A family member working in a major London hopsital expressed concern that the student nurses being put in the frontline will never recover from the trauma .... the Doctor writing this is just 25 years old "I have fought hard for a patient to be considere for ventilation" .. for a chance of life
Junior doctor Rosie Hughes.
Iam a junior doctor. In the past few weeks I have seen dozens of people die from Covid-19. I am 25 years old. I’ve been working in the
NHS for just over eight months at a major metropolitan hospital. When my colleagues and I decided to apply for medical school six years ago, we knew that we were signing up for a challenge. We were under no illusion that it would be an easy ride. But I don’t think any of us imagined that we would be on the frontline of a pandemic less than a year into our careers.
I have cared for patients from admission until death and I have held their hands when they have been too breathless to speak. I have fought hard for a patient to be considered for ventilation despite knowing that they didn’t meet the criteria. I stayed with them after my shift had ended, gowned and gloved, and watched them take their last breaths, knowing that a few months ago they might have stood a chance. I ring families to tell them that their loved one who came into hospital for something totally unrelated now has coronavirus and will not survive.
I then apologise and tell them that they won’t be able to visit because of the infection control risk. On one occasion I failed to hold back my tears while I was on the phone and hoped that my voice didn’t tremble enough for them to hear.
This week we have received constant emails from our trust about our lack of personal protective equipment (PPE) and so we have little choice but to care for the patients at our own risk using just surgical masks and plastic aprons because we have now run out of gowns too.
Our ITU (intensive therapy unit) is now full. Our HDU (high dependency unit) is full too. We are now sending patients to an offsite facility to be ventilated. Two of our own staff members have died from the virus. I have no doubt there will be more.
On Sunday evening last week I began to feel run down and noticed that I had lost my senses of taste and smell. This is a newly described but increasingly well recognised symptom of Covid-19.
On Monday morning, after spending five hours on hold to my occupational health department, I got through to a nurse over the phone who advised me to remain in work and was unable to arrange a swab for me on the basis that I didn’t have a cough or a fever. Her answer was totally in line with the current World
Health Organization guidance, but it left me with a difficult choice.
Knowing that I was potentially putting lives at risk by staying, I decided to leave the hospital.
Before I left, I managed to source a test request form and my consultant agreed to authorise it. The current test for the coronavirus is a throat swab. The physical swabbing process used across our health service is an aerosol generating procedure which means that there is a high chance of viral transmission between the patient and the person performing the swab.
This is essentially because sticking a swab to the back of your throat causes you to cough virus particles on to the person swabbing you.
I couldn’t ask the nurses on my ward to swab me because we had completely run out of eye protection so I swabbed myself instead. I then arranged to have the swab sent to the virology lab for testing, ensured my ward was adequately staffed and took myself home.
The following day I got a call from occupational health, saying I had tested positive for Covid-19. This means I have to isolate for seven days and my two flatmates, who are also junior doctors, will have to isolate for a total of 14 days.
Testing positive for the same virus that has killed so many of my patients is obviously a daunting prospect but it felt inevitable given the lack of safe PPE. In a way, I was relieved that the wait was over and it had finally hit.
It’s not surprising that I am finding it difficult to relax at home in the knowledge that I am infected with the same virus that I have written down countless times as the “primary cause of death” on the death certificates of my patients. Many of them were young, many of them did not have underlying health conditions.
Did they give it to me? Or did I give it to them? I’ll never know, but I stay up at night wondering.
I am lucky. My symptoms are mild and I can only hope that it stays that way. But while I sit at home in isolation, my mind is occupied by fear and guilt.
I replay images of breathless patients in my head and recall my telephone conversations with their families. I wonder if I had been just that tiny bit more careful, or washed my hands once more or not scratched my face with my gloves that maybe I could have prevented some of those deaths. I feel guilty that my flatmates can’t work. I feel bad that my colleagues who are now covering the shifts that I cannot do will be overworked and are prolonging their exposure to the virus.
I also worry about the possible consequences of having swabbed myself. When the occupational health nurse told me to remain in work and couldn’t swab me, I bent the rules and exploited my position. I hope that it will be overlooked. Ultimately my instinct proved to be right and my rule breaking resulted in protection for the patients and colleagues that I could have infected if I had done as I was told and remained in work.
Beyond all the fear and worry, I miss my friends and my family so much. They ring me daily and ask how I am doing. They probably can’t even imagine the things that I have had to do or see. I don’t know if I will ever tell them how bad things have got because I can’t bear the thought of them being worried.
Most of the time I just long to be in the hospital because it is the best distraction. As a result, my colleagues have become my family. The doctors, the nurses, the admin staff, the porters, the cleaners. They are brave and they are brilliant and they inspire me to be the same. Beyond the fear, exhaustion, uncertainty, loneliness and tears we somehow still manage to smile every day. We smile mainly with our eyes because covering our faces with masks has become the new norm. The pandemic has united us in ways that I can’t describe.
