It’s almost a year since I graduated from medical school, excited about starting the next chapter in my life. I knew that being a doctor was going to be a challenge mentally and emotionally, but nothing could have prepared me for working as a respiratory junior doctor, looking after those with suspected or confirmed coronavirus.
I have learned first-hand how quickly a patient can become critically unwell from the virus. Our patients can quite often end up being taken to the intensive care unit, leaving me unsure whether I will ever see them again. We also look after those who are too frail to go to intensive care, for whom ventilation would be of little benefit and would increase their suffering. The outcomes for these patients can be poor.
In the process of becoming a doctor, you learn to manage and cure disease – but failing that, to do your utmost to give the person in front of you a good death. I have always found a great deal of solace in a patient dying a natural, timely death, without discomfort and surrounded by their loved ones. Covid-19 has stolen that.
We do what we can, though it often feels like it is not enough. I remember the faces of the patients I have been beside during their last minutes. I still struggle to find the right words and am aware that mine is the last face they will see: a near stranger covered up by a mask. After I confirm the death, I gather myself and phone the person’s next of kin. We try to let the family know that their loved one is dying, but occasionally it happens unexpectedly.
We’re taught at medical school how to have difficult conversations with patients and relatives – always in person. Now many of these conversations are happening over the phone, sometimes with poor reception, or when the person on the other end is hard of hearing. It feels so impersonal. For them, I am just a voice at the end of a phone changing their reality for ever, and I can’t even offer them a cup of tea or a tissue. Nor have they seen in many cases just how unwell their loved one has become, so it demands a great deal of trust on their part in the judgment of the medical team. One reason I chose to go into medicine was to be useful when others are at their most vulnerable, but at times I feel useless in the face of some of these most basic needs of my patients.
A small proportion of the patients we see have caught the virus either from hospital or another care setting, and there is a great deal of guilt that comes with that. In healthcare we make the promise to first do no harm, but being a patient in hospital now comes with a level of risk never before experienced. This is despite stringent infection control measures, such as PPE and handwashing. I see patients only when necessary, in order to reduce their exposure, whereas previously I would stay and chat, particularly with those without many visitors. Only now that’s all of them, and it’s too risky to simply go into their room to brighten up their day.
It is almost impossible not to take an element of the darkness home. I will do anything to keep busy to avoid thinking about the suffering I have witnessed and been unable to prevent. I feel exhausted, but so do many of my colleagues. We talk about “Covid fatigue”, which has come partially from not being able to see an end to the type of medicine we’re now practising: the pandemic has increased our workload while taking away much of what makes the job rewarding.
With lockdown measures easing we are going to have more patients coming into hospital with Covid again, as well as having more patients attending with other issues who may contract the virus. We managed the first wave by putting all but the most urgent services on hold, but things will have to resume, only now with longer waiting times than ever for patients. It will be a long time before our hospitals will be operating normally again. How things are now will be impossible to sustain longer term, but in the NHS, as always, we will find a way, for the sake of everyone.
• Gisele Spencer is a junior NHS doctor
Read the original article at The Guardian