Returning to clinical practice amid a pandemic

Returning to work can be a stressful time, but what is it like when the world is in the grip of a pandemic?

Amid the current covid-19 pandemic, there have been widespread calls for doctors currently out of training to return in order to facilitate efforts to ensure the NHS is not overwhelmed. The UK public have expressed gratitude for healthcare workers putting their lives at risk working on the frontline, but behind this emotive picture are real people who are having to adapt rapidly in order to cope with exceptional circumstances.

Before the emergence of SARS-CoV-2, I had arranged to return to work from parental leave at the beginning of April 2020 as a core trainee on an acute medical ward. In normal times returning to work is a stressful, albeit exciting, time. My concerns ranged from clinical worries, such as will I be competent and will support be available, to the practical—how do I navigate the web of HR to arrange my return, and what will the rota be like? My biggest personal concern was, will my children be okay at nursery?

As this was my second return to work, I was initially feeling fairly relaxed. I had fought my “admin battle,” and arranged a rota that worked for everyone and sorted childcare around it. I signed up for some SuppoRRT days, and knew that my clinical concerns were actually more about confidence than competence. I expected that after a week, I would be back in the flow.

But then the covid-19 pandemic began to take hold. The SuppoRRT days were cancelled, messages began to circulate about emergency covid rotas and personal protective equipment (PPE) guidelines, and discussions about covid-19 treatment options began to predominate. New concerns quickly rose to the forefront: this new illness would apply to a significant proportion of my soon to be patients, yet I had not been working, as my colleagues had, during its buildup. I felt like I was returning to uncharted territory and was unprepared. My clinical self-doubt began to take hold again, and now there was no NICE guideline or (at that time) e-learning module to help.

Then there were more personal concerns: I had two children under 3, parents in their 60s who helped care for them, and a husband who was on the government’s shielding list. What if I brought the virus home to them? This could well happen, even with measures such as changing clothes before leaving work, showering before seeing anyone, and disinfecting everything I touched. Perhaps, therefore, I should move out and isolate myself? But my husband was adamant he did not want us to be separated for the foreseeable future, and I was still breastfeeding my son at night, who had categorically refused a bottle despite our best efforts. In addition, my carefully arranged childcare would have to be renegotiated, especially if I was put on the new covid rota, and what now should I do with my children on their days with their grandparents?

Even having “done it before,” it was hard to know how to deal with these concerns. Help is available, but even once identified, there are psychological barriers such as not wanting to bother already busy people, or to shirk my sense of responsibility and duty as a doctor. Then there was the fact that there are some questions others cannot answer, like how to balance the physical health risks to your loved ones with the psychological pain of being parted from them indefinitely. 

However, one thing I have learnt is: it is always worth asking. People cannot help when they do not know there is a problem, and there is no benefit to struggling alone; it results only in professionals who are burnt out and poorer outcomes for patients. Some people couldn’t help, but by asking I was able to find those who could and was offered both practical and psychological support. My specialty tutor helped me coordinate my return with HR and individual departments, addressed some of my immediate safety concerns by directing me to fit testing for FFP3 masks and donning and doffing of PPE training, and was able to direct me to Health Education England’s online learning resources for covid-19. They also supported me in arranging my rota and agreeing that I would start work in a “green zone.”

This experience has taught me a lot about myself. The conflict between doing my job and keeping my family safe has caused me many restless nights. I have learnt that I love my job, and believe in the importance of it, but this is also the first time I have resented it. I have not fully resolved these feelings, even now, but I believe through personal reflection, talking to my loved ones, and seeking help and support at work, I have found a middle ground that works for me as well as it can. I have emerged more grateful for what I have, and more resilient, as a result.

Gemma Blackbeard is a CT2 ACCS anaesthetics trainee at Colchester Hospital, UK.

This article was written with the input of Hasanthi Gooneratne, a consultant anaesthetist at Colchester Hospital, UK. Twitter @mededhg

Competing interests: none.