Dr L – Foundation Year 1 experience

Dr L is a Foundation Year 1 doctor who started his intensive care rotation in December 2019. In April 2020, when he should have been moving to his next training post, he was told his rotation would not be changing until August. As he had recent intensive care experience, he has been training other trainees and some consultants during the pandemic.

He described going into the pandemic as facing the unknown, a bit like going into a war – with individual doctors having very different emotions at the outset. He says, ‘It's a real mixed bag of stuff that happened, kind of a roller-coaster. Some of them are obviously really frightened. Some of them are a bit excited that this is a big thing that's happening that they're going to be a part of. For me, it was a little bit like that, to be honest.’

His unit benefitted from being well-led already, with the head preparing for the pandemic, buying extra ventilators, and taking control when it landed.

But he says it was still tricky for consultants who went from managing a unit of 15 beds to having patient in three different locations spread across the hospital, with very sick patients in areas that weren't kitted out for intensive care initially. ‘That's not easy, and it's really hard to get across what that feels like.’

There were lots of extra doctors brought in to help out but often they had little experience in the specialty. As a result there were many rota changes, including for consultants who were resident on call at nights, not at home, which made the trainees feel well supported. Consultants generally worked harder and for longer hours. Rather than trainee doctors, it was the nursing roles that the unit was most in need of.

Dr L was transferred from days and some weekends to some nights, which he had not done on the intensive care rotation before. ‘It messes with your body clock and everything feels a bit different at night.’

It was ‘really distressing’ seeing patients either very sick and dying with no family present, and at times, it was emotionally gruelling, with a ‘really rough period’ when none of the patients were doing well.

He says, ‘This was over a period of nights, so I probably was feeling slightly more emotional, because nights make me feel a bit weird sometimes, but certainly, that string of nights, quite a few people died. That was difficult. They're young people…or people who didn't really have very much wrong with them.’

He also found it frightening seeing his medical colleagues becoming sick with COVID-19. ‘We had one colleague who got very unwell and had to go to our intensive care…his shoes that he would change into are still sitting in the box. He hasn't come back to work yet, obviously, because he's gone through the whole process of being in intensive care, and being super unwell, and trying to recover. His shoes are still sitting there for the day that he does come back to work, but when will that be? You don't know.’

Dr L took it upon himself to work out of his role, learning nursing work in preparation for when it got busy. As a result he was able to give nurses breaks. ‘In the height of this, I found myself doing the range of stuff that in one day, went from helping move patients, cleaning them, flipping, we did proning, helping people clean, doing mouth care, things like that.

‘All this stuff that's super important, and changing syringes, to then being like, "Oh, okay, well now I need to do a central line." That's a big procedure, and what is typically defined as a very, is obviously, it's a bit of a doctor-y thing to do.’

At the same time he was impressed by intensive care nurses also working out of role, stepping up overseeing the huge influx of staff sent into help, teaching and managing patients.

In working outside his role, Dr L said how communications from the GMC were helpful in acknowledging the adaptations people were making. ‘The statement we had from GMC saying, "It's going to be tough, and you're going to be working in places where you're not used to, we acknowledge that," I think that was really positive..."’

Because he already had experience of the intensive care software, he ran informal surgeries to teach people how to use it, including consultant anaesthetists. He also worked with the simulation (medical education) team running PPE donning and doffing training. ‘I ended up teaching 50-odd people one day about how to put on and off the PPE, things like that,’ he says.

By the end of the first wave, he admits he was ‘fed up’ with COVID-19 and has concerns that in a second wave others will be similarly fed up and exhausted.

But generally, he enjoyed the camaraderie between the professions and the ‘can do’ attitude and hopes these can be maintained in the future. The whole experience has reinforced his desire to became intensive care consultant, and the specialty has greater visibility.

‘I think broadly, I've felt very positive that, yes, I'm doing a job that is key to society. It is productive. It is of value, and that's nice. I mean, I don't think you can deny the fact that that is a nice thing, to feel like the thing you are doing is worthwhile, so, good, overall.’