Is it safe to look yet?

As we start to move to the next stage of the COVID-19 pandemic, it feels like a moment to take stock. The country has gone through huge changes to our way of life over the last few months, and those changes have been mirrored in our hospitals. We may be starting to see a light at the end of the lockdown tunnel, but what will that mean for healthcare staff caring for patients? I’ve taken this brief pause in a busy time to reflect on what the recent months have meant for us.

As an anaesthetist, this spring, my and my colleagues’ working lives have been transformed. Our normal routine of planned surgery halted, we quadrupled our ability to look after critically ill patients, and many of us (myself included) went back into intensive care to look after the really, really sick patients admitted with COVID-19. We repurposed equipment like anaesthesia machines for ventilating ICU patients, and our operating department colleagues came up with many ingenious workarounds that made it easier to care for our patients in challenging circumstances. We have struggled physically – particularly the nursing staff, who have endured long shifts wearing cumbersome and uncomfortable protective equipment, often resulting in skin sores due to tight fitting masks.

We have also struggled emotionally. A recent survey by the Royal College of Anaesthetists (RCoA) found that 64% of anaesthetists have felt mentally unwell in the past months. We have cared for patients clinging precariously to life, and experienced a sense of failure when despite our every effort our patients deteriorate and pass away, with their family often unable to spend those precious moments with them before they die. We have felt their grief, taken part in their tragedies, and watched helpless as their loved one succumb. Most of our patients may not have had their families around them, but we were with them, we cared about them, we held their hand, stroked their hair. They did not die alone.

There have also been positives. The joy of seeing some of our patients recover, often after a period where we really did think we would lose them, has been incredible. The camaraderie we have experienced where teams of doctors, nurses, physiotherapists and others who normally wouldn’t be working together give up their day-to-day roles and start working in a completely new discipline, has been inspiring. Anaesthetists and intensive care doctors welcomed doctors from other disciplines, including surgery and sexual health, and nurses from endoscopy, surgery, and many other specialities. They were nervous as they started, but they have not only been useful, they have brought skills and viewpoints that have enhanced our patients’ care and changed the way we think. This transfer of skills should be encouraged and maintained beyond the COVID-19 pandemic.

Things certainly feel different now. London experienced a high number of patients early in the pandemic, but our overflow intensive care units are now closed, and in my hospital we haven’t intubated anyone with severe COVID pneumonia in the last month. Although we are seeing more “normal” patients, we are by no means back to normal. A patient of mine recently delayed seeking help for a life threatening condition because he thought the hospitals were closed – we need to make sure our patients know they can seek help. I worry that we have many patients with undiagnosed cancers whose delayed treatment will mean their cancer is incurable. Our safety guidelines currently mean hospitals are working at around half the efficiency we had before the pandemic hit, while fear, and the regulations around pre-op self-isolation is putting our patients off having their elective surgery in the current climate.

Despite the easing of lockdown, currently the number of cases and deaths are still thankfully reducing. As we move on, we hope desperately there won’t be a second wave, and carry with us the grief of the families we spoke to but never met, and the joy of the survivors who will probably never remember being cared for by us.

Helgi Johannsson