Reflect on a high pressured situation in the hospital, its impact, and lessons learned

As a junior doctor in the height of the Covid-19 pandemic, I became accustomed to death and low morale in the hospital. Medical School teaches us to use the acronym S.P.I.K.E.S when breaking bad news (1). I quickly realised that it is much more difficult to remember what the K stands for when on the phone to a distraught relative, than when sat across an actor in an OSCE station.


My colleagues and I became well acquainted with arterial blood gas (ABG) needles, pulse oximeters, prescribing Dexamethasone and Remdesivir, and the bleep numbers of the High dependency Unit (HDU) and Intensive Care Unit (ICU) registrars. As a Foundation year 1 Doctor (F1), you have the luxury of always being able to escalate to seniors. Yet even this comfort seems futile when faced with a patient on maximum Oxygen; when no beds are available for more invasive life-saving treatment.


During an evening on call, I was bleeped by the nurse to a review a relatively fit elderly lady desaturating on 12 litres of Oxygen. I reviewed the patient, increased her Oxygen to 15 litres and instructed her to prone. I called the HDU registrar to review the patient for consideration of Non-invasive ventilation (NIV). At this point, I get called in to see the patient again, her respiratory rate steadily climbing. In a state oddly mirroring my patient, I became more tachycardic and tachypnoeic with anxiety. I rang the HDU registrar again, pleading over the phone for them to review this patient as a matter of urgency.


Eventually the HDU registrar arrived, and fortunately one bed space was available in the ICU. Even after the 9pm handover had taken place and the possibility to leave the Hospital was available to me, I stayed in the ward, mulling the situation over, feeling like I could not leave. As a new doctor, this was my first time in the job that I felt paralysed, unable to do more for the patient in that moment. On reflection, I felt a sense of shame. I knew that the relief I felt when the registrar came was not just for the patient, but for myself as the only doctor on the ward looking after her.


Looking back, this is one of many situations I confronted while working in the second wave of the pandemic. Every F1 will know the algorithm for reviewing an unwell patient is an A-E assessment and a call for help. However, in recent times, this is accompanied by a silent prayer that a bed space and equipment will be available.


Only recently have I found myself opening up and discussing these experiences. It has provided me with an unexpected level of comfort. That wave of Covid-19 may have finished, but the virus still remains, and we face future challenges. Throughout Medical School the importance of taking care of your mental health has been reiterated at many times. However, through discussions of these experiences with friends and colleagues, this lesson has finally sunk in.


References:

1. Baile WF, Buckman R, Lenzi R, Glober G, Beale EA, Kudelka AP. SPIKES-A six-step protocol for delivering bad news: application to the patient with cancer. Oncologist. 2000;5(4):302-11. doi: 10.1634/theoncologist.5-4-302. PMID: 10964998.


About the Author

Siddhant Pherwani - SUTURE UK September Blog Competition Runner Up

Siddhant is a F2 Doctor, working in North West London, with an interest in surgery