The emotional toll
The emotional toll
‘Going to work was no longer going to somewhere I felt safe. It went from being my cosy second home into what felt like a danger zone. My tummy tossed and turned en route and throughout my working day my skin bled and itched and raged as I scrubbed my hands and scrubbed again with utter fear that I could cost someone their life if I wasn’t careful.’
M-CR, palliative medicine specialist registrar, London
Fear of an unknown adversary. Anxiety about personal safety and that of patients. Exhaustion from relentless shift work and covering for colleagues. Despair at government inertia and public reactions. Sadness as care of and communication with patients deteriorated. Anguish and hopelessness as cherished patients lost their lives.
Challenging situations and difficult emotions weighed heavily in the hearts and minds of our survey respondents. These distressing accounts disclose the extreme situations they faced behind the scenes every day. They also reveal the real human feelings and responses often hidden behind a professional façade.
DS sleeping during a meeting
DS sleeping during a meeting
Photograph by Philip Braude, early 2021
Donated by DS, geriatric and general internal medicine consultant, south-west England
DS was photographed by a colleague as he appeared to fall asleep during a meeting. In his survey testimony, DS described the exhausting struggles he experienced in a new leadership role during the early days of the pandemic:
‘The main challenges were the immediate leadership of the department during Wave 1. I was personally new in the lead position, having formally commenced as clinical lead on the 1 February 2020 and was therefore in the first few weeks of the role when the pandemic arrived in the UK and the response was activated. I therefore did not have the benefit of any past experience or growth in the role, nor any of the key cross-division/discipline/management relationships which would have come with that. In hindsight, one year later, these would have proven themselves to have been useful.
‘We also had to manage challenges of staffing. At one point I remember having 40% substantive clinical staff unavailable for action due to sickness, shielding or isolation. We lost two members of staff to long term isolation as a result of pregnancy and a third member of staff due to health difficulties. The fourth substantive consultant […] became unwell at the start of the pandemic and was not able to participate in any further clinical activities. This colleague has subsequently never returned to work and has subsequently retired early through ill health.’
Transcript: DS talks about the context of this photograph
D S – Photograph context
So, there’s a picture of me in a sort of lunchtime meeting I think in January 2021, so actually second wave, which is when we were at our busiest as I sort of mentioned a while ago, and it’s just a picture of us having a catch-up, a departmental meeting. An attempt again -- so this was the whole thing about wave two, was that there was an expectation that we tried to carry on with as much business as usual as we could, whilst also responding to the second wave and it was an exhausting time, I think, having had a year of fatigue, with some let-up of course during the summer. Everyone’s just tired and it’s winter of course, not great weather, cold, no light in the evenings, everyone’s, you know, pretty fatigued. There’s a picture of me as I say, sort of shutting my eyes during a meeting, which was capitalized by one of my colleagues, who took a photograph. I’m not sure I’m actually, necessarily fully asleep but I think it looks like I am. And I think it captured the moment really, just of everyone just slightly -- not broken, but just tired and exhausted and a bit shattered. Not necessarily always physically, but I think the pressure of constant decision-making for us particularly, I suppose the moral burden of making these decisions about escalation, and who’s going to be escalated, who’s going to be treated, who isn’t, and I guess after a while the sort of amount, the volume of death that’s been seen. I mean, we see quite a lot of death in our normal practice anyway because most of our patients are, you know, frail and elderly, coming to the end of our natural lives, and I think most of us are fairly sanguine about it, but after a while of course it does begin to grate again, some with more than others. And, as I say, this colleague of mine took the photograph and I thought, actually, it captured the atmosphere and the situation quite well in January 2020 [corrected to 2021], when there was less panic, less sort of energy and adrenaline, just more sort of general fatigue, and pending on, you know, exhaustion.
Empty corridors; beer and newspaper; distanced lecture hall
Empty corridors; beer and newspaper; distanced lecture hall; getting some sleep, 2020
AB’s photographs give a glimpse of her day-to-day working life during the pandemic:
‘I took the photo of the corridor with my phone and the others during the height of the first pandemic wave. The empty corridors with the cleaning trolley visibly demonstrate how overnight we stopped having visitors and all unnecessary staff were safely in lockdown. We instantly pivoted to cleaning our offices and corridors as we were so fearful of transmitting the virus.
‘The emptiness in the picture is stark as was our fear at this time […] [it was] very odd and made the experience quite sterile and void of the usual emotion around critical illness.’
Transcript: CM talks about her feelings before and during the first wave
Apprehensive, scared, but not for myself, I can’t really say why I wasn’t scared for myself. ‘Excited’ is the wrong word, but a nervous excitement, that kind of feeling of being ready for something… Not quite sure what was coming, not quite sure how hard it was going to hit us. A bit of a torn sensation really of, ‘Oh, we‘re probably overacting’, to, ‘I really don’t think we’re overacting, I think we need to be moving quicker’.
I think one of the most striking things was the absolute plummet of general medical admissions. It dropped off incredibly rapidly and within the space of probably about two weeks of me seeing the first case, the whole ward was red. And that was all we saw, we only saw COVID. It was just really quite scary. I’d gone home on the Friday, you could feel everything really revving up, and then by the Monday, the whole ward was red and all we saw was COVID. And even patients who you thought might have had something else, didn’t. The punchline was COVID. And I just thought, ‘Wow, this is it.’
‘I was proud of how hard myself and my colleagues were working, but I was so ashamed of some of the things we had to do, including turning away relatives at the ward doors, and refusing people ITU [intensive therapy unit] care based on comorbidities that never would have excluded them before […] Some patients that I have cared for will stay with me forever and I’m honoured to be able to carry memories of them.’
AE, geriatrics IMT2 (internal medicine stage 2), Midlands
The first UK COVID-19 case, 29 January 2020
The first UK COVID-19 case, 29 January 2020
Donated by PL, infectious diseases consultant, north-east England and Yorkshire
PL cared for the very first known patient to have COVID-19 in the UK. The fear you can see in his eyes was echoed in another survey response:
‘I thought it would be a simple virus, no worse than influenza. I could not have been more wrong. I remember the fear which spiralled amongst my colleagues as the media started reporting increasing number[s] of cases of COVID-19 worldwide. Viewing the news and seeing the lethality of the virus as it hit countries like Italy, with hospitals being overwhelmed. Anticipating that it would eventually hit us in England, but not knowing when or how badly. The fear of the unknown was the worst part.’
ED, respiratory registrar, London
Transcript: LJS talks about memories of losing a favourite patient
L J S – Memories of losing a favourite patient
And it’s sometimes difficult to know why some kind of patients get to you more than others. Sometimes it’s because you see something of yourself in them, or they remind you of someone you know, someone in your family. Sometimes you have something in common that’s sort of weirdly, specific… But this one patient, I think she was admitted at the end of December. I think one of the things that really hit me about her is [it was] an example of many of the problems we were seeing at the time. So, she and some members of her family had met up over Christmas, as many people did, and then a lot of them had been ill. They’d already lost one family member in the first wave, and then this time they’d been pretty hard hit, and this patient who I was looking at was on our ward, and opposite her was her sister. And their mother was also in the hospital, unwell. This patient had been quite sick and had been in intensive care for a few days, but only needed high-flow oxygen and then stepped down to the ward and was doing quite well for a couple of days then stepped down to a Venturi Oxygen Mask, so a standard oxygen mask. And there was this one day where we saw her, and she just wasn’t quite so well that morning, so her oxygen requirements were just going up a little bit, and so were like: ‘Umm, that’s not ideal but we’re still okay’. And that day we sent her sister home, and they sort of waved goodbye to each other, and they were so lovely, and they were obviously so chatty, sort of sitting opposite each other on this ward, and kind of chipping in with each other’s consultations so, it was kind of a really fun ward round, and they were lovely. So, we sent her sister home and then she just got worse throughout the day. And then the next morning, I came in and we were kind of alerted by the nurses that again she wasn’t doing well, she was really struggling to maintain normal oxygen levels, even on the absolute highest amount of oxygen we can give. And she was sort of chatting away and she was like, ‘Oh no, I think you know, I’ll just reposition’. We were helping her to self-prone and… [pause] She was Facetiming her family… Anyway, we would see her and say, ‘Look, you’re not doing well, I think you’re going to need to go back to intensive care. I think we’re going to need to put you on the breathing machine.’ And that conversation is just so hard, and she’d been sort of fine the day before, and so that deterioration is just again really hard for her to kind of fathom, and to see her sister go home. Anyway, so, intensive care team were around and we were having some discussions kind of away from the bedside and, she really didn’t want to be intubated. Her family member who died in the first wave had been intubated and then died, and so, in her head that was what was going to happen to her. And we said, you know: ‘That’s not the case, lots of people do get off the ventilator, but we can’t leave things how they are’, you know, ‘We can’t keep your oxygen levels up.’ And so we Facetimed her daughter to explain this, and obviously it was so hard because we couldn’t have visitors in the same way we normally would. Normally, family would be at the bedside with all of this, but that wasn’t what we could do at the time, so we did our best. So, we were Facetiming her daughter and sort of saying very tearfully you know, saying, ‘We’ll see you soon’. We intubated her and off she went to ITU. And this was in January, and so every week I have checked to see if she’s left ITU, [breathes] and then I didn’t check for a couple of weeks and then it was looking bad you know, once you’re in ITU that long, she’d been there a month already, I was getting a bit like ‘Oh dear’. When I checked last week, and she died in March just recently and, I don’t know I think it was just… Her and her sister were so lovely, and so chatty and we’d had such a nice conversation, and she’d seemed okay, and she’d kind of gotten over the worst already, she’d been to intensive care once and she looked like she was getting better because she had all the treatment in a really timely way, and then I think all the Facetiming with her family just, you know it’s just, you really like looked straight into someone’s family is just… It’s such an intimate thing, and kind of trying to reassure her that she’d be okay and that you know it was necessary to go on the ventilator, but that we’d see her soon, and to know that she never woke up… [pauses] …Yeah, it was really hard, I clicked on… [pause] …Clicked on her number and then you kind of get the death notification, and it’s just that thing of like, I sort of knew that probably what was going to happen having been in intensive care that long but, and that’s happened to a lot of people, but for some reason that one patient kind of gets to you and -- so it’s just hard to see.
‘The absolute worst experience of the pandemic was finding out one of my favourite patients had died of COVID (I know we aren’t supposed to have favourites but I’m sure most of us do) […] I knew she was on ICU [intensive care unit] before I went off and I was too scared to ask when I got back. My colleagues had to pluck up the courage to tell me she had died. I will never forget how I felt when I found out: angry, disappointed, sad and most of all inadequate as though I had let her down.’
CM, acute and respiratory medicine consultant, north-east England and Yorkshire
Waiting room with social distancing signs
Waiting room with social distancing signs, 2020
Donated by AS-L, medical oncology consultant, London
Social distancing within workspaces affected patient care and forced changes to working practices, as described by AS-L, who worked with cancer patients and research:
‘In the first wave we were very cautious about giving myelosuppressive chemotherapies to anyone beyond first line due to the fear of COVID infection whilst myelosupressed [bone marrow suppression, which causes the body to produce fewer blood cells]. We moved to telephone reviews where we could due to the social distancing requirements in the waiting rooms. We stopped all clinical trials as our research staff were redeployed, even two years on we are not back to pre-pandemic levels of access to clinical trials. We moved to a ward based rota for consultant care of inpatients that has now become a permanent change.’
Socially distanced lunch break
Socially distanced lunch break, 2020
Donated by HT, acute medicine consultant, south-east England
Behind the smile, HT’s testimony reveals the exhaustion and psychological trauma he faced during the pandemic:
‘Work shifts became longer and harder with relentless working tightly strapped in PPE/masks. Sickness among colleagues meant double impact on us, on [the] one hand it would make us fill the rota gap and cover their shifts probably till midnight, on other hand it will scare us to become more vulnerable.
‘Lock down made things worse for NHS key workers [e]specially those work[ing] in ED [emergency department] services, no time for essential grocery shopping, lack of proper sleep and struggling for daily chores. [The] psychological impact [on us] of [the] growing morbidity and mortality among [the] population was also shocking and painful. We closely witnessed patient[s] and their family succumbing to [the] pressure of [the] pandemic.’
Transcript: AE talks about changes in working practices
I remember going into the hospital as a patient for a CT-scan and it was alien, it was an alien environment. You know, there’s a massive lobby when you come in the main entrance, and it was just deserted. Everyone there wore hand gels, and everyone guiding people, and people asking where you were going, ‘You can’t go that way; you can go this way’. It just feels like a very sort of alien environment right now. And in fact I had a Zoom lunch with one of my colleagues last week and he goes, ‘It’s nice having a Zoom lunch just because --’, he said, ‘I know you are at home, but actually you hardly see anyone, you really hardly see anyone even in the hospital’. So actually that typically professional interaction, is not the same as it was, because I said that’s the thing I missed as well, it’s just every now and again as you’re going to pick up the next patient label, or at the coffee machine, you’d say, ‘Oh, I just saw so and so, and I was thinking of doing this and this. What do you think?’ And so that’s not you formally seeking some feedback or formally asking an opinion, it’s just discussing your patient management, and I miss that because I think that’s reaffirming. I mean, if it’s a serious decision I will involve colleagues because that’s not an issue. I don’t think I’m compromising patient safety, but it’s just that soft, that soft signal, that soft reassurance that I think is missing when you are working in isolation. I think that’s the same for everyone. I don’t think it’s just for me. I think physical contact in hospitals and the lack of professional interaction is an issue.
‘I have had to suffer a complete transformation in working practice in a specialty which requires a lot of face-to-face assessment. I have felt that this has led to a deterioration in the care I have been able to offer my patients. You can gain so much from just observing respiratory patients and this has been lost by having to use telephone interviews […] Inability to pick up on non-verbal cues from patients and their carers. [It’s] difficult to take a proper history using electronic media and this has gone against all the teaching as a physician to listen and observe the patient which will tell you in a large number of cases what is the real problem.’
KM, respiratory consultant, south-east England
Transcript: RM talks about anti hospital protests
So, lots of different companies like Holland and Barrett in Castlebar would deliver little hampers, so there would be a little care package for healthcare workers. They’d send up two or 300 packages there might be like a wash or a little bottle of essential oil or there might be a soap or a hand cream. That was really thoughtful. There’s a café called Rua, it’s a really nice deli slash cafe and they would like, I think, at one point they sent up cakes and maybe little pastries to us. Lots of businesses kind of showed appreciation that way. There was banners put up in businesses locally you know, ‘Thank you for your work’. There were also people who didn’t appreciate what we were doing and there were groups of people who would campaign in Market Square in Castlebar. You know, there was a certain group of people who felt the hospital wasn’t managing Covid very well, and so they would have demonstrations on the weekend and they would have placards. That was quite unsettling because we were doing our very best, but some people felt we were not doing enough. I don’t know. It was really difficult. There was [pause] there was a lot of stuff going on back then, a lot of politics.
I think anti-vax people joined up with this other group of people and they kind of became a united front and would have these weekly protests about Mayo University Hospital and they accused the hospital of covering up deaths, and stuff like that, which was not -- not true and not accurate. So that was quite, that was quite harmful, I think, to us as healthcare workers, I think we found that very hard to contend with.
‘The tables seem[ed] to completely turn several months later, when the “war spirit” started to crumble and people started getting quite demoralised by everything […] We started getting some unpleasant comments from patients, and more of this on social media. The Daily Mail started a campaign against GPs that we were not seeing our patients. It felt so demoralising when we were all working flat out and feeling totally overwhelmed.’
JG, general practitioner, east of England
'Doctors Diaries' videos, 2020 & 2022
RCP members discuss their experiences of working during the COVID-19 pandemic in a series of short videos. The initial videos were recorded in 2020; some were followed up in 2022. You can view the full selection of Doctors’ Diaries by registering for free for the RCP Player here
BC, physician associate and teaching fellow, obstetrics and gynaecology, north-east England and Yorkshire, March to May 2020
Photograph by Jessica van der Weert
‘Physically, I struggled with the PPE in long theatre cases and when speaking to patients – it really felt an obstacle to clear communication, which was challenging when at times, we would be giving difficult diagnoses and having sensitive conversations.
‘Mentally, one of the biggest challenges was having no escape from work – it was all consuming. Usually I use the gym, outdoors, trips away to help me destress from the work environment and ‘switch off’. Not having that was exhausting, especially when people were suffering so greatly in so many ways. There was no release, and so I carried a lot of that home, and it was difficult. Thank God I have a great husband, who also worked on the front line – we had many stories to share at dinner time!
‘Emotionally, I found it a struggle to witness people suffering in the various ways they did – with physical illness, through illness, through loneliness, not being able to grieve or mourn losses. I felt so much compassion for those that followed the rules to the letter, meaning they missed out on precious last moments, and those who struggled through labour and delivery, and took their babies home to an empty house with no visitors. At the same time, I worked in a team of excellent doctors, nurses, AHPs [allied health professionals] and admin staff who tried their best to keep spirits high. I don’t think many memories from this time will ever leave me.’
Part of the exhibition Fortitude