As part of the Government’s response to the coronavirus pandemic, 300 of Liverpool’s medical students started voluntary placements on the wards this month, working at a level just below a junior doctor (Sub-Foundation Year 1, Sub-FY1). In normal circumstances, final year medical students undertake several months of intensive clinical electives and apprenticeship-style work placements – before starting work in the NHS in August as FY1 doctors. Our co-founder, Shane, describes five things he has learnt whilst starting work on the frontline in the midst of a pandemic.
1. Personal protective equipment (PPE) is a commodity
PPE (think masks, visors and gowns!) is scarce and without it, we place ourselves at risk. Whilst there may be many reasons people are hoarding toilet paper, for PPE, there is only one – we just don’t have enough. Earlier this week, I was asked to take some bloods from a suspected COVID patient, but the ward had run out of PPE. Situations such as these leave us with a difficult decision – Do we carry on without proper protection for the sake of our patients? Do we say something and risk our tentative positions as newcomers to the hospital? We are human too and must consider the risks to ourselves but also the families we come home to every night. The deficiency of PPE has been echoed by leading organisations such as the British Medical Association (BMA) - doctors are being forced into a corner and face "heart-breaking decisions".
2. Breaking bad news is even more difficult through a mask
We arrived on the ward and doth masks, gowns and gloves. We explain to an 80-year-old woman that we won’t be able to repair her broken hip as she may not survive the general anaesthetic or the tolls of major surgery. She looks numb. If I could show my face behind the mask, she would see my emotion. After that, we phone the patient’s daughter to say we are treating her palliatively. Medical school teaches us the principles of breaking bad news, however, no simulated patient felt like this experience today.
3. The NHS has finally embraced technology
On a surgical ward round, the team normally consists of several doctors and a senior nurse. Due to COVID-19, ward rounds are being conducted remotely – to minimise staff exposure, only the consultant and the nurse physically examine and speak to the patient. Using video conferencing, they communicate with the rest of the team to discuss management plans and document findings in the patient’s notes. Technology has a large part to play in modern medicine and its importance has only been highlighted during the pandemic.
4. Predicting the outcomes of patients with COVID-19 is tricky
In a war, you see the bullet and you know who the enemy is. This time our opposition attacks with an invisible bullet – everyone you come into contact with could be dangerous. According to the Intensive Care National Audit & Research Centre (ICNARC), 93% of patients in ICU were independent prior to admission. Data on 3800 patients shows that over half of patients on the ICU die. Of those patients, 35% are Black, Asian and minority ethnic (BAME), 70% are male and over a quarter were aged 16-39. This is not just a disease of the elderly.
5. I love coffee and the outpouring of love for the NHS
One positive from the outbreak has been the immense support from the general public and businesses both locally and nationally. From the unlimited supply of caffeine provided by Costa to discounted vegan essentials from Soulful food to the weekly clap for carers. After a long shift, these kind gestures uplift our spirits and make us feel like we really are all in this together.
Author: Shane D'Souza, Final Year Medical Student