One morning in early March 2020, I found myself sat under a lemon tree on a Mallorcan farmstay, frantically emailing my haematologist over ropey wi-fi. Early information had been released around groups of people thought to be at high risk from covid-19. Given my recent history of lymphoma, I needed to know if I was able to work as usual as a medical registrar. With an initial, tentative green light to see low risk patients, I flew home, and did two final, fairly anxious night shifts before my formal shielding letter arrived. The information had already changed in that short space of time.
I’ve spent the past year moving between periods of shielding, and periods of low-risk, patient-facing work. Over that time, a lot of knowledge about covid-19 has been gathered, and practices have evolved. I have become used to remote consultations, high levels of screen time, and switching from being at the beck and call of a bleep, to sometimes going days without speaking to a member of my team. Last year I followed emerging covid-19 mortality data associated with my own medical history and found it difficult to swallow. This year, I wait anxiously to see the outcome of vaccination, both on a personal and national scale. Although I have now reached a stage where the intense fear of relapse that most cancer patients know all too well has started to fade, this has to some extent been replaced by a constant consideration of occupational risk.
Decisions around national shielding are based on numerous factors, but in healthcare there are so many shades of grey in terms of the different facets of our jobs, and differences between departments and hospitals; for example, are you working in a green zone, a green that is really an orange, or an orange that is now a red following an unexpected outbreak? There is also the issue of whether acute hospitals will ever by definition be “covid-secure” environments. Social distancing and patient care do not really go hand in hand, particularly for the patients that I see in geriatric medicine, where patients often have sensory impairments and cognitive disorders. There was a period in December, when I was still in the hospital building, and was feeling increasingly like a frog in hot water. Covid admissions were rising, rotas were ever more stretched, additional wards were reopening, and there I was, trying to work out how to know when it was time to go home; the temperature was rising. I eventually made the switch to remote working a week before shielding was reintroduced for a second time.
Risk perception is complex, multifaceted, and a little psychological. Imagine living in a house at risk of falling into the sea: when would you move out? When there is a one in ten chance, or one in a hundred, or a thousand, or ten thousand chance? What might sway the decision? It might depend on whether you had somewhere else to go, or how much you loved the house. Over time, the risk might change, but you may be so used to thinking in a certain way that you struggle to objectively reassess the risk. This is a little how the past year has felt, with the constant weighing of decisions, which despite support, remains a challenge. My working life is more complicated than it used to be, and every new post requires additional thought around what adaptations I’ll need, who to speak to, and what I’ll do if circumstances change. This is likely to persist for some time, yet many of my peers will be able to return to more normal training landscapes, as services recover.
In the future, I hope that some of the new things we have learned will stick around. I’ve appreciated the option of phone clinics as a patient, and as a doctor delivering them. I feel that despite some access considerations, they work well for some patients in some circumstances. The option of remote work and increased flexibility around what needs to happen in an NHS building and what can happen elsewhere, could also provide wider options for healthcare workers with disabilities, who are phasing back after sick leave, or who have caring duties.
Overall, I have learned a lot this year, despite my restrictions. I’ve learned a lot within my specialty, as remote consultations have enabled me to care for patients in a virtual space. I’ve also learned about what it has meant to be someone at risk, a similarity I share more commonly with my patients, than my peers. I often worry that people with clinical vulnerability to covid-19, whether due to a single factor, or several, will be left behind, or that the vaccination programme may give a false sense of security. I have been a proud advocate this year, for trainees such as myself who have been required to shield, and also, given my specialty, for older adults. I have a feeling that this need is going to remain for some time, given that many in both groups, have at times felt forgotten or undervalued.
My second, and hopefully final, period of shielding will soon end, and the UK will start to open up, but probably not at equal speeds. Risk assessment around everyday activities remains a daily, wearying consideration for many. It may be a while before people, including me, are comfortable on public transport, in large groups, or in closed spaces. It has been so easy to forget people, when they have disappeared from our workplaces, supermarkets, and streets. Ultimately, some of this high-risk group have died this year and have disappeared forever. Some, like me, are just a little out of sight, and still walking a tightrope of decisions. Please, don’t forget us, and don’t leave us behind.
Charlotte Squires is a specialist registrar in Geriatric and General Medicine, based in South East Scotland. She tweets at @charsquires.
Competing interests: none declared.