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A Reflection from the Wards

27 March 2020

A Doctor’s Reflection from the Wards (written by an ST1 in Ophthalmology on his return to acute practice on the wards at Royal Free)

 

Yesterday, I had my first shift covering a confirmed Covid-19 ward at the Royal Free Hospital in Hampstead. I’m an ST1 ophthalmology trainee at the Royal Free. I finished my foundation training 8 months ago – I know this may not sound long at all, especially compared to many of you who have been out of general medical training for longer, but it feels like a lifetime ago for me. So when I found out that I would be joining the medical rota with the rest of my ophthalmology team, words cannot describe the sense of foreboding, anxiety we felt. I didn’t know where my stethoscope was, I didn’t know how to order a chest X ray, how to request bloods, where to find scrubs etc. I felt so deskilled and utterly unequipped for the task ahead as my day job hadn’t included any of this.
 
Here are my thoughts on suddenly entering the world of general medical wards after thinking I would never leave a slit lamp or operating microscope for the wards ever again. I received an email at 5pm on Thursday 19th March with over 150 doctors allocated to teams and varying shift patterns. We were informed that this would stretch, at the least, over the next 24 days but most likely for the forseeable future. We were expected, as per the rota, to start at 9am Friday 20th March. Yes, we were all shocked at the exponential pace of the changes  and escalation. 

I turned up at 8pm to the medical handover. There were over 30 juniors there for the night team, 5 consultants. Put that into perspective, where there are normally 5/6 night medical doctors on. They are taking this seriously and trying to act early. The entire rota was explained; we were divided into teams that we would stay in for the foreseeable future, which consisted of 6 people (2 SpRs, 2 SHOs and 2 FY1s). ST1 & ST2 ophthalmologists were classed as SHO level, ST3, associate specialists, trust grade doctors was classed as FY1s). Everyone is kind, everyone understands we are all scared and I felt fully welcomed into this team There were lots of doctors away because of childcare, anxiety, sickness, isolation etc. But the main thing I have to say is the medical team behind these changes ALL understand we have lives, we have families and everyone is worried and they are happy to do everything to support us. A few things I heard mentioned were free parking, accommodation for doctors, food and drink provided etc.
 
With regard to the job on the wards, the medics aren’t expecting anything from ophthalmologists right now. They are expecting us to be NEGATIVE in terms of our contribution, having to teach us everything about the IT system, how to escalate things etc. They have deliberately acted early to get us on the wards a few days/a week before they say the tsunami hits so that we feel slightly more comfortable with the basics. Lots of doctors were even sent home early into the shift last night (myself included) because they understand this is a marathon and the goalposts are moving every hour. I was so so nervous starting this shift, but I am so glad for yesterday’s shift. This is coming for all of us, the ST1s up to the ST7s, the fellows and very soon I’m sure the ophthalmology consultants. The sooner you’re involved, the better for you because you’ll get your induction, your training, your questions answered and some of your doubts resolved before it gets crazy. We are not expected to do anything out of our comfort zone. The medics want us to become comfortable so that we can be more helpful later down the line.
 
With regard to PPE and training, I was worried that I had missed mask fitting and never had training as I think we all are. In fact none of the medics and most of ITU even have not had mask fitting and/or have failed the mask test. It seems like there are 2 types of FFP3 masks (1 that requires fitting, 1 that does not). When seeing a CoVID confirmed patient, the guidance is to wear a surgical mask, apron and gloves. There is a clear protocol with procedures such as taking bloods and cannulation that I’ve been taught. For crash calls and intubated patients, full PPE is required. I’ll be honest I haven’t yet received training on this and have been told clearly until I do, I will not be involved in care of these patients.
 
During the day and night shifts, there are on-site consultants around. For any patient (CoVID or not), the registrars and consultants are making decisions for escalation. My main job is really to document for now and to prepare discharge summaries (which I’ve been shown in 10 minutes how to do because I had no idea!). Things that I was worried about such as how to escalate these patients, oxygen requirements were all explained to me before the shift but actually there are lots of seniors on site reviewing these patients and making these decisions.
 
Overall, it is safe to say that this is happening. Over the next few hours, days, or weeks things will continue to change. Above all, we are all doctors. We have all taken oaths to fulfill and unfortunately over the next few months we will have to uphold this in ways we were not expecting to. These are unprecedented times and what is coming is said to be a tsunami of respiratory illness. We are all scared but we are all in this together. Our medical colleagues are no less frightened than we are, no specialty is prepared for this pandemic. We will get through this and we will be back in the safe haven of our clinic rooms and OT before we know it. But for now we have to stand united with all our NHS colleagues and stay positive.