As a consultant hepatologist at the Royal Glamorgan Hospital, my day job before Covid-19 often involved many face-to-face patient reviews, ambulatory unit hot clinics (where patients can access same-day care), endoscopies and multidisciplinary teams. On the wards, I was responsible for looking after between 20 and 30 gastroenterology in-patients, as well as being part of an on-call rota for patients with acute gastrointestinal bleeding.
That suddenly changed in March as lockdown began and Covid-19 rotas were launched. Overnight, our endoscopy services were scaled back to only include emergency procedures, and for the first time as consultant physicians, we were rotated to work resident night shifts and multiple weekends.
I was part of a team of clinicians looking after one of the medical Covid-19 wards - where patients would have medical therapy, including some respirator support but not for escalation to intensive care due to their frailty or co-morbidities. Death and dying is something I am used to as a medical consultant, and especially as someone who manages large numbers of patients with both cirrhosis and cancer, but caring for almost 30 patients every day, many of whom had a high risk of passing away due to Covid-19, was and still is tough.
I was probably amongst the first clinicians in the health board to suffer from Covid-19 and perhaps unsurprisingly, given I was performing large numbers of endoscopies in the run up to lockdown and the adoption of PPE for endoscopic procedures. The first five days were quite scary, and I was bed bound, but the guilt of not being part of the team was worse, and eclipsed by the fears that my young family (my wife Beccs and four children under seven) may become unwell…. or even worse.
My youngest had been in the special care baby unit only four months before, after being born in respiratory arrest and my biggest fear was that that would happen again. I was lucky to recover. My family only suffered mild, if not prolonged symptoms, and several of my close colleagues and friends who went on to contract Covid-19 survived, all of them avoiding ITU.
Coping with this unprecedented scenario has been challenging physically and mentally, but I’m acutely aware that even at the relatively young age of 35, I had to lead, support and care for my team of juniors; a group of doctors pulled together from specialties across the NHS. The team varies from day to day and includes doctors working in psychiatry, ENT, dermatology and orthopaedics. What I can say is that every one of them has stepped up to the mark and gone above and beyond what was asked of them - for every day and every week of the three months that we remained on a Covid-19 rota.
What was even more remarkable was the response of our medical students, some of whom were only three years into their training, who became a core part of our teams and performed bloods, clerk ins and other tasks like well-oiled SHOs.
Life within gastroenterology and endoscopy continued during Covid-19 and the crisis rota. I did most of my clinics over the telephone, often on my days off at home or in between ward rounds and night shifts. On rest days I worked because the work needed to be done. My colleagues would never have dreamt of deferring reviews and clinics because of the pressures of Covid-19. In many ways, it has allowed us to transform our ways of working within the outpatient setting overnight, and overall, our patients seem to support the new ways of working, whether that’s being reviewed over the telephone, Skype or “virtually”.
Emergencies in gastroenterology and endoscopy are never far away, and they didn’t stop despite Covid-19. I was part of a team of endoscopists who continued to provide ad-hoc cover for those presenting with upper gastrointestinal haemorrhage, as well as being part of a smaller team providing ERCP (Endoscopic Retrograde Cholangiopancreatography)
cover for those with obstructive jaundice and cholangitis due to stones or cancer.
Cancer care and cancer patients probably stick in my mind more than most things during Covid-19. I have had to diagnose and break the news to several patients (probably 15 or more) that they have cancer, and at times that we had no options of treatment. I don’t know if I did a good job and probably never will. I cried after breaking the news to several patients who I had got to know very well, knowing if this horrible virus hadn’t struck, their future may have been different. The guilt of diagnosing patients with advanced cancer will be something we will live with for months, if not years to come, and will probably scar me more than most of my other Covid-19 experiences.
Covid-19 has already had a profound impact on both my working and personal life. It has left scars that will never heal, and guilt that will never disappear, but I remain very proud to have been a very small part in the NHS family that will hopefully defeat this virus one day.
Dai Samuel is a consultant hepatologist at the Royal Glamorgan Hospital