Every Thursday, at exactly 8pm, we clap and cheer for NHS workers who are risking their lives to fight the coronavirus pandemic. While it’s easy for us to bang some pots and pans for a few minutes before going back to Netflix or a takeaway, it’s difficult to imagine what it is really like to care for Covid-19 patients.
The fear is real: more than 100 NHS and social care workers have already died from Covid-19—and that number will continue to rise. So how are hospital staff and healthcare workers dealing with the battle on the frontline?
We spoke to neurologist Caroline Neuray, 32, who is working as an intensive care unit specialty registrar at University College London Hospitals NHS Foundation Trust (UCLH) during the crisis. She spends more than 50 hours a week in the Covid-19 ICU treating critically ill patients. Here, Dr Neuray tells us about her fight for the future of humanity, the challenges this brings—and the emotional toll it’s taking on all NHS staff.
How did a neurologist end up working in the ICU during Covid-19?
People are coming out of retirement to help, so I thought it was time for younger people to step up.
I’m in quite a particular situation. I trained in Austria and Germany as a neurologist, so I usually deal with strokes and epilepsy, things like that, but I trained in intensive care medicine as a subspeciality.
I came to the UK eight months ago to take up a research fellowship at Queen Square [the National Hospital for Neurology and Neurosurgery and part of UCLH]. I came to look into the genetics of epilepsy, but when the crisis started the lab closed. The ICU was quite well-equipped and they were desperately looking for staff, so I signed up. Even if the lab hadn’t closed I still would have volunteered. People are coming out of retirement to help, so I thought it was time for younger people to step up.
What does your day-to-day look like?
We are on shift rotation with long days and nights of 13 hours each, up to four days a week. This is done to provide consistency for patients and colleagues, but also to reduce the number of days we go in. If you have two teams a day instead of three, there’s less chance of information getting lost, which can happen in handovers.
Usually you have one nurse per patient in an ICU but here it’s one for every five patients. Without the nurses, we couldn’t do our jobs.
I arrive at work at 8am. The staff on the night shift hand over and update us on each patient. I then see all my patients, examining each one, checking how ventilation is going and so on. There’s the “clean area” and the “dirty area”, where the patients are. Here you need PPE [personal protective equipment], which is very uncomfortable to wear, especially for hours on end.
All our patients are critically ill. There’s one doctor for five to six patients. My workload is very doable at the moment, but the nurses have it really hard—they’re severely understaffed. Usually you have one nurse per patient in an ICU but here it’s one for every five patients. Without the nurses, we couldn’t do our jobs. They complete very long ICU training and know how to run all the equipment and machines.
Are you worried about working so closely with a potentially deadly virus?
I worry about how it’s going to change Europe. It’s not a very scientific concern is it, for a doctor?
I’m not scared for my own life, I’m more concerned for family members. And society and politics. I worry about how it’s going to change Europe. It’s not a very scientific concern is it, for a doctor? Being a firm believer in the EU—and coming here as a non-UK citizen amid the whole Brexit debate—it’s the political ramifications that concern me the most.
If you contract it while restocking shelves at Tesco, that’s just as noble a job as being a nurse or doctor.
There’s a concern about doctors becoming unwell and doctors have passed away. That’s especially unfortunate, knowing that they passed away caring for others, but I think it’s statistics as well. Let’s say one in 100 people die from the virus: you know it’s going to hit a doctor or a nurse eventually. I don’t think it’s fair to say that they contracted it at work doing something noble. We’re not doing anything noble, we’re doing a job that we’ve been trained for.
If you contract it while restocking shelves at Tesco, that’s just as noble a job as being a nurse or doctor. I don’t think there’s a difference. A life is a life, whatever the person’s background. I don’t like the idea that NHS staff are now suddenly “heroes”. We’re not, we’re just doing a job.
Are the patients mainly elderly?
It is quite eye-opening to see how young some of the patients are. Most of my patients are in their mid-50s to 60s. At the moment, none are over 70. We have some who are really young—one chap is 27—but they all have underlying health issues, a severe condition, like cancer or HIV, or real immune deficiency problems.
I think that when scientists say they don’t know much about this virus, they mean that there must be something underlying, or maybe even related to genetics, which they haven’t defined yet. There’s just no pattern to explain why some patients get way more ill than others.
How does it affect you personally?
Doctors usually have a social life to blow off steam. That’s definitely missing and I’m really feeling it. I’m very sociable so it’s weird for me to go from having this really intense job to a big void when I get home. As a doctor, you don’t want to meet people who aren’t working in the hospital and put them at any risk. That’s why I moved out of my houseshare and am temporarily living alone.
A colleague told me that elsewhere in the hospital they’re turning an entire ward into an acute psychosis ward for doctors.
Having perspective keeps me going. I’ve been trying to meet my basic needs: eat, sleep and do something physical to be more active. I just bought a racing bike so I can go places while still social distancing. I’ve also been listening to lots of music.
Recently I’ve been babysitting a fellow doctor who burned out due to Covid-19. A colleague told me that elsewhere in the hospital they’re turning an entire ward into an acute psychosis ward for doctors. I think we’ll see lots of PTSD [post-traumatic stress disorder] cases related to the crisis.
What are your biggest concerns about the pandemic?
Once the corona crisis improves, there will be a wave of untreated conditions hitting the NHS that have been put on hold, but this will cause huge financial issues, and doctors and nurses will already be exhausted.
Yes, we need to focus on coronavirus right now, but there’s a little “but” in the back of my mind because there are many, many patients out there who aren’t getting treated for other conditions. If a woman has breast cancer, for instance, and surgery is delayed, that’s going to affect her outcome and it’s not going to show up on any statistics. If that woman dies five years earlier because she didn’t get treatment at the start, that’s another corona-related death.
There are waiting lists of more than 18 months for heart surgery. Once the corona crisis improves, there will be a wave of untreated conditions hitting the NHS that have been put on hold, but this will cause huge financial issues, and doctors and nurses will already be exhausted.
What’s the hardest thing about the job?
One of the only things I really struggle with is that we can’t have face-to-face conversations with patients’ relatives. This is something I always try to do because if you’ve ever been on the other side, you’ll know how horrible it is and how you really want any kind of information.
Because of Covid-19, no relatives are allowed inside the hospital. Each patient is allowed two visitors once during their time on the ward. I call the families of my patients daily with an update, but I really don’t like having to pass on news on the phone. You don’t get a feeling of how they are reacting.
Testing for coronavirus has been hit or miss in the UK. Is it still a problem?
This is another concern of mine. The UK is lacking testing. We need to test people over and over again—for the future and for statistics.
The Government is making political and economic decisions, such as whether we can ease up on lockdown, based on numbers. But we don’t know the figures because they don’t represent the actual numbers. We don’t know who’s dying outside hospitals and testing is the way to find out.
Despite everything, does your job still feel rewarding?
To see teamwork and how everyone is trying their best is really rewarding, especially the nurses, as it’s their care that really makes a difference in ICU
One of the most rewarding things is having a great team to work with—it was one of the reasons I chose this profession. To see teamwork and how everyone is trying their best is really rewarding, especially the nurses, as it’s their care that really makes a difference in ICU. Even overworked, they are still in a good mood.
How will this pandemic impact your outlook as a doctor?
I hope I won’t take normality for granted once it returns. Professionally that means I’ll appreciate families being able to see their relatives and that patients don’t need to die alone. It makes a big difference; not being able to say goodbye properly.
I’ve always been very communicative with relatives and I want to keep this up, with the knowledge that there was a time—these crazy months or even years—when that wasn’t possible.
What message do you have for the Government, your fellow NHS staff and the public?
I really hope the Government will help the NHS—and that’s not just clapping on a Thursday night.
For the Government, my message is to appreciate and value the health system, support it financially and don’t forget it once this is all over. I really hope the Government will help the NHS—and that’s not just clapping on a Thursday night.
And for society? Be patient. Take the crisis and use it to reconsider your values
For my co-workers, keep perspective and do what you’re doing. Keep your sense of humour; don’t get too grim. Have a laugh now and then. And for society? Be patient. Take the crisis and use it to reconsider your values. Appreciate what you can learn from this about taking things for granted.
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