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13 January 2021

Personal Story: On the Covid front line

As a junior doctor walking into the intensive care unit for the first time, I saw a ward lined with unconscious patients attached to ventilators, and the gravity of the pandemic suddenly hit me. 

By Clara Sattentau

On the morning of Friday 13 March, I opened an email from my university, ordering me to take the first flight back to the UK. I was in Germany, where I’d moved two months earlier with a friend to finish our last few months of medical school on a placement in Berlin. Four days later, both still stubbornly in Germany, yet to fully comprehend the extent of the coming crisis, we received a second email. “We have ­decided to close all Year 5 clinical placements from today, Tuesday 17 March 2020,” it read. “You will now progress to graduation following ratification by the programme’s Board of Examiners.” We were left to pack our things, get on a flight, find somewhere to live and prematurely begin our careers as doctors.

A month later, with the UK in a national lockdown, I started working in obstetrics and gynaecology at a hospital in Greater Manchester. Here, the environment remained largely unchanged: though the world was at a standstill, babies were still being born. (Childbirth remains the only medical event where a visitor is still ­allowed to be present for an indefinite length of time.) It was exciting to have the ­opportunity to use everything I’d learned over the past six years, and to be of some use during a crisis. In my spells working in ­hospitals as a  student, I had seldom been given real responsibility; the thought of my name at the bottom of a prescription seemed outrageous.

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But it was also nerve-wracking. The NHS uses a human error model called the “Swiss cheese model”. Slices of cheese – staff members – represent barriers that prevent mistakes, and the holes represent weaknesses in these barriers. Only when all the holes align do mistakes go unnoticed and patient harm is risked. We sometimes joke that as junior doctors on call, we feel as if we are the only slice of cheese. The simplest task, such as prescribing iron tablets, left me hoping my patient would be there the next morning, my mind racing with a long list of potential side effects. In contrast to the black-and-white answers of medical ­textbooks, medical practice is filled with grey areas. It was unsettling to discover how many medical decisions are based on educated guesswork.

Towards the end of May, as Covid cases were beginning to fall, I was moved to the intensive care unit. I walked into the ICU for the first time in full PPE – a hazmat suit, two plastic aprons, a mask, visor and surgical cap, plus two pairs of gloves and clogs – and saw a ward lined with unconscious patients, attached to ventilators. After the relative normality of obstetrics, this was a sudden reminder of the gravity of the ­pandemic. It was as though I had entered one of the videos filmed inside Italian ­hospitals early in the pandemic: ICUs filled with patients being turned on to their front every few hours.

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With time, this dystopian image became less shocking. There were positive moments on the ward, too. A couple of patients who had been fully sedated when I arrived on the unit were conscious and talking by the end of my rotation. Every afternoon, we called the relatives of all the patients to give them an update – a difficult but often rewarding ritual. When a patient became well enough to leave the ICU, we lined the corridors and clapped, as their family watched over FaceTime.

I moved to the acute medical unit – a huge, whole-hospital triaging ward where we receive patients who are sick enough to be admitted to hospital, either straight from A&E or from their GP.

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Late one ­Saturday night, a few weeks into my new job, a nurse pages me from a newly opened Covid ward. The nurse tells me she’s with a patient who is deteriorating. The patient is an elderly man. I remember assessing him the night before after his oxygen levels had dropped dangerously low.

From his medical notes, I know the patient has pulmonary fibrosis, a condition that makes ­coronavirus infection far more deadly. As I approach him, he grips my arm and looks up. He says he can’t breathe. Over and over he says he won’t survive until morning and pleads to be given morphine. Panic rising inside me, I take blood samples, ask him to lie on his side and scan his list of medications, ­willing myself into action when deep down I know there is nothing I can do that will make much difference. People know when they are dying.

When my registrar arrives, he calls the patient’s family and reassures me we have done everything we could do. I leave the ward and shortly after learn that the patient has passed away. I carry on with my shift – I am the first port of call for a hundred other patients who may need my attention overnight. On the tram home the next morning, I feel grimly elated – like I’m in possession of a secret that none of the commuters around me are in on. It’s only on my day off, three days later, that I realise the patient was someone’s husband, someone’s father, someone’s brother, and that what I should have done was hold his hand in his last distressing moments.

Now, with the current wave of the pandemic approaching a new peak, there is a sense of foreboding in the hospital where I work, growing each day as cases surge in London and the south-east. With our ICU already full and spilling into theatres, it feels like it is only a matter of time before we are once again overwhelmed with cases.

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Death has become a regular part of my life. It’s easy to leave hospital with the feeling that everyone in the world is sick or dying. I have cried for my elderly Covid patient who died alone and distressed, and for his family, who were not allowed to be by his side. The pandemic has taken away the fundamental right of the dying to be ­surrounded by people they love. It has become the job of healthcare workers to ­provide those final moments of empathy and support. That’s not something I’ve ever been formally trained for – perhaps you can’t be.

In my patients’ final moments of life, it’s my powerlessness that is hardest to deal with. At medical school, you learn to take action. But when someone is dying in hospital, it’s much harder to stop, to sit down and hold their hand, even if it should be the most natural reaction of all. 

This article appears in the 13 Jan 2021 issue of the New Statesman, American civil war