This evening, someone at church asked me if I were okay.
"Yah".
"Really?"
Actually, no. I'm not okay. And I probably won't be okay for a bit longer. But I didn't say that.
I asked what his week ahead was looking like.
"Strategy meetings, planning for Christmas..."
We exchanged another look as he trailed off. We both knew we were not okay. No one is these days. I remember when we were both also 'okay' back in February when we last saw each other.
February
I'm keeping track of the number of coronavirus cases on a daily basis, but things seem alright. I go to work, and nobody's behaving like we could be hit here in the UK. Sure, the number of cases are rising in Italy and France... but nahhhhh we will be okay.
Still February
At work, we are all asked to get fit tested. There's a bit of a state of panic when we get multiple emails from the medical director asking us to get fit tested -- urgently -- and to inform the team as to which masks fit.
So I go along to this 'fit testing'. It's a bit of a joke. I put a large specialised hood over my head and stick out my tongue. My colleague squirts a spray into the hood. I taste the spray. It's bitter. Good.
Off I go and return 30 minutes later. We repeat the entire process, except this time, I'm wearing an FFP2 mask. I can taste the bitterness after about eight squirts. Oh dear. That's not supposed to happen now that I'm wearing a mask. Alright let's look for another mask.
Three masks later, I can still taste it every time. I don't even need the spray to tell me that the masks don't fit me because my glasses fog up every time I put it on. What does this mean? Does it mean I can't look after Covid patients?
I'm on call as a medical registrar and A&E refers a patient who has just returned from South East Asia with a fever. I can't see the patient since I've not passed the fit test. Hmm.
After many phone calls later to the microbiology registrar, we have an action plan. The poor A&E SHO who saw the patient initially will continue to review the patient while they are in A&E to minimise the exposure for the rest of us. The patient is kept in our only Covid cubicle in A&E, and the nurse and A&E SHO looking after the patient gown up and wear full PPE. In the end, we discharge the patient (from A&E) as the patient improved on their own and did not need any oxygen or IV medications.
MARCH
5/3/20
I turn up to my ward and there's a patient in a side room with ?covid ("?" is used by medical teams to communicate possible, but not confirmed, diagnoses). He has a pre-existing chronic lung condition and turned up to the hospital with breathlessness and a fever. The impression is that he has an exacerbation of his lung disease (which is common and expected). This patient hadn't travelled out of the UK recently, nor has he been in contact with anyone who has. Nevertheless, we follow protocol and treat him as if he has got Covid, although none of us really believed that he could have it.
At this point, we have zero Covid patients in our hospital.
At 4.45pm, my SHO calls me and tells me that the virology registrar needs me to go to the ward to have a word with him. Oh, this must be about the patient with acute hepatitis B that I saw earlier.
Turns out it wasn't. One of my other patients has Covid. Shit. Okay.
I ask the virology registrar, "So I guess you guys do all the contact tracing and we just have to tell the patient?"
"No. There's now too many Covid cases so we aren't contact tracing anymore."
Wait what???
My SHO, FY1 and I frantically try to find other masks. We get fit tested by the nurse in charge but we all fail testing. Didn't get to tell the patient he was positive until Monday, when another colleague who passed fit testing was at work.
16/3/20
I turn up to handover on Monday as I am on call. My fellow colleague who worked the weekend looks drained and shell shocked. He runs through the admission lists from Friday to Sunday.
It consists of patients positive for Covid, patients with results still pending, and patients with negative Covid tests, but still highly suspicious. Okay, there's the odd malaria case too. I learn from him that they had many peri-arrest calls over the weekend as the staff have been panicking when patients with Covid desaturated.
I start my shift, and the medical take, so far, is pretty quiet. Patients seem to have stopped coming into hospital. Hmmmmmmm.
At about midday, I get a text from a colleague saying that PPE has been 'downgraded'. Now, according to the new regulations, all we need to wear is a surgical mask when seeing Covid-positive patients, and FFP2 masks when aerosol-generating procedures are involved (e.g. if patient is on non-invasive ventilation (NIV)).
SHIT. Are they serious right now? I'm terrified.
It's now 5pm and I get referred this man with what was described to me as "likely Covid". Oh dear. I had just discharged him from A&E a few days ago because he didn't meet criteria for admission. Now he's got oxygen saturations of 80%. This is not good. The A&E registrar puts him on CPAP and calls the ITU registrar as well. A few hours later, he's been intubated and is in ITU.
17/3/20
I was previously speciality-based, but wards have now been categorised into Covid-positive wards, Maybe wards, and Covid-negative wards. We will now be based on single wards to prevent cross contamination. I'm moved to a Covid-positive ward.
My boss comes round to give us a pep talk. We really need it. My registrar colleague and the two SHOs who worked the weekend now have a fever and a cough and are self-isolating at home.
"We are learning from Italy. We are about four weeks behind. We think we may run out of oxygen in four weeks but we are working on it," he said. He said a lot of other things too, but the "running out of oxygen" bit was pretty much the only thing that stuck.
21/3/20
I feel a bit achey, so I take my temperature and the numbers "38.0" beep back at me. Oh no no no no. We're all going down one by one like flies. It could be the level of PPE we use. Or it could be my tube journey to work. Or it could be one of my colleagues. At that time we weren't wearing masks around each other.
I self isolate for two weeks with fevers and myalgia. I'm sleeping most of the day. I'm so tired and scared.
2/4/20
A hospital nearby has had to declare a major incident because of oxygen pressure issues. I thought we had four weeks??? OMG.
6/4/20
I'm back at work! Woohoo!!! I'm still feeling tired, but I'm glad I'm back. I felt like I'd let the team down when I got sick.
We are now on a three-long-days-on, three-days-off rota. Thank God! My colleagues had been struggling out of hours with very sick patients prior to this rota. (For some reason, the Covid bus hits us badly in the afternoon. People start to desaturate and get sick then. We really need more doctors after 5pm and at night.)
Food in the canteen is also now free. Wow. This makes a HUGE difference. I work 13 hour shifts but I get to eat three meals.
But things are tough. I've got to re-train as now I'm looking after patients on CPAP. I learn about CPAP settings, how to get the patients on the machine, etc. Sure, as a medical registrar, I know how to start non-invasive ventilation (NIV). But I usually tell the nurses the settings the patients need, and they set it up. With Covid, nurses are busy and overworked, and some patients are too sick to wait. This time, I learn about the different types of machines so I can put my patients on it myself.
12/4/20
A patient of mine, Mr C, is claustrophobic and couldn't tolerate the CPAP mask. We keep him on a non-rebreather mask (NRB). He seems okay for now.
Another patient, Mr S, is also on a NRB and seems okay. But when I get back from lunch, I see he's taken off his mask. I check his sats and they are 70%. He tells me he had taken the mask off as "the oxygen tank had run out of oxygen". OMG. I get a new tank and his sats go back up. Note to self. I have to be more vigilant with these tanks!!
13/4/20
Mr C now is desaturating on the NRB. He cannot be persuaded to go back onto CPAP. We prone him and he seems to be doing okay.
After lunch, I do my sats and oxygen tank checks. (Oh. Is it normal for patients to be on oxygen tanks? Not really. Oxygen usually comes from the wall behind the bed, but because I'm in a ward which used to be a surgical ward (before it was converted into a Covid-positive ward), not every bed has walled oxygen. I know.)
Mr S now needs CPAP. Despite being on NRB, his sats are now less than 90%. I call the ITU registrar. He asks me if I can wait an hour as he is trying to get a patient transferred to another hospital for ECMO. Yah, we can wait. In the meantime, I call the bed manager and request they get a bed ready for Mr S on the CPAP ward. But when the ITU registrar turns up, they decide that Mr S is probably going to need intubation soon so they whisk him straight to ITU.
14/4/20
Mr C is now VERY breathless and is looking like he is going to tire out. His family have been speaking to him on the phone and he finally agrees to have CPAP. By now, he's really quite ill. We don't have time to wheel him to CPAP ward. Me and my boss get the CPAP machine and masks from the CPAP ward, put him on it, and wheel him to the CPAP ward with full PPE. ITU team also comes to see him as he may need to go to ITU.
15/4/20
I am on my first day off after the last three days of working long days. I really need this break.
17/4/20
I'm bored out of my mind. I can't wait to get back to work.
18/4/20
I'm on the night shift today. The day team hands over a woman in her 40s who needs CPAP imminently, a man in his 20s with a