It’s incredible what you’re able to normalise just because you are seeing a lot of it. I reflect on my 15 months in hospital wards during the Covid-19 pandemic, and I’m not surprised by news that many of my colleagues are re-evaluating their career choices. According to a survey from the British Medical Association, one in five doctors are considering leaving the NHS, with respondents citing excessive workload, poor working conditions, low pay and problems with mental health. A quarter are considering a career break, and one in three are thinking about retiring early. The conditions we worked under as the health service battled Covid-19 precipitated this crisis. While the onslaught has now mercifully subsided, I, too, have had serious thoughts about whether to stay in a profession that I love and spent years of my life training for. But nothing really could prepare me for a typical night shift during the pandemic’s peak.
It’s 7.30pm. I hurry through the usual pre-work ritual and arrive at the “hospital at night” meeting for my first of a block of four shifts covering the medical wards, still humming the melody from the song I was listening to in the car on my way in. The co-ordinator informs us that due to a combination of sickness, self-isolation and a long-term rota gap, we are four doctors down tonight and efforts to plug the holes were in vain. I find myself amused by my own lack of surprise that nobody made themselves available for these shifts at such short notice. The bank of people who can be called upon are trainee doctors like me, and no doubt they only recently had the pleasure of drudging their way through 12 sleep-deprived hours responsible for more than 500 patients with half the usual complement of doctors. I can’t say I blame them for not having the mental or emotional currency left to come back for seconds. Pleas for doctors to work at “enhanced rates” fall on deaf, exhausted ears.
A typical night shift during Covid was carnage. After being informed we were four doctors down, the acute medical ward handover from the nurse-in-charge confirms our suspicions that our nursing colleagues have a similarly unhappy staffing situation. I know from experience that this, more than anything, means we are in for a rocky night. Being more closely involved with the beat-to-beat care of our patients, the nurses are the first to see problems emerge.
Collectively we accept our fate and swiftly divide the projected workload with a grim sense of purpose. Trepidation is quickly replaced by a feeling that I’m falling behind with the ever-growing list of jobs to do.
“Jobs”, in this case meaning being alerted to attend to someone whose vital sign trends might herald that they are on the cusp of serious deterioration. An “early warning score” – a collation of data points covering the body’s major systems – aims to trigger timely evaluation and action. However, during Covid the average patient was often so sick and there were so many of them that the scoring system became utterly devalued, making it impossible to prioritise patients. The bleep would go off incessantly and I had no choice but to try to be in multiple places at once, checking the “end-of-the-bed-o-gram” to try to assess the urgency of the situation.
Alas not all situations can be rescued, and in this shift alone I lose count of the number of families I have to call up in the middle of the night to explain that their loved one is not responding to treatments. I explain why the time has come to shift our focus to their comfort and dignity rather than survival at all costs. I’m not sure anyone woken at 4am to be told about the imminent death of someone dear to them is in the best position to take in such information, and I can’t be sure I’m on my best form either; I do what I can to help them make sense of this sad, confusing time. It’s not all doom and gloom, and it feels good to make some decisions tonight that I’m confident will have benefited people, but the volume and acuity certainly takes its toll as the hours pass.
An unsuccessful resuscitation attempt of a younger man leaves me with yet another traumatic experience in an ever-growing portfolio to process and compartmentalise. A professional bottling-up of one’s emotions at this stage appears to be the only protection from moral injury and burnout, short-lived though this strategy may be. But our sense of duty keeps us going.
The shift is close to what feels like a conclusion. Having not yet stopped for so much as a sip of water – and my Strava showing me I’ve covered 10km – the only thing motivating me is the thought of a canteen breakfast after handover. And a coffee to make the drive home a little safer. I take pleasure in the irony of the posters I pace past in the corridor advertising the virtues of proper sleep, more water and stopping to meditate or perform yoga. The illusion of calm that comes with the rising sun is a regular feature of such shifts – the erroneous sense that everyone will be fine now the night has passed. The veil is thin though and you can’t help but carry home the responsibility of your choices, and wonder how many of the patients will still be there when you return.
I have since left medical training. I’m taking up a permanent position that affords me more flexibility and a better work-life balance rather than continuing on the training pathway to becoming a consultant. Many, many doctors choose this route, which could lead to a training shortfall. Sadly, I think the profession is slowly destroying itself by not properly looking after its own.