This meeting is. Okay.
Can you just start by saying your name and what you're currently doing in life?
Yes. So I am a flint and I'm a first year psychiatry trainee at the moment.
Okay. And what were you doing in Oxford in the last six years or so?
So I studied medicine at Oxford.
So I started there in 2014. And I yeah, So I did a six year medical course there.
And then I did my foundation is also in Oxford, and now I've stayed to do psychiatry training in Oxford.
So I've been there for a little while now. Right.
Okay. So it's going back to the very beginning.
How did you first get interested in in studying medicine?
So I think I probably first started getting interested in studying medicine maybe when I was about 12 or 13.
And I think I was thinking about what I would like to do. And I liked a lot of different subjects at school.
I quite like languages and odd things as well as science, but I wanted to pick something where I felt like I could make a bit of a difference.
I could do something that felt quite fulfilling and would involve science, but also would involve a kind of caring role.
So it was obvious to think about maybe medicine or something like nursing midwifery.
So I kind of considered all of all of those and also teaching and basically just did a quite a bit of kind of work experience.
And it's a voluntary experience and that's what led me down the road.
In the end, I really enjoyed it. So I decided in medicine.
Mm hmm. Do you have any medics in your family? No, I don't.
So I'm the first person in my family to go to university. And there's no one kind of medical or even in nursing or anything in my family.
So it was a bit of a different path, I guess. They kind of.
We didn't really know what it would be like going to university or studying medicine,
and I think that made it quite difficult in a way when I was trying to decide because it was quite
difficult to get work experience of things when you don't know anybody who who works in medicine.
But I'm very grateful to, you know,
I had a got quite lucky as I went along that I managed to meet people along the way where I if I kind of volunteered in
one hospital and then there'd be someone who would be quite kind and realise that I didn't know anyone in medicine.
So then they would suggest other opportunities and things like that.
So, you know, that's why I always tell people if they don't know anybody and they're thinking about medicine,
just take whatever opportunities present themselves because they'll be kind people on the way who kind of help you.
What kind of volunteer roles were you doing? So I did a lot of work with children, with learning difficulties at a local a local school,
which is it's kind of mixed abilities school, but they have a lot of special needs work, which was really interesting.
And I also kind of unrelatable. And I did a lot of working with children just in a holiday club.
And then I basically just wrote letters out to all of the GP practices in
hospitals that I could think of that were remotely commutable from where I lived.
And one hospital there was a a lady in the voluntary team there who saw the letter and got back to me and it was a I hospital.
And so she just said, Oh, you know, I thought it was unusual that you sent a letter rather than an email.
So I that's why I picked up on it. And so I was really lucky that she was so kind.
And basically I, through that, managed to do some volunteering at an eye hospital.
So I was helping patients, but just before they were going for cataract surgeries and things.
So I just help them with kind of getting, you know, tea afterwards and helping them and their relatives feel relaxed before.
But it meant that I had a chance to chat to some anaesthetists and kind of watch the videos of the procedures.
So it gave me a bit of exposure. And then and then there was a lovely anaesthetist there who basically then said, Oh, you're interested particularly.
And I was interested especially in obstetrics at a time when I'm delivering babies, which is why I was considering midwifery too.
And so he had a contact who was a gynaecologist.
So then I got a bit of work experience through that.
So it was very much just kind of, you know, just being willing to do whatever and just kind of enjoying it for what it is.
And then people seeing that you're interested. And then they were really keen to offer other opportunities.
Hmm. And how did you go about choosing where to study? So I grew up in Slough, so not very far away from Oxford.
So I mean, a big part of kind of deciding was.
I wanted somebody quite near to home so I could see my family quite often, but also not not so close.
So I didn't kind of have my own separate life and everything.
So, you know, I wanted something relatively place and I really liked that Oxford was quite a
traditional course in that it had a as a part of the course where you you work on,
you kind of see bodies that have been dissected so that you can learn anatomy from them.
I think that that was really appealing to me as a part of the course.
I thought it would be really helpful and I really like the idea of the tutorial system and
having that kind of close working relationship with with a tutor and a few other students,
a bit more like a family sort of atmosphere. So those things really drew me about the Oxford course and yeah, so I so I decided to apply.
I did, but I kind of thought that it was a bit of a long shot, given that my background and that I hadn't,
you know, no, I didn't have much experience of what it might be like to go to university.
But yeah, so I applied there and I applied to Cardiff, Leicester and Holyoke Medical School as well.
And and you got in so that I mean, how did you find the experience of being a medical student at Oxford?
I really enjoyed it. There were definitely difficult, difficult parts to it.
I mean, it wasn't an easy road by any means, but it was really fun, really interesting.
And I kind of I definitely enjoyed probably the clinical is more it's more what I'm inclined towards.
But I did love the fact that we had a year to do a research project as well.
I thought it was really important that we got that experience and exposure and I loved the tutorials of the first few years.
Like I said, that kind of family atmosphere.
I was at Wadham College and it's quite a close knit community that everybody knows all the different years.
And I'd say kind of, especially the clinical years, I always say to students, I try to that now, so I'm a tutor at the college.
I always say, just enjoy the medical school years because it's kind of almost a bit like
you're a medical tourist in a way that you get to see all the most interesting
and best bits of the different specialities and just have a bit of a taste of everything and just go where the interesting things are happening.
So just make the most of it and you see some incredible things.
So you're very privileged position to be in.
And what did you do your research project on? My research projects.
So I was because I was still quite interested in obstetrics at that time.
So a lot of my research and things that I've done has been geared towards that.
So that project was looking at endometriosis and so it was an epidemiological project looking at the relationship between endometriosis,
so subtypes and severity and how it relates to metabolic measures.
So kind of BMI and waist to hip ratio adjusted for BMI essentially because the genetic message is a snip,
a genetic variant that seems to be associated both within Demetrius and with metabolic variables.
Basically they think it's associated with obesity.
So basically you tend to find that women who have a lower waist at ratio adjusted for BMI tend to have a greater severity of of endometriosis,
although it wasn't a very I didn't really find a massively strong association, but that's the that was the working idea and it was quite interesting.
It was, you know, I didn't really show much of significance, but it was an interesting idea.
And has that made you think that research is something you'd like to include in your career as you go forward?
So it definitely it definitely interested me, and I've done some other bits since and I did an academic foundation program,
so I did a reset research and my foundation is as well.
I would say I definitely wouldn't rule out, but I would say that the more I've done research, the more I've realised that to really, I guess,
make the most of it and to really find it enjoyable and something that you don't mind going that kind of extra 110% for because you have to,
especially if you're an academic clinician, because you will do a lot of it in your free time,
You will do a lot of it on the evenings after you've already spent a really busy day in connected things.
It has to be something that you're really interested in so, so much and that you find passionate,
you're passionate about and you're you've got that drive for.
And I guess I haven't found my area of that in research.
Like I found things very interesting and really enjoyable. But I if I do it, I think I want to maybe come back to it later on.
Once I found my niche in my clinical work that I then find that relevance for me.
So I wouldn't rule it out kind of. I really had a thought for a while about whether I would do an academic clinic,
clinical fellowship, go straight from the founder academic fellowship program to that.
And then actually I thought, actually, I've done a lot of it.
So I did a lot of work in the obstetrics and gynaecology,
and then I did a bit in my academic foundation stuff was in paediatrics because I was thinking more paediatrics then.
And actually now I've gone into psychiatry and I thought actually maybe just focus on the clinical for a bit and then come back to it later.
If it's something grabs you when you're a registrar and then you know what you're going to
be focusing on because then it'll be something you're really passionate and interested in.
And is it the psychiatry that you think you're going to be sticking with, though?
Yeah. So that's my that's my chosen speciality. Yeah.
Yeah. That's exciting. And I noticed from your LinkedIn profile that you will said it's a volunteering as a, as a student, as a first responder.
Yes. Yeah, I did. Do you have to tell me about that?
How did that come about? So. So that was. So with the ambulance service?
Mm hmm. So that was kind of a program that they've done for quite a few years where you can.
Do some kind of basic training. And so first response of first aid.
And so a day or two course, I think if I remember right and you pair up with another student,
usually originally with someone who's a bit more experienced than you, but then eventually you can do it with your peers.
And there's a little ambulance car that we have at the John Radcliffe and you sign on like a normal ambulance
would date and make yourself available for calls and then they can send you to see patients and you will.
The idea is basically that you might get there quicker because you might happen to be nearer to an emergency than an available crew.
And you can give the first sort of treatments and first line response to the patients.
And it's especially helpful if it's something like a heart attack, cardiac arrest, because you have a defibrillator.
So if you can get a CPR and a defibrillator that quicker, you can really improve their chances of survival.
But it's also obviously useful for other things, too, like if you can, you know, if you can find out that they've got low blood sugar,
you can then potentially get them to have something sugary things like that where you can make a quick difference.
And yeah, so I as soon as that was an option, which for me they piloted for the first time when we were actually still in the preclinical years.
So in my third year I signed up to do it and so I did it from the third year and then up until the sixth year.
And in my I think it was my fifth year, I became a team leader and I coordinated the program and trained the younger volunteers and I loved it.
It was really interesting, good opportunity for students to get involved in kind of helping in that community
and then getting some exposure to what medicine's like in the real world.
So yeah, I would always recommend that to people. Yeah, Yeah.
And getting, as you say, exposure to kind of frontline emergency care as well and see Yeah.
And have having just a better understanding of how what life is like for your colleagues, what the job is like for your colleagues.
Because I think that then later on when I've done jobs in A&E or in other specialities,
I have a much greater understanding of what being a paramedic is like, what it's like managing patients in the community.
You know, for instance, you go to a patient and actually if you make the decision that they can be managed in the community and not go to AMA,
what that actually involves. And actually sometimes that can be, you know,
even hours on the phone trying to sort that out for them just to save that one patient from going into A&E and and really relieve the work for A&E.
But that's a massive undertaking sometimes and often a lot more work than just taking them into A&E,
but having that appreciation of the fact that they have you know, they have that as part of their role.
And if if they do manage to keep a patient out of A&E that's more appropriately managed in the community, that's often a massive undertaking for them.
You know, things like that, it's invaluable to have that understanding. People, you know, work in roles.
So let's arrive at 2020. So you you qualified essentially in this in the spring, is that right.
Yes. So I base yeah. I basically when when things were sort of kind of hotting up about the pandemic in the UK sort of around March time
and it was becoming more you know it was definitely the medical school staff to talk to us about some things.
At that point, I had just essentially finished all of the compulsory parts of my course.
There's kind of two groups of students in final,
final year and you you do it on the different you either do your elective first and then you do the
other bits of the compulsory course that you need to finish off or you do it the other way round.
And I happened to be in the group that had done the compulsory bits and not be the elective period, so I just finished that.
So And what were you planning to do for your elective? So I was going to go to Australia in New Zealand for three months and so I actually just and I.
So it was a bit of a long story, but basically the short version is that I ended up in Australia and had to come straight back.
Oh goodness. So I went to start my electives,
but for an unrelated reason the plane was delayed and so during I missed my connecting flight from
Singapore to Australia and in the kind of time that that delay cause they changed the rules,
that meant that you'd have to isolate as soon as you enter Australia.
So I did that with my friends and then shortly after arriving I placements cancelled and a lot of our accommodation cancelled and the UK was saying,
you know, come back if you're, you know, if you're UK nationals in your abroad, come back because you might not be able to otherwise.
But also I received an email from the medical school saying you would be able to help in an A&E because you've finished these compulsory parts,
of course. So you're if you're able and qualified to help, can you help?
So me and my friend made the decision that we need to come straight back.
So we basically came back within within two or three, three days.
So it was a bit unfortunate. But so I came back and I volunteered in the A&E during the time that would have been in my elective.
That must have been well, on the one hand, very disappointing.
But I guess knowing that there was something you could do helped a bit.
Yeah, it was it was quite disappointing. And it wasn't a decision we took lightly because we we did think, you know, if we stayed,
maybe we could spend some time in Australia or find something to be helpful with in Australia potentially.
But we, we made the decision that especially as soon as we got the email saying that we could help and, and in Oxford that,
you know, that was the place we wanted to be, that we could help and hopefully, you know, make a small kind of difference there.
So yeah, it was really disappointing.
I mean we'd planned it for two years and we'd booked everything that was a risk that we would lose a lot of money as well.
Luckily, I travel grants basically covered a lot of the loss, but you know, we never got any money back for any of the flights and things.
Oh goodness. They kind of gave credit which had to be used within a year.
So obviously I could never use credit in Australia within the year during the COVID situation.
Yeah. So, you know, it was you know, it was a big it was a big thing and it was a once in a lifetime opportunity, really.
I mean, now that we're doctors, it's not like we'll ever have that length of time off again,
on or off, but, you know, available to work in another country unless we take time out of training.
Yeah, So, so yeah, it was disappointing, but it was, you know, an exceptional circumstance.
And, and what I ended up doing was I felt really valuable for me and, and I felt that I could in good conscience be anywhere else, really.
So indeed, indeed. So I mean, what I hadn't asked you a question I usually ask everybody first,
which is what can you remember when you first heard that the pandemic was happening
and how quickly you realised that it was something that was going to affect you?
I think I remember first sort of hearing about in reference to to the situation in China maybe a couple of months before then.
I don't know, maybe sort of late January, February, I can't really remember.
So the time. Yeah. And I suppose the situation in Italy, you've come back.
I suppose the situation in Italy was when it especially started to feel real here, but.
I think I remember this sort of oddly.
So there was still obviously events and things going on not very long before things started to close down in, in, in, in the UK.
And I was at a concert in I think it was February or something like that.
And I remember then that was the first time I remember thinking, Oh, actually this is this, this is a bit weird that this is happening.
So and that that was the first time I was thinking, I think things are going to change.
See? Okay. But, but, but all the advice you were getting was that you should still head off to Australia at the time.
Yeah, exactly. And, and, and at the time there was See nothing wrong with that concert happening and things, you know, it was,
there was no recommendations against the UK was very much still of the message going out was that there's nothing to worry about,
there's minimal cases you know. So this was a massive concert in London that was just still happening and that I had no problem with travelling.
And everybody said, go, you know, if anything go now.
So it's, it just it was a situation that escalated very quickly, I guess, and that's why.
And obviously Australia took a much more. Direct gas and quick response then.
Then the UK did. So that's partly why I ended up coming back so quickly because they were having very
clear rules and and actually I remember so because of the actual layover in Singapore,
because of that delay that I mentioned. That was interesting because Singapore had already been affected quite significantly.
So I remember being a bit concerned that when we had to go to Singapore that that would affect our ability to come back because obviously
we had a documented record in Singapore and I know that some countries weren't accepting travellers from certain countries and,
and then they were taking a lot more precautions. So they were already everybody was wearing masks, they were taking their temperature.
If you went into anywhere, we weren't allowed into the hotel without having a normal temperature.
You know, all the way they handled food was very careful about, you know, transmission of illnesses and things.
So that was almost like seeing into the future of of of what the UK that ended up being like about, you know, six months later, really.
So that was quite interesting. And in hindsight, yes.
Yes. So when you got back, you kind of turned up for duty.
What was what were they asking medical students to do?
What kind of work? So so there were students being asked to help and eventually in all different departments.
But the very first one that they started asking for help with was Amy.
And that's where I ended up working.
And so they were kind of three main roles that we helped with.
And so one was helping at the reception desk with just getting patients booked in any administrative tasks that we could help with.
One was helping in a sort of health care assistant type role,
so helping with doing EKGs and blood tests and cannulas and urine tests and helping patients go to the toilet, things like that.
And then the third role, which is actually what I spent most of my time doing, was manning the front door of Annie.
And so the idea was that the medical students would take on a role that had been for a little while for a few.
You know, they they instigated it maybe like a week or two before, had been run by kind of advanced triage nurses.
They'd been triaging patients, entering the front door of the hospital.
So the idea was that we could alleviate that role so that they could then go and do their usual role, I think was the idea originally.
That was my understanding anyway. And basically we would sort of trained on how to follow a flow chart to say whether a patient
coming through the front door needed to go to one half of the A&E or the other because they had
been split in half based on whether they would have respiratory symptoms and could have COVID or
whether it was something that we could pretty safely say We didn't think that they had COVID.
And so they had drawn lines on the floor even, and different colours on the doors to indicate where the separations of the department were.
And and they they made it so that everybody who entered the department came through the same door.
Now. So instead of having sort of ambulances coming in one way, patients coming in another, everybody came through this one door.
And regardless of what they came in with, we had to stop them and yeah, and decide where they went.
And so even if they were on a gurney being pushed by paramedics, you still.
Yeah, exactly. Exactly. Even if they were on a gurney.
Yeah, exactly. You'd say, okay, one second.
Do they have a fever? Do they have any breathing problems?
Are they on oxygen, any cough, any you know, all we had like a set list of things we checked.
And if the answers were all no, then they could go to the blue area, which is the normal way.
If it was yes to any of them, then they would go to the red area, which was the the Kobe A&E.
And the other part of that well was that if they had any relatives with them, then we had to ask them to leave.
And there was some exceptions to that. And that kind of the rules around that changed over time as as as it became more apparent.
Obviously, all of these things were measures that were were implemented really quickly.
And to be honest, commendably, how quick, how quickly in the NHS,
It was amazing how quickly we made these changes as a department because you know, often in the NHS things take a long, long time to change.
But because of that there was, there was like learning curves to be had and, you know, things that needed to be adjusted over time.
And you know, originally obviously the rules were just like no visitors, no visitors.
But obviously it became very quickly apparent that there's some groups where that's not appropriate.
And if someone's got learning difficulty or if they're at the end of their life or if if they're obviously a child,
they would need a parent, you know, So there were rules that very quickly became apparent.
There were certain groups of people, what they were allowed a visit to come with them, but it still meant that there were some.
I think probably the hardest part of that role was, you know,
there were still obviously some patients who didn't fall into those special categories, but that, you know, so they weren't allowed a visitor.
But you felt for them because obviously. It was a really difficult situation and you can understand why they would want someone with them.
So. And did they did the family members give you a hard time?
Oh, some of them did, yes. Yeah, Mostly no.
People were really quite understanding. If anything, it's you know, it's it's a bit difficult.
But often, to be honest, the the patients and the families who were dealing with the most significant,
you know, horrible things, often with sometimes the most understanding.
And and, you know, that makes you feel even worse that, you know,
in some ways that they're so understanding and they're in such a difficult situation and you really want to help them.
And it goes against, you know, what we're trying to do really, you know, you always want to involve the family.
You always want to keep families together.
So, you know, that feels difficult. But, you know, the difficult ones were sometimes often people who were maybe dealing with things that were
not quite as serious and sometimes might be a bit understandably frustrated at the rules.
But, you know, taking it out on the the people in front of them, which, you know,
you understand it's not personal, but it wasn't a pleasant part of the role.
But. You know, it was something you just had to try and explain that it was to to help their relative and to help other people, too.
Because if they go in with a broken ankle or they go in with a, you know, a cut on their hand,
but then they come out with COVID, that's not a successful outcome really.
Mhm. And how many of you would be on the dole at the time.
So we, we did it deliberately so that we'd have two people so that you had that back up in case something was difficult.
Or if the dole got really busy and lots of people were arriving at once or if you needed to go and check some things.
So there was never the dole was never left, you know, not not manned because the shifts would well they were variable length.
I can't remember how long I think they were usually about eight hour long.
That's what I was going to ask you.
I think they were I think they were usually about a but they they could be longer like 12 sometimes if you did a night shift, it was it was variable.
And did you get a break in in an eight hour shift or was it 8 hours straight?
So we would just like arrange it amongst ourselves. So you do it so there'd be two of you.
But then so that way, if you need to go to grab some food, then you could say to the other one, right, you go, you go.
And it really depended on how you, how you sorted it between you.
So to be honest, for me, I never had like a break because then I was away from the door.
Really? Unless I went to the loo. Because I usually, you know, because it was quite flexible.
We tend to decide on with people that we knew or people that we'd done previous shifts with and got new.
We got on well because sometimes it was super busy and sometimes there'd be, you know,
downtime where you just that way you'd be able to chat with them and things.
And so you want to it's quite nice if it's with someone that, you know, you get on with.
Well.
And so to be honest, all the people I did ships with, generally we kind of preferred being together in case we needed someone else there on the door.
So we would do is we would generally bring our food to the to the door and just eat there and then, you know, work through all breaks, as it were.
But, um, yeah, it was, I just remember it, to be honest, quite funnily it was, there was a lot of camaraderie and kind of a feeling that,
you know, we weren't doing anything massive, but that maybe we were making a little bit of a difference and.
I got to know a lot of the other medical students who,
although maybe I'd been with them for six years in medical school, we looked from for various reasons.
You don't always know everybody in your group very well.
You know, you might be a different practical group, so tutorial groups and things.
So it was nice to get to know some of them really well.
And a couple of them I hadn't really known before, but now we're really good friends and we still keep in contact.
So, you know, it was a very different unique experience and kind of, you know, you bonded over a unique experience.
And how long did that go on? So that must have been three months or 2 to 2 or three months.
Mm. And then in May or just well, I guess it would have been just before May we So some of us,
those of us who who done all of the compulsory parts of our course, we were graduated early by the GMC.
So normally we would have been graduated and given what we were graduated and then given GMC registration,
but normally would have been graduated and given GMC registration and I think around July.
But so I guess for me it must have happened late April because I remember on May the fourth that we started working as Interim Foundation Doctors,
which was a new role that they made, which would basically be another foundation job.
Before you start your usual foundation program to help in supporting with the work from COVID.
So I started as an interim foundation doctor in A&E from May.
And what the until August when I started my normal foundation program.
Mm hmm. And what did they do working at you when you were no longer minding the door at that stage, presumably?
No. No. So then actually so part of what we did in the last few weeks,
working in the role of the volunteer kind of medical student volunteering role was we trained up then the fifth year.
So they by that point, because medical school had been closed, basically, they were then free to to be volunteering if they wanted to.
So we then trained them to take a verbal so that they carried on.
And then we stepped up into these interim foundation roles.
And so for me, I mean, it was very different depending on what department you helped.
And again, but for me, being in a and a,
I think there was maybe so maybe before there was like 30 of us also doing the front door mining from my year.
But then most of them ended up then doing if they chose to work as an instructor, went to other departments.
So it was, I think maybe seven of us in in Annie.
So still quite a lot of us. And we initially got paired with a more senior doctor.
And I guess the initial vision for that role was that we would help increase the efficiency of more senior doctors who had more experience.
So the idea would be we'd be paired with them, we would go with them,
we would do their writing for them, we would do whatever, take the bloods for them.
If the Bloods hadn't been done, we would prescribe medicines, request X-rays,
just do all those things so that the more senior doctor could just focus on the right
deciding this is what the problem is and this is what we're going to do about it.
And then we could see more patients as a paired than he could he or she could see on their own.
That was the idea. And we did that a bit.
Very quickly, I guess it depended on what consulting was on.
But very quickly, the role kind of actually more went into just more traditional role as a doctor.
And actually they were just like, actually, you know, you're qualified as doctors.
Just go see patients on your road, you know, So so we would see patients,
probably fewer patients than maybe a more experienced doctor would be able to do.
But it was a really good learning role.
And we were still seeing more patients than we would have seen if we weren't that.
So it sounds like being chucked in the deep end.
It was. It wasn't it? It wasn't.
It wasn't like, I think the A&E, particularly the really supportive team and they, they were from beginning to end, to be honest and as an F1 job.
So I actually later in my foundation years, I actually already had a foundation placement in a in a in that same department.
So I, I came back into that role later on as well, many months later.
But that role was very similar to what I did in the interim role.
And basically any F1 role in any is essentially meant to be supernumerary because.
They don't want you working night shifts all kind of out of hours because you need to have that supervision.
And you're expected to discuss every case pretty much with with the consultant or with a senior registrar.
And so it felt very safe and very a good learning opportunity.
So so although it was a big learning curve, it was, I think, you know, a Yeah, very well supported.
And that, you know, I never felt like it was unreasonable or risky.
It was just a good opportunity. What were some of the weather?
Were there any particularly memorable cases that you saw? Um.
Oh, goodness. Trying to remember that now. I think.
I mean, I remember this. This was from when I was an intern.
This is from when I was. Volunteering on the on the front door.
But I do remember one thing that that sat with me for quite a while was that there was a quite early into my row.
There was a lady who came in who had was going through a miscarriage, and she was quite early on in her pregnancy.
And so whilst if she was coming in, giving birth at the end of the pregnancy, she would be allowed to visit because it was not that case.
She was having a miscarriage, she wasn't able to have someone with her.
And so I found that quite difficult.
And actually it was a day where I had a I was working the front door, so I was the one you had to kind of tell them that they couldn't have someone.
And she and her partner were really very gracious about it and weren't, you know, kicking up a fuss or anything.
But I felt bad because I felt like, you know, it was unfair in a way.
But then I also did a health care system type shift later,
so I made sure to check in on her and see how she was and kind of try and
bring her cups of coffee and things because I felt like she was on that road.
So that one kind of stuck with me. And I remember it was from that kind of time.
I don't know if I, to be honest, I don't know if I remember any particular cases from when I was an interim doctor.
But I just remember there being a lot of people coming in with COVID.
A lot of. They need a lot less of that kind of the accidents, you know, and things because people weren't doing this.
Many other extreme sports, motocross, things like that during the pandemic.
But but still, obviously, people falling down outside quite a lot of and and a lot of elderly patients, particularly,
who were confused and then didn't have people readily available either because
in some cases maybe rules or in other cases because their families had COVID.
So they couldn't come into the hospital and visit, for instance,
and that being quite difficult and having to give bad news on the phone to families a lot,
that was quite difficult as well because you feel like you're not maybe,
you know, you're not doing justice to be giving, you know,
really bad news about patients the coming end of life and things on the phone when you'd normally do that face to face.
Yeah. So, I mean, did you actually have people that reached the end of their lives in a and even would they be moved on to another world by that time?
Oh, yes. So definitely there was patients who passed away in A&E and who would be put on an end of life kind of pathway in A&E for sure.
Obviously, it's more common maybe once they were under the medical team,
but sometimes it would be apparent, you know, when they were still under our care.
And certainly so there's a second part of A&E could be.
So it's like the emergency assessment unit, the EU, and that's both medical and A&E.
They share it and that's sometimes where patients will be.
They'll be kind of held if the taking more than the four hour target, but they just have a few more things to tie up, say,
and then they might be able to go home or have a, you know, a clearer view of where their care is going afterwards, but within kind of 12 hours.
So. So they might be managed there.
And so another role of this interim foundation job was often to assist with looking after those patients.
And some of those patients were often quite unwell and, you know,
kind of decisions being made about what was going to happen to them in terms of where they might go for end of life care and things.
So. So.
So it was definitely and you know, something that happened,
it was something I probably faced a lot more when I then later on went into my medicine job during the pandemic.
But it definitely was a feature of that first job as well.
And, and does that p I mean, what what was it actually physically like to be going into work in A&E under those conditions?
What what were the precautions you had to take? So.
So when we first started, it's kind of difficult to remember that because rules changed so many times.
So I hope I'm not remembering wrong,
but I remember there being a lot of concern about whether whether there would be enough PPE generally from people working hospitals,
care homes, GP practices. My experience of the John Ratcliffe was that I never didn't have what I needed.
They always they always had what I needed when I was there, which was was really good.
I think that maybe there was more problems in things like hospices and GP practices and smaller centres.
But the John Ratcliffe had, you know, at least in A&E, they had obtained adequate PPE, but I remember.
So we would usually on the front door, we would wear a mask and then an apron and gloves.
To be honest, at that time, the rules were a bit unusual in that we would wear an apron and gloves.
But, you know, obviously we were greeting patients continuously, so it wasn't like we could change it between patients.
Whereas obviously the idea would be that now that you would change the gloves and the apron between each patient.
But I suppose we were more protecting ourselves in terms of that rather than protecting the patients in that context,
because you couldn't change it for, you know, that would be hundreds and hundreds of pieces of PPE if we were change and not practical.
So I suppose that was fair. But what I do remember was that we have to be very careful with the masks.
We we would give a mask to each patient as they came through.
And if they were allowed a visit to the visitor as well.
And whilst we did have enough masks, we had a very limited supply of the ones that have like the elastic straps.
So for us, we obviously were familiar with the ones that you can tie behind your head from that you would use in surgery normally.
And you know, even though they're a bit fiddly, we could sort them out with us.
So we would use that for ourselves, but we had a lot less of the other kind.
So we were kind of trying to make sure that if staff came past, they were that they didn't use that.
And we were kind of instructed to, to, to do that.
So I remember that being a kind of sort of not rationing, but something that we had to be mindful of.
But we usually a few times we would run out, but we'd usually always find a box somewhere.
And in it, when you were working in A&E itself, did you have to wear more comprehensive peace?
So it was so it depended where where you were.
So, again, I hope I'm not remembering wrong because the rules change so many times.
But usually in the non-covid side of A&E, it would be very similar.
We'd wear a mask all the time. And then if you went in to see a patient, you would put on gloves and an apron.
And ideally, or if there was any, especially if there was anything that was, you know,
if if they might, obviously they shouldn't be coughing if they were in that sort of any.
But, you know, if you might give them a swab or do something that might make them cough.
For instance, if you were in the the bedside, the bedside of a a I believe you had to wear an FFP three mask at all times.
I think if I remember right in that side of and a and then if you went into a bay where.
A patient was COVID positive like known, or if you were doing something that was an ever so generating procedure,
then I think you had to wear level level two PPE. So you would have to wear the full length gowns and the long gloves.
So for the gowns for visor, obviously still the FFP three mask.
Like I said, I'm a bit hazy on exactly what the rules were when, because I know at various times over the course of the next few years,
sometimes the rules change between you didn't have to wear an F 53 mosque in the area,
but you did if you did an aerosol generating procedure or the patient was known COVID
and that you could just wear the normal mask otherwise until you went in to see them,
things like that changed a lot, I guess, you know, And the rules were just changing as, you know, as evidence came available.
And to be honest, based on what I think probably realistically what PPE was available,
they had to make decisions on a kind of global public health perspective for those in terms of, you know, the policy making.
And also the other significant thing was there was big changes in the rules about CPR and protocols of that.
So that was part of what we were told about induction. And again, that's changed quite a few times.
But that was a significant change at the time that you you went to to basically start compressions, which this was the original rules.
I think it's changed since follow on I go. I always have to keep updated notes the changes.
But you weren't meant to start compressions until someone was in full PPE because compressions could be an aerosol generating procedure.
So the idea would be that you would just put defibrillator pads on first until someone was in PPE and then could start compressions.
So all of these things were having to constantly be revised.
You have to constantly keep abreast of the changes to make sure you're given the best practice.
So it was a challenge at the time. Mm hmm.
And so your your role as an interim foundation doctor that lasted until that you say August?
Yes. So I guess it was sort of March to May was when I did the voluntary medical zero, then May to August.
And August is when the normal foundation programme starts.
So I went into my job then. And what was your first placement as a foundation doctor?
So that was gastroenterology at the jail. And so I did that.
And then I went to General Medicine at the Horton and then back to A&E at the John Radcliffe.
And then my second year was EMT at the j j R, a GP placement and then intensive care at the jail and the judge so.
And so when you went back to A&E, how much of a problem was COVID still at that stage?
It was definitely still there, but very different,
different place to where it had been when I'd been there before because I joined the it was kind of coming back up to the summer months.
So that was, you know, the winter had been I'd been in medicine in winter, and I think that had been a really rough job because of that.
But when I went back to A&E, things were kind of picking up at the time that we still had.
I believe if I remember right, we still had some separation of of kind of COVID side from some non-covid,
but it wasn't as firm as it had been when we first had the complete split of the two.
And. There was a lot more. Testing by then.
Then there had been originally. People were more familiar with the P.A., I guess, and the expectations and also the rules about visitors.
And we were seeing a lot more, I think, although COVID was still there and I think we'd had some vaccines as well.
So that was helping in severity. But I think we were seeing a lot more of the other things, maybe the things that hadn't.
The had had kind of built up from from covert I think that word opiate related.
I think one thing I forgot to mention about the first time around and A was what was
quite shocking sometimes was seeing things that haven't been really seen that often.
And sort of in my my generation of medics because of modern medicine.
So for instance, I know some of my friends who volunteered in cardiology, so a lot more ventricular wall ruptures following heart attacks.
And so that's kind of like a late stage complication where if you don't get heart, a heart attack seem to sometimes the wall can literally tear.
And mostly they do happen. But there are a lot less common nowadays because people get really quick attention.
But they were telling me that they were sort of anecdotally seeing a lot more of these because they felt
because people weren't seeking as much emergency help when they had a bit of a chest pain or a bit of a neck,
they were more inclined to stay at home because of the worry about COVID.
And so those kind of things, although rare, still were more anecdotally seeming more common during that first wave in comparison.
Maybe the second time when I came back to A&E, it wasn't so much that kind of thing,
but more maybe people managing chronic conditions who had a meant to have an appointment six months ago that for some reason didn't happen.
And so they're still in pain and so they're getting quite frustrated and coming to A&E and things like that.
I think little, little things that if you leave it a long time become bigger and that people get more frustrated about understandably,
and people feeling like they can't access the GP, a lot of frustration about people feeling that.
Maybe that they find it difficult to get through to their GP and get a face to face appointment so they come to you.
A So that was a lot of what I was dealing with, I would say, in that second job.
And your, your I don't know what you call it too.
No, I used the word placement before when you went to intensive care.
Hmm. Were there still COVID cases in intensive care?
Yeah. So when by the time I came to intensive care.
So that was this? Well, I suppose it's last year now because we're just into 2023.
But yeah, that would, that would have been sort of summer of 2022.
So it's quite far. And now we were still seeing COVID cases.
However, the big difference was, to be honest, usually either they were they had COVID, but they actually were in ICU really for something else.
And it was either an incidental finding or they had something and COVID or the people who had COVID very badly and they didn't have something else,
it was that they were unvaccinated. To be honest, that was that was what we were saying.
There were very few people who were there just with COVID. And if they were, they were almost always unvaccinated.
And if they weren't unvaccinated, they usually had some other massive condition that meant that they were really immunocompromised,
like, you know, chemotherapy or something like that. And that became that.
That was really quite clear. But I would say most of the patients didn't have COVID most of the time, but we had these kind of over the four months.
So it's the sort of peaks and troughs where, you know, occasionally so so what we kind of did was as if we just had one or two cases,
we would put them inside rooms and manage them that way with enhanced PPE for the side rooms.
But as more and more people would have COVID, if there were these peaks,
we would then sort of cohort them all into one side of A&E and then make that A&E ICU and make that kind of COVID ICU.
And then there would be a whole section where you would have enhanced PPE going into there.
And then as the cases went down again,
we would again move them into side rooms and then manage the rest of the department as non non-covid, if that makes sense.
Mm hmm. Um, yeah. So it sounds as though your whole experience over the last two years has given you.
Maybe it's always like this, but it seems to me anyway.
Well, tell me this is real. The fact that there was a pandemic going on gave you a kind of enhanced crash
course in practically everything you were likely to encounter in a medical career.
It's really interesting one that you say that to be, to be honest, because I think people have very different opinions on it,
because I've had quite a few seniors during the those two foundation is make comments either to me or kind of to the view that that
they feel that actually our education has been really disrupted and that they feel that we'll be less qualified because of it,
less, you know, less experience because of it, I suppose.
And their reasoning is often because because we've been dealing with COVID,
all we'll know how to deal with this COVID and we won't know how to deal with everything else.
I think I can see kind of both, both sides.
But I don't really I don't agree with that argument because I think we've seen a lot more than just cover it often,
to be honest, especially the last year or so. Like I said, it's mostly been if they've got COVID, they've got COVID and something else.
A lot of the time, most patients, especially with since since since people have had multiple vaccines, that's definitely seem to be the case.
But what I would say is that I think that having seen what training used to be like when I was a med student for,
you know, foundation doctors, you know, because when you're on the wards, you kind of, you know,
you're pushed around very much So a fly on the wall and you can see what things
are like and seeing from from the view of when I was maybe a fourth year,
fifth year medical student, seeing what the training opportunities and quality used to be like for foundation doctors and core trainees.
I think that there's a lot less training opportunities and I think that generally whilst there are still some
amazing senior doctors who will take trainings under their wing and take the opportunities to teach in things,
the whole system is so much more stretched now and everybody has a lot less time because we're dealing with higher volumes of patients,
higher acuity of patients generally with fewer staff members.
There's just a lot less time for training and I think that it's getting less kind of
directed supervision and simply having to go from patient to patient doing the best you can,
it feels. Yeah, to be honest, I feel like I feel like whilst.
I feel like, you know, we're supervised from the point of view of making sure the patient care is safe, you know?
You know, I will always make sure if I see a patient at this.
Any questions I have that I'm worried about for that patient safety. I always make sure that they're addressed and I'll talk to a senior about that.
That kind of supervision doesn't worry me. If you you can always access that some way if you need it, to be honest.
But I think there's less supervision from the point of view of actually where's your training going?
What do you need to do to become a better doctor longer term to get exposure to the
things that interest you or the things that you haven't had as much experience of?
Because there's just a lot less time and energy available for that.
And I don't blame the seniors for it, and I don't blame my colleagues or myself for it or whatever.
It's just the system.
Everybody's so stretched that, to be honest, I do think that generally people are prioritising teaching junior doctors and I mean,
I even see it in myself, although I desperately fight against it because I love teaching.
And like I said, I teach it for my for my college. And if I ever have a foundation, doctors with me or medical students with me,
I try and take as much time as possible to show them things and at least make that afternoon or whatever
time they would me valuable in some way because I know how disheartening it is if that doesn't happen.
But equally, when you're really stretched and really busy and you've got so much service provision to be to be doing,
sometimes it's just not possible.
And so, yeah, it does feel a lot of the time, like almost all of the job is service provision when actually we're in a training role.
You know, it's a training post. And so, you know, if you're a junior doctor, you're still in training in some way.
So there should be a certain amount of time allocated to learning and teaching as well.
But it's very, very difficult because I think consultants, job plans and things are very stretched and the whole service is very stretched.
Mm hmm. Yeah, I think it's it's you can do either way.
I think we've in some ways had a very steep learning curve for those of us who started during the pandemic.
And I think that I think that what we have gained is maybe a lot of experience of being flexible and trying to adapt and being used to
rules changing all the time and keeping abreast of of changes and often stepping up into roles more senior than we would have otherwise.
But then I think that maybe we've had less opportunities to do things.
So if I was interested, I'm obviously doing psychiatry, so procedures aren't something, for instance,
that I'm that interested in getting lots of exposure to when I was in foundation years.
But for someone who is interested in doing medicine,
I think there was a lot less opportunity to do things like lumbar puncture as chest drains and things like that.
That would be really useful experiences because there just wasn't enough time and opportunity for seniors to to to supervise you for them.
And that means that you will get core trainees in two or three years time who have a lot less experience of doing those things.
Mm hmm. And what about the morale of the junior doctor workforce?
I mean, are you seeing contemporaries deciding to throw it all in?
Yeah, I think that's a really big issue, to be honest.
And so I have got friends and colleagues who have already decided to leave clinical medicine completely and for
various things to do research or management consultancy or I've got a friend who's doing med medtech and teaching.
And and I've considered myself slightly leaving, you know, to be honest as well.
I was quite close to leaving earlier this year.
And whilst I love medicine, I wouldn't rule it out in the future as well because I think there's a lot of issues with staff,
wellbeing, morale and you know,
my close friends and also students that I've taught in the past who are now foundation doctors I see struggling really,
really badly with mental health and with, um, with managing the expectations of jobs under such difficult situations.
And, and I feel like I've been been there myself in these situations too.
And I think I don't know what the solution is,
but I think that the needs to be something major changing in the way that we we train doctors and we look after doctors.
And I'm sure the same goes for nursing and other allied health professionals.
But I feel like. Since the pandemic that we weren't in a brilliant position before the pandemic.
And since the pandemic, it feels like everybody's been working at speed 110, and it's never really stopped.
But yet the workload has increased even more because now there's all of the routine
things that we're kind of put on a bit of a hold or were waiting lists were building up,
for instance, over the time of pandemic, where understandably we had to prioritise the most emergency cases.
Those things haven't gone away. They're still there and they're just adding to that workload.
And I mean, you do see a lot of rota gaps, a lot of people needing to take to take time off, understandably, for mental health.
And so I think that we are going to need to do something to invested in the wellbeing and morale of staff.
I think otherwise it's going to just only escalate. Mm hmm.
Yeah, That's not not a good picture. So just finally, I just got a few questions about what?
How you found living through the pandemic. I mean, first of all, given the position you were in,
standing at the front door of the hospital and seeing all these patients coming in, some of whom may have had COVID.
How frightened where you live of actually being infected yourself? So.
So I was I wasn't I was scared of of of getting COVID like I'm sure everybody was to an extent,
but I wasn't really so much worried for me as worried that I would then pass it on to a patient or a friend or family or something.
So I was living on my own at the time because my flatmate, she had moved in with her mum as kind of lockdown started.
So I was living on my own. Um, and I know obviously lockdown rules change at different times.
I can't remember exactly the timing, but I remember that I deliberately,
even once I was allowed to go to see as my support bubble, as it were, which would have been my parents.
I deliberately didn't see them for several months because I didn't want to risk giving them COVID
given like how high risk I would be really seeing every person coming in through the hospital doors.
I did actually become unwell during the summer with this respiratory illness.
At that time we were only kind of doing it. We didn't have lateral flows, we just had the PCR.
And so I had one PCR which was negative, but then I had all the symptoms of COVID, including really bad shortness of breath and exertion.
So I really was like, I couldn't like if I walked from door to door, I would be like painting.
So I actually had to take this loss of taste and smell that you lose taste.
And still not that time I did, but I, I, I had basically everything else and I had the persistent cough, which I then had for eight weeks.
So I don't know. Obviously the PCR was negative, but I don't really see what else it likely would have been,
especially given that I was working through the day and, and seeing COVID is probably the most likely thing.
It's more likely that I just had one negative PCR, which we know we're not, we're not infallible.
So I had thought I was quite well with that for two weeks.
So then, um. So then a bit, to be honest.
After that I relaxed a little bit feeling that I probably had had it. Obviously, I was still obviously obeying all of the rules, etc. but you know,
I felt a bit more relaxed and a bit less scared because I felt like hopefully that means that I've had it and that I've been okay in the end.
But the calf lasts a long time.
But then, yeah, I've had COVID twice actually positive swabs since I lost my taste and smell on one of those two times.
Both, I think from from work. There were times when I was working in an environments where lots of people had COVID, either staff or patients and.
So, you know, it's it's an occupational hazard in a way.
But I suppose now it's circulating so much that anyone could catch it from anywhere,
but at least by then, because I'd had COVID and then I'd had the first vaccine.
The second time I had it, it wasn't as severe.
So, you know, I think the vaccines have done a lot of good with with reducing the severity for people and sort of reducing.
Yeah, reducing ICU admissions and. And.
Yeah. I mean, I've been asking everyone this, and I guess you've partly answered it,
but do you think the fact that you were able to work on something that was,
you know, helping people doing good helped to support your own well-being, or was it so stressful that that didn't make much difference?
No, I definitely think the like the medical student role and the interim foundation role I definitely think helps.
It was difficult because obviously I was away from my parents and if I wasn't volunteering, then I could have been with my pet,
with my family, my parents, and that would have helped kind of, I guess, my wellbeing in a different way.
But if I was in the situation, I was where I was going to school and I was living alone, I was really glad to be honest,
to have this role where I was able to leave the house and go into the hospital and see people and talk to people.
And like I said, at that time, there was a lot of morale, like team morale and camaraderie right at the beginning and.
I think I know a lot of people who kind of work from home, especially those who work from home and lived alone,
really struggled during the pandemic with their mental health and understandably,
because they couldn't socialise with people, they felt very isolated.
And I definitely felt that being able to go to the hospital and see colleagues and talk to patients, that socialisation I really needed.
So actually for me, as well as hopefully helping with the health care for these patients,
it really helped me to have something that I felt like I was doing that was helpful and that meant that I could see people.
Excellent. So this is the end. Okay, the final question.
So has the experience of working through the pandemic changed your attitude or your approach to your work?
And what would you like to see changed in the future?
I think it definitely has in a in like a variety of ways, it probably wouldn't take way too long to explore.
But I would say like so I'd say probably.
One of the most notable is that it made me realise that I've got a particularly
great career so I can take a quick check and forcer because I'll be cutting.
So, so so one thing was that I would say is that it has made me realise how important the role of families and carers is in,
in patients recovery and in making sure that people are happy with.
The plan. And I think that being having to give bad news and things over the phone to relatives.
And not being able to address kind of the psychosocial needs of a lot of our patients.
Really affected me during COVID and I think really made me realise how much that's
important to me and how we deal with things and how well you can do everything.
Perfectly right in terms of right, I'm going to give you this medicine.
We're going to get this investigation. We're going to book this clinic.
People can still feel really unhappy with the care they're receiving.
Or you can be completely missing the point or missing what's actually affecting them.
If you disregard what's going on with their family or what's going on with their mental health.
And I think a lot of the way the pandemic affected us caused us to have to
work in that way by necessity because we were dealing with emergency things.
And so I think that's what's led me to do psychiatry in a way.
So I think that made a big change, changed me in the way I practice because I was thinking of doing.
Mostly physical health medicine before and now have gone towards mental health.
And I think that's because it's highlighted the importance of that.
And then I think also it's really highlighted the importance of staff wellbeing and the importance of.
That you can't you can't continue working at that kind of giving 110% pace for ever.
There will be a point where that's not possible. And I think a lot of what we do in the NHS.
Relies on the goodwill of people. People willing to spend that extra half an hour, hour, 3 hours of their own free time.
To do what's needed to make sure their patients are taken care of.
Well, which is admirable.
And I've done it all My colleagues do that.
You know, I don't think I could name a doctor who hasn't done that.
Or does that hasn't done that. And it it's difficult because it's a vocation.
So we obviously want to do that because we want what's best for our patients and then we care about them above, you know, above all else in a way.
But you can't do that forever. And.
I think what we'll need, what needs to change, I don't know how, but I think that the system, we need to have more doctors.
We need to have more nurses. We need to have more.
More support so that people are trained better and have more time for the training and the things that bring them enrichment in their job,
whether that's, you know,
a nurse having more time to look at her area or special interests or history or special interest or whether it's a cool trainee,
be able to go and do that procedure with supervision or whatever.
And then we need, you know,
more doctors and nurses on the rotas so that people can hand over on time and leave on time so that they don't become overwhelmed with their work.