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Jessica Nolan

Jessica, a recent MB ChB graduate, reflects upon her experience as an F1 working on a Covid-19 ward:

"When starting work as an F1 this year I never thought that I would be facing anything as challenging as the Covid-19 pandemic. Not only is it a new virus which we are learning more about on a daily basis, but also the whole structure of my F1 year has changed. We were due to rotate to new wards in April however it was decided that it would be safer for us to stay in our current jobs. Our rota structure has also completely changed - we are now working 4 long days on followed by 4 days off and then 4 night shifts. This is to ensure 24/7 cover of all wards by not only junior doctors but also registrars and consultants. I am currently based on a Covid ward and therefore seeing a lot of patients who have tested positive for Covid-19.

One of my consultants pointed out this week that this is a totally unique situation for everyone. They said that in terms of understanding and managing patients with Covid-19, no matter how much experience doctors have behind them we are all on a level playing field. This is something I had not really considered before this conversation. We all know as much as each other about this. We are all learning about this together.

I have been faced with several challenges at work over the last few weeks. We are no longer able to have visitors on the wards to protect relatives from coming into contact with Covid-19. This presents us, as healthcare professionals, with new hurdles to overcome. We have a lot of poorly patients on our ward and we are having conversations over the phone with relatives that we would normally much prefer to have in person. It can be much more difficult to have this conversation with somebody over the phone as you cannot read their body language - a crucial part in communicating with people. I feel that I have developed my communication skills so much because of this. I am now more comfortable with having the conversations over the phone - however it will never make them easier.

Another challenge of not having visitors present is that when patients are approaching the end of their life, a time when they would ordinarily be surrounded by family, they are alone. I have found this particularly difficult to come to terms with as if this was a relative of mine I would be heartbroken to think of them on their own. I am lucky to work with a very compassionate team and we try our best to be with patients who are approaching the end of their life. This gives comfort to not only the patient but also the relatives. It also, in these difficult circumstances, brings fulfilment to the team knowing we have been with our patients during their time of need.

PPE, although essential, presents another obstacle. We have lost the ability to smile at our patients. A smile can be so comforting when a patient is in an unfamiliar environment and they are feeling unwell. It also poses difficulties when communicating with patients who are hard of hearing who would normally lip read. I can’t imagine what it must be like for patients who are confused to have the people who are looking after them approaching them in masks and visors. It must be confusing and disconcerting for them. It has therefore become even more important to try to make patients feel at ease in different ways using other gestures where appropriate such as holding their hand when talking to them and also thinking about my tone of voice when having conversations.

Although there have been difficult times there are also positive things that have come out of this. The ward has really pulled together as a team. We all support each other through the bad days and celebrate any successes, where possible. Food has become a very important part of boosting morale. There are always freshly baked goodies or kind donations from local businesses around to help get us through! The trust has also come up with some great ideas to help us connect patients with their relatives - these include an email address for families to send letters and pictures to, as well as iPads to allow patients to video call loved ones. It is amazing to see the difference this makes to patients.

Staff wellbeing is also very important at this difficult time. Our ward has set up a wellbeing room for staff to go to and have 15 minutes away from the ward. In the room there are pictures drawn by local children, inspirational quotes and chocolate. It is always greatly appreciated during a busy shift to have a few minutes away from the ward to switch off.

I know that the experience I gain from working on a Covid ward will stand me in good stead for the rest of my career and they are certainly experiences I will not forget for a very long time. I am so grateful for the support I am receiving from family and friends as well as colleagues, I know this would all be much harder without that."