Handwritten diary

Sacrifice

 Sacrifice
 

 ‘I have a background in working overseas with MSF [Médecins Sans Frontières/Doctors Without Borders]. This felt like that at the beginning. It was surreal, and quite exhilarating. Now however it is demoralising and frustrating, and, partially as a consequence, I am leaving my post.’

KD, general practitioner, north-west England


Like everyone, healthcare workers suffered during the pandemic.

They lost beloved colleagues and friends. Their careers were derailed, ended unexpectedly, or were irrevocably shaped by the pandemic. Health inequalities and a lack of government support destabilised their trust in the system, and some lost confidence in their professional abilities.

They became isolated from their families and felt the burden of bringing their profession – and the virus – home with them. Their mental health was impacted by witnessing the devastating effects of the virus up close. Some became ill themselves, and some died.
 

Screenshot of a doctor wearing an oxygen mask.

 

MS with oxygen mask, 1 April 2020

MS with oxygen mask, 1 April 2020

BBC documentary of the Royal Free Hospital, London

Reproduced with permission from the BBC

During the final week of his 41-year career as a geriatric consultant, MS contracted COVID-19. He was admitted to hospital – on the first day of his retirement – with pneumonia, thick blood (a high level of red blood cells in the blood), a disturbed liver function test and a rash. His oxygen levels were very low at around 80% – a healthy adult’s levels are around 95–100%.

MS was interviewed by the BBC as a consultant who had just retired and had caught COVID-19 at work. He was filmed as he walked out of the hospital, 10 days after his admittance. He continued to suffer from long COVID for 5 months.

‘Professionally my career ended with COVID – I had planned to do locums etc as I am in my early 60s still, but have no desire to do so. I am keen to have an active retirement when circumstances allow. It is too early to say what the long term effects on medicine will be in the future, but one thing is sure – it will never be the same again.’

Transcript: M S talks about his last days of work and admission to hospital with COVID

I couldn’t bear to end a career of forty-one years in medicine by just being absent on the last two days. So, I thought, you know, ‘Maybe I’ll be lucky, maybe there’ll be equipment, and maybe the virus won’t have reached my ward.’ But it had. So, I followed my conscience and it nearly cost me my life. It was the first of April, one minute past-midnight was my official day of retirement, April Fool’s Day. And by a strange irony, in the afternoon, I watched a funeral of a retired GP colleague, whose son is a friend of mine, who died of the virus. This was a Zoom funeral in Liverpool. And then afterwards my wife said, ‘I’m calling an ambulance, I’m not even going to ask you, I’ve sent for an ambulance’. I then went and had an X-ray. Like most consultant physicians you know, when I have an X-ray done professional curiosity gets the better of me and I always say, you know, ‘May I have a look at it?’ And I’ve never, ever heard them say, ‘No’. So, I go have my X-ray and, you know, thank the person for doing it, and I said, ‘Do you mind, as a noisy consultant physician, if I look at it?’ And the person said, ‘No’. He said ‘No!’ So, I put my mask on, and I went back. So about half-an hour later, the registrar comes in again, and he said ‘Blahblahblah, well, we’re going to admit you, you know, just for some observation for two or three days’. And as he left, just about to turn away, and you see this a lot in medicine, they say ‘By the way,’ you know, or ‘While I’m here,’ doctor syndrome, ‘By the way was my X-ray okay?’ But in these days of disclosure and candour, the young registrar who was about a third of my age said to me, ‘You’ve got typical features of Covid pneumonitis and Covid pneumonia’. And that was the only time where I did think ‘We might be in difficulty’. Because I didn’t feel too ill, but I knew the oxygen level was low. I knew I’d been ill since the 19th of March. I knew the illness was biphasic, and I knew once you get to hospital, you have a certain percentage chance of doing badly, being ventilated, and once you’re on a ventilator, there are statistics which, at the time, were not good. So, I did feel a bit despondent then. And about half-an-hour later, the BBC came in and asked me all sorts of typically journalistic questions and that took my mind off it.

Transcript: DJ speaks about looking after patients and having COVID at Christmas

Obviously we get training on breaking bad news and coping with stress, but I don’t think anything could have prepared me for what COVID was like in the beginning. There was a husband and wife, and unfortunately the husband passed away and the wife survived. And I think just the relationship they had, I think that stayed with me and just seeing how distraught the wife was when her husband passed, and she was able to recover, it was almost like a ‘Why him and not me?’ situation. And there was another patient that I had that was really like my dad, and I grew really fond of him. And he got to a point where he was really unwell but then started to pick up. And I think it got my -- I know you’re not meant to invest too much into a patient, but I got my hopes up that, ‘Oh my gosh, he’s going to recover, he’s doing so well now’. And then he took a turn for the worse in, like, forty-eight hours, and he passed away. And I think there’s so many stories like that, that you just look back and you remember, and you think, ‘Gosh so many people passed away’. And it wasn’t just old people, it was young people, and I think that stayed with me, that I didn’t just see old people pass away, I saw people the same age as me pass away which was the scary part of it.

So, I had COVID in 2020, and then I had it in the Christmas of 2020, and then I had it in the Christmas of 2021, so I had miserable Christmases. The first two times were really awful and I think the second time was the worst of all when I actually said to my mum at one point I was like, ‘I don’t think I can do this anymore, I just haven’t got the energy to push on’. And I was like, ‘If anything happens, I’m content at this point ‘cause I haven’t got the strength’. I felt so weak. Every breath I was taking it was like a struggle and I was like, ‘I just can’t do this anymore’. And she was like, ‘Stop speaking rubbish’. And I was like, ‘I’m being so serious, Mum’. I think it’s always hard for healthcare professionals to be a patient, especially when you’re usually on the other side. And because I’d looked after patients with COVID, it was difficult ‘cause I was like, ‘I know how quickly things can change,’ so I think I went into it with a pretty negative mindset and I was lucky enough to have, like, my family and my friends around me to keep some sort of positive input because I’d seen what COVID can do to people, and I was like, ‘Yep I’m definitely not going to make it’. So, I think it was quite a tough place to be.

‘ I am 65. I loved my work and planned to stay for another 5 years or so. When my job changed at first I felt good to be part of the huge effort made by everyone to deal with the problem. Each holiday was cancelled and I carried on working. I had no childcare commitments and could be flexible so picked up more work as people went off as contacts [of someone who had tested positive for COVID-19] or with COVID. By September [2020] I was worn out. I retired at Christmas. The guilt is awful. I should have stayed, but I was so tired. I miss it every day.’

AH, medicine and geriatrics consultant, south-west England

‘ Last year was particularly tough for me and my family as I contracted the infection myself while working on one of the COVID wards […] I had to be taken to the ICU [intensive care unit] where I ended up having to stay for 6 weeks, requiring among other things, CPAP [continuous positive airway pressure therapy], ECMO [extracorporeal membrane oxygenation], tracheostomy, and prolonged ventilatory support for a further 4 weeks. I was very fortunate to have survived where many others didn’t. But I think it was even harder on my friends and family who couldn’t be with me in the ICU and lived in a state of constant uncertainty and fear regarding my condition for 6 weeks.’

W, oncology registrar, north-east England and Yorkshire

Blue diary.
Page of diary.
Page of diary.

Diary of AK

Diary of AK, 2020–2021

Donated by AK, palliative medicine consultant, London

AK kept a small, handwritten diary between 30 March 2020 and 7 April 2021, as a ‘safe place to moan and admit my feelings so I can continue my “it’s a bit naff but it’s all going to be fine” jokey work persona.’ The diary contains many powerful entries:

6 April 2020, 18:25: ‘2 junior Doctors have come to me today with different degrees of angst about the recent events. One in a pragmatic but honest way admitting she wants to cry at times. The other, with a background of anxiety and depression, was utterly thrown and destabilised by her recent sick leave and intrusive thoughts about what Covid could do to her. Guilt also seems to be a big component, the traditional doctor issues about leaving others in the lurch.’

30 April 2020, 07:23: ‘I was personally shocked by how I react differently to a nurse who is unknown to me dying but who is from my hospital rather than so many sad deaths across the expanse of society and amongst critical workers specifically. I am curiously either in denial or just unfearful of dying from this personally, but the thought it could affect a member of my team/family so indiscriminately is a hard thing to get my head around.’

7 Dec 2020: ‘I did my usual funeral thing and started crying as soon as I saw the casket (a rather lovely woven willow) and grieved for the person in it but also about 10–15 people/patients... I probably need to find a better way to channel my day-to-day grief.’           

Doctor selfie in PPE

 

Selfie in PPE

Selfie in PPE, received June 2022

Donated by MG, gastroenterology registrar, south-east England

The trauma of working during the pandemic caused MG to leave his profession:

‘My wife was pregnant with our first child and as I started working on the frontline, she was advised to move out to limit her exposure to the virus. I found myself living alone, working lots of hours and every time I went to a supermarket there was no food because of panic buying […]

‘I next saw my wife almost 3 months later, she was in labour. We were separated again as I was not allowed to be in the hospital. Luckily, I got in just before the birth of our beautiful (and chubby) son, Arlo.

‘This pandemic has caused so much hurt […] the NHS was, and still is, under tremendous pressure. It is staffed by the best people I know, true hero[e]s. Unfortunately, I no longer have it in me to be one of those hero[e]s and with a heavy heart I am leaving the profession this summer.’

Transcript: TKL talks about living away from home

In the end, you know, I was away from home staying alone for five, six weeks. I have a young family with two young children and everyone was very worried how this will affect young people and particularly children. So, I remember my wife and I saying well, ok maybe the safest thing for me to do is to stay away until we understood a little bit more about what was going on. We were very fortunate, one of my friends happened to be able to let me use their facilities, their house, in the neighbouring village, which was not far from where I worked. So, I ended sort of waking up, getting to work, spending the day at work, and then I could come home to an empty house, and, and wash, and just rest and then the day began again. It was seven days a week then. And I didn’t have to worry about, you know, spreading it or passing it to anyone. As the weeks went by I’d pop by and stay by the gates of the house, so they’ll see me but we didn’t really have any close contact at all. No hugging or kissing or anything of that matter. And yeah, that was hard, that was hard [pause] on many levels. But in my case, I think I immersed myself in work and thought, ‘I just have to stay safe, I have to keep my patients and my colleagues safe and we’ll -- we’ll get through this some way’. I just had no idea what the future held. I think it’s easy sometimes not to see how scary and worrisome the whole, the whole thing was at that time because we were just thinking, ‘We’ve just got to get by week by week day by day’, and it’s only in retrospect and looking back now  I could see there was a lot of unmet [pause] expression or emotion that we are only being to see now, as things start to, to resume some level of normality.

Transcript: EN speaks about rarely seeing his children

Well, it was horrendous, if I’m completely candid. I mean I was in a situation where I’m, you know, me and my ex-wife had separated at the time, we’ve got fifty-fifty childcare, but again I was in a situation where I was working eighteen-to-twenty-hour days, often away from home. So, it was a pretty lonely and brutal time, to be honest. And like everybody else I locked down very early, but probably unlike everybody else, because of my strategic roles that required me to go into a main building in London and elsewhere, you know, I was the one person on the six o’clock train to Didcot with nine carriages and literally me in it, and walking through London in what I can only describe as what you would expect in an Armageddon, I mean literally, you know, no one in Paddington, no one in Whitehall. I mean it was truly extraordinary. It was incredibly difficult. For several months actually I rarely saw my children, which was very challenging. But, you know, we got through it and I spent a lot of time on the phone to them, and Facetime, as many of us did, but yeah it personally took its toll I think it would be fair to say.

I think there was a, as there often is in the military, a kind of stoical camaraderie in the thick of it. I think an acknowledgement that, you know, that there’s only twenty-four hours in a day, and you do need to sleep for a few of them. You know, there was a certain humour that developed, which would probably, to an external person not always be entirely appropriate, but I think, you know, in the truest military senses, you know, we were in a conflict, not a traditional one, one might argue, but nonetheless operationally focused and you know, you look after each other as a team. So yes, I actually, you know -- It was again, I will often say to people when they ask me about Covid that it was the most -- whilst one of the most challenging periods of my life, probably one of the most professionally rewarding.

'My partner was sick abroad and I couldn’t visit him. I was frightened he would catch the virus and become sicker. I left work fretting about my patients, and went home to fret about my partner. I was a ball of nerves. And the scariest thing was that there was no end in sight.’

M-CR, palliative medicine specialist registrar, London

Christmas Day selfie.

 

Christmas dinner

Christmas dinner, 2020

Donated by MK, respiratory consultant, Northern Ireland

MK contracted COVID-19 at work. He tested positive for the disease on Christmas Day, 2020, and ate his dinner in isolation from his family:  

‘[The] pandemic, for me, is going to be my main, career defining moment. We saw a complete frame-shift in how we worked. Suddenly, we were faced with the unknown. We feared for the lives of us and our families as well as our patients […]

‘Personal impact: awareness of own mortality! Got C19 myself at Christmas. Sat at home on Christmas Day, wondering if the breathlessness would set in. I am 51 [years old]. It could have got me. And my poor family, who were spared infection. Take *nothing* for granted. Try to keep yourself well. Enjoy each day. Walk, listen to music, be happy to be alive. Be grateful for all your blessings.’

A Hindu memorial service held for Doctor.

 

Photograph of the memorial service of Tapan Kumar Banerjee, 2020 

Donated by, and reproduced with permission from, the family of Tapan Kumar Banerjee, senior consultant physician, Kolkata

Tapan Kumar Banerjee died from COVID-19 on 31 July 2020. His family donated these items in his memory.

The photograph shows the memorial service held at Dr Banerjee’s hospital, the Calcutta Medical Research Institute. His photograph is garlanded, in accordance with Hindu custom.

A memorial to Dr Banerjee is included in the RCP's digital publication, In tribute: Remembering RCP members and fellows who died from COVID-19

In tribute: remembering RCP members and fellows who died from COVID-19

Royal College of Physicians, published December 2020

 

The RCP commemorated members and fellows who died from COVID-19 in 2020 in this digital publication. It includes obituaries written by family members, friends and colleagues. Click here to view the publication.

If you are aware of anyone who has not been included, please email commentary@rcp.ac.uk

The RCP also continues to commission and publish obituaries for all fellows, which can be found in the Inspiring Physicians collection.

‘ [It] seemed likely there were going to be deaths within the trust and I vividly remember working out how many there were likely to be from the mortality rates published from China in different age categories. I remember calculating my own expectation that we would lose three to four members of staff […] from the Trust workforce. I am aware that these statistics have proven correct; with I believe the loss of three nursing staff and one consultant physician. There was therefore this underlying anxiety at how we will get through it, and the needling question of will any of us be sufficiently unlucky to be killed/seriously affected by the infection? It never occurred to me at any stage that I would not catch coronavirus. I considered it to be a matter of time.’

DS, geriatric and general internal medicine consultant, south-west England

Portrait.

 

Portrait of Donal O’Donoghue

Portrait of Donal O’Donoghue (1956–2021)

Oil on canvas by Lisa Timmerman, 2021

The RCP’s registrar, Donal O’Donoghue, died from COVID-19 on 3 January 2021. This portrait is displayed at the RCP’s base in Liverpool, The Spine. The portrait’s caption shows how deeply his loss was felt:

‘He was globally loved and respected in medicine and when he died all were shocked and saddened’.

A memorial to Donal is included in the RCP's digital publication, In tribute: Remembering RCP members and fellows who died from COVID-19

Transcript: AG talks about memories of Donal

A G – Memories of Donal

So, Donal was the registrar here, he died in the second wave. Contracted COVID on the 15th of December, died on the 3rd of January. I can remember Donal getting COVID, and I can remember him being a little peaky and having conversations with him in meetings when he carried on working to begin with. And then he became more and more unwell, and then I can remember having email conversations with him from his hospital bed, to the final email conversation with, you know, ‘I’m going to go to ITU now and...’ [long pause] er, sorry, [long pause] with a list of what he wanted to achieve when he woke up, and he didn’t. So here we go, I say I’ve processed it all and I’m all fine, but you know, I’m still finding it quite hard to talk about. So, yeah. It was, in many ways, a terrible thing and a lot of good people died, both in healthcare but in all sorts and parts of society.


Part of the exhibition Fortitude

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