As Britain comes out of lockdown – and as fears of a possible second wave of infection rise – Sirin Kale shares the frightening experiences of front-line medical staff who worked so tirelessly to keep this country safe.
Writer’s note: As Britain approached the peak of the coronavirus pandemic, I spoke by phone almost daily with female doctors at West Middlesex University Hospital, led by consultant Dr Caroline Smith. Over the days and weeks that we spoke, I felt like I got to know these doctors, and saw a tiny glimpse of the impossible decisions they were being forced to make, on a near-daily basis. As we come out of the coronavirus lockdown – and as fears rise in the UK of a possible second wave of infection – it felt right to share their experiences, as the front-line medical staff who worked so tirelessly during those terrifying March and April days. This is their story.
Monday 6 April, evening
Driving into work, registrar Dr Natalie Ring tries to remember what night shift this is. Her third, or fourth in a row? She can’t remember. The nights blur. Since the coronavirus pandemic hit the UK, a third of doctors and nurses have been off sick. The ones left standing have had to pick up the slack. It is punishing work.
As Natalie is driving, news breaks that Boris Johnson has been admitted to intensive care with coronavirus. Across the country, WhatsApp groups light up. It is all anyone can talk about. But inside the A&E department of West Middlesex University Hospital, an unlovely concrete sprawl situated under the flight path of Heathrow Airport in west London, there’s no time for that.
West Mids, as everyone calls it, isn’t one of the big teaching hospitals. It doesn’t have the prestige of nearby St Thomas’s, along the river, or St George’s. And it certainly doesn’t have the staff to match: just seven consultants oversee the entire A&E department, which serves a population of approximately 480,000. St George’s A&E department, by contrast, has 29 consultants, to oversee a population of 1.3 million.
But being the ugly sister creates a unique camaraderie. People stay working at West Mids for longer than they’d planned. The team is close-knit. Like the rest of the NHS workforce, which is 77 per cent female, West Mids’ A&E department is predominantly staffed by women. Many of the senior doctors and nurses are female. These women are standing shoulder-to-shoulder on the frontline of the worst health crisis for 100 years.
And tonight Natalie, 30, is in charge. She was a junior doctor at nearby Chelsea and Westminster Hospital the night Grenfell burned. There was a man in reception that night, his trousers were burned off. He held a child in his arms. They were both covered in ash. At the time, Natalie thought she’d never see anything so harrowing in an A&E department again. She was wrong. Two weeks ago, she oversaw the care of Dr Adil El-Tayar, the first doctor to die of coronavirus in the UK. Afterwards, Natalie cried driving home.
At 7.30am, Natalie starts her shift. The patients start coming almost immediately. A 58-year-old man with coronavirus. With his underlying health condition, he is not a candidate for admission to the intensive care unit. The ICU is slammed. Without an ICU bed, he may die. Natalie delivers the news. An 85-year-old man comes in from a care home. He also has coronavirus, and has at best a few hours to live. After prescribing him medication to ease his passing, Natalie calls his son, and tells him to come to the hospital right away.
But a global pandemic doesn’t stop patients presenting other medical issues. A patient who has been in a car accident keeps asking Natalie to fetch him tea. A woman is miscarrying in reception. Meanwhile, the care home resident’s son arrives, just in time to be with his father as he dies. Dressed in protective gear, he is allowed to hold his father’s hand as he passes. Not everyone is so lucky — some hospitals make relatives watch from behind glass windows, to prevent the spread of coronavirus.
Leaving West Mids the next morning at 8.30am, Natalie is blinded by dazzling sunlight. It’s beautiful out. At home, falling asleep, Natalie worries about her patients. Did she miss anything? She dreams of wards and beds and the sick and the dying.
Tuesday 7 April, morning
Dr Caroline Smith has never been able to stay in an office when there is action on the ward. She was in a meeting the day two commuter trains collided outside Ladbroke Grove station in October 1999. Thirty-one people died. Caroline was a surgeon at the time, and ran to the A&E to help. The other surgeons stayed in the meeting. She quit surgery not long afterwards.
Just like that October, in 1999, today was meant to be a desk day. Caroline, 51, is a consultant, the most senior doctor you can be. It’s a job with a lot of responsibility – and paperwork. But if there are patients that need her, she can’t stay behind a desk. It’s not the sort of doctor she is.
Two men have arrived in A&E. Both have coronavirus and are struggling to breathe. There’s only an ICU bed for one of them. One is 30: young, fit, and healthy, he was discharged from the hospital earlier in the week, and told to rest and self-isolate. As often happens with coronavirus patients, he went downhill fast. His lungs cannot supply enough oxygen to keep his heart pumping and brain functioning. Unless he is admitted to the ICU, and put on a ventilator that will breathe for him, he may suffocate to death. The other man is in his mid-40s, with a chronic lung condition. He’s in even worse shape. He will almost certainly die without an ICU bed.
Both men are lying side-by-side in the resus room, in plastic isolation cubicles. Massive air vents create a negative pressure environment inside, to reduce the risk of coronavirus leaking out. Inside the cubicles, doctors and nurses in full protective gear tend to the men. The vents are so loud Caroline has to shout to be heard.
Under normal circumstances, both men would have been whisked to the ICU immediately. But these are not normal circumstances. Doctors are practising battlefield triage: determining who will recover the quickest, freeing up the bed for another person, and prioritising their survival. Before coronavirus, Caroline had never seen battlefield triage before, not even after the train crash. Now it happens daily.
Caroline pleads the older man’s case on the phone to the ICU, but they couldn’t take him even if they wanted to: there’s only one bed free, and it’s going to the 30 year old. When the older man is told there’s no ICU bed for him, he doesn’t grouch or complain. He just shrugs. At that moment, Caroline wants to hug him, but she can’t. He’s contagious.
Tuesday 7 April, evening
Ece Cinar is nervous coming in for her night shift. A 26-year-old junior doctor from Turkey, this is Ece’s first job. She loves how supportive the team is at West Mids, and how the senior female doctors, like Natalie and Caroline, are so inspirational. But Ece is struggling. Emotionally, it’s a lot to take.
Last week, one of Ece’s patients died from coronavirus. Ece knew the woman; she’d met her husband. She liked her. When she died, it hit her hard. Ece was crying before and after work. She had headaches. She wasn’t mentally right. Her bosses sent her home for a few days, to recover. Today’s her first day back. Natalie greets her with a smile, and asks her how she’s doing.
Natalie’s isn’t meant to be working this evening. She’s covering for Dr Parisa Amrisi, a 35-year-old registrar from Iran. Parisa moved to the UK for university, working three jobs to put herself through medical school. She came down with coronavirus last week – she doesn’t know who she got it from.
Parisa hasn’t told her family back home in Iran that she has coronavirus. Her dad isn’t well. She doesn’t want to worry him. At home in North Finchley, she’s self-isolating in her bedroom, whilst her husband sleeps in a separate room. Parisa’s mother-in-law Zholiet, 56, lives with them too. They are very close: Zholiet used to live next door to Parisa’s family in Iran. Parisa jokes that she fell in love with Zholiet before she fell in love with her son. Zholiet leaves her trays of food outside her room. Ash reshteh, a Persian vegetable soup, and ginger tea with slices of lemon. Zholiet is frightened for her.
Compared to last night’s horror show, the shift isn’t too bad. An Italian woman in her 70s comes in with coronavirus. Natalie calls her sister to tell her it’s not looking good. They send her upstairs to the acute medical unit, where she dies that same evening. There is a domestic violence victim who insists on discharging herself, despite her broken bones and fractures. Natalie does her best to stop her from leaving and get her to a place of safety instead, but in the end she has to let her go.
At 4.30am, Ece and Natalie grab a bite in the staff break room. Ece eats a bad vending machine sandwich and they watch the news. Boris Johnson is still in the ICU. They wonder if he’ll make it. Leaving that evening, Ece is grateful that none of her patients died that evening. It would have been hard to cope if they did.
Wednesday 8 April, morning
Another day from hell. Caroline gets in around 8, and has barely taken her coat off when the alarm goes: a blue light call in the resuscitation room. A young child, in cardiac arrest from coronavirus. Senior doctors are piling into the room, all trying to help. Despite their best efforts, the child dies. Afterwards, the atmosphere is dreadful.
That afternoon, a junior doctor comes to fetch Dr Maria Bigo, from Argentina. There is an elderly woman in the “dirty” zone, where they keep Covid patients. She can’t find the words. Can Maria break the news?
Maria, 48, is an experienced senior registrar. She moved to the UK with her husband, Diego in 2013. They’ve been together for 31 years; they have a son and a daughter. Diego had heart surgery a few years ago. Coronavirus could be fatal to him. Maria has been sleeping on the sofa, to keep him safe, but she worries it’s not enough.
They go to the patient’s bedside. She is 87, a life-long smoker, absolutely awake and conscious. Maria checks her X-ray: there is the tell-tale spiderweb of fluid, white on grey, as familiar to Maria now as her own children’s faces. The woman will die, most likely within hours.
Straight away, she asks: “Am I going to die?” Maria is honest. “Yes, that is a possibility,” she responds. “Your lungs are in a very bad condition.” The old lady is calm. “I really don’t want to die,” she says. “I’m going to be a grandmother.” They wheel the woman upstairs, to the acute medical unit. Two hours later, Maria calls to check on her. She never got a chance to meet her grandchild. She died in a hospital bed.
Across the UK, the coronavirus death toll climbs to 938 people, its highest number yet. Every day is a day from hell these days.
Thursday 9 April
When Maria saw Claude*’s face, her heart lurched. Claude is a West Mids A&E nurse. He’s one of them. “Dr Maria, I’m not going to make it,” Claude says. “I can’t breathe.” Maria scolds him. “Stop calling me Dr Maria!” she says. “It’s Maria. I am with you. You’re not alone.” But Maria can tell just from looking at him that he’s not good. He’s going to need an ICU bed. And their ICU is full.
Around them, the nurses – Claude’s colleagues – are shell-shocked. Caroline gathers together the junior doctors. Can they cover for the nurses for an hour or so, to give them time to decompress? They volunteer immediately. Caroline scrambles to find Claude an ICU bed in another hospital. When she does, the relief is overwhelming.
When this is all over, the A&E team tell each other that they’ll have the biggest party ever. It’ll be like VE Day, when the Second World War was finally done, those black and white pictures of everyone dancing around the Eros in central London. Reaching the end of hell, and walking into the light again. Until then, Caroline tries to buoy up her team as best she can. She tells them that they are a family, that they should think of her as their mother; to call her if they’re unwell.
Driving home, Maria thinks: every single day, my heart breaks into pieces. Maria wonders at how she can put the pieces together and keep working, how any of them can. She lets herself into her home via the back door, heads upstairs, and showers. After flinging her clothes in a hot wash, she washes her hands again. Only then does she permit herself to kiss Diego.
Boris Johnson has been moved out of the ICU. News reports say that he is sitting up in bed again, making phone calls. Parisa is still in bed. Her condition is worsening, her breath becoming more laboured. Zholiet hovers outside her door. She is really scared now.
At home, Natalie’s week of night shifts is over. It is night-time when she rises from her bed, groggy, pulls on some clothes, and stumbles outside. Thursday night: the weekly round of applause for the NHS.
Outside, the sound of clapping rises into the air. Natalie has the sense that she is living through something much bigger than any one person or hospital team, something that she can’t quite track the contours of now, but requires posterity to be fully known. Something like history.
*Some names have been changed.
Vogue, July 2021.Categories: Uncategorised