Apothecary 2020

was firstly that the evidence from the scientific journals
was not robust and secondly, misinformation was
evident throughout the media. Anxiety had to be
managed predominantly with communication, and we
had to consider the perceived risk, and to make shared
decisions with patients. In London some boroughs set
up GP COVID-19 Hubs, for self-isolating patients
requiring medical attention to be seen face-to-face. I’d
approximate that for every three hour shift I worked,
one patient was ill enough to be admitted to hospital. A
middle-aged gentleman collapsed in the car park. He
was weak. We measured his oxygen saturation level at
66%, we gave oxygen immediately and called an
ambulance. The senior GP had a conversation urgently
with the patient’s daughter-in-law, explaining the
prognosis was poor. She was distraught, she already
had relatives who had succumbed to the disease. This
was my first insight to the multi-generational
consequences of the virus.
Whilst working on the Geriatrics ward in a tertiary
care hospital I scrolled through the Intensive Care list, to
get a grasp of the demographic of patients requiring
ventilation namely, ethnic middle-aged men. I hovered
back up to a particular name. It was the gentleman from
the hub. I was relieved to hear he was being discharged
soon. Amongst the successes, during the peak, it was
heartbreaking to keep vulnerable, elderly patients (due
to infection control ‘no visitor’ policies) from their loved
ones to die in fear, isolated, with hardly anyone to listen
except staff who are merely eyes peeking above a mask.
The ability to emote and empathize was diminished.
CPAP machines and ventilators were limited, and
Consultants had to make painful resource allocation
decisions. The front-line workforce was subject to
systematic factors causing moral injury (psychological
distress resulting from actions violating one’s beliefs,
values or ethical codes).
If felt like the systematic and logistical factors were
what diverged the workforce from saving lives. At the
time, I found comfort that this catastrophe wasn’t
anthropogenic, as there was evident social cohesion on
the ground. Many would relieve the weight of others’
tasks, as the staff hierarchy flattened. Projected
psychological stressors had been noted at induction to
the Nightingale hospital, essential for the domestic and
healthcare assistant staff, who nobly volunteered
despite many of them never working in a clinical setting
before. It felt like a novelty, roaming around a
convention centre which mimicked an airport terminal,
on our breaks. Reality hit inside the boardroom,
fashioned into an intensive care unit, with patients’
bodies intertwined with tubes and machinery. Many of
their faces swollen and sore from proning (positioning
the body to lie flat on the stomach, to enhance dorsal
lung air entry maximising oxygenation potential). In the
early morning hours, we would theorise whether
clinical features were due to the virus or just the fact the
physiology of these patients were pushed to their very
extreme, as noted on blood gases often showing values
incompatible with life. Looking up, the corrugated
silver roof extended beyond my visual field, I felt
grateful that the units beneath were not required for use.
Weeks on, I am grateful for a hiatus to spend time
with someone I share beliefs and goals with, who visited
with impeccable timing. He is a mirror that I reflect back
in (comprised of loyalty, empathy and courage),
allowing recognition of areas to address and the
furthering of accomplishments. Writing this now,
working in the Paediatric Emergency Department, the
virus is attending in a polite manner most recently,
found incidentally in a teenager with an ankle fracture
and amongst positive parents accompanying their
feverish child. The political climate suggests unrest, and
more time required. But scientific research has already
offered us medication breakthroughs (Dexamethasone
and Remdesivir are now being used as standard-ofcare)
and vaccine developments progress in record time.
We remain reactive and endeavour more tools to be
deployed to allow us to practice with grace. With time
will we be able to answer questions of our close ones
definitively?
Safia Akhtar
Conflict & Catastrophe Medicine (CCM) student
GP Specialty Trainee doctor
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