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'We will survive. We have to': a letter to my fellow healthcare workers | Society


This is a terrible time to be working in a hospital. It may be the first time in years you are working in one again. People are asking for you in the middle of one of the worst periods in healthcare in the past 60 years. You have never seen patients so breathless, you have no idea what “FIO2 0.6 15l” means or what a “35% Venturi” is, and you feel powerless.

I know how you feel. I am an intensive care anaesthetic doctor. I usually work in the peace of an operating theatre, dealing with one patient at a time. Most people think I play sudoku or do the crossword (which I do) and put smaller tubes in bigger tubes. I am usually behind the scenes to the surgeons. Now I am the person you call to review the sickest patients on the wards or in A&E. I am the person you ask for help and I feel powerless too.

To the doctors and nurses on the wards

Thank you for bearing with me when I say I will come to review your patient. I try to tell you how long I will be. I know you are worried and it feels like hours before I get there, and it often is. I know you are scared and I can visibly see the relief in your eyes when I arrive.

Three weeks ago, if you referred your patient to me I would have accepted them to intensive care. Now it is getting difficult: we are dealing with a different cohort of patients – ones who are sicker for longer and who might not survive.

I cannot accept them at present. I give you parameters to look out for and ask you to call me back if you think they are getting worse. Usually I would keep them on my radar via a list, but when that list is the whole hospital, I need your help.

To my consultant

I often ask you for help. You come and review the patient I think needs to come to intensive care today. I do not envy your task: how do you allocate the scarce resources? How do we decide who comes when before we would have accepted them all? You ask me if I think the patient has a chance. I say yes.

You then ask another consultant to come and review the patient. Often it is a three-person decision. We have little ethical guidance on how to make such difficult choices. How do we decide which of four patients get the last three intensive care beds?

We try to look at data. Males do worse, as do those over 70, but all this data is observational and collected over the past few months.

To the doctors left with patients we won’t take

I know you have difficult discussions with those who we can’t admit to intensive care. You are doing a stellar job. It is terrible telling someone that this is the best we can offer them at the moment. You know the odds of your patient are grim without intensive care but let me tell you, the odds of your patient with intensive care are grim too.

If your patient is accepted you must feel like you have won the lottery. But then you hear me asking the patient to speak to their loved ones as this might be the last time they ever speak to them. You then ask me how the patients are who were admitted last week.

For the patients admitted we try our best but that does not seem to be enough. Over the past two weeks we have successfully removed the breathing tube from two patients. That’s not encouraging, you think.

We are still waiting on more ventilators, more nurses, more testing, more everything. We are running out of hats, so this week I have been wearing hospital plastic panties on my head as personal protective equipment and I’m thinking of shaving my head.

To the healthcare assistants, advanced nurse practitioners and other clinical staff

You are amazing. You help clean patients when they cannot breathe, you toilet them, give them toothbrushes to make them feel human, and you hold their hands when they are dying. I know you are stretched. You are here, you are trying and that’s all any of us can do at the moment.

To the hospital porters

You get us the medicines for our patients, take patients all around the hospital, and transport them to scans. Thank you for carting the unfortunate away. Thank you for the bad joke you made when you saw me upset and for saying good morning to me.

To the hospital domestic cleaners and caterers

You keep the corridors clean, sort out the bins in the pigsty that is our office, offer me a wipe for my plastic goggles. Thank you for serving tea to our patients; you even ask how they like it. You are doing such a great job providing sustenance and a clean environment for them to fight this terrible plague.

To the hospital security and IT staff

Thank you for keeping us safe, and for saying good morning and good night to me when I leave every day.

To those in IT, thanks for keeping the computer system working and for giving me my password when I forget it.

To the hospital pharmacists, radiographers and biomedical scientists

You’re trying to get us the supply of all the medicine we need. I know you’re trying to source more antibiotics, paracetamol and other drugs. I can’t imagine how difficult it is, yet you still smile and correct the charts with your green pen. Thank you for checking I have dosed the medicine correctly.

Thank you to the radiographers for coming to the ward for the umpteenth time to do another X-ray. I know you are worried about whether you are wearing the correct PPE.

Thanks to the biomedical scientists for running the million flu and Covid swabs we send. Without you we wouldn’t know what on earth we were treating. I know you are scared about being exposed through handling so many positive swabs.

To everyone else

I have forgotten so many other key workers in hospital and I’m sorry. I would like to thank each and every one of you for coming into work and trying.

Like everyone at the end of a 13-hour shift, I’m glad I’m leaving. I cry on the tube home. People move away from me because they have no idea what to say.

I have the faces of those patients I could accept to intensive care etched in my mind. I replay that conversation I had with parents about their child’s prognosis saying they could not visit their daughter.

I’m exhausted. I haven’t eaten since breakfast. My feet hurt. I’m worried that I will spread the virus to the people I see and about that patient I intubated.

Did I inhale the virus? Will I die? Will my loved ones die? Was the PPE appropriate? Will I get the test myself? How will I get to the testing station without a car? Does it matter?

But there is hope. The birds have come back, I can see them from my high-rise apartment window for the first time. When I leave the house I can smell grass. They are delivering so much donated food from nearby restaurants to the hospital that we don’t know what to do with it. Costa is offering free coffee to hospital staff.

Every Thursday people clap for us. I’ve discovered knitting. My partner has started cooking. Each time I leave the house for my daily exercise I’m so grateful for my health. I will be scarred at the end of this but I will survive. We will survive. We have to.

If you would like to contribute to our Blood, sweat and tears series about experiences in healthcare during the coronavirus outbreak, get in touch by emailing sarah.johnson@theguardian.com

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