7.30am: Set off for work
Today’s a long day as its my turn to cover the coronavirus centre this evening. There aren’t many bonuses of lockdown, but I am enjoying the reduction in traffic. A 1 hour journey has been cut to 30minutes…which obviously means an extra half hour in bed, which I definitely will need today. As I contemplate dressing I remember the order of the day is infection control. As a result a lot of us have decided to go rooting around to dust off our old scrubs (I swear this top fitted before – must have shrunk in the wardrobe!). As I throw them on bleary eyed I remember how much I enjoyed them – its like wearing pyjamas all day!
8am: Get to work and most importantly…coffee
Looking around the practice a lot of things have changed since Covid 19 came into play. I have never seen the surgery so empty. The reception area has just a couple of staff at either end of the room answering phones and the waiting room is now as quiet as Jeremy Hunt’s leaving party at the junior doctors HQ. On the outside you would have thought this place was closed.
8.30am: Start the telephone triage list
There is one list for all of us working today. Every patient that rings in for an appointment gets put on this list to be rung back by a doctor or nurse. You just keep going till it is done (which is usually about the time the practice closes). This is a massive change to how we normally practice. Nowadays any face-to-face consultation is only done as an absolute last resort. We don’t want people to be put at risk of Covid 19 by leaving their houses and coming to the practice, likewise we want to make sure the practice staff are not put at risk. We do have some aprons, face masks and gloves to use if we do see someone who we suspect has Covid 19, but the evidence that these help anyone is as flimsy as the see-through pinnys we clumsily wrap around our necks.
Personally, I had always found telephone consults to be quite stressful since you can’t physically examine the patients and you could potentially miss out on vital clues you could have picked up face to face. To be fair, judging by the few patients we have been bringing to the practice and the fact that we haven’t seen much in the way of disasters, it has opened my eyes to how much can be managed over the phone. Maybe this is something we need to look at in the medical community after all of this is done….?
We sadly get far more calls from people struggling mentally with lockdown than with the symptoms of coronavirus. I spoke to one lady in her 90s who was in tears as she felt so lonely.
Normally she has a few visitors a week who stop for a cup of tea and a chat but that stopped when lockdown started. I found myself really struggling to know what to say to make her feel better, as our training didn’t prepare us for anything like this. The hard truth is most people are struggling with how this is affecting their life and that we are all feeling a little vulnerable right now. As it turns out I’ve sometimes found that just talking as two people, and not as a doctor and a patient, has often helped these people feel better – after all it’s what she was missing.
I settle for a homemade sandwich at the desk….there are a lot of calls today so it will be tight whether we all finish by the time the practice closes today. This is something that hasn’t changed with Covid 19.
1pm: Hurrah – a patient in the flesh!
The only face to face patient of the day…a baby check and immunisations.
We are still doing childhood vaccines and combining it with the 6-8 week baby check…we don’t want an outbreak of any other illnesses and it has been suggested that if we don’t keep up with this we could get another measles outbreak – the last thing we need! Its so nice to see a patient face to face, especially a very cute baby, which is a good distraction as I find myself blurring the lines between clinical examination and peekaboo.
5.30pm: The End!
Finally the telephone list is done and the last patient is sorted. As is usually the case the last patient ended up being quite complicated and so I land up with a one week old baby with a red eye (which is always a concern if you are under 4 weeks of age). I have the usual run around whilst ringing the automated switchboard, explaining for the 50th time that I wanted a “paediatrician’ and not “a clown on a mission” – although after 5 minutes I’ll settle for this. Finally (and mercifully) an actual person answers the phone and gets me a paediatrician to speak to who agrees the baby needs to come to hospital immediately.
6pm: Start of the shift in the Covid 19 Hot Clinic.
This is where patients with symptoms of Covid 19 have been triaged by the out of hours teams to attend for face to face assessment to see if they need direct admission to hospital. There is also another parallel clinic running to see people with no Covid 19 symptoms and it is safer this way to avoid patients mixing and spreading Covid 19. To prevent the patient groups mixing the clinic has been set up like Fort Knox (minus the guns).
The Covid 19 patients are given an exact time to attend, and advised in the strongest possible terms to stay in the car and call us when they arrive. At this point, if we are ready for them, a nurse in PPE (Personal Protective Equipment) attends to them, presenting them with gloves and a mask and escorts them into the building. They are then taken to a room to be examined by me for either sending home or admission to hospital depending on what they need.
There is a good amount of PPE at the moment but I am not sure how long that will last, and it does appear that the guidance on what is safe changes daily. We put on a surgical gown and plastic apron then gloves, goggles, surgical face mask and face shield. We keep the same scrubs and surgical gown on throughout the shift and change everything else between patients. The room and equipment is deep cleaned by the nurse after every patient to make sure we reduce the risk of viral transmission from the room, and we all try and stand 2m apart at all times except from the clinical examination.We try and do this as quickly as possible to prevent us getting Covid 19. This is fine by me as after 10mins in PPE you start to overheat and begin to perceive your breath. And those who are wear glasses end up more so due to the perils of steamed up glasses.
At the moment, the level of PPE feels pretty safe, although it’s not quite like what we have seen in some other sites – it appears different areas of the UK can independently decide what they choose to use as long as it meets the current government guidelines.
There was one lady booked in tonight who was very unwell. She could barely string a sentence together without gasping for breath so we immediately called 999 for her. It’s scary just how quick people can deteriorate with this condition – in all my years as a doctor I have never seen anything like this. A sobering thought and one I make a mental note to share with my friend today who was planning on sunbathing in the park at the weekend.
10pm: Home time
We have to change out of the surgical gown and bag everything we’ve used to get cleaned. When I get home I make sure I immediately have a shower. You can’t be too careful working in the Covid clinic and even with the best PPE there’s a risk of some contamination when you take it off. After dinner on the sofa I reflect on a day in General Practice where I have only seen 2 patients in the flesh, but am so exhausted I seem to be falling asleep half way through my favourite episode of “Tiger King”. 2020 has turned out to be an interesting one…
Dr Serena Alim