On the Frontline with Greg, Junior Doctor

In this series, we speak with friends and family on the frontline to hear about their experiences of the pandemic; the impact it’s had, the challenges they’ve faced and their hopes for the future.

When you’ve just started a new job as I did a year ago and are immediately thrust into a national lockdown its easy to bemoan the lack of face time with colleagues, the after work socials, the learning opportunities and general feeling of togetherness that comes with the office environment. But when close friends of yours are out there on the frontline, dealing with the threat of the pandemic head on while also just starting out in their career it puts things in perspective.

And that has been the experience for the last year for my friend Greg, a Junior Doctor in the North of England, who has been navigating the complexities of Junior Doctor training whilst dealing with COVID-19 head on.

What is your role? 

Junior Doctor in a Cancer Hospital.

What has your experience of COVID been in your job?

My first experience with COVID was covering the Infectious Disease unit on night shifts last April, where our medical interventions were limited and our understanding of the disease poor. I saw patients at the start of my shift feeling a bit short of breath, but maintaining their oxygen saturations on 2l O2, and by the morning on maximum oxygen therapy and being referred to ITU.

Since then, working in the Cancer Hospital, I have cared for many patients, where a priority has been to minimise the prevalence of COVID within our walls, including full PPE, distancing between beds and within staff areas, and twice weekly staff swabbing. Despite everything, we have not been able to keep it out. I have cared for several patients who have had COVID, some who would be blissfully unaware had they not been swabbed, and others who have deteriorated rapidly and died, some within 2-3 days from onset of symptoms. My patients have underlying health conditions, with metastatic cancer being a major player. When they become ill, their physiological reserve is poor, and they tire quickly.

How has it impacted your day to day work?

I now work in scrubs, and wear full PPE when seeing any patients. On the wards, even outside of patient rooms, I wear a mask and a visor at all times. Everything in the hospital smells of Tristel, the disinfectant of choice that leaves the phones damp to your ear and the keys on the keyboards sticky.

Face-to-face teaching has stopped, which is a shame as this is a vital part of junior doctor training. Due to social distancing, I am unable to gather my colleagues for lunch or a coffee trip.

How has it impacted your patients?

My patients are scared.

They are scared of catching the virus, having been made abundantly aware of the increased risk it poses to them with their underlying condition and their compromised immune systems.

They are scared of coming to hospital in case they catch the virus with us, and this is leading to patients presenting late, often much more poorly and requiring longer admissions than they would have done previously.

They are scared of being in hospital alone, undergoing treatment with unpleasant side effects and the possibility of complications graver than the cancer itself. This is normally made easier by having their relatives available to them. Instead the only company many have are those of us there working, in disposable blue plastic with our faces covered and our hands gloved, and our attention divided between many patients. Some chemotherapies damage patients’ hearing, and they may rely on lip-reading, which is taken away from them by the use of surgical masks.

And understandably, some are angry about COVID. Some have told me about delay in reaching a diagnosis due to the pandemic. Others are aware that their life expectancy is limited, and COVID has taken away their opportunity to spend their last months surrounded with friends and family.

How has COVID affected you (physically but also emotionally)?

I think most of my colleagues, including myself, have had COVID at some point, with varying symptom burden. Staffing levels seem to often be short, with people having to isolate to await a swab result and this puts pressure on everyone.

From the illness, I fortunately have no residual symptoms. Some of my colleagues are suffering with long-COVID weeks or months after they tested positive.

Generally, I feel drained. I have found myself struggling to get out of bed, and wanting to do less in the evenings than I normally would. I have found my capacity to deal with non-urgent tasks outside of work to have greatly declined, and have noticed that I am less sympathetic to reported problems from my friends and families lives if they are not involving death. Weekends and annual leave has felt non-restorative.

I feel like during the pandemic and during the lockdowns there has been an expectation to better yourself, and to communicate with your family more. I don’t think I have achieved either of these things.

What has been your biggest challenge during the pandemic? Why?

The longevity of it and seeing the effects on my colleagues.

Initially, there was hope that it would all be over within a few months, and it seemed possible to grit teeth and bare them for this time, dealing with all the usual badness that comes from working on a cancer ward, made worse by COVID and the implications on patient wellbeing this brought. There was a real “in it together” mentality, with staff being vocal in their support for each other, and takeaways etc. being brought in regularly.

However, it has persisted. By October/November time, I was noticing that I was finding more of my colleagues crying on the wards, in quiet rooms by themselves. The increased burden that the pandemic has brought, along with the stripping of our normal coping mechanisms, was wearing us down.

Currently, things feel different again. The pressures are no different, with patients still unable to be supported by their families and having to turn to staff for their support. But the staff seem to be having a different response to a few months ago. Or at least, less of a response. I don’t know if this reflects a positive change in coping mechanisms, or if we are becoming numb. I hope it is not the latter.

What are your hopes for the future?

I hope my patients will soon be able to have regular visitors back on the wards and not just when they are dying.

I hope that any of my colleagues suffering with effects from COVID return to health quickly. I hope all my colleagues I work with, and across the NHS who have worked through this pandemic have something positive to look forward to in the coming months.

I hope I can see my friends and my family, in person, this Summer. I hope they forgive me for not having been in touch as often as I would have liked to, or should have been, during this.

I hope that the vaccination programme is as successful as it is hoped to be, and this will soon be a bad memory. I hope that lessons have been learned from the pandemic, and that we will be better prepared for, and better in managing, the next.