I’ve got a bad sense of direction too, something that runs in the family, and often got lost on my own with the dogs. One day I found myself having to phone my husband at work because I kept finding myself back at the same junction in some cruel Groundhog Day nightmare. I’d already been out for three hours and even the dogs were tired. I also had no snacks on me, for me or the dogs. His work colleagues were in fits of laughter as they heard him trying to calm an emotional and hungry wife. I sometimes resented having to walk the dogs so much but, in truth, being surrounded by nature’s beauty and peace really did make a positive change. And I needed those moments where my brain could rest as our whole way of working was turned on its head. Policies started to change, we made major alterations to where we would send patients in the hospital. We were having more discussions with every department in the hospital. We were learning a whole new disease process as well as how to detect it, diagnose and manage it. This was work I’d never had to do before – learning to interpret the chest X-ray of a Covid patient, how to turn a patient in respiratory difficulty onto their front to improve their breathing. It was all completely alien to me. I was still learning months into the pandemic because no one really knew how to manage it. It was all so new and there wasn’t enough evidence. As each day went by, the death toll would rise and new evidence would come out guiding towards a different way of managing the virus.
That aspect of guesswork was perhaps part of what made this whole situation all the more terrifying for me.
Let me explain. I’ve had patients who come into A&E when they really don’t need to. One girl once came in with a spot.
‘Genuinely, what do you want me to do?’ I asked.
‘What is it?’ she said.
‘It’s a spot,’ I told her. ‘It’s not a problem that we in A&E are best equipped to help with.’ People also came in with a common cold. GPs get annoyed when that happens, let alone us.
A&E is so readily available. It’s great because you come in and essentially we give you a bit of an MOT and tell you what’s wrong or not wrong. That’s sometimes all people want but it can stop us from giving timely care to those that need it most. We don’t help ourselves because we continue to do it. As well as anxieties about our patients, we have the threat of litigation hanging over us like a guillotine ready to take off our head.
I struggled with this in my first months as an ACP more than ever before. I was newly qualified. I didn’t have the experience or the confidence to not check absolutely everything that I could to make sure that I was doing the right thing.
‘One day you will kill a patient,’ I was always told in my training. I think what they meant was that I’d potentially miss a diagnosis and the patient would die. I always have that in the back of my mind and it has stopped me from becoming cocky and over confident, but it has also put the fear of God into me.
By this time in March, five months into the job, two patients had already contacted the trust to complain about decisions I had made. It usually happens months down the line. A consultant came up to me when I was working on the shop floor. I was completely oblivious and they asked, ‘Do you remember this patient?’ It’s like asking, ‘Can you remember this time when you were three years old?’ Then I read the notes and I remembered. They went through everything with me. Luckily, in both situations, I was right in what I had done. But I never know when the day will come when I’ve done something wrong. As a result, I’ve learnt to talk to people to try and understand what their expectations and concerns are, because that way I can usually get to the root of the problem. Many want to know they haven’t got cancer, or had a heart attack, but it can take a while to get them to articulate their concerns. When they do, usually I can help.
With coronavirus, however, it was all different. From what I was seeing in patients, I knew it could overpower someone so rapidly. They went from being fine to suddenly not in the space of fifteen minutes. My anxiety was off the scale when I saw someone who had symptoms but looked all right. We couldn’t keep everyone in hospital so I assessed everything and if they seemed OK, I sent them home with advice to come back if their symptoms worsened. Covid-19 is a respiratory illness so everyone was breathless. How does someone who is not a healthcare professional know when their oxygen levels are dangerously low? They don’t. It’s different if you’ve got low blood pressure, say, because you feel dizzy and light-headed. Or, you collapse.
I would feel absolutely dreadful if I found out that my actions had harmed a patient. It hadn’t happened yet, but I knew it might be around the corner. It was a sense of foreboding that was always with me. And as coronavirus took hold, that feeling of doom loomed even larger. Nobody knew enough about Covid. I certainly didn’t. I spent my time off reading research papers and articles. I couldn’t escape from it. I felt fatigued and saturated with information that kept changing. It was guesswork, educated guesswork. I hoped I was doing the right thing by my patients and would often check with my consultant if I had the slightest doubt.
The weekend of 15 March, I had a twenty-mile race. Half marathons had become quite easy for me and I had booked this because I wanted to push myself. Ed was also taking part. I had secretly hoped it might be cancelled because I had never run this far before and I hadn’t trained nearly as much as I should have. We drove there and picked up another member of our running club on the way. It was a sunny day and Ed, who is very sensitive to the sun, started sneezing. We all started joking about how he might have coronavirus, but was our guest a bit worried? I couldn’t tell for sure.
All other races had been cancelled because of worries around coronavirus. Standing at the beginning and waiting to go felt very different. Normally, it’s very crowded and everyone jostles for space, rubbing shoulders. On this occasion, every time someone coughed, there was a moment of tension and audible gasps. I tried desperately to suppress the tickle in my throat.
Ed is a faster runner than me and this race was in the middle of the countryside with no people. It would be lonely and I knew it would just be me in a mental battle with my thoughts for the whole way. My usual running playlist had become too predictable and I wasn’t sure it would get me through to the finish line, so I opted for one on Spotify called ‘Coronavirus playlist’. Best decision ever. As I ran, I was buoyed by hits such as Nelly’s ‘Hot in Here’ and ‘Fever’ by Peggy Lee. That soundtrack kept me going until mile sixteen, which is where I hit a block – ‘the wall’ as many runners term it. Thoughts of not being able to finish crept into my head. I had rationed out jelly sweets to keep track of how many miles I had done. I had two left; one for each two miles. I stopped to walk for a bit because the pain in my legs and joints was getting unbearable, but then I thought that would take me twice as long so I may as well run it. My energy levels were low. It was hard. It was emotional. But I did it and the wave of relief when I finished was palpable, so were the tears. Ed was there waiting. ‘Marathon next?’ he asked.
The following week cinemas closed, which was truly gutting as I went almost every week with Ed to see the new releases. The day after, Parkrun – a 5km run at 9 a.m. every Saturday that happened in locations around the UK and the rest of the world – was cancelled, which was another blow as it was a weekly feature in our social lives. It was free, open to anyone and everyone, and was a feel-good event and a great start to the day. Well, for my husband and me it was. We even did the local Parkrun the morning of our marriage ceremony. I remember dragging my sister along a couple of times and she hated them, though she did come to cheer with my parents when we ran the 5km on our wedding day.