Update from the frontline

As the fight against the coronavirus pandemic continues, RMBF volunteer Charles Holden shares his colleague Gina Allen’s thoughts and experiences from the frontline – and what the impact could be for the future wellbeing of doctors.

As a junior doctor I’ve been thrust to the front and centre of the hospital response to Covid-19. The intensive care unit, which normally provides a diverse range of support to different specialities has been completely restructured and focused on a single pathogen. The comfort of experience and protocols for illnesses we know well has been replaced with a virus we have no experience of and no evidence base for. We’re learning lessons daily through our own experiences and the shared knowledge of other departments nationally and internationally.

Our rota has been re-structured so that exposure to the virus is kept as short as possible, with what we hope is enough time between shifts to recover. Work is intense, sweating through our scrubs and PPE, performing manual tasks like turning patients to improve their ventilation. During downtime we are expected to check into online webinars and read daily email updates.  Guidelines, PPE and working protocols are changing day by day. You can never fully check out. You know you’ve been exposed to the virus so when you aren’t at the hospital you try to keep your own trips out of the house to a minimum to reduce the risk you pose to others.

Things are evolving so quickly it can be unnerving returning to work after even a day away, unsure of what lies in wait on the unit. Due to my experience I have been asked to act up as a registrar, where I’ll be managing a small team caring for sick patients. I know colleagues who are anxious about taking on this role and the increased responsibility it will bring.

It’s hard to feel comfortable before a shift when you don’t know who will be in your team or what their skills or experience are. Colleagues are dropping into and out of shifts as they or someone in their household self-isolates with symptoms. Sometimes fit testing a new batch of masks takes place during the night to ensure they seal correctly on your face. You were just getting used to the last batch. You have to be flexible about who you work with and how many patients you care for, and keep up to date with daily changes in practice.

The feeling of being at the forefront of a constantly moving and evolving situation can be exciting. I have never felt so valued by the public for what I do. However, it’s also very emotionally and physically draining. I don’t know how long the health service can continue to keep up this effort, or what will happen if this crisis extends for months or even into next winter.

There will be a long and protracted fall-out for patients as a result of the crisis. I wonder what is happening to the people waiting for operations or avoiding coming to A&E. I’m sure patients are at home clapping the NHS while quietly worrying about a new sinister physical symptom or mental health crisis, not wanting to trouble their GP. They’re reminded regularly by the media that this is a time of national emergency, feeling it’s their altruistic duty to put their own health concerns on hold.

As we begin to gain control of the current situation and normal services are reinstated, these patients will present to us and their need may be greater because of the imposed delay. They’ll be met by a group of doctors who’ve just mounted a mammoth effort and have been working flat out – perhaps suffering from their own physical or mental health issues brought about by the crisis.

This is precisely why at this time it’s so important to financially support the RMBF, and help fund the services they provide for doctors in need.

RMBF volunteer Charles Holden, writing on the experience of colleague Gina Allen