In July of 2020, a friend of mine from medical school approached me with an exciting new idea. A podcast. About medicine. Needing something, anything, to take my focus off Covid, I jumped up to this opportunity immediately. Very soon a team had formed and as the summer became autumn became winter and 2021 rolled around, we had ourselves a brand new podcast.
Join us, as we discuss the bright ideas that are changing medicine as we know it!
End of Life and Palliative Care: Response to the Covid-19 pandemic –
Ward and Peace
When the world entered a global pandemic, none of us knew what devastation it would bring. But in the grief and sorrow of it, also came a shining light of determination. The community came together as one and helped support those who were at the end of their lives. In this episode, Dr. Rosie Arnott discusses how her hospital in Nottingham, England and many like her’s across the globe adapted their geriatric and palliative care services to better support their populations with focus on having honest, transparent conversations about end of life and incorporating the use of tele-communication to ensure patients and their relatives receive the support they need.
Hearing that there is more to the world than the grim and difficult year that’s just passed has made me appreciate the work of scientists, medics, humans around the globe and the determination of our population to keep striving for the good.
I’m proud of this but more importantly I’m proud of what that means for our future – an enlightened future where today’s discoveries will lead to an improved future for medical and healthcare.
Thank you London. Thank you for giving me a year of excitement and wonder. A year of tears and despair. A year of learning and yearning. Thank you for taking me to where I am today.
As tomorrow marks the end of my second year as a doctor and with it my foundation years, a new beginning is on the horizon.
As time flies past me, I can’t make it slow down, I get closer to realising my dream of specialising.
A lot of trepidation and a lot of hope is brought with me to my new apartment, to my new job, to my new life.
Beginnings are always a little difficult. The introductions, the navigating a new city, the step up in responsibility in the new job. But growth is where comfort ends and I think I might be ready for this step.
So, thank you London, you’ve been splendid. And as I officially become an Internal Medicine Trainee, a new city welcomes me.
Stick around y’all. I’ll no doubt be back with new updates on life as an IMT doctor!
DISCLAIMER: The information below is to the best of my knowledge and what my experience has been as a working doctor in the UK. By no means is this a comprehensive guide to the process and for official documentation please look at the NHS websites or your local hospital’s guide on death of a loved one.
When someone dies in hospital the first thing to be done is for the patient’s loved ones to be contacted. And as discussed in Part 3 of the series , the verification of death is the next step.
But what happens between the family finally saying goodbye to their loved one and the funeral itself?
Most doctors are used to achieving. School exams tended to be easy for us, uiversity, though challenging, had the safety net of a guranteed job at the end and our careers are all about clinical excellence.
And that narrative tends to form the basis of the ‘no-mistake’ culture. A culture that has no leeway for tiredness, burn out, distraction and certainly no place for mistakes. Because a mistake even if not done on purpose can lead to serious consequences. It can, at best , cause distress and at worst a clinical mistake can kill someone. Of course, mistakes happen all the time. And as a result we become defensive clinicians. Erring on the side of caution, taking no risks and documenting documenting documenting. Because no one wants to hurt anyone and the price of hurting someone is high. These aren’t low stakes.
Combine this with our highlight reel social media feed. Sophie is getting married, Andrew is going on a sky-diving holiday, Preeti has a new dog , Lola a new job and so on and so forth.
It’s been a busy few weeks for me, personally. And certainly a busy few for the country as national lockdown eases. Though still cautious, it has been incredible to meet and laugh with loved ones and to share a cuppa or a drink with a friend.
As a doctor, one of the most fundamental things that changed when Covid hit was the restrictions we had to place on visitors to the hospital. How do you explain over the phone that someone’s dad no longer looks like how they did because of their stroke? How do you explain to a mother that her son died? How do you console a daughter her father might not make it?
The importance of these conversations but more so these visits to the hospital for the morale and support it provided families was not lost on me.
On a personal level not being able to visit my own family abroad in times of sickness and the frustration of not being able to help , despite being a doctor myself, was a harrowing experience.
Whilst we make light of our difficulties and laugh with our friends, every single one of us has lost and gained something important during this pandemic. The loss of time with those we care about and the gain of strength in meandering the craziness of it all.
If we survive this, its because many of those like us haven’t. And in order to heal as a community we must remember those who fell and learn the lessons we are being given now.
But most importantly, life is a gift and therefore we must enjoy every day of it to the best of our abilities.
It was my mother’s birthday today. And in line with the current local lockdown rules, I was allowed to see my family in the garden and thanfully the weather outdid it self and though I’ve lately been feeling a little stressed, the day became one of the most gorgeous days I’ve had in a while.
Stress is a peculiar thing. If you’re not stressed at all then how can you respond to urgent/ emergencies/ important events? I need to feel a little stressed in order to meet my deadlines, care for my sick patients, sit exams etc…
But too much and you spiral into a parnoid frenzy or anxious pacing of the room.
Stress is a peculiar thing.
But like almost all things in life, it isn’t permanent. And as lockdown rules start to lift (and god the thought of socialising is a stress in itself), I find myself hopeful that the things I enjoy will be there for me to enjoy despite the 1 + year of perhaps the most stressful experience in all of our lives.
Spring is here. And though I have an exam. Though I don’t know where I’ll be working in August, there is a delicate sense of community and readiness.
I’m going to smell a fresh rose, walk bare-footed on the grass and sneeze as the hayfever hits me…for spring is here and it is here to stay!
I’m carrying the container with someone else’s bloody urine to the sluice and as I lean over to flush it down the sluice the stench of it reaches my nostrils. For a moment I think i’m going to vomit or pass out.
When I moved to London in August last year I was pleased as punch. I’d made it, I thought. The lights, the city noise and even though it was lockdown I still managed to squeeze in many things: Adam Kay’s comedy show, walks to Buckingham Palace, saying ‘hi’ to all the tourist spots, eating weird pizzas in ‘cool’ restaurants and going to all the markets especially at Christmas.
But of course the main thing I was looking forward to was working in a famous tertiary hospital where people from all over the country send their complex patients too for various medical and surgical interventions. I was looking forward to learning from the best in their fields. To sharing space with the directors and presidents of societies. Having chats with consultants who had been recognised by the Queen for their serivce, working alongside seniors who were managing full time clinical work alongside research projects, doing post-docs and bringing up a family. In short I was looking at my dream job in a dream city with the hope that one day I won’t be a guest in London but a permament resident.
Well this isn’t exactly a surprise. A second wave of the pandemic has resulted in another national lockdown. With figures in hospital rising sharply and more intensive care beds being used, it is hardly a surprise that the morale in the country is at an all time low. Its January, no christmas (however bleak Christmas 2020 was) to look forward to, no beautiful and touching New Year’s firework display to feel a sense of community. I’m finding this time round to be a lot more challenging than before. I’m just that bit more tired this time. A bit more jaded. A bit more cynical. A bit more…just done with the pandemic.
I normally save the year's reflection for later on in December. But I've said this often…I don't sit down to write, the writing compells me. For me, writing is a form of catharasis as has this whole year been. A form of catharasis and internal reflections. A chance to find hope, safety, empathy and salvation within myself. A year to define my life. As it has been for so many else.
In Jaunary, working on the south coast, I didn’t know how fundamentally life around for and globally was about to change. None of us did. I was on a medical ward and slowly starting to feel like the NHS was home.
In February, I did something I had always wanted to do. I travelled to New York. I visited a friend I’ve known for as long as I’ve known my own name. It was a week of forging new memories with people from memories of the old. I even met family members I had not met before.
In March, the first hint of a Black Mirror-esque dystopian future made the headlines. People were starting to get sick. Disbelief and misinformation was infiltrating our social media platforms. But other more horrible and scary political events of the early 2020 were still in our minds. Coronavirus was a novel term for the average person.
In April, I staretd on a new firm. Yet again – meeting new faces, new teams, new expectations, new roles, new – well- everything. A particular moment I rememebr is when my consultant said :
“It’s not ever going back to how we knew it before”.
But that’s the truth isn’t it, of life? It doesn’t every quite go back to what it was life before. Instead we learn from it, adapt it, deal with it and at times feel helpless, hopeless, pointless…
In May, I learnt that as clinicians, our duty is to our patients – first and foremost. Deffering to seniors, staying back late at work, not retaliating to a co-worker only is valid if the reason behind it is for the patients we are collectively looking after. But our health – physical and mental- matters because without it, we are not helping our patients.
In June, I realised that Scrubs (which are basically glorified PJs) are the best thing for work. No hassle of bodily fluids getting on your clothes, easy to put on, comfortable to wear, and the fashion choice is taken right out of your hands. It was also particularly beautiful how the community as a large came together. A friend offered to make some scrubs for the hospital for free. When I bought my first pair online, I received with it a small message of ‘Thanks to the NHS’. It lifted my mood.
In July, I started realising I was finishing my first year as a doctor. What a tremendous year to have joined the NHS. From the weekly clapping for the NHS, to Mr. Trump declaring it wasn’t real, to meeting and seeing my first Covid patient die, to the coming together of the hospital, of staff and key workers. In those short months that I had been a doctor, I had seen the NHS at its best and its worst. We didn’t know half the time how we were going to cope but the only thing we knew for sure was if we stopped, then it would all only get worse. Not just us: but the teachers, the grocery store workers, the Vloggers, the community workers. Everyone wanted to make it better and for once it felt that the whole world was joining up for a greater purpsose.
In August, I moved to London to start my new job. This move was a new beginning for me. New attitude, new flat, new outlook to life. I was pumped to get involved at work, in teaching, in research. I was meeting like-minded people. I loved what I was doing at work and my physical and mental health was at its best.
In September, I turned 27. I started an acting course. I continued to learn from my patients. Learn from them the meaning of life: resilience, hope, overcoming barriers, surrendering to grief and importantly acknowledging it isn’t always easy or good. But that it is temporary.
In October, I cried. A lot. From grief, from uncertainty, from being overwhelmed. From feeling it wouldn’t ever stop.
In November, I reached out to others for whom Covid had been worse than it had been for me. For those getting sick, for those whose addictions were worsening, for those who had a relationship breakdown or lost someone they loved. And for those who lost their jobs. Through my patients, I reached out to them. Through my friends, I told them I was here and that I cared. Because someone was doing that for me too.
In December, I dared to look at the lights with a fierce yet vulnerable hope. Can we draw a line under 2020? Can we take the lessons we learnt this year into our future? Can we make the future one worth fighting for?
Well I can’t on my own. But perhaps if we all lift ourselves and work it out together then we can. After all what is more important than saving humanity itself?
I’m a very practical person. Emotional, yes. Empathetic, definitely. But I really am not one to sit down and be unable to do my work. I remember having the flu a few years back and it took the fact I kept falling asleep in clinic for me to realise I really needed to be at home, resting.
I had a massive row with someone I cared about and went into work the next day, perfectly fine.
My grandad died. And I was stunned. shocked. But then I carried on because , well, what else was I supposed to do?