If someone had told me when I graduated from medical school that just three years later I would be walking down the corridor of a hospital in the middle of a pandemic towards a medical emergency call, I would have asked them what horror film they had just been watching. Yet here I am, in 2020, calmly walking down a corridor to see an unconscious COVID-19 patient. Despite being in the last half hour of my shift, I am feeling well-rested and prepared.

I work in a hospital that normally has around 700 beds – that includes the intensive care unit, which has ten dedicated beds for patients with multiple organ failure, and a six-bed high dependency unit for patients needing close observation.

The usual average age of an admitted patient is 80, and my hospital covers an area of 535,000 people. So, in the middle of a pandemic, I should be experiencing hell on earth – perhaps seeing nurses wearing bin bags, or holding their breath for lack of masks, or patients being told cruelly that they must die at home. I struggle to reconcile these images, which I see reflected in media headlines, with the hospital I am walking through: my hospital has over one hundred empty beds, plenty of free ventilators (with extra capacity in surrounding hospitals), and well-rested doctors. The ward registrar has even managed to watch the original Star Wars Trilogy and sleep for five hours this shift, while I have managed to read my fourth book this week. In fact, last week we had so much spare capacity that there had been one doctor for every three patients on quieter wards. This includes the Care of the Elderly COVID-19 dedicated ward. Even our respiratory team, supporting patients who may need intensive care, have been able to have extended lunch breaks.

Things weren’t always this blissful. COVID-19 has changed business as usual: our hospital was intubating around seven patients a day at the disease’s peak – now it’s around one. My hospital’s admissions list has reduced from a 13-hour shift, with minimal breaks, to hours between new patients being admitted. I dread to think how my hospital and colleagues would have fared if case numbers had continued to rise. The horrors reported from Italy do not bear thinking about.

Has the United Kingdom been overwhelmed by COVID-19? Personally, I don’t think we are – in part because we have learned lessons from the tragedies abroad, and our country benefits from having some of the best scientific minds the world has to offer. Our response appears, at least superficially, to be led by experts and not politicians. The emergency social care funding announced in mid-March by Rishi Sunak now means that our frail patients no longer sit in hospital for weeks – as soon as they are ready to leave hospital, they leave.

From my position, it would be easy to think that every element of the health service is running smoothly, and the world is panicking over nothing, but that is not the case. As resources were shifted, rightly, to combat the pandemic, other departments have begun to feel the strain. Many of my General Practitioner colleagues feel totally abandoned, ill-equipped and ignored, while the focus has so heavily been on hospitals. I do not experience what they and district nurses and carers are facing, struggling to get the equipment they need to protect themselves and their vulnerable patients from COVID-19. My hospital is lucky – others serve vastly different populations and have different facilities, such as major trauma units and tertiary centres. So it may not be hell on earth where I am, but that’s because I am at a lucky hospital.

Despite the calm, the hospital can still be a bleak place. Last week one of my colleagues, a nursing assistant, died from COVID-19. I did not know him well, but I did know he was always kind and helpful and much loved by all his colleagues. Healthcare workers across the country are now battling the virus on ventilators in the hospitals they used to work in. Some of them will not survive.

Patient care has become colder and more clinical. The most heart-breaking moments are staring into the eyes of conscious people after seeing their X-ray and observations and telling them that they almost certainly have COVID-19. I cannot imagine what it is like being told that you have a virus with no treatment, especially for those who are in a high-risk group.

Worse, patients are likely to be told the terrible news by a faceless entity behind a mask. And once a patient has been informed of their diagnosis, they cannot even speak to their loved ones to tell them that everything will be OK and that their love for them is eternal. If a patient is lucky enough to be conscious, they can have that conversation on the phone, but relatives often cannot visit in case they themselves also get sick. Discussions about resuscitation and intubation with patients’ families are essential, but these often descend into lengthy phone conversations, explaining to various relatives that we are not simply letting their parent, child or sibling die. It is not demanding work physically, but emotionally I see it slowly taking its toll across the hospital. Fighting the sense of hopelessness can now be the hardest part of any working day.

As I walk along the corridor my registrar reminds me to keep a sense of perspective. The NHS frontline can be a scary place to work at the best of times. There is the constant reminder that any one of us can have a stroke, heart attack, car accident and then not leave the hospital alive. The reality is that most people exposed to COVID-19 will have a rough week and then go back to living as normal. The Office for National Statistics estimates that 86.9% of deaths are in over 65s, 39% of these being over 85 (and it’s worth remembering that 85 is 4 years greater than the average life expectancy). It’s important to remind ourselves that a COVID-19 diagnosis is not even close to a death sentence and that most, even the frail, will survive.

COVID-19 will not be the end of humanity; it has shown us the best of it. Our humanity is shown not only in those who have volunteered to support their communities – even old rivalries in the NHS have melted away and been replaced by a spirit of camaraderie I previously had never thought possible. To prevent services being overwhelmed, hospitals up and down the UK halted their elective work, freeing beds, ventilators and staff, resulting in surgical teams having a dramatically lower workload, whilst the intensive care units have been expanded rapidly. Sadly, a surgical consultant’s skilled hands do not possess in them the in-depth knowledge of the management of multi-organ failure, but their help is invaluable when combined with an intensivist’s guidance. Consultant surgeons now provide both medical care and assistance in caring for patients, including moving patients in bed, washing them and changing their clothes. A consultant in urology catheterised all the patients in ITU, when normally this would be done by a nurse. All staff, including nurses, porters, and healthcare assistants are all moving across the hospital to areas they have never worked in before, guided by a clinician-led management team, so that our inpatients will not experience a drop in the quality of their care.

The hospital I work in, although one of the most supportive and well-managed in the country, is a different place to the one I began work in a year and a half ago. Similar changes have happened to hospitals across the country. For the first time in a long time, maybe ever, hospitals no longer feel like a group of services desperately trying to reduce their workload. We have become one team, brought to this level of humility by something a thousand times smaller than the width of a human hair, and which cannot even be described as alive. Now, we can sit down and talk to each other. We can vent our frustrations, share our sadness and spread the laughter we have always held. One of our two registrars may have been able to rest for a long period of time, but when it is 2am and they need to make a decision that could mean life or death, it is important that they get both medical and emotional support. So it is heartening that we are now in the workplace we have long wanted, where care comes first, and such emotional burden is shared between us all.

I hand over my bleep to the day-team as my shift ends; I am not sure the patient I just have seen will still be here this evening when I return. I walk into the Easter Saturday sunshine and sit down to read my book in our hospital garden. Our medical examiner spots me and asks how I am; I smile and tell her that I am fine, and she does the same. Others might think I am putting on a brave face, but the opposite is true. I first started talking to her a week ago when filling out COVID-19 related death certificates. Today, she knew I was on call and went out of her way to make sure that I was coping well. I am, because of people like her, and all the staff in this hospital. We are one NHS – and I hope that this spirit of caring and sharing remains after all of this.

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