January, 2020. Only a few modules left of medical school before I am officially a doctor. Final exams, a medical elective, and transition to FY1. A simple trajectory, or so I thought, until March, 2020, when the pandemic began in the UK. To embark on my career in the midst of COVID-19 was something I could never have predicted. Nevertheless, the lessons I have learned and the losses I have experienced have moulded my clinical practice and greatly impacted my outlook on life not just in medicine.
In January, 2020, I was fortunate enough to secure a medical elective in haematology at my local hospital. It was a speciality that I particularly enjoyed during medical school and wanted to explore as a potential career option. My supervisor was Dr Shafi, a doctor who I had heard of before starting at the hospital, not just for his clinical excellence, but also his kindness. I am pleased to say that everything I had heard about him was true. He integrated me into the ward team almost immediately and ensured I was exposed to a variety of haematological opportunities. I got to attend a plethora of clinics, the laboratories, and assist in bone marrow aspirates and biopsies. I was in the middle of ward round, just outside bay three, when I got a message that my final exam results had been released. I had passed and I quickly scurried off to ring my family and let them know the news.
I attended Dr Shafi's clinic that afternoon. I barely sat down before he turned to me and asked about my exam results. Despite his very hectic schedule he still remembered the significance of that day for me. He was the first to congratulate me in person and his words that followed often echo in my mind. Before the beginning of each consultation he would introduce me as Dr Megan. I was a snivelling wreck that entire clinic not only because I had passed my exams but also because of the impact his words had had on me. In the blink of an eye my elective had concluded. Unfortunately, Dr Shafi was in a meeting so I did not get the chance to say goodbye. I left him a card thanking him for everything, expressing how I had left not only a better doctor, but also a better person for knowing him.
The pandemic struck and I began my interim FY1 post back on the haematology ward. The ward was one of the only clean wards in the hospital due to the vulnerable demographic of the patients we treated. I noted Dr Shafi's absence and was informed that he had COVID-19. I did not think much of this news at the time and assumed that he would be returning to work in the following weeks. In the meantime I started to develop my clinical practice. I was slowly able to formulate management plans that addressed issues I had identified during the ward round. Whether it be taking bloods or prescribing antibiotics, these small acts made me feel that slowly but surely I was growing in clinical confidence and was deserving of my doctor title. Meanwhile, Dr Shafi's condition worsened and he was admitted to the respiratory ward, then to the intensive therapy unit, and finally to a London hospital. I was outside bay three when I saw several nurses teary-eyed after a meeting. I knew in that moment Dr Shafi had passed. I have no recollection of the rest of that day. His loss was felt on so many levels, a great loss to me, to the Trust, and to medicine. It demonstrated to me how cruel and unforgiving the virus could be.
Despite the sadness and grief there were still patients that needed tending to on the ward. As the weeks passed and the infection rate surged, there was an outbreak in bay three. Only two patients made it to the following week. Till this day I have not stepped into that bay.
I started on the respiratory ward at the tail end of the first wave and it is fair to say it was at the complete opposite end of the spectrum to my previous ward. To my surprise one of the patients from bay three was there, a month after the outbreak. He did not remember me, but I remembered him. He was on Optiflow and was failing attempts to be weaned off oxygen. I was the first person who he expressed his wish to die to. He was the first person I had to palliate. He was my first death certificate. I felt as though we both had closure concluding that journey together.
Throughout my time on the respiratory ward I again have witnessed clinical excellence to the highest degree and I genuinely feel incredibly blessed to work alongside such talented individuals. I have been exposed to a wide variety of respiratory emergencies and can confidently tackle aspiration pneumonias, deteriorating COVID-19 patients, and appropriately escalate oxygen therapy. I could probably do an arterial blood gas with my eyes shut, adding a whole new meaning to a blind procedure. Despite this, my biggest lessons have revolved around the art of medicine, not the science. I have been in positions where I have had to inform family members over the phone that their loved ones are deteriorating or have unfortunately passed. I have had family members fly from abroad to be at the bedside of their loved ones. I have had incidences where people are shielding and have asked me to send their love to their loved ones knowing full well that my words will be one of the last their loved ones would hear. All of this simply from the words I speak. Just like how Dr Shafi's words had impacted me, my words now also held a much more significant meaning to those I had spoken to.
I recently received my first gift from a patient, two jumbo packets of biscuits, which I successfully polished off in a slightly alarmingly small amount of time. He was very sick with COVID-19 pneumonia; however, we were able to wean him off oxygen while also tackling other issues such as his asthma management. It was an honour to sign off his discharge paperwork knowing how far he had come during his admission. His card detailed how thankful he was that he was able to return to his family. I felt privileged to be acknowledged by him as I only played a small part during his hospital stay. I read his card often; I do not think he will ever know how much I treasure his words and the kindness that he showed me.
The pandemic is still very real and people are losing their battle every day. They are not just a number; they are an individual with a family and a legacy that they leave behind. The fight is still ongoing and the road is still unclear, but I have faith that in time we will be able to overcome COVID-19. Reflecting on the past year has been very insightful for me. I have learnt at an exponential rate and it is a credit to everyone I have had the privilege of meeting along the way. In the future, I hope that my practice emulates that of my colleagues and that my words engender the same feeling of kindness that both my patients and colleagues have engendered in me.
Megan is a newly qualified doctor working in southeast England. In her spare time she enjoys weight training and supporting her football team, Tottenham Hotspur.
Acknowledgments
I declare no competing interests.