MY YEAR ON THE FRONT LINE AS AN ICU DOCTOR

HEALTH

One way or another, we’ve all had a grim year, but to be working for the NHS during the pandemic requires a whole different level of resilience.

As a consultant in intensive care, Dr Carmen Lopez Soto really has seen it all. She’s cared for the sickest patients and had some of the most heart-breaking conversations with their loved ones. She’s been overwhelmed, exhausted and lonely, yet a year on, she has started the healing process and is searching for ways to be thankful.

I genuinely don’t know how she has got through it – and is still going through it. I am in awe of her…

Two main concerns have arisen from the COVID-19 pandemia that relate to the mental health of workers directly involved in the care of patients: burnt out and post-traumatic stress disorder (PTSD).
Resilience: the capacity to recover quickly from difficulties; toughness. The ability of people or things to recover quickly after something unpleasant, such as shock or injury.
Burnt out Syndrome: a syndrome conceptualised as resulting from chronic workplace stress that has not been successfully managed. It is characterised by three dimensions:
Feelings of energy depletion or exhaustion;
Increased mental distance from one’s job, or feelings of negativism or cynicism related to one’s job; and
Reduced professional efficacy.
Post-traumatic stress disorder (PTSD): may occur in people who have experienced or witnessed a traumatic event such as a natural disaster, a serious accident, a terrorist act, war/combat, or rape or who have been threatened with death, sexual violence or serious injury.
The real impact of COVID19 on front line health workers is yet to be seen.

December 2019. Something is happening in China with a new pneumonia. Nobody knows much about it, apart from that it’s spreading fast within their borders. For me, December 2019 is just another December, spending Christmas away from my loved ones while caring for the sickest in the hospital as part of the intensive care team. Little did I know how our lives will change in the coming months.
January 2020 came with a lot of plans (as usual when a year begins). I really like that New Year feeling, the expectations created from what life can bring. More importantly, every New Year gives me the opportunity to be thankful for the people in my life. My family are all in Spain and, with aging parents, all I ask is that they remain healthy. And my friends, old, new and in between, with whom I’ve spent so many moments of my life, and despite the time, they are still there! China still seems far away but ongoing reports of more cases are flowing in. This disease keeps spreading not just in China, where there’s now a national lockdown (I had to ask the meaning of this word), but to Europe and the rest of the world too.
February 2020. Life carries on but at work the mood is changing. The World Health Organization declares COVID19 a sanitary emergency. Increasing number of cases in Europe are being detected, including here in the UK. Italy seems to be hit pretty hard. Arrangements at work start happening, and planning for expanding areas, sourcing of medications, machines… We will also need staff to man those new areas… and that will become a real challenge. ICU nurses and doctors take time to train. We do a very specific but holistic work that requires long hours of studying and training… One thought starts creeping in as I hear about all this, and it’s if we will be able to look after the patients in the fashion we are used to and with the attention to detail they deserve. It becomes a mission now more than ever to provide the best care we can.
Friends and family start asking questions: “What do you think this is?”, “Is it as serious as they say?”, “How much do you think it would hit us?”. At that point, what I thought and knew were very much the same: “It looks like a flu, maybe a bit more contagious. No, I don’t think it will get bad here… but we should be careful.”

Little did I know, or wanted to acknowledge, what was coming. How could I? How naïve of me.
February was the last time I went to a live performance.

March 2020. The first (of many) COVID19 patients is admitted early in the month. There is a sense of trepidation at work. Plans to increase capacity, personnel and equipment become reality within days. Friends from Italy and Spain describe the situation there: “It feels like a war zone”. It’s becoming really scary to think about.
Our last book club was on March 5th.

Spain enters a state of emergency on March 14th. Mum, dad and brother are all well, they will have to close their business putting their workers on furlough (another word I didn’t know the meaning of). The family business has been running for more than 50 years despite ups and downs. Will they be able to get over this one too?
England enters lockdown on March 26th. By then, I have worked double the amount of shifts I initially had to work this month. The hospital is soaring with patients. Families aren’t allowed to visit. We have to break bad news over the phone, they can’t say their goodbyes to their loved ones. It’s heart-breaking. I wonder how much else we will have to go through to then realise it’s only the beginning. Having suffered an episode of burnt out before only makes me more aware of how important looking after my wellbeing is going to be.
What if I fall ill? There’s so much work to do, I’ll just keep going and not think about it. But… What if I fall ill? What would be the consequences of having another one?
My main de-stress therapy, the gym, is closed. Exercising has proven a real therapy, and going to the gym is the only social interaction I have through the course of the week if I’m working from home. What am I going to do? How am I going to get through this?
I start writing five minutes every day and meditate. Try to do the online classes organised by the gym… but can’t face it most of the days. I spend almost a month not doing much exercise. Eventually start running… I hate running, but it seems the only way of making me feel good.
April 2020. It’s the weirdest and loneliest birthday of my life. I spend it on my own but family and friends video call me, I feel lucky and blessed. Order Indian to celebrate. Next year will be different, I think, I hope. I get brownies, a full box of veggies and a bunch of flowers. You know who you are, thank you.

It is past mid-April by the time I can get more than four days off work. The past few shifts have been really tough to get through, patients are presenting really sick, some are dying and with families not coming in, stressful conversations happen over a phone call.
By now I have stopped journaling. I am doing some Zoom exercise classes and going out for runs.
I am mentally exhausted and hope that does not affect me at work. I cry almost daily and feel lonely and alone. I read, watch films. I still care but mentally I’m finding it difficult to enjoy being at work. Thankfully, my colleagues are supportive and despite the downs, I carry on.
Been speaking to my mother almost daily. They are keeping busy at home and with admin for the business. “They are ok,” I keep repeating.
The social initiative ‘clapping for carers’ lights up mixed feelings. Front line workers are not heroes. We study and train for years, this is our job. My nursing colleagues are going through a pretty rough time, they deserve more than claps.
May and June 2020. Covid numbers are coming down. Plans are being drawn to ease lockdown “in an orderly manner”. I have tickets to go home to Spain in the summer, will I be able to go? Will it be safe for my family? As a back-up I book some days away from London, just in case.
The exhaustion is now translated into insomnia. Why can’t I sleep? I wake before dawn and can’t get back to sleep, so go out for runs (manage to catch some nice sunrises). When I sleep I wake up with disturbing dreams that I know I don’t want to remember. Dreams of hospital corridors, alarm noises… Eventually, my sleeping pattern improves… Would anyone else be going through the same?

The days are longer and spring rolls into summer.
Summer 2020 feels like a breeze of air. Work is still busy, the pendulum is going the other way, with increasing non-covid patients.
Luckily gyms reopen, which is a huge mental relief. Get to see my gym friends in the flesh! That is just enough to keep me going. We get together for a book club some time in July. I only met these guys a few months ago, but they have been there for me over the past months and for that I can’t thank them enough.
Some time in August I realise that by now I haven’t been hugged in over five months. Five months of intense moments of loneliness. Will I remember how to hug? The thinking about it even feels weird.
I get to go to Spain to see my parents and friends. I feel nervous and reticent to be close to them, full with fear I may be a silent carrier and may put them at risk. Only hug them by the end of my stay in Spain. These hugs were so much needed I had not realised… I’m hoping to go back for New Year.
October- November 2020. Numbers start coming up again and a few cases are coming through. At work we are watching very closely what is happening in the north of England… the second wave is coming. How bad will it be?

England enters its second lockdown in November. Zoom exercise classes restart and I realise that going home for New Year is a no-go. I get ready to move to a new flat which keeps me busy.

I also manage to pick up some admin work that I had parked for better times. Work does not stop for one reason or another.
This Lockdown I can have a bubble and two amazing people take me under their wing despite not knowing me that well.
December 2020/January 2021. And just like that it’s December again. Lockdown is lifted but within a short period of time, London enters tier 3 that then becomes tier 4 and before Christmas it is lockdown again. We start seeing higher numbers of patients coming through the doors… and here we go again.
This time is just work and dark days. I try to remain emotionally flat to keep me going. Crying is not really an option these days. Just keep going. Have I forgotten how to cry or have I run out tears? Has anyone ever run out of tears?
February 2021. I’m increasingly cynical when interacting with others and my emotions are running high in general. Can’t ignore feeling fed up and tired. I also worry about expressing how I feel openly because on one hand, we are all on this boat together but on the other, there are so many people who are much worse than I am and whose worries seem more important than mine.
March 2021. And here we are again… a whole year since the rollercoaster that has been the past 12 months began. Things start to settle again. I have some time off and focus on my healing process, which is by now much needed.
On reflection, this year has posted challenges for everyone. The many emotions over the past 12 months could be summarised as overwhelmed, lonely (and, eventually thankful?).
My road from “hell to health” starts some time in March. Still tired and mentally drained, I’m becoming more aware that the healing process will take longer and will be harder that I thought.
The storm of experiences and feelings both at a professional and personal level that I have encountered, ones I thought I would never have to face, will leave a mark on my soul. It is now in my hands to figure out how I will grow from them and how to help the scar heal.
Will it heal to remind me to be thankful for all the people in my life? Will it grow to sour my character and darken my personality? Will I be able to calm the guilt of feeling exhausted because of work whilst others have lost theirs and are struggling? Or will I ever be thankful for how this time has changed me? Many of the questions that have come up recently I have no good answer for. Only time will tell.

“But why… do people work anyway?” is one of the many tricky questions I tackle in my debut book BUT WHY? which is available to preorder now and also on audiobook.

Fancy some more?

Listen to Dr Joshua Wolrich on Honestly Podcast talking about his journey to becoming a doctor and working for the NHS.

Read Leah Hazard’s list on why she decided to leave her job and retrain as a midwife.

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MY YEAR ON THE FRONT LINE AS AN ICU DOCTOR

One way or another, we’ve all had a grim year, but to be working for the NHS during the pandemic requires a whole different level of resilience.

I genuinely don’t know how she has got through it – and is still going through it. I am in awe of her…

Two main concerns have arisen from the COVID-19 pandemia that relate to the mental health of workers directly involved in the care of patients: burnt out and post-traumatic stress disorder (PTSD).

Resilience: the capacity to recover quickly from difficulties; toughness. The ability of people or things to recover quickly after something unpleasant, such as shock or injury.

Burnt out Syndrome: a syndrome conceptualised as resulting from chronic workplace stress that has not been successfully managed. It is characterised by three dimensions:

Feelings of energy depletion or exhaustion;

Increased mental distance from one’s job, or feelings of negativism or cynicism related to one’s job; and

Reduced professional efficacy.

Post-traumatic stress disorder (PTSD): may occur in people who have experienced or witnessed a traumatic event such as a natural disaster, a serious accident, a terrorist act, war/combat, or rape or who have been threatened with death, sexual violence or serious injury.

The real impact of COVID19 on front line health workers is yet to be seen.

Little did I know, or wanted to acknowledge, what was coming. How could I? How naïve of me.

February was the last time I went to a live performance.

Our last book club was on March 5th.

What if I fall ill? There’s so much work to do, I’ll just keep going and not think about it. But… What if I fall ill? What would be the consequences of having another one?

My main de-stress therapy, the gym, is closed. Exercising has proven a real therapy, and going to the gym is the only social interaction I have through the course of the week if I’m working from home. What am I going to do? How am I going to get through this?

I start writing five minutes every day and meditate. Try to do the online classes organised by the gym… but can’t face it most of the days. I spend almost a month not doing much exercise. Eventually start running… I hate running, but it seems the only way of making me feel good.

It is past mid-April by the time I can get more than four days off work. The past few shifts have been really tough to get through, patients are presenting really sick, some are dying and with families not coming in, stressful conversations happen over a phone call.

By now I have stopped journaling. I am doing some Zoom exercise classes and going out for runs.

I am mentally exhausted and hope that does not affect me at work. I cry almost daily and feel lonely and alone. I read, watch films. I still care but mentally I’m finding it difficult to enjoy being at work. Thankfully, my colleagues are supportive and despite the downs, I carry on.

Been speaking to my mother almost daily. They are keeping busy at home and with admin for the business. “They are ok,” I keep repeating.

The social initiative ‘clapping for carers’ lights up mixed feelings. Front line workers are not heroes. We study and train for years, this is our job. My nursing colleagues are going through a pretty rough time, they deserve more than claps.

May and June 2020. Covid numbers are coming down. Plans are being drawn to ease lockdown “in an orderly manner”. I have tickets to go home to Spain in the summer, will I be able to go? Will it be safe for my family? As a back-up I book some days away from London, just in case.

The days are longer and spring rolls into summer.

Summer 2020 feels like a breeze of air. Work is still busy, the pendulum is going the other way, with increasing non-covid patients.

Some time in August I realise that by now I haven’t been hugged in over five months. Five months of intense moments of loneliness. Will I remember how to hug? The thinking about it even feels weird.

October- November 2020. Numbers start coming up again and a few cases are coming through. At work we are watching very closely what is happening in the north of England… the second wave is coming. How bad will it be?

England enters its second lockdown in November. Zoom exercise classes restart and I realise that going home for New Year is a no-go. I get ready to move to a new flat which keeps me busy.

I also manage to pick up some admin work that I had parked for better times. Work does not stop for one reason or another.

This Lockdown I can have a bubble and two amazing people take me under their wing despite not knowing me that well.

This time is just work and dark days. I try to remain emotionally flat to keep me going. Crying is not really an option these days. Just keep going. Have I forgotten how to cry or have I run out tears? Has anyone ever run out of tears?

March 2021. And here we are again… a whole year since the rollercoaster that has been the past 12 months began. Things start to settle again. I have some time off and focus on my healing process, which is by now much needed.

On reflection, this year has posted challenges for everyone. The many emotions over the past 12 months could be summarised as overwhelmed, lonely (and, eventually thankful?).

My road from “hell to health” starts some time in March. Still tired and mentally drained, I’m becoming more aware that the healing process will take longer and will be harder that I thought.

The storm of experiences and feelings both at a professional and personal level that I have encountered, ones I thought I would never have to face, will leave a mark on my soul. It is now in my hands to figure out how I will grow from them and how to help the scar heal.

** “But why… do people work anyway?” is one of the many tricky questions I tackle in my debut book BUT WHY? which is available to preorder now and also on audiobook.**

Fancy some more?

Listen to Dr Joshua Wolrich on Honestly Podcast talking about his journey to becoming a doctor and working for the NHS.

Read Leah Hazard’s list on why she decided to leave her job and retrain as a midwife.

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“But why… do people work anyway?” is one of the many tricky questions I tackle in my debut book BUT WHY? which is available to preorder now and also on audiobook.