So yesterday I tested positive for covid. After 2 years, 3 vaccinations, no kids, no holidays, living with my husband when he was positive over Christmas, and after treating countless patients up close, the fiend finally found me. Thankfully after 4 variants, the Omicron variant which must be what I have, is mild. I have definitely felt worse than this before now, and I've had several covid negative viruses in the past couple of years, and this isn't much to write home about. Grateful for the vaccines too. I have been so careful still, despite the may rule changes, and recent relaxing of all things sensible by the government, but in the past 2 weeks we have had friends to stay with their kids (all well), we have seen Rich's family, as his brother had returned from Dubai and we celebrated our sister in law's 50th birthday (all well), and the one thing I have avoided for 2 years for fear of covid is to swim in our luxurious residents pool...but we did last week for the first time.. and steam and sauna, and I walked out saying I wasn't sure we should have! And here I am.. but we won't ever know. It was inevitable I suppose, and I'm just glad it's not too bad, just exhausting!
Rich was away at his games most of last week. I started coughing mildly on Thursday evening, when he was back. I had been caught in the rain most of last week walking home from work so thought it was that. Friday I tested negative, went to work, nurse Sue had been coughing and sneezing the day before, she was also negative. The morning operating was hard for me, I was feeling fragile, a bit under the weather, had empathy fatigue, and held it together until I finished, and wept on my boss's shoulder (literally) and now hoping she hasn't caught it. I felt really low, and I had made an error in putting the wrong patient label on a prescription for a patient and her daughter was unhappy about it, and had to come back to collect a new one-it was a sure sign I wasn't well, and now I'm fretting that these old folk have caught it off me.. How will I know? I went to the hygienist (oops) and then I went home and slept for 3 hours on the sofa. I put my dressing gown on over my clothes and that was me gone until nearly 8pm. I was in bed half an hour later and managed a video call with Rich who was now in Liverpool for his match yesterday. It didn't last long. My first job yesterday was to test , and for the first time I saw the 2 horizontal lines- C and T - and I called Rich. This explained a lot. Afternoon tea at Claridges for just 6 of us as a gift to our now retired colleague Frances was now off for me and I was gutted. The covid hub at work told me to isolate now until I test negative at day 5 and 6 so I will be off work until Thursday. I mean, I managed to stay working when Rich had it as I tested negative each day and work let me in-first time since the hospital realised it couldn't cope with winter pressures as well if so many were isolating simply due to contacts.. I reported my result to the NHS app, and within an hour I had a call from a doctor at UCLH called Josh - because I was on the clinically vulnerable list due to my previous lymphoma, and I had been flagged immediately. I had been sent a PCR test a couple of months ago to return in the event that I got a positive lateral flow test, as they have been giving antiviral infusions to some patients, but I was sure I wasn't in need of this. But their system was perfect, and we talked through my history, my treatment, stem cell transplant in 2006, full remission, breast investigations, and I mentioned the 2 holter monitors I have had and am awaiting my GP report on this this week-could I have had covid in Jan 2020? We will never know, and my antibody test had been negative that summer so assumed not, but again we don't know. He thankfully concluded that I don't need to be on the clinically vulnerable list anymore, and I don't need a transfusion. I was way past the 12 months since a stem cell transplant, and I was just hugely impressed and touched by the efficiency the NHS has had with the Covid regimes since this started. So even now they are spot on with their follow up and record keeping.
And so I posted off my PCR anyway , and after cleaning the flat and spraying and wiping everything down to be safe for Rich;s return, (a bit breathless) I spent the rest of the day in bed. The cough and sore throat were the main symptoms, and some headaches, and a bit bunged up, but predominantly very tired . But now I have the time and the space to rest . I had a bit of a temperature at around the time his game kicked off, (I had already taken paracetamol) but I watched it on my phone and always proud to see him on the tv. He came home very late last night and I had made up the spare bed and he had the other bathroom to use too. It was a regime we were familiar with after he had covid at Christmas, and I was sitting outside the bedroom door having dinner with him from a distance!
Today I have been absolutely shattered.. the cough is there but less, the sore throat improved as the day wore on, the tiredness the dominant symptom, and the sneezing much more! No fevers, but I did feel quite dizzy earlier. But all in all it really is rather mild. I have slept, I have window shopped (and shopped..) online, have ordered our very first Tesco home delivery to come tomorrow, and Rich has been a darling, gone to get a few things before the shop arrives tomorrow, has fed me soup and bread, tried me with chocolate-a no go, I must be ill.., bought me my favourite dried apricots, and brought me a yummy dinner, which took a while to eat. He sat outside the bedroom door to eat with me too..
But what is this to anyone when this is the week that has seen Russia's bloody and pointless siege on Ukraine, and my darling best friend losing her mum, to whom I had also been close. There are battles, and there are wars, and in the end we have to be grateful for small things.
Today is a new day, and a new year. Everyone I know has wished this day to come for most of the whole of last year. I just want to keep saying to them all that today, just like every day, is a blessing, and wishing time away is all too easy. It's nearly 8 months since I last posted here, and so much has happened in that time, for me, my family, my work, my colleagues, and the many many people I don't know and only see on TV or hear about through others. And sadly all this time later we find our country in a worse situation that the first wave of the covid-19 pandemic. It has undeniably been the hardest of years for so many, the world over, and to find that a mutant strain has infiltrated our population and is now filling our hospitals beyond the limits it saw earlier this year, is a worrying and hard way to see in the new year that everyone has been pinning their hopes upon. So many feel anxious, disappointed, despairing again. But maintaining hope and courage and strength and supporting each day remains so important, and many are forgetting that they have done this to get them to today.
As I write, my own hospital this week has hit crisis point, 300 covid admissions compared to 125 the first time around, 15 on ITU, one of them being a young healthcare assistant. Christmas was a lonely place for many this year, as the situation forced our government to abolish mixing over the 5 days we had been "promised". Yes I missed my family, but their health is more important to me so we can all be together next Christmas. And I said all along that the virus doesn't go in to hibernation or on holiday over Christmas just because we were allowed a break in the rules.. and this week is telling its own Christmas Carol. It has been hard once again for me to hear the righteous and downtrodden opinions of the healthy and the sheltered and the well fed and the wealthy and the able bodied and those not reliant on the income that so many have lost from the closure of so many businesses, that they are so hard done by to have restrictions placed upon their usually gilded lives, no restaurants or bars, no holidays or shopping trips, as these people have no idea of the reality of the majority, nor the reality of the devastation that this infection has and still is causing so many. And the ostrich mentality lingering in our midst still has some people not believing this virus is a real thing.. the behaviours of the individuals and crowds we are still seeing, mask wearing still worryingly variable, and secret mass gatherings still occurring. I realise that hospitals really are setting the example and our vigilant practice outside of there remains. We have got this far, and PPE has kept me well all this time, I won't be dropping my guard anytime soon.
And as we enter the new year we have the hopeful saviour in the form of the vaccine-the most positive development to see us to a better situation we hope by this time next year and with luck well before that. The UK was ahead of the rest of the world in developing the Pfizer and AstraZenica vaccines, and the first people to have them were the elderly on 8th December (my late grandmother's birthday-I wonder what she and all my other late grandparents would have thought of all this, but then they were alive in the time of the Spanish flu pandemic). We will have the Pfizer one rolled out at work from 4th Jan, and in the meantime may be called to assist with administering them as our elective and routine work is now to stop again, and we revert to urgent and cancer work only in dermatology. Reminiscent of months ago, but this time with the experience of having muddled through and then successfully established our ways of working remotely, with our technology systems in place, we have nothing to fear this time around. We have done it before and we can do it again. Echoes remain however of "I could be doing more", but I am reminding myself and my colleagues that we all have a place in this, the peace I came to and wrote about in this blog all those months ago when I had felt rotten for not being redeployable based on the care and attention of my colleagues who were concerned after having been a cancer patient. But hard work still continued for me throughout, and as soon as we could open our surgical services again I doubled my days to be now working four days a week and we ploughed through our 200 on the surgical waiting list between May and August, established a really fast pathway for patients coming directly for surgery following photo assessment, and never before have we had such happy patients seen so swiftly from GP contact to hospital treatment. It has really worked, but has involved huge amounts of effort and adaptability in this constantly changing environment, and we should all be proud of what we have done to manage and cope and learn throughout this time, and continue to take forwards much of the good of what we have established now, even beyond covid.
As I look back and summarise since I last wrote, the second half of the year has seen the country in varying states of lockdown, the second wave no doubt having been catapulted by the summer holiday travels and laissez faire behaviours of people happy to bury their heads in the sand about covid, but not in the sand on the beaches of their holiday destinations. Schools stayed open second time around, but children and teachers have been regularly dropping out like flies due to covid contacts and outbreaks, so education and parental home care thrown into disarray all too often. The airline industry and many businesses large and small have been folding quietly, high streets and shopping centres, hair salons, entertainment, theatre and film, dining, hotels, and countless more suffering under the weight of the gargantuan but invisible viral load that covid has implored upon them. The world will never look or feel the same, maybe ever again. And the economic fallout is yet to be fully known. Our airports and ports and the lack of stringent policy, testing, tracking, policing, have undoubtedly allowed our country to be the worst in Europe for infections. We are an island. We could have prevented this. We have to look at how some countries have managed it so well and repeat this. I still can't understand that a problem affecting the whole world hasn't meant a single policy for all, closure of borders, and containment from the outset. It has been each to their own, and this has been a deadly price to pay.
In my world, I have thrived, as has my husband, remaining hard at work and remaining sensible and careful to protect ourselves, each other, and our loved ones. We haven't been to a restaurant, a bar, and social event, we have seen family or friends from a distance, we haven't had an urge to travel, although a week long break in a small cottage in Norfolk in August with much cycling and running as well as resting, was very valuable given that we have have otherwise had no time off. Him more than me-football has continued, without fans, and games across all borders and tiers now (we were put into highest tier 4 before xmas) still continues. They still test all of them weekly, and some nearly 50 negative covid tests later I see that he is my measure of being covid negative when I'm not having testing myself. Low accuracy lateral flow covid tests have only just been delivered to us at the hospital, although I'm aware that a positive test by me at any time would mean he can't work.. So this is a current dilemma. Football has somehow been justified to continue right now, even as this new wave grips the country, as this week has seen him travel to Southampton and Liverpool already, and positive tests turning up more and more in their circles, it's wonder if it can continue as it is. Travelling out of tier 4 is not allowed for anyone, but football seems to manage to swerve this, which is hard to understand.. But of course it is my husband's livelihood, and neither of us wants to be out of work, but his safety is priority. Having him home for Christmas Day for the first time in 20 years in football was a gift, especially in the year when we couldn't now mix with our families for Christmas. And seeing the empty streets on Christmas Eve on our impromptu drive to town after work that day to see the lights was a magical moment.
My Mum remains furloughed from her teaching English job, as language schools have suffered the loss of travelling students. But her experience of retirement has suited her well, she walks on the beach, she reads, and she has played tennis when able and as with all my family has remained upbeat and understanding of what is important. She has still been caring for the health and welfare of my Dad, who has had a hard year with his health. He had three non covid related hospital admissions this year, first from campylobacter gut infection leading to sepsis, and then twice from urological sepsis, resulting in AF and a number of scary moments when he became acutely unwell. But in true Dad style, and with the usual tenacity of an ox that all our family, generations gone by have had, he bounced back, albeit slowly, and has taken his place in his room downstairs now, which he has found a comfort. He has so far been declined home oxygen for his COPD following assessment (he has an incredible GP who has allowed me to openly communicate my concerns, and questions, and always emails me back. I don't wish to be the interfering doctor daughter, but I approach with respect and care and we have collaborative communication about dad, all with his consent). He has had a ruptured cyst on his leg more recently, and swollen legs and some venous eczema which has been a new but predictable problem given his general immobility, and we believe some early heart failure, but all is being managed well, and I have been in very close contact, although hard from an enforced distance. I have been careful to visit my family a couple of times, and touch wood we have managed this without hiccups too. My older brother has been in the UK for a few months now, after leaving USA, and his girlfriend, and his work has been curtailed in many ways as travel is so integral to him as a photographer and videographer, but his creative ways have seen him still capture amazing things as he remains safe in the family home by the coast. His long distance relationship has continued to grow, and that is a wonderful thing given the disruption that this year has caused otherwise. We have at times found it hard to understand each others' stresses, him with his work and his inability to travel to be with his loved one, and me with the full on pressures of my work which I have been eternally grateful to have, and the initial fears of covid at work put to rest for the most part as I realised more and more that my PPE and my care with my practice has been protecting me and I gained trust of the practices we were employing to keep ourselves and our patients safe. My brother and I had an unexpected and uncharacteristic falling out, and I have still found it hard to truly understand why some of it happened, but over time the situation mellowed, and we became friends again. My younger brother has been in and out of work in the film industry, and we of course worry for him with the ongoing restrictions being what they are for his work. We had some lovely bonding time over the summer, and spent quite a bit more time together than we might have otherwise, and bringing him to our home, in the surroundings of where Harry Potter was filmed, a film he has worked on more than once, was lovely-we just couldn't show him inside the Great Hall where it actually happened, as it was locked due to covid! Sometime soon we hope. But contact has waned again, and my unannounced visit to see him and take some things to him ahead of Christmas was something I needed to do. Pinning him down to get a response can so often be so hard, and finding him at home in tier 4 lockdown (same tier as me don't worry) was my only hope! A few minutes at his doorstep was enough for me (even if too long for him!). I hope we can again find the emotional and physical space to see each other more this year too, it's mainly in his hands, and we all live in the hope that he will come back into the family fold, at his own will, in time.
Permitted to Pause has continued to grow, and I have met incredible people and kindred spirits through instagram, which has been like gaining a whole lot of penpals! I have enjoyed seeing the charity Doctors in Distress become more visible. I was honourably asked to be a Trustee of the charity. After much and agonised thought I felt it unfair to take on this role when I am already so busy and fearful that I couldn't give them the time they deserve right now, and being keen to expand of some of my own longstanding projects too (I have written five chapters of my book so far) which need the time I am already trying to find, I regretfully had to decline. They understood, we remain in collaboration,, and I will continue to support as and when I can without question, and perhaps we can revisit this in the future. But through these wonderful meetings on instagram, between Sept and Dec I have been invited to be interviewed on four things with P2P I never thought I could or would do-a webinar, a podcast, an instagram live, and a video stream-I learned so much, and the conversations we had were enlightening and bonding and I am so grateful to each one of the hosts. And this has given me a hunger to try to be brave enough to do my own thing in some way, to try to effect change in the culture of medicine and enable healthcare professionals to be healthier and happier in ways that are simple and are passed on at every level, and that self care in the profession will be seen as something mandatory, and not just by chance, or because it is "deserving" and that is becomes second nature, and remains guilt-free. My Imposter Syndrome has gobbled me up at times, but I have been infinitely encouraged by my husband throughout. I have bonded on ever deeper levels with my colleagues this year as we have worked thorough this unexpected journey together. And I have continued to have the love and support of the incredible friends I call my sisters, and we have all grown and projected along this past year's runway, and we remain by each others sides.
And my final reflection is on the view to the future, as this year we found a place in the New Forest that we hope to call home in the very near future. The James Bond house as we have called it, the perfect idyll with so many elements of all the homes we have lived in before, in London, Wales, Montreal. We are looking to a future which brings us more control, more security, more of nature, more time with family, and most of all more time with each other. We have both grown as individuals, and as a couple ever more united by the life events that have surrounded us through the years. We are not afraid of what lies ahead, we positively embrace it, whilst holding the health and good care of our family in equally high esteem. And we count our blessings every single day, and today is no different.
I will end this blog post with the post I put on my instagram yesterday, and as I don't know when I may again be writing, but today I was determined to do so.
Think Positive: I found this the other day-something I acquired during my cancer treatment (no idea how but I think it was given to me having been pinned on the wall somewhere!) and I thought it a timely reminder to share these words as we enter a new year in just a few hours.
Let's remember to make every hour count, in 2020 and in 2021 and beyond, and don't take your previous time for granted. And as you reflect on this year gone by, do so positively, and with gratitude, for getting to where you are now. You have had strength and courage, more than maybe you knew. Without reflection how can we learn and grow and figure ourselves out and gain the tools to figure out the next bit in the stages of this meandering life? Steps we have walked before are what bring us to where we are in the present, and take us onwards to our future-we don't have to have it all worked out, because we can't, and continuing through this year's constantly dynamic state can be an empowering reflection for us all.
So onwards we go, and may 2021 be a healthy, nourishing, and ever positive year for us all.
There seems to have been a shift in mood, attitudes and behaviours over the past couple of weeks, as covid-19 leaves its heavy footprints following its sweeping devastation. It's not over yet. But in the UK, despite lockdown still being in place on paper on many counts, increasingly we are seeing scenes of packed beaches and tourist spots, packed trains, unmasked faces in the crowds. Whilst this has brought joy and freedom to those defiant enough to voluntarily break free from the confines, conversely it has brought fear to many more who continue to adhere to the public advice by staying at home and safely distancing. The plain disregard of others' health concerns are being taken for granted by those willing to take their own risks, and this discrepancy in the interpretatation of the advice is only getting wider. Agreed, the government information hasn't always been clear, particularly lately, and it hasn't reached out to all the people of all social classes (not everyone will have ever afforded a cleaner for example, so making this dilemma a topic for discussion is not appropriate for many). But there is the matter of common sense, and ownership of responsibility, and the flouting of these things is what is doubtless feeding the flouting of the advice and risking future spikes in covid infections.
After a nation brought together by a health crisis, which has by today, at the time of writing, taken more than 37,000 lives, the highest in Europe, we have seen rainbows, applause, solidarity, community spirit, fund-raising, discipline, support for mental and physical health, volunteering, and an NHS which has defiantly torn down the red tape and rapidly adapted, with all the skill, knowledge, technology, and selfless devotion of those working within in it, to try to defy the invisible assailant that is covid-19.
Yet as the peak now appears well behind us, with fluctuating but lower numbers of deaths and cases showing a very clear downward trend, there seems to have been a change in the atmosphere-I sense there is growing discord, blame, judgement, anger, rebellion in the air. People are understandably desperate to get back to earning, and impatience, boredom, cabin fever, and frustration are rising-the novelty of the extended enforced "holiday" is wearing thin for many now.
And there seem to still be pockets of concern in areas of the country which have been behind the curve until now-Weston Hospital in Somerset has just closed 48 hours ago due to the pressure of numbers of covid patients-a surprise indeed. Or is it, with the weather being so glorious and this seaside town being one to attract tourists? So here I find myself judging people's behaviours, but it's hard not to make an opinion from the other side (especially the healthcare side) when it's put right in front of us. The fear of further spikes in the next two or few weeks is a worry for many. Then there's the matter of Mr Cummings, whose early misjudged travel across the country in March, with covid symptoms has made headline news: his will was to safeguard his child, is understandable, but he was carrying around risk to others too, and this visibly conflicted with his own postion on the matter. To be exposed, and in his elevated and prominent status through the pandemic, has given the media and its viewers none other than an opportunity to judge, and to blame, and with clear health risks at the fore during a health crisis, this opinion can be justified. This mood appears to be sweeping across our screens and in our homes and in our hospitals.
And as the call to end the weekly Thursday evening Clap for Carers and the NHS has gained momentum, tomorrow evening will see the 10th and final week of this ritual, which intially brought emotion, support, optimism, charity, and empathy for so many. Engineered and energised organically over the weeks, it has marked a renewed respect and gratitude for the work done behind closed doors, which I hope will not be taken for granted once Thursday evenings are silenced, as the recognition of the intensity and risk associated with fighting the covid pandemic must not be forgotten, but neither must it go unnoticed that this skilled work was going on well before the pandemic, thus making the fight against it even possible, and it will continue to do so as it always has done.
Indeed the aftermath of the plight of those vocational healthcare workers, having been catapulted through the emotional highs and lows of a time in the profession that will never be forgotten and hopefully never repeated, is yet to be known, but recognition of their fragility must continue to be recognised, identified, and addressed, or a far greater crisis will infest and infiltrate our NHS and everyone is responsible for not letting that happen.
I personally have documented some of my own perspective of the past several weeks in this blog. I have found opportunities to reflect, and to learn, both at work and outside of work. I've already blogged about my internal conflict surrounding the lack of access to cancer services for patients during the pandemic, probably because I'm a former cancer patient myself, and couldn't imagine being told I was limited in my choices for treatment simply based on the timing of my univited disease. Like anyone, I have found it challenging telling a young patient with melanoma that we couldn't offer him the usual pathway for lymph node biopsy to further define his prognosis because the timing of his disease diagnosis, at the start of the pandemic, saw a stop in tertiary referrals to carry out this procedure due to the restrictions the pandemic forced upon the cancer services. In the end he paid a small fortune to have it done privately when this was the only option with a surgeon who was still just about able to offer this before further restrictions may have afflicted his private service for this also. But what price is there on one's health? I know I would have done the same.
I have found it difficult breaking bad news of malignant melanoma to a patient on the telephone, not able to hold a hand, to engage in the normal way I would if face to face, yet the steel and strength I still felt from her was admirable. And only 2 days ago, a longer standing patient of mine who developed metastatic disease in recent months whilst under my care, was admitted to our hospital with a fall, was found to be covid positive, and has now succumbed-I can from a distance only summise that it was covid that took her, but in this case may have saved her from the ravages of her metastases which had riddled her body in a short time. I have contemplated since which of the two I would rather have been released from my fate with.
On the positives, I have learnt and given training to my team on the new digital platform which I was pivotal to introducing pre-pandemic, and which has come unto its own as the whole team have embraced remote working in dermatology using photographs and thus reducing the unnecessary footfall in the clinic and bringing urgent patients to the procedures and treatments that they actually need. And we have had the opportunity to write about our experiences for the British Association of Dermatologists summer newsletter-learning from one another in healthcare has been and will be invaluable, as we all strive to recreate an NHS that has been reduced to ground zero and the lessons we have so quickly gained must take us forward as we build better and more efficient and accessible services. Dare I say that the public have a part to play in this too, and respecting healthcare services for what they are most needed for in all the sectors of primary, secondary, and tertiary care, will also be key.
Resuming my own surgical practice for skin cancers in our department last week has brought me the same pleasure I have always had after this 6 week hiatus of working behind closed doors, albeit with the new look of full PPE, and the introduction of "Hello, my name is Dr Sam, and I'm here from outer space", just to break the ice with the patients when they walk through my procedure room door! But as a patient said to me only yesterday, "don't worry, I understand these are the times we are now in".
Outside of work I have taken the opportunity to bring Permitted To Pause to life, to begin to propagate its message to our profession not only during, but I hope well beyond the pandemic. I have felt compelled to engage in fund raising in small ways-the Run for Heroes, and with the sale of the Permitted To Pause NHS postcards to raise money for the charity Doctors in Distress, which I have no doubt will be increasingly needed from this day onwards, to save the mental health of those who have been battling quietly over these past weeks, many I'm sure alone in their heads.
I have had kindness and support shown to me, from my husband, family, friends, colleagues, and have done my best to do the same for them, as everyone's experience over the past weeks has been different, and individual to them. My heart has swelled from the distanced interactions with all my immediate family, the highlight always being any engagement with my younger brother who has the biggest part of my heart, and someone who understands my head as much as I understand his, and perhaps more than we both realise.
So as the tide changes, as the covid pandemic further unfolds, and diminishes, as the "new normal" evolves, and as small pockets of our lives, our work, our friendships, our relationships, our health, and our future-proofing slowly come back to life, we must remain kind, supportive, caring, defiant, resilient, and also learn, of course, to pause, to reflect, to restore, to learn. And perhaps we should all take care to put aside blame, judgment, and anger, as after all, this life event was a global natural disaster, totally unplanned, unrecognised, univited, and hugely disabling, but we have fought and we are conquering, and in the wake of such tragic loss, we must remain insightful, alert, and ever thankful.
The twists and turns of the past 2 weeks have brought much contemplation. And none more than my dear Dad being admitted to hospital with fevers and diarrhoea 10 days ago. Thankfully he tested covid negative, and there would have been virtually no way that the virus would have contemplated reaching the front door of my parents' house with the meticulous and regular sanitising that my Mum has been doing, largely, and heroically, to keep my vulnerable COPD dad in his late 70's from contracting it.
He had complained of feeling tired the Friday night, then was late to rise on the Saturday too, and I knew something was up. He sounded fine when I called him, but by evening I found out he had been in bed all that day when Mum told me he had had a bad gut. All these highly out of character. I facetimed him and got Mum to give him the thermometer in bed, and waited while he took it. 38.8..his oxygen sats were 81 (while we know he runs at sats in his mid to late 80's sometimes in each day since he has willingly complied with 3 times a day checking and reporting to me, they have never been this low), and he had diarrhoea, all very worrying for covid was my immediate thought, knowing what this diagnosis could mean for him. I asked them to call NHS 111, take paracetamol, drink fluids, and let me know. I assured them that on on any other occasion I would have given this advice and not involved 111...but we are in the midst of a global covid pandemic and this was a necessity.
He was advised,, his temperature responded, and I had a fretful night wondering how he would be. My parents may be no more than unmarried housemates on paper, but they do still care and look out for one another as they did when they were married, and my Mum wouldn't let anything go unnoticed. NHS 111 were excellent. They called back at 5am while dad was sleeping, then again later that morning, and despite my Dad sounding well and chirpy, he omitted to tell them his oxygen sats level (I found out later from my mum), they saw through it and based on his fevers and diarrhoea they advised that he got assessed at the hospital. My Dad has 3 phobias I have learnt over recent years: going to hospital (he told me the night before that he wouldn't be going, hence perhaps the tactical omission of the oxygen sats I'm sure), going on oxygen, and having any walking aids, all of which have been explained to him may be in the offing at some point. And here he was, having been convinced by the lady on the phone, I assume to have been a doctor, and packing a bag to head in. He would have a full respiratory work up, and covid swabs, a chest xray, and anything else they would deem necessary in the current climate. He was warned that someone would collect him from the car in full PPE, and that Mum or anyone couldn't visit. I know he was nervous, but we all were, and I promptly contacted both of my brothers. And through all this, the most trusted opinions I took from my most trusted and oldest medical school pals, who are sisters to me, who are always "on call" as we all are to each other 24-7, and to have two of the best GPs I know advising me and my family and supporting us with their own experiences right now was invaluable.
Mum was of course amazing as always, trying to arrange his commuications with his less than useless mobile phone, his ipad, his chargers, and something to keep him from boredom-his crossword book. I managed to see him every day at least once on facetime and he was absolutely cheery in there! Bournemouth hospital have looked after him before; with his 5 star stay in a side room, the whole 4 days of his admission were only marred by the ongoing fevers and diarrhoea, the "terrible" coffee, and the pressurising by a Care of the Elderly consultant who was pushing him for her to document a Do Not Resucitate decision, while he was well , soon to be discharged, and on his own in this discussion with her. He said he felt bullied-a sad moment when I hear this happening in my own profession to make anyone let alone vulnerable patients feel this way. And he stuck his ground that he wanted to talk to his family about it. So after a fretful afternoon thinking about this at work, and sharing with my colleagues the best way to broach this issue with Dad and the family, it was my two "sisters" who both said there was no rush to make this decision while Dad was about to be discharged, and that once we chatted as a family these issues of documenting agreed resuscitation status should his heart stop, could be done with his GP. I didnt' know about the RESPECT protocol which is implemented in the community, and nor it seems did my hospital colleagues, but it was worth Dad and all the family reading about it. This was a relief to all, especially Dad, who was discharged after 4 days without a question about it from the morning consultant on the rounds on his last morning.
I had in fact had a conversation on face time with him on what was his last night in hospital that day, about what the decsion about resuscitation status meant, and I realised that this was all of a sudden too close to home for me. I put on my doctor head myself, discussing the whats and wherefores in a gentle and non-directional way, and yet realised afterwards, as I have on many other occasions over medical matters with my family, that my own coping mechanism is to remove my emotion from it and deliver the advice and explanation as though I were talking to a patient. But then it grabs you afterwards. And by then I was already feeling far away, not able to be there, no able to visit him, to have this discussion face to face, my mum couldn't visit him, and it upset me to think he might be feeling lonely, and my thoughts went to those poor patients whose fate was worse at this time, and that succumbing to their illnesses, whether covid related or not, without their loved ones, must have been excrutiating for all involved. I just couldn't imagine this for my own.
But I was pleased to know that Dad was actually on good form, and joking with the doctors and nurses ("the thai nurse with the mad hair" made his days), chatting to the Nigerian doctors about his own years in Nigeria, the constant traffic into his room for observations, and his best bit was rediscovering jacket potatoes! And all this while the poor man was battling through campylobacter gastroenteritis ie food poisoning, which had been the cause of this whole episode!
The final issue was that of home oxygen based on his chronically low oxygen sats The team visited him to discuss what home oxygen would entail, and all of us sure that this would be an incidental side-gain from this hospital admission, even though it was not respiratory related (his chest xray was clear on admission to hospital so they were sure he didn't have covid from the get-go), he was told before he left that he wouldn't in fact be needing it after all just now-so this was another relief. As Dad's COPD has been stable for so long, they said this would only be revisited if he deteriorated at any time with his chest. He didn't have single whiff of oxygen during his entire stay in hospital, so this was as a good a sign of stability as any.
So covid and its risks had taken on a new meaning for us as a family, to have Dad admitted to hospital at this time, thankfully with an unrelated problem, but I have also thought in the past week about patients' mindsets at this time: we know that patients have resisted hospital admission despite being unwell, on account of fear of catching covid in hospital, and sadly we know that this resistance has cost lives. My Dad may well have resisted going to hospital (although not if my mum had anything to do with it!), and there is a good chance that without his iv antibiotics, fluids, and regular input with investigations and assessments by the medics, that he may have deteriorated at home, and then where would we be? Equally we know that many patients needing hospital care haven't been able to receive it on account of the risk fo covid infection being too high for them. Again, these situations have tested medics, patients and their families, in ways that we may have not had opportunity to process as yet, but we know that we are dealing with a time in our generation that we will never forget.
It's been a busy week kickstarting our new digital system to manage our patients remotely in dermatology. We seem to be ahead of the game through our pre-Covid experience with piloting the system in other ways, and with the post-Covid future inevitably going to see healthcare as well as many other industries and workplaces adopting remote and digital working for many, we are fortunate to have had the chance to learn it in a short time. So many things will change, we have to embrace whatever is to come in our new future. But it's also proving to be a lot more tiring working in this way, and staring at a screen for most of the day is a large part of it!
So I'm sure it's this that caused me to suddenly develop cold-like symptoms out of the blue before the weekend started..I could have called it hayfever on any other day, but I hadn't gone out, and it had rained all day! It was enough to see me to my bed, and hayfever doesn't do that to me.. The thermometer battery had run out, and as the symptoms continued on Saturday, I thought I should tell someone. I would NEVER report a simple cold...but with a global pandemic going on I want to be sure to do the right thing! I called occupational health at work and the doctor, kindly working at the weekend, took me through the list of symptoms, of which I had none, and reassured me that I was doing the right thing as I apologised profusely for reporting such pathetic symptoms! I had the all clear to work on Monday, as long as the symptoms didn't worsen, to wear a mask at work, and keep my distance..but no test was suggested. Then the Covid App which I had reported to sent me an email, signed off by Prof Tim Spector, my colleague's husband, inviting me to have a test..
I was confused! So with direct access to the man himself, I messaged her to ask him if I should do this, and in the name of the study, and a result in 24 hours, it was advised, in order to correlate any new symtoms with the virus-anything to help us work towards more knowledge in these muddy waters!
Unfortunately despite trying numerous times and being invited to attend what was my nearest test site in none other than Belfast...one opportunity eventually urned up locally, but by Sunday I still hadn't received confirmation from the gov-uk application, so no QR code, and no test pass for my drive through, and by then my symptoms had completely resolved whilst trying! But I still slept int the spare room to protect my husband as he has returned to his workplace, and I will still have to remain responsible when I go to work. As who really knows if any of these little symptoms mean covid-19, or was it just hayfever?!
Today I came home from work to this heartwarming piece of art from my gorgeous God daughter-it reminded me to take a moment to see things through the beautiful eyes of children, and to keep looking at what lies at the end of reach rainbow. What they see is what we should keep believing, and never more than at a time like this, and with all our rainbow warriors.
The end of last week seemed to finally see a visible drop not only in the number of infections and deaths from covid, but in the numbers in our own hospital beds. After my two colleagues were turned away from helping on ITU on Tuesday, by Thursday my consultant colleagues who went for their usual morning on the wards came back by the afternoon and said that there were only 2 covid patients on their ward, which had previously been full of these patients. A truly encouraging sign!
But the angst they now had was in having to manage patients with all sorts of other general medical conditions such as fast Atrial Fibrillation (irregular heartbeat), Parkinson's, elderly patients who had had falls, and this was no longer a place where they felt safe to practice-it had gone beyond feeling out of their comfort zone, and now that the apparent crisis was abating on our wards, it seemed time to come back the specialty they knew and could make a difference in, and to leave the medical patients to the medics better honed to treat these patients in their daily work.
So as we continued our afternoon skin cancer meeting and team meeting, on zoom and distancing in our offices, another glimmer of future hope appeared as we began to talk of planning ahead to resume opening some more normal clinical activity and more skin cancer procedures-perhaps in May. I was beaming at the thought of going back to doing some hands on again, and of course would be somewhat dependent on the government's advice by that time, as the next lockdown review would be 7th May. But unsurprisingly, with the idea of seeing more patients and having more foot fall in the department, rose the subject of PPE once more. The virus is still invisible, and always will be, so how can we be sure that it isn't still around us come May, or ever?
The excellent channel 4 panel discussion I saw on Wednesday evening, called Can Science beat the Virus, was the most informative I have seen yet-no politicians, only a panel of eminent virologists, doctors, and professors from such places and The Crick Institute, Imperial, and Oxford, that latter two of which are looking into a vaccine against Covid. In their own words they still at this time feel it is too early to know everything about this virus, its virulence, its behaviour in different individuals, its treatment, the length of time someone gets immunity after infection, the most accurate antigen and antibody tests, and how we manage releasing lockdown, and anticipating further peaks and waves of infection. Contemplative viewing in one sense, but informative and to the point in another sense. And from the people who are looking at it every day in the kind of detail that enables more knowledge into this freak killer.
As numbers dropped from 821 on 22nd April, to 763 and 638 on the following 2 days, this seemed to support the downward trend. Then on Saturday 25th we saw another spike at 813. This was disappointing to see this weekend. But the numbers yesterday and today were down to 413 and 350-the lowest seen yet on the decline, and so encouraging again. But reaching over 20,000 deaths in the Uk this weekend is stark so hard to fathom I’m such a short time.
The peaks may well be a reflection of the amazing weather, with all these sunny days (which have passed me by except for my daily exercise), the Mothers Day and Easter weekends, which may all have contributed, but of greater concern has still been the seeming apathy to the lockdown and the rebelling at the lack of usual freedom that appears to be sweeping around. Whilst such sad and pointless deaths continue, in hospitals, and in nursing homes, it is angering many that people are continuing to flaunt the lockdown advice and remaining a risk to themselves and to others. As has been said before, and again, the longer the rules are maintained, the sooner we will see ourselves out of the lockdown, but this isn't computing with some people still! And seeing Boris back at number 10 today, and recovered from covid, his message was clear, that whilst we see the numbers dropping, we aren't out of the woods yet, and just need to push on a little bit longer... hard for the economy and people's livelihoods of course, but that would be nothing if you didn't survive covid infection.
But as we finally seem to be over the worst of it, may the sun keep shining on us all as we hope for an end to this pandemic and a return to some normality, albeit slowly and safely.
21st April 2020:
Having felt so underused recently as a qualified doctor in this pandemic, as I work through my patient list, the new skin cancers list, and make calls to my patients, meet about ongoing developments in managing remote working with our team, not only for now, but to future proof some of these new ways of working after covid, I finally come to realise that what I'm doing as a doctor behind the scenes still matters, even if I'm not now on the frontline and seeing volumes of patients. It's taken a while to come to terms with being held back from helping outside of my department, but I'm busy, and I'm useful, and even writing this makes me see how much I have been trying to justify myself!
I had the best therapy this morning at work-a few of us slowly gathered in the empty patient waiting room as more of the team arrived to work, and whilst maintaining our distances we sipped tea and had a good old natter, an offload, and a sharing of recent experieces. And best of all my two besties, whom I feel I have been separated from for so long, and who heroically trained and worked on itu one day last week, walked through the door and it was like a waiting room tea party! It was so nourishing for all of us, and confirmed how important it is to see people face to face.
In fact they had been appreciatively turned away from ITU after the morning ward round as there were half the number of patients there, having previously been double that before now. So this seemed a positive thing-that perhaps numbers of infections and deaths reported in the media in the past few days was now actually visible in our hospital. We had seen numbers escalating to a daily death toll of 980 at its peak on 10th April we saw some temperary daily drops and up they went again. But after 888, then 596, then 449 daily deaths reported between 17th and 20th April, this has looked really encouraging. But I came home today and 828 were reported again. This is another dismal number, and I looked back to see if the peaks were 14 days after the Mothers Day weekend and the Easter weekend, both streaming in sunshine, and both filled with crowds of people venturing out to enjoy it. A crude observational assumption, but one I couldn't ignore.
Positive suggestions of a vaccine being developed in a matter of months, as opposed to years, at Oxford University sounds promising, with the hope that the small differences in the covid strains can all be destroyed by the vaccine. Meanwhile debates continue over the sensitvity of the covid antigen and antibody tests, and we are being encouraged to all wear face masks in public to prevent our own droplets spreading to others-sounds effective if we all do this, and for prevention of spread of all droplet-spread viruses. I order some online and order some directly to our parents.
18th April 2020:
I have a group video chat with my fabulous 4 (well 3 if you don't include me!) as it's a birthday, and we link in as we always do, from Hertfordshire, Sussex, Hampshire and Tokyo. Two of the girls are GPs and I hear that the face of covid in the community is brutal: one of them has been doing remote video ward rounds of the patients in a local care home in Sussex, and it has been very saddening, as the loss escalates, and the residents on the ground floor (generally more physically mobile than the nursing residents and the dementia residents on the middle and top floors of the home respectively) are contracting the virus and dying in their multiples, with what she said was only 12-24 hours from symptoms. This culling of groups of humans assumed to be safe and sheltered in these places of care, and entrusted to them by many loving families, are suddenly becoming victims of a disease which seems to be working on human life something like a gas chamber. I can't imagine he impact this is having on families, carers, doctors, nursing staff, as numbers are being reported again as just that.
And some 50 hospital staff in UK, many from ethnic minority backgrounds, are have also died. The lack of PPE and lack of effective testing are still spinning around the country, many having no choice but to work without their armour and potentially sacrifice their lives in doing so. This can't continue, but how can there even be a dilemma of whether someone looks after themselves before being able to look after others? The oxygen mask on a plane analogy comes to mind, but planes have a mask for everyone, as every head can be predictably counted. Not for daily hospital admissions for covid. Not yet.
The Nightingale hospital has seen very few patients admitted there, yet this 4000 bed construction appears to be well equipped, so perhaps some supplies will be shared out if it isn't required in the volumes they were expecting.
So the uncertainty continues. I have been reflecting on the words of our well known and much respected BCC news anchorman George Alagiah, who has been battling bowel cancer since 2014, and recently spoke about contracting covid, thankfully only mildly. He said: "the very fact that we are living with cancer I think gives us an edge. We've confronted those difficult, dark moments in our life, And in some ways I think that we..are stronger because we kind of know what it is like to go into something where the outcomes are uncertain".
I have felt very similar to this about so many things I have confronted since having cancer, and sometimes I have reflected on the most difficult times back then, to get me through a difficult thing in front of me. Sometimes it works incredibly well. And I hope that George, and many others who have experienced ill health, grief, and difficult life events, can use their experiences to realise the strength they had to get through that, and that they were armed with invisible tools to get through the next thing that life throws at them. However I will admit that sometimes it doesn't work to do that, for me anyway. Because how you feel about something in any given time is related to all the circumstances around it, and whilst each event you pass through to the other side of gives you more of those invisible strengthening tools, you still know you are climbing seemingly insurmountable mountains to get through them. And until you do, it is hard to keep climbing. But you have to also trust in yourself that you will, and that when you do, you are armed with even more for what life might throw at you next. I hope that this is how patients and families and all the healthcare workers the world over can continue to take another step up that mountain each day, and get through this.
Thursday 9th April 2020:
Who knew that being a doctor behind a computer and on the phone could be so tiring?! This may be my temporary new normal at work, but I already cannot WAIT to be back seeing and treating patients face, the reason I came into my beloved profession. Out remote cancer meeting interrupts my computer time briefly, and I go back to my desk to finish the day. Our Team Time is very bonding, albeit from various locations, which can never fully replace the flow of being in the same room as one another, but it's clear to see that we can work in this way quite effectively. I am almost certain that our new work "after covid" will involve more remote working for many of us in the NHS.
But behind the unity of the meetings, and the individual and group support we are all lending each other, there are also moments of unease, shorter fuses and minor intolerances to small things which seem to be magnified in ways that at any other time wouldn't even bring attention to us, altered reponses, either with far greater or far lesser emotion than would be expected of that individual, more disagreements that agreements over some things that would have easily been managed and far quicker before now.
And I have recognised all of these things also in myself. And even of a particularly strong and long friendship with a colleague of mine, and someone who we mutually regularly share our worries, our uncertain clinical judgements, our insecurities at work, yet somehow through the medium of whats app and emails we have unnoticeably been building a chasm that felt to be widening. And when all we needed to do was to talk about it and iron out the mis-read intonations in the messages. We talked it through after work today on the phone, a long awaited and much needed chat, and realised immediately that we were both misreading the tone and intention of the messages and therefore needed clarity, closure, to reset, and to go back to our usual understanding of each other. There is no question that the underlying uncertainty, anxiety, and lack of usual contact in the usual ways has been hindering our judgements, responses, and defences, and in the end we realised we need each other as much as ever right now! Such is the infiltration of this current situation in different, and sometimes the same ways, for us all.
The clapping for the NHS has become a regular Thursday fare. Amazing scenes around the country, around our neighbourhoods, around all of us. Every Thursday, for a special few minutes, the applause and the cheers and the fireworks and banging pots and pans and the people, and the rainbows that everyone everywhere are painting, and the messages in our high streets, make it feel like we are all having one enormous hug. It makes me weep again tonight, and I wish I could do more. Then a text comes through from my GP surgery looking for volunteers to take small medical supplies to patients who can't get to the surgery. I volunteer.
By Dr Sam Anthony
Survivor of a career in medicine, a career break from medicine, cancer, and blogging..join me in my quest to make us happier healthier individuals and doctors