At the beginning, the symptoms of Covid were fairly defined so we knew who should be in isolation. We’d later find out that there were other symptoms of course. Was someone’s temperature more than 37.8, had they had a persistent cough in the last seven days?
Patients were kept in the isolation unit for hours at first, which was too long. I had one patient who was waiting for a bed on a ward for twelve hours. This was because the public hadn’t grasped how serious the situation might become and we were still getting the high numbers that normally came to A&E. It very quickly changed, however; I would ask for a bed on a ward and five minutes later, there would be one. That was unheard of. Management had made it happen as they didn’t want people hanging around in A&E for fear of the virus spreading.
One man was surprised he had the virus when the test came back positive. ‘I haven’t left the house in three weeks!’ he exclaimed.
‘Have you got any family?’ I asked.
‘No.’
‘Who has been helping you with your shopping?’ He was in his eighties and couldn’t walk more than a few metres.
‘My niece has been coming in most days, but she’s been feeling fine, so it can’t be her.’
I didn’t know who else could have transmitted the virus, but I didn’t want to point the finger of blame at anyone. We were beyond the point of contact tracing. It was starting to feel like the situation had got out of control.
After six back-to-back shifts working in isolation, I was tired. I went into the roll call we had at the beginning of each shift thinking that if I was going to be put in the Covid area again, I would have to say something. I hate to be someone who makes a fuss and I often just get on with things but I was getting desperate. The consultant came in and asked, ‘Right, who has worked two shifts in isolation?’ My hand shot up. Some others had too. He went round the room asking how long each person had worked in the Covid areas. When it got to me and I said I’d done six shifts in there, everybody turned round and looked at me aghast. The consultant said, ‘Right, you can have a break then.’ I was so pleased to have a day working in non-Covid minors. It was a welcome rest for my face, which had suffered while I wore a respirator mask that pinched the bridge of my nose and cheeks. It also made me feel like an overweight hippopotamus when I climbed the stairs and tried to talk at the same time.
A&E had become very quiet very quickly once the virus seeped into everyone’s consciousness. We’d normally have between 600 and 700 patients a day but admissions to the department had halved, which was worrying in itself. Were people suffering at home when they didn’t need to be? That day on the non-Covid minors section I was reminded there were still patients out there who were on the hypochondriac end of the spectrum.
I saw one woman in her fifties who had skipped lunch, stood up quickly after watching television, felt dizzy and ended up crawling her way to the kitchen where her partner was. She had given her a chocolate bar and some lemonade and she immediately felt better.
‘Do you think it’s a heart attack, doctor?’ she asked.
No, I didn’t. Nevertheless, I carried out all the necessary urgent investigations to reassure her that she had not had a heart attack. After half an hour, I told her, ‘All your test results have come back fine. You’re ready to be discharged now.’
‘Are you sure there’s nothing wrong with me?’
‘I’ve done a thorough examination and your results suggest everything is as it should be.’
‘Is there anything I need to do to make sure I don’t end up back in A&E?’
‘Definitely don’t skip any meals in future,’ I said.
My next patient was middle-aged and had been sent in by her GP with a swollen, red, hot and painful calf. The GP had put her on a course of antibiotics; they thought it might be an infection. There had been no improvement after five days and so here she was. I was flummoxed. I had no idea how to manage a patient in this way; this is normally a complaint handled in primary care and not A&E. I spent an hour and a half on the phone to various different people arranging an ultrasound and follow-up appointment for her, as well as writing a prescription for the right drug for a blood clot in her leg. I was desperately trying not to feel annoyed at what was most likely a severely overstretched GP practice. Then I spent a further thirty minutes teaching her how to inject herself with the drug as nobody would be able to come out to her over the next couple of days.
I went to see another patient who had a fungating tumour on her left breast. It was really difficult to mask the look of shock and horror on my face when I peeled back her shirt and saw it. It also smelt really bad and my eyes were watering. She had been diagnosed with cancer shortly after her son had passed away. She had to be admitted to hospital. I referred her to the oncology department who told me her recent scans showed a spread of the cancer that was inoperable. She would be told the next day that nothing more could be done. Awful things were still happening to good people, outside of the pandemic.
My time of relative respite in the cold area didn’t last any longer as my consultant came up to me in a hurry. ‘Louise, I need you to go and work in isolation again. Can you make your way there now please?’ I wasn’t even halfway through my shift when I found myself back in PPE and in the unit of claustrophobia. They would have sent the other doctor on shift, but he had a young baby at home.
By late March there was clear messaging over what to do if you had come into contact with someone who had recently returned from a country where the virus was prolific. Although advice was changing, I thought it was pretty obvious that you were to isolate at home if you had the following symptoms: a dry cough, a temperature or shortness of breath. We’d put huge signs up at every entrance to the hospital explaining when you should be self-isolating.
Yet still, some of the patients I saw were oblivious to what was going on around them. The media were reporting only one story – coronavirus – and the death toll in England was getting higher with each passing day. Did people not read or watch the news? Had they not seen the signs up everywhere or even heard the general chit-chat on the streets?
One day, I walked into the isolation unit to see a patient. He told me he had a cough and a fever but assured me he hadn’t travelled recently. I continued taking his medical history. It all tallied with suspected coronavirus.
‘Just to double check, you definitely haven’t travelled abroad in the last few weeks; or been in contact with anyone who has?’ I asked.
‘Oh yeah, I’ve been looking after my friend who was unwell after returning from China.’
The country, China, where this whole thing started, did he mean? It had taken twenty minutes to get to this point. And he had gone into the main A&E before he was transferred to the isolation unit.
I felt frustration building but knew I had to keep a lid on it. I reminded myself that sometimes people aren’t exposed to the news; maybe they weren’t aware of all the guidelines about what to do if you started getting symptoms? It was my role to educate people and not to be judgemental. Sometimes it’s really hard though. Especially when this man had put who knew how many other people at risk just by coming into A&E that day.
I explained the gravity of the situation and that we needed to try to prevent the spread of the virus. He was well enough to go home and self-isolate. I told him what to look out for that would indicate when he should come back in to hospital.
‘Do you live with anybody?’ I asked.
‘No,’ he replied.