Learning on the job

As coronavirus spread in the UK, junior doctors had to put their knowledge of infectious diseases in practice rapidly, writes Edwina Hegarty

Location: Northern Ireland
Published: Tuesday 2 June 2020
Edwina Hagerty

COVID-19. It started as something of interest, something on the news. As junior doctors half a world away, we were busy with other things: sick patients, busy on calls, time not at work spent catching up on portfolios, sleep, loved ones and ourselves. Changeover was on the horizon, many of us were getting ready to rotate to yet another new job.

And then it was our turn to prepare.

Working in infectious diseases I had known for a while it was coming, maybe before some of my colleagues. I was lucky to be involved in much of the local planning, offering insights from junior doctors who work hospitals on a 24/7 basis.

Simple things became complex. How do we take bloods? Actichlor everything! How quickly can we get into full PPE (personal protective equipment) for an emergency? Communication hampered by masks became the new normal. Difficult conversations would now have to take place on the phone or behind a mask. There was a feeling we were not moving fast enough to prepare. As news came in from Italy, we began to wonder how many of our colleagues would be treated as patients? How many of our loved ones could become our patients?

Drilling colleagues to go against their training, protecting healthcare workers from infection, was now more of a priority than ever. Social media became a nightly trawl, scanning for new information, infection rates and rising mortality, the John Hopkins live infection graph became a permanent fixture in emergency care.

And then the patients started coming.

As juniors we get used to seeing diseases and conditions we are not familiar with, but guided by senior colleagues, we develop our experience and knowledge, reassured that someone will know the answer, someone will have seen this before.

 

But not now. Everyone was unfamiliar with COVID-19. The basics we knew: hypoxia, pyrexia and thromboembolic events. It all sounded familiar but all the parameters were off.

Junior doctors from across all specialties had training sessions on how to use ventilators in preparation for redeployment to the intensive care unit. Lessons learned travelled quickly, all experience mattered. Impending breakthroughs and new clinical information circulated daily, but was it accurate? Would I risk someone’s life on something I alone had read? What if we became so weary and saturated with that we no longer knew?

But we had to know.

Because, in spite of the planning, drilling, public announcements and reading, this was someone’s dad. This could be my dad. Our thoughts were never from our loved ones and the risk of carrying infection back to them. So we had to know. We had to be there, confident and calm in our care for them. And for each other.

Our patients kept us going. Understanding and appreciative of the smallest of things. But the thought lingered, were we doing enough? Could we do more? If so, what?

And now it’s quieter.

Advice is telling us we have passed the first peak, the surge is receding. The cost has been high. Too high for some. Others don’t seem to realise the sacrifices that have been made. Some people’s sacrifice will only become apparent in the coming months; this will undoubtedly leave a dark shadow. Many of us are still working on punishing COVID-19 rotas; coping with burnout is becoming more of a struggle.

And all the while, knowing there will be a second wave, that we will have to do some or all of this again. But those fears shouldn’t detract from what we have to be proud of.

We have seen amazing examples of inter specialty support, collapsing of the traditional hierarchies and innovative ways of communicating with our patients.

We have seen global science communities rapidly come together.

We have been the recipients of outstanding acts of kindness and selflessness, public donations of food, skincare and PPE to keep us going and to protect us.

We hopefully now have a few weeks, maybe longer, to review and learn from not only our successes, but more importantly from our mistakes.

We hope our employers can see the personal sacrifices each of us made. And we hope in turn that they won’t let us down. That additional pay for additional hours is accepted, that banding reflects the level of work we undertook and that we don’t have to haggle for annual leave.

Recognising the personal effort of every junior doctor who has unflinchingly met every demand of the most serious public health crisis in the last century has never been more important. Without our continued effort, the next challenge would likely be insurmountable.

Edwina Hegarty is a member of the BMA Northern Ireland junior doctors committee and specialty trainee in Infectious diseases and microbiology based in the Royal Victoria Hospital, Belfast