just overreacting, she says; she’s been a bit down because she can’t get out and about to see her friends, that’s all. She’s been sleeping a lot because there isn’t much else to fill the days. She does have a bit of a headache, it’s always there when she wakes up over the last few weeks, but that’s all, and it’s not too bad.
This is the type of story that frightens me – just a headache, and the question of a subtle change in behaviour, which could so easily be dismissed. While taking the history and examining this lady, I am half-inclined to dismiss it myself: there isn’t much out of the ordinary to comment on. But the story is enough to warrant a head scan. And when the pictures come back they show a six centimetre mass in the right frontal lobe of her brain. So then we have to tell her. I can’t bring myself to make eye contact with her as we walk together into the room where we’re going to break this life-changing news, tell her this thing that will change everything. And she’s all on her own: even now, we can’t allow anyone to visit her. The story goes around and around in my head for days. I keep imagining being told that news, and being alone to hear it. It’s unbearable.
People are still being diagnosed with brain tumours. We are still breaking bad news, giving treatment for chronic conditions, dealing with victims of car accidents, delivering babies. On a selfish level, the fact there are no visitors on the wards makes the job easier – in normal circumstances, with visiting hours every afternoon, a fair amount of time is spent updating concerned relatives, explaining, reassuring. But when I think of the times I’ve had relatives of my own in hospital, it breaks my heart to think of not being able to visit. If I am ever a hospital in-patient myself I know the one thing I’d want above anything would be to be able to see my family. COVID has affected our ability to care for our patients in so many ways. The new visiting rules are just an extension of this, a side story, really. But it’s never hit me in quite the way it does today, just how lonely this must feel.