Mary Higgins: Covid-19—crossing the threshold

The first year of work as a healthcare professional is hard enough without covid-19

Similar to many other doctors, I have the pleasure and joy of being involved in the education of medical students. Teaching young, enthusiastic, bright people is a pleasure that keeps giving, as we get to know them over the years in medical school, passing on the little more knowledge we have, hoping that we can share our experiences and prepare them for the wonderful and scary world of working in healthcare. I am also one of many of those who wonder what it will be like for our final years students who have graduated early so that they can help provide care at one of the most challenging times in medicine, thus combining a double hit of starting medical work with dealing with a pandemic.

I graduated in medicine twenty years ago and the memories of those first few weeks are fresh in my mind. Starting on my first day (without an induction) and being handed the cardiac arrest bleep (which promptly went off), learning how to work together with nursing, physiotherapy, occupational therapy staff (not to forget porters, medical scientists, catering, administration…), facing the first person with chest pain, the next person with a suspected pulmonary embolus, the next person with sepsis, while also learning how to triage multiple calls from multiple wards, and how to work through the night and still somehow smile the next day. The friendships I built in that first year stay with me, as you realised who would be willing to swap a call and who would not, who would help with an admission and who would not—we learnt the true value of each other.

The first year of work as a doctor is hard enough without covid-19. I guess that the new doctors are going to become as expert on bilateral interstitial pneumonia as the rest of us, an expert on how to don and doff personal protective equipment, on when to alert staff to suspected sepsis, on how to interpret rapidly evolving evidence and what sources to trust. They are going to be assimilated into a new system that none of us anticipated even a couple of months ago, let alone when they applied to medical school.

They will join us as we all one by one Cross the Rubicon. Just as the hero sets out on the journey, they too are embarking on a trip that will change them forever. In his book “The hero with a thousand faces” Joseph Campbell describes the monomyth—the foundation of all stories—where the hero leaves the “normal world” and crosses a threshold where they will meet trials and failures, grow with new skills, have a revelation that will change them, atone them and they will return changed.  We can see this in the differences between pre-clinical and clinical medical students, between medical students and doctors, where having crossed this threshold we know we cannot go back to where we are before. And it is so much more with covid. To put on personal protective equipment (PPE) for the first time and enter a room, to take that breath and put your faith into the equipment that you wear, to the colleagues you work with, to the laboratory that is interpreting the test, to the system. That is faith, that is belief, that is hope.

And yet, even though we are called the hero’s for doing this, for turning up day by day to continue to provide care, we are not the only ones. There are others who take a breath and then take that step into the unknown. The healthcare professionals working in testing centres. Medical scientists processing results. Those who have to inform people that their result is positive, breaking bad news, and then moving onto the next and the next. Those who are working in shops to help feed people. Hauliers leaving home to cross countries. The police, the army, the bus drivers, the politicians, the leaders. Every one leaving their loved ones because they know it’s right to do it, but hoping that they will not bring home the infection. Each one of these is another breath, another conscious choice to  not only do the right thing, but to also do the thing right.

So despite the challenges that these wonderful former final year medical students have, despite the challenge of both first year of training and starting work during a pandemic, I trust them. I trust that we have trained them well, I trust that they can do this, that they can will do us proud. I hope that they will be safe. I believe they will be valuable members of the team, where we are all learning at the same rate. All in this together, all as a team.

Mary Higgins is an obstetrician working in Dublin.

Competing interests: None declared.