I’m An A&E Doctor & This Month Feels Like An Episode Of Black Mirror

Amile Inusa is a junior doctor from London in her fourth year of work. Here, she shares what it's been like tackling COVID-19. Some patient-specific details have been edited in the interest of preserving anonymity.

Four weeks ago, I met my first patient with likely COVID-19. 

I was working in a busy emergency department when I was asked to see a baby in the back of an ambulance. This struck me as an odd request for a variety of reasons: 

1. The baby sounded well. They had no temperature and the most perfect vital signs: heart rate, oxygen saturations and breathing rate were all normal. This baby was the cutest thing ever!

2. If someone is brought into hospital by ambulance, they will likely need urgent treatment. Since graduating from medical school four years ago, I’ve never once been asked to do this by a paramedic. Even patients giving birth or having CPR performed can be transferred. 

3. Everyone loves to carry a baby. They’re as portable as the latest micro-bag, so why not just bring them into the department?

Like every acute medic, my mind always prepares me for the worst-case scenario. We were experiencing one of the first confirmed coronavirus cases in London hospitals at this time. And so I donned my gloves, apron and basic surgical mask while running through the tenets of paediatric life support in my head. As I knocked on the door with my elbow, desperate to keep my newly gloved hands uncontaminated, I saw a giggling baby with a snuffly nose. Immediately, my alertness dissipated and I listened to the worries of her teary and anxious parents, who had recently been confirmed as having COVID-19.

After I examined the baby, advised the parents and sent them home in the ambulance, I returned to the department with a feeling that things were about to change in a way I hadn’t anticipated. Pulling off my gloves and mask, it struck me that my PPE was not only a necessary physical barrier but an emotional one, too. No longer would patients be able to see me shoot them a reassuring smile or feel the touch of my warm hand on their shoulder. All I could rely on from here on out was comforting words, vigorous nods and sympathetic sounds.

Three weeks ago, social distancing measures had just been put in place. There was no language of lockdown and no guarantees of salary compensation. The word 'furlough' hadn't yet been uttered in conversation. 

At this point I was working in a busy emergency department at a big London hospital. I came into contact with four patients in two days who had attempted suicide. I don't want to be alarmist and say COVID-19 is solely to blame but it was hard not to see the connections. As you talk to patients and become more acquainted with their intimate struggles and personal difficulties, you see the burgeoning potential for tragedy in their lives.

What do you say to the depressed teenager whose only friend is moving back to their home country? How do you help the struggling father who has already suffered two redundancies in the past year? Where do you suggest that the woman who just got into a dodgy relationship and has now lost her income should live? How do you reassure the young carer whose hands are red raw due to washing as he looks after his mother on chemotherapy?

Unlike an asthma pump or insulin syringe, there’s no quick way of prescribing a better life, mental wellness or social support. And so I offered what words I could and I kept going.

Two weeks ago, we saw a dramatic reduction in the number of people attending A&E. The messages to contact 111 and self-isolate were clearly being understood and practised by the general public. But this signalled the beginning of a change in our work and the type of patients we would see.

Pre-coronavirus, I would go to work in A&E and see several patients who fell into neither the Accident nor the Emergency category. Much of our patient cohort were the 'worried well', those in need of outpatient/GP appointments and those who could’ve engaged in some self-care at home. Now, on the other side, I miss those mundane and easily fixable maladies. 

Now we're fully in coronavirus season, people attending A&E are either sicker or have more serious injuries. Thankfully, fewer patients means that you can spend more time and energy focusing on them. However, the decision to admit a patient into hospital is more complex. Hospitals now carry the inherent risk of exposure to coronavirus, irrespective of our best efforts with infection control. For those who need admission for non-COVID illnesses, it's a risk we need to consider. With the elderly or those with pre-existing medical conditions, it’s an even finer balance, as they are more vulnerable and are likely to become more unwell if they catch COVID-19. 

One week ago, I remembered some words of wisdom from a senior doctor on a ward round: "In all interactions, imagine that you have two groups to consider. The patient and their loved ones." 

We aren’t allowing visitors into A&E in order to make sure well people stay well and aren’t exposed unnecessarily to the virus. This means we also have to consider how we can better keep loved ones involved in the process. It’s easy to show patients that we care as we touch, comfort and laugh with them. However, if we don’t pick up a phone and contact family members, they can easily feel disregarded, unfairly treated and of course, anxious for their loved ones.

My old hospital is collecting iPads and tablets to give parents digital contact with their babies in the NICU. My colleagues are making phone calls to families after they’ve made an initial assessment of their patients. While these aren’t groundbreaking solutions, it’s an example of practical compassionate change we all can make. 

Every day of my last week has felt surreal. You only need to look at the latest Italian figures to see that over 100 healthcare staff have died in an incredibly short space of time. This situation feels like a mix of a bad simulation game and an apocalyptic Black Mirror episode.

On my last 'resus' shift, I made phone calls to two families explaining that their loved ones weren’t responding to treatment as well as we hoped. I made the appropriate referrals to our medical and ICU colleagues, got on with the rest of my shift, saw more patients and then made my way home on the eerily empty London Underground.

It’s easy to leave these situations and feel guilty for not being able to do more. However, I think it’s important that we all begin to exchange that guilt for gratitude. So here’s just the beginning of my list of things I'm saying thank you for every day we're going through this:

I’m grateful that I live with my sister and friend, both of whom are healthy and aren’t scared of living with a healthcare worker.

I'm grateful for colleagues that support me, friends that distract me and the time alone, just to be still. 

I’m grateful that I’m a locum doctor with the ability to pick and choose my shifts while my colleagues work a more gruelling rota. 

I’m grateful that if I were suddenly unable to work, I have savings and parents to support me. 

I’m grateful that I can go outside, take in the fresh air and enjoy my quiet commute to work on public transport.

I’m grateful that my A&E environment provides me with an opportunity to debrief and see patients who are well enough to go home.

I hope that we find a way to invite the space and energy needed to process our feelings of helplessness, pain and guilt. But right now, we are in self-protection and fight mode.

So please don't judge me if you see me obsessively doing workouts on Instagram Live or buying yet another syrup for my home coffee station; just know that it’s my way of getting through this time.