Working in the NHS is very different right now. Personal Protective Equipment (PPE) is the norm, beds are distanced, visitors are sparse, and doctors can’t even shake hands. A warm smile for patients is now hidden behind a mask.

These changes are perhaps most stark where I work in paediatrics; a place normally full of toys, music, and play, especially at Christmas time when children eagerly await the arrival of the stored away tree and a visit from Santa on the ward.

We know now that children are fortunately less likely to develop serious complications from covid-19, but in the early days of the pandemic we had to take every precaution and many of these guidelines remain so that we can continue to keep our patients, their families and carers, and their healthcare workers safe.

Precautions include strict limits on visitors, play areas shut, and musical therapy halted. Most displays and toys on the ward must also be kept out of reach or “wipeable,” preferably laminated—a far cry from life before covid-19 when children could grab sensory toys or play with interactive wall games.

This has not only had a massive impact on our patients and their families and carers, but also on the healthcare workers working in this environment.

Treating sick children is always emotionally difficult, but because of the pandemic, families, friends and siblings haven’t been able to visit as usual.

In maternity care, fathers and partners have not been able to be present during antenatal appointments. While in most cases they were able to be present at birth, any time spent in hospital after birth, including the postnatal ward, fathers and partners were unable to visit. 

Babies could be admitted for 14 days following birth, have a lumbar puncture, be treated for meningitis, and partners and families wouldn’t be there for any of it, putting immense pressure on mothers. We try to give as much emotional support as we can, but it cannot replace the support they would have received from loved ones.

This has been particularly difficult for families.

Updated guidance still allows only one support partner on maternity wards, and while many hospitals will continue to make their own decisions based on local risk factors, this is still a far cry from normal and where we used to be.

Denying visitors is not something that comes naturally to doctors. We know how important family contact is for children and how much it can help in their recovery. Turning siblings, relatives, even parents away has been immensely challenging for all of us.

There have also been times when we know our patients won’t get better, and while this is something that doctors face often, supporting families through this during covid-19 has been more difficult than usual.

The BMA has published a series of recommendations as part of its mental health charter, which recognises the emotional difficulties that working in a covid-19 environment is having on doctors and why it’s so important staff talk about their experiences.

This includes making sure staff are supported by their employers, that there is equal provision of wellbeing services, and those presenting with mental health conditions get the appropriate treatment they need.

Doctors have a reputation for “just getting on with it,” and many might not recognise the impact that the pandemic has had on their mental health to date.

As we look forward to Christmas and do all we can to keep patients’ spirits up—in my hospital we’ve put the decorations up and had virtual choir arranged perform for the children as well as other virtual and socially distanced forms of entertainment—we must remember to also look after each other and ask for help when we need it.

We can’t look after patients in the way we want to if we don’t look after ourselves first.

Latifa Patel, deputy chair of the representative body at the BMA and paediatric respiratory doctor.

Competing interests: none declared.