I came away from a brutal round of night shifts feeling shattered and exhausted. There was nothing particularly bad about them, but I felt desperately emotional. Adjusting to Covid medicine has been hard. Not in terms of patient numbers or workload, but rather the upheaval and psychological ramifications. In my experience, workload has been manageable. I used to be responsible for over a hundred patients on a night shift, since Covid, the most I’ve looked after is nearer twenty. It’s hard to put into words what exactly is so draining.

The stakes in medicine always feel high. You pour your heart into your work. You walk the line between life and death. You console families, quell patient anxieties. You are constantly learning, striving, pushed beyond your depths and capabilities. You are forced to adapt to change, many changes, on a constant basis that is so often beyond human capacity. Covid has heightened all these things a hundred-fold. Like everyone, we’ve had to adjust our work life, at a far faster pace than we can cope with.

I’m feeling my way at work. We all are. We turn to each other and realise neither nurse nor consultant has any more experience in handling a pandemic. I keenly feel my inexperience, my clinical practice mere months in the making. I’ve been a doctor eight months and now all bets are off with what responsibilities I’ll take on in this time of crisis.

You learn to step up.

The most basic factors can make you feel derailed. I struggle with night shifts. I’m a natural lark and I find the nocturnal disruption disconcerting. Sleep is broken. I’m often too exhausted to exercise and I’m out of kilter with the rest of the waking world. it’s difficult to feel mentally sound if you can’t get the basics right.

Our rotas and teams have undergone huge changes. I’ve had to get used to new team members and personalities. Understanding the expectations of your seniors has been the most challenging part of working as a doctor, especially as it is a system built on hierarchy. I’ve met seniors who have not taken well to the changes themselves and thus take it out on their juniors. I’ve felt patronised and demoralised, add in sixty hours of night shifts in under six days and my confidence hit a new low. I felt more lost in the system than ever before and found it increasingly hard to see any positives or affirmations in my work.

It’s difficult to find your way amongst the unknown. To work through muddied waters. I’m hugely grateful for my first placement in Infectious Diseases (ID). It gave me knowledge and confidence in navigating diseases invisible to the naked eye. It eased my stigma – taking blood from patients with HIV, frank discussions alongside patients with tuberculosis. I learnt first-hand how effective good handwashing is when looking after a patient with norovirus, escaping the onslaught myself despite close proximity.

Infectious diseases taught me to see people before their diagnosis. We all have an ingrained instinct to recoil from someone with an infection. You’ve probably done the same when your friend had a winter cold or bout of tonsillitis. ID drew my awareness to infection stigma in health care. The avoidance of practitioners in seeing a person diagnosed with an infectious disease and misconceptions in disease transfer, particularly in hot spots such as walk in centres or A&E. ID taught me that by taking the right safety measures, there is no reason you can’t look a patient straight in the eye. I see so many healthcare workers recoiling from patients with corona, too anxious to even talk to them. It’s so crucial to care for patients without making them feel like lepers, this pandemic is difficult enough without us carers exacerbating feelings of isolation. Our patients deserve to not be alienated. It takes learning, experience and knowledge to break this stigma, and of course the right protection.

Let’s talk about PPE. Personal protective equipment. It’s currently big news, and for good reason. It makes all the difference in protecting everyone and avoiding the spread of disease. It’s why I wear a mask to the supermarket.

The rules for what PPE we wear keeps changing, mostly it seems, depending on what stocks we have. Full gowns, FFP3 masks (duckbill shaped with elastic taught to the face), double gloves, goggles, caps and visors are known as full PPE. These are reserved for intensive care or aerosol procedures, where the risk of infection is extremely high. For the rest of us in the hospital working with corona positive patients we wear surgical masks, glasses, gloves and plastic aprons. We might examine, take blood, insert cannulas or counsel them. We are in close proximity, certainly closer than two metres.

PPE shortages are terrifying and real. I worked on a query corona ward – patients with symptoms yet awaiting test results. The masks I was given were not the surgical masks with the wire nose bridge and ribbons which can be tied tightly around the head (used effectively these offer 93% protection.) Instead, I had masks with elastic hooked round the ears. The sides gaped and sagged – useless against corona. I tied the elastic tightly round my ponytail to offer slightly more adequate protection and went off to pocket some proper surgical masks.  After hearing of a patient spitting at a porter in the corridor, I now wear my mask at all times, not just when seeing patients. Interestingly the deaths of healthcare workers are not in ICU where adequate PPE is a given and is ingrained in their work culture, but places where we get caught out, where protection is substandard, where we are not looked after.

Due to being on the night team, I missed out of the formalities and infrastructure of the day. Who is going to be around 8 pm to tell me the rules have changed and where to access all the right stuff? I wouldn’t have had a pair of glasses were it not for a particularly maverick consultant who snuck me into theatre and gave me some from a secret stash. I see doctors bringing in their own superior masks bought in bulk off the internet. In nearby hospital, there was talk of using bin bags because they were running out of plastic aprons. I ask myself, is this really first world medicine?

We currently know very little about the disease process of corona. My perspective is to liken corona to radiation. Each time I see positive patients I absorb more of their viral load. This may have little effect on me as a young healthy person but who knows what the long-term damage may be. It could be that my immune system is fighting it off. It could be that with every exposure my lungs are building scar tissue. Like handling radiation without gloves, without the right mask who knows how this condition will metastasise after going back into Chernobyl day after day.

For optimum protection, we limit our exposure to patients to the absolute necessary. I find this immensely sad and difficult about my change in medical practice. My favourite part has always been talking and connecting with people, seeing medicine as so much more than just a diagnosis. What constitutes as necessary? A patient is distressed, lonely, frightened – do we purposely not see them? We’ve put up barriers with curtains, doors, and masks. They see bodies move like spectres behind Perspex glass. With every added layer of defence, we lose connection, and yet those barriers also allow me to disconnect, detach and cope with whether or not somebody will die.

I can see how frightening and lonely it is to be hospitalised with corona. I’ve witnessed anxiety be confused with breathlessness, an impending doom of death by suffocation. When I’m bleeped with escalating respiratory rates, sometimes my antidote is reassurance and support. Their breathing calms. I’ve learnt to extend my smile to the crinkled corners of my eyelids and provide the precarious balance of comfort, hope and realism. I’ve learnt that so much of your communication comes from your eyes and facial expression, noticeable from even behind a mask. I’ve learnt to do all I can to support families and provide a link from the hospital bed to beyond our doors.

Patients take the news of a corona diagnosis differently. Some are unfazed, having attended hospital with another ailment and appear genuinely surprised at their diagnosis. Other patients are terrified and struggling to breathe.

We have not yet the data, science or experience to understand how this disease moves, we can only guess and thus often don’t know the answers. As part of new protocol, we have to discuss resuscitation and death with every patient who tests positive. Whether they are under forty or over eighty. How do you broach that conversation with someone who’s never once thought about their own death, who until a few days ago was in perfect health? How do I, as a twenty-six-year-old first year doctor, open that discussion? How can I make that conversation as appropriate and kind as possible? How do we keep the end in mind?

I was directed to Dr Kathryn Mannix’s book of the aforementioned title, to ease myself with death and dying. My sentences are still clumsy, but I’ve found you learn by repetition and trying. A grounding of compassion is the essential foundation to any difficult conversation. I make effort to improve each time.

My heart hurts with every step I take through the hospital. I feel adrift. Swallowed by its infrastructure. So often you feel like merely a body propping up the health service. Would anyone notice I weren’t here other than as a gap in the rota? I miss wearing my dresses to work, a hint of personality as I’m swept along in a sea of blue scrubs. I see my familiar colleagues so infrequently as rotas and shifts alter and staff are deployed. Patients come and go swiftly. No-one hangs around here for long if they can help it. The work can feel gruelling without the light relief of teaching, team building and educational opportunities. I feel the limitations and repetition of a single illness being at the forefront. I miss the variety. We are all wondering where are the heart attacks, cholecystitis, delirium, appendicitis? Are people too fearful to leave their homes, gritting their teeth through life threatening illnesses? Our low numbers of anything other than COVID have us all worrying if these people are where they need to be.

When healthcare feels overwhelming and burdenous you hold onto even the smallest of things. My favourite registrar seeing me in tears and asking if I’m OK. A consultant bringing us all the best Easter treats from M&S. Watching Pretty Woman during an especially sedate shift. Making effort to get to know the nursing team on shift and laughing at our abandonment of hair removal. A surprise delivery of body shop facemasks. Endless cups of tea. And let’s not forget the clapping at 8 pm every Thursday. A time when we feel supported, comforted and heard.

Space from work is crucial. A reminder that these feelings are circumstantial and the exhaustion chemical. I’ve taken a serious liking to Sudokus, writing letters and watching Feel Good. I’ve become obsessed with interiors and had the sudden urge to paint the living room. After grabbing the last pot of white Dulux from Wilkos, I’m on a role. I’ve ordered a new dining table and I’m endlessly boring Ben with pictures of glassware and gallery walls. There is so much inspiring content coming out. Articles and podcasts have taken on a new lease of life. I take comfort that this pandemic has caused its own renaissance. In times when I don’t want to think about Corona, my favourite episodes of desert island discs become dearer than ever (Mary Portas, Lynne Barber, Noel Gallagher, Ian Wright, Gok Wan, Jed Mercurio, Russell Brand). A happy accompaniment to a day painting over grubby magnolia, my new form of meditation.

I can’t help but notice how full of questions this post is. We are all living through an endless question mark. How long will this last? How will this affect us? When will the glorious pubs finally open? There is so much beyond our control and I’ve found keeping my world small and introspective helpful. It’s natural to feel angry and frustrated at the bigger things, when people don’t adhere to social distancing or the never-ending state of lockdown. But these feelings are futile and will not bring resolution. Instead, I’ve been looking at what I can control. How much news I watch, how much social media I consume, how careful I am in ensuring I’m not responsible for spreading disease, and most importantly, what colour I paint my walls. I try and focus as much as I can at what makes me happy. I also keep a diary – as a record of history, a catharsis and a place to write lists for all the cushion covers and table settings I’m obsessing over. I’m waiting for the day I can have people round and throw dinner parties again. It’s coming.


Words by Imogen Bicknell 

Originally published on: http://www.mentalscale.com/