James Finnerty shares a diary entry he made working on the Emergency Ward during the peak of the second wave of the pandemic, and reflects on the impact Covid has had on his medical career plans and outlook on life.

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Day 10,097,254 of the Pandemic, October 2020.

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I work as an Emergency Medicine Junior Doctor at Senior House Officer level, and for the past eight months my job and my life around it has been dominated by Covid. The pandemic has affected many healthcare workers like me at different levels of seniority throughout the NHS.

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I leave work every night feeling shell-shocked and empty after the things I’ve seen, only to arrive the following morning braced for a new day, and this particular day is like any other during the second wave of the pandemic.

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It is 9am in the Emergency department, and I arrive at the department as one of a rotating team of staff. I am not a wet-behind-the-ears first year fresh out of med school, but nor am I a hardened Consultant who feels I’ve seen enough to be numbed to real trauma. We begin the day by gathering together, listening to a speech from our Consultant in charge of the department. He is the commander leading us to the battleground and our certain (spiritual) death. He knows this, and he doesn’t look us in the eye as he addresses us. He says a variation on the usual.     
 
"There's no movement of patients to inpatient beds, there's very few spaces to see anyone new and there's double the number of patients that legally should be in the department,” he begins.

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In the absence of any good news or comforting platitudes to speak to us following this, he simply says, “Let's do what we can."

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These words often ring in my ears before I go to sleep. Like I say, the SHO title doesn’t provide me any immunity from the daily traumas the Great British public has been spared in the tabloids and Boris’ briefings conducted in safe, warm meeting rooms. The true horrors of the pandemic will stay with me and the other doctors of the pandemic (while the conspiracy theorists and Covid deniers take to the streets with their megaphones), but it’s the medical students I feel most sorry for. They gather for this little speech every morning alongside the team of stressed-looking doctors, nurses and healthcare assistants they might otherwise look to for reassurance. Each med student looks increasingly terrified at our morning briefings with each day that goes by during the peak of this second wave. 

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I often try to raise spirits by joking around with the more terrified-looking ones as the gathering disperses, because humour is my coping mechanism for stress.

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"I still reckon Covid is a hoax," I say today to one student who has lost all colour in his face.
 
He pauses, staring off into space with little light behind the eyes. He laughs eventually, once, strained, but only because he jumps, meets my eye and apparently remembers where he is and that I am a couple of levels his senior, so he should probably laugh when I make a joke. Tough crowd.
 
Today I am covering the Respiratory High Care area - a six-bed area for the sickest patients with respiratory symptoms (coughing and breathing difficulties, mostly). They tend to come to us directly from an ambulance. During most of late autumn, all six beds will be filled with patients suffering from Covid pneumonitis (a serious infection and inflammation of the lungs, leading to pus filling the air spaces, preventing normal breathing functions like the absorption of oxygen). 

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Today, a gentleman in his early 50s is whisked in on a hospital trolley directly from an ambulance. 

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When I first catch sight of him, he is surrounded on all sides by three paramedics who are holding various pieces of monitoring equipment he has been relying on during his journey in. The oxygen tank that has been keeping him alive, supplying extra oxygen to him via a face mask, is strapped firmly either side of his mouth. The most senior paramedic begins his handover:

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"52 year-old gentleman, increasing shortness of breath over the last week, dry cough, and loss of sense of taste and smell. He had a Covid test four days ago which was positive. He has been requiring 15 litres of oxygen to maintain his oxygen saturations above 94 percent."

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This is not good news. The normal percentage of oxygen in the air is 21 percent. Delivering 15 litres per minute of oxygen is pretty close to delivering 100 percent oxygen. If this is required to keep safe enough oxygen levels in his blood (monitored with a small probe on the finger) for life to continue (above 94 percent), this suggests his lungs are in serious trouble.
 
I introduce myself to the patient who is called Boris (obviously not his real name) and I carry out an initial assessment on him whilst my nurse colleague sets up some initial monitoring, takes some bloods and makes note of an up-to-date set of vital signs (essentially, all the hard work). This chap has no past medical history, is on no regular medications and isn’t overweight. He looks exhausted, taking in each rasping breath through his bluish lips as if he fears it might be his last. I listen to his lungs with my stethoscope and they are clearly full of fluid, most likely related to pneumonitis and the reason he is requiring so much oxygen. 

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I explain to Boris the most likely cause of his illness (Covid-19), and what immediate treatment and further investigations I am going to organise for him.

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"You almost certainly have pneumonia in both of your lungs, most likely related to this coronavirus that’s going round at the moment. We will continue to support your lungs with oxygen through this face mask, which at the moment is just about enough to keep your body supplied with enough oxygen. I need to do one extra blood test from your wrist, and we'll get a chest x-ray to confirm what I think is happening. We'll also give you some tablets to try and dampen down the inflammation in your lungs, and some intravenous fluids and antibiotics. If you're not getting better in the next 30 minutes, or if you get worse, we'll have to think about other treatments. One of these is going to include strapping a larger mask to your face which is connected to a machine that further supports your breathing. I'll talk about that a bit more later if we need to use it.”

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“I'm not going to lie to you Boris,” I continue, “you're very unwell, but you're in the right place and everyone here is looking after you. Don't worry if you forget some of what I've said, I'll be around this area for the rest of the day if you have any questions. Do you have any thoughts or questions about what I just said? I'm also happy to speak to your wife on the phone if you'd like?"

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"No... , it's alright... doc, (cough, cough, cough) ...I don't want to worry her any more for now... only call her if I get worse."
 
I walk away, feeling a rare pride over the succinctness of my explanation, and the fact I can sense Boris feels well looked after. Not all discussions about treatment and investigations go so well. I once tried to explain a colonoscopy to a profoundly deaf woman on an inpatient ward. Diagrams of this can be misinterpreted. It's difficult drawing an anus under pressure.
 
I spend some time on the computer, documenting my assessment and prescribing the medications he needed. This always takes ten times longer than it should due to NHS computers not having been replaced since 1979. I soon find myself restarting my computer for the third time, and it is while I am waiting, staring at the spinning wheel of death that Jess - one of the nurses - comes over to me to discuss Boris.
 
"I've set up his antibiotics and given him the steroids,” Jess says, “and we're aiming for oxygen saturations of above 94 percent, yeah?"
 
"Perfect. Thanks a lot."

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It is at this moment - on a day that has followed the pattern of so many others that have gone before it since 2020 began - that the truly toxic nature of the pandemic is thrown into sharp relief, and I find myself lost for words.

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"You know he doesn't believe in Covid," Jess says.
 
I turn my head in disbelief, hand hovering over the computer mouse.
 
"He doesn’t believe in an illness he’s been tested for by the NHS, and shown a positive result?”
 
Jess shrugs. "He thinks he has a bug.”
 
“And what does he think Covid is?”

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Jess smirks, turns on her heels and I'm left startled and saddened at the thought of Boris walking the streets without a mask, coughing and spluttering over passersby in the days leading up to today.

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What shocks me about the whole thing is how powerful a belief can be. This man literally is almost dead from Covid, yet he still doesn’t believe in it. I also feel disappointed. Doctors are consistently voted the most trusted profession nationally, and yet, when it comes down to it, this guy doesn’t trust me. Does he think I am in on the conspiracy? Am I just a pawn in Bill Gates'/China's/5G's game?! It's easy to talk a load of bollocks about Covid when you're safe in your home and no-one you know is unwell, as this is more comforting than the reality, but to be stricken, fighting for enough breath to stay alive, to be in hospital with your lungs filling with pus and high flow oxygen zipping into your lungs via a mask strapped to your face, and to STILL be in denial, now that's a leap of faith. 

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Thankfully Boris is doing better by the end of my shift and doesn’t require any more intensive interventions to support his breathing, so on my drive home I’m spared the angst of thinking another of my patients could die overnight and left to ponder the less painful question of how on earth we got here.

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It can be frustrating dealing with people that are Covid deniers, particularly when working on the frontlines and seeing the very worst of the pandemic’s impact in such a visceral, fundamental way. At times even my sense of humour can’t lift me up amidst the depressingly sinister points of view which paint a deadly disease as a lazy cover up for governmental corruption or 5G-mediated or cooked up by your Chinese Nan. 

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And yet, months have passed since I wrote this diary entry, and I’ve continued to reflect on my experiences with patients and acquaintances clinging to all sorts of beliefs about Covid - the scientifically-supported and the baseless alike.

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What I’ve realised is that most opinions derive from fear, misinformation and isolation, and there is surely a learning here for all 20-somethings. It’s easy to get angry with posts about vaccines causing infertility on social media and write a belittling comment which gets you lots of likes, but does this help anyone? Making someone feel stupid is unlikely to change their opinion on an issue, and if anything will drive more of a wedge between you and that person. Convincing Boris that he had Covid was never going to be the thing that ultimately saved his life, and at the end of the day, that is not only our goal, but our duty. As a doctor, I am here to alter patients’ ill health, not the beliefs they entrench within themselves and others. 

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I’ve had some constructive conversations with staff at work who were initially reluctant to be vaccinated, and most of them have ended up being vaccinated. 

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If I (or the countless other doctors they’d discussed it with) called them ignorant, huffed and puffed and said, “I’m not even going to explain why that’s wrong because it’s so obvious”, I think they’d be far more likely to double down on their original opinion.
 
On a more positive note that we can all take comfort from, Covid has brought out some great sides of humanity. The deep-rooted desire most people have demonstrated to help others in the past year has been incredible: whether that has manifested in nursing applications going up by 32 percent, or the millions of people who took steps to ensure their grandparents and elderly loved ones were being properly looked after. There have been many wholesome, chunky diamonds of positivity amongst the depressing roughness. 

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For me personally, it’s given me a sense of duty at a point in my career when I was losing my way and considering other options, and has made me double-down in my focus on a career in Emergency Medicine. 

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I look forward to a time when we can rip these masks off and smile at each other again, and thanks to the vaccination programme, that time will be soon.
 
Boris Johnson can still fuck off though.
 
 

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Image taken from Scrubs.