I was eight months into my career as a doctor when the first wave of Covid-19 hit London and the hospital where I work.
Before this time, as a medic, I felt powerful – not as an individual, but as one part of a formidable system. There were times when I observed my team and saw how together we seemed to acquire a superhuman mightiness. We could see your past (medical history), and use algorithms to predict the future. We had X-ray vision (and MRI, and PET, and CT). Together we could perform near miraculous feats, from transplanting hearts to dissolving pain.
Cuando la pandemia golpeó, surgery was cancelled at the hospital where I work and I was redeployed to critical care. There I found myself drowning in the first swell of Covid cases. I saw up-close the death of patients who would have expected many years of good health ahead of them. Not that the statistically “timely” deaths were any less painful to watch, as gasping individuals tell you that they are afraid, and all the reasons they aren’t ready to die.
Working in the ICU meant I saw no one with mild disease, no one who would go home after a few days of antibiotics and observation. I met only people whose Covid had left them intubated and ventilated. The most stable patients were transferred to other hospitals, leaving those with multi-organ failure, whom we could not oxygenate.
As the pandemic raged on, I struggled to cope with the deaths that I was witnessing. All of a sudden, the practice of medicine didn’t seem so powerful. Stethoscopes became an infection hazard; we needed two pairs of gloves before we could feel for a pulse. Stripped of our tools, our workforce halved by sickness and fear, we staggered on. The work felt painful and futile. Why am I doing this, I thought, and on what terms do I find it rewarding? Do I, deep down, want to care only for patients who have a chance of getting well?
It was an early stage in my career to face so much death and suffering, but I know that my more experienced colleagues have also struggled. I have now seen every grade of doctor cry. And it was through the casual guidance of my senior colleagues that I began to glimpse a path through it all. One night shift, I spoke to a consultant thyroid surgeon in a halogen-lit corridor.
“You seem frazzled," ella dijo. “You should go home.”
“I’m fine. I just want to go on a ward round outside ICU. I just want to speak to one patient who’s not dying.”
“That doesn’t help anyone. Tell me, who of us isn’t going to die?"
It was a simple question but it jolted my perspective. That same week, a senior orthopaedic surgeon, now redeployed to the “proning team” – turning patients on to their front to alleviate acute respiratory distress – quietly threw me another lifeline. As we exchanged scrubs for civilian clothes in the ICU locker room, ella dijo, “I went through the same thing as you in my third year, when I was attached to a neurosurgery firm. There was so little we could do, for so many of our patients.”
I saw what she was telling me: this isn’t exceptional – this is the fabric of medical practice. Another colleague casually reminded me at a handover what a privilege medicine grants us, to be the one stranger in the room during these painful, private moments of existential transition.
They may appear obvious, but these lessons were a revelation Once more, I was able to find strength outside of myself. These are fragments of conversations that amount to minutes, but I was able to distil them into three principles.
1) To die is not back luck, but an inevitable result of being born. This does not make the practice of medicine futile.
2) Our job is not just to save lives, but to care for people when they are sick, and do anything we can to promote more time in health.
3) We have chosen the realm of suffering and sickness; as much as we wish (for our patient’s sake) that everything will be well, we train for the times that things aren’t right. We meet people when they are at their lowest, feeling weak and sick. That is where we will make a difference.
I feel acutely what a responsibility and privilege it is to care for people when they are unwell. The practice of medicine isn’t about negating death, but valuing life – and all we can ever hope to gain is a little more time. The application of so much training, effort, resource and expertise to something so small in absolute terms is remarkable when you think about it. I could not be prouder to be a part of it.