Exhaustion, pride and camaraderie: a London hospital experience of the pandemic

When Segun Olusanya, an intensive care physician at London University College Hospital, heard about a new and highly transferable variant of Covid-19 in November, he felt the worst kind already seen.

After more than 18 months fighting the pandemic and seeing both other clinicians and patients die, he had to ask himself if he could withstand another wave. “Each wave leaves a scar … so my big concern with Omicron is whether this is the scar that makes me stop?”, He reflected.

While London is no longer the national center of the Omicron rise, with the number now rising in the north of England, staff in the capital continue to work flat, partly due to very high absenteeism among colleagues who are ill or isolating themselves from illness.

Conversations with a number of front-line staff at UCLH, one of the capital’s largest hospital foundations, revealed a group driven by camaraderie and institutional pride, but permanently changed by unsettling experiences. They talked about personal relationships frayed by the intense professional demands of the pandemic, and about exhaustion and burnout after being pushed to the extreme and beyond.

The burdens have been exacerbated by staff shortages. The number of employees voluntarily leaving the UK publicly funded NHS increased by more than 40 per cent in the quarter ending in September, compared to the previous three months according to official data – an emigration that an understaffed service cannot afford.

Amidst a tangle of impressions from the top of the eruption, Olusanya recalled “the warmth and stickiness… When I remember things, I remember them through this very hazy blur of visors.” He added: “You are trying to do a job, which I have certainly been trained to perform for a very, very long time, but you try to do it while wearing a spacesuit and hardly hear people, by 10 times [usual] number of patients and trying to provide the same level of care. “

At UCLH, as across the country, Omicron has not filled intensive beds as previously originated. Yet the cumulative effect has been enormous for staff who have struggled on the Covid front line for so long.

“People are burning out. do it all over again ‘, “said Louisa Weighill, a critical physiotherapist.

Olusanya added that he loves his job and cares deeply about his patients “but no one should be forced to do something they love at the expense of themselves”.

Psychologist Anna Batho highlights an ingrained NHS culture by putting collective needs before individual needs © Tom Pilston / FT

Yet there have been positive things: New, more collaborative ways of working have emerged, along with a culture where staff feel freer to acknowledge that they are struggling with mental health issues and secure the support they need.

Sarah Burton, the trust’s lead cancer nurse, said: “We have become much better at checking in with people and noticing if people seem a little quiet, or mentioned that they have not slept well and we tend to take it up. much more and take care of each other. ”

That corpse spirit which has helped them get through the emergency, however, may be a double-edged sword. Anna Batho, a psychologist who works with both staff and patients in the intensive care unit, highlights an ingrained NHS culture of putting the collective, before individual needs. When colleagues seek her help, “I say every single time ‘have you thought about keeping something free because you tell me you’re having a hard time’. And they have said ‘but what would my team do?'”

Elaine Atkins: ‘I’m lucky in the fact that I can get to work and interact with people. But I’m also exhausted ‘© Tom Pilston / FT

All of the interviewees felt changed by the experience of the past 22 months. Elaine Atkins, a radiographer now working as a “specialist in vascular access,” said she has become far more anxious and so worried about being sure she has only seen friends three times since the pandemic began. Instead, she returns after each shift to her home around the corner from the hospital, always alert to a call to return.

She emphasizes that she enjoys her role. “I’m lucky I can get to work and interact with people. But I am also exhausted, ”she said.

Batho has found that the relationship has had to be renegotiated due to the pressure from the pandemic. “I had friendships or relationships that stopped because they did not want contact with me because of where I worked,” she said, adding that “even now, with Omicron, I have had people cancel social events” because they think I’m tall. risk.

Olusanya, who has combined his work in the intensive care unit with preparing for exams to secure a promotion, describes himself as “pretty shattered, pretty exhausted. Basically, I have to learn to live a normal life again.”

Memories of those lost are rarely far from the minds of UCLH staff. Among Burton’s most poignant moments during the pandemic was receiving his first dose of Covid vaccine. Relief that she and her family were protected was mixed with guilt, “that I had reached the point where so many other people had not done so”.

Increased emotional strain on staff has witnessed the number of people whose care has been delayed, sometimes with catastrophic consequences.

Olusanya remembered the first patient he saw at another London hospital, whose condition had deteriorated so far that life-saving surgery was no longer possible. “It’s deeply morally disturbing… It was someone who had had their heart surgery delayed by six months and they couldn’t get it anymore because they showed up and they were too sick.”

Arup Sen: ‘It is quite difficult to deal with as a clinician [patients only seeking help several days after falling ill], knowing if they had come earlier, we could have made a bigger difference ‘© Tom Pilston / FT

He said he and his colleagues began to see more and more people “with delayed presentations of heart disease, cancer, and it’s so hard to keep up”.

Arup Sen, a stroke counselor, faced similar grueling situations where some patients only sought help several days after becoming ill. “They lacked the time-critical period of treatment that is usually within the first few hours,” he said. “It’s pretty hard as clinicians to deal with it because we knew that if they had come earlier, we could have made a bigger difference.”

Yet, despite all the psychological support offered to staff, Batho believes it is important not to “pathologize” a natural and human response to everything they have gone through and seen. “I think in the end, it’s not so much wellness support we need, it’s more people to help, it’s trained doctors, trained nurses, trained therapists,” she said.

Her comments speak to the endemic staffing shortage in the healthcare system. The NHS, which last published a detailed workforce plan in 2003, entered the pandemic with around 100,000 vacancies.

Olusanya also stresses the need to address recruitment and retention. “I’m six months away from being a consultant, and at the moment, if I throw a stone, I get a consulting job because there are vacancies everywhere,” he said, adding that while this may seem positive, “it is not good for me because I’m still going to work in a system without enough people to tackle “.

Flo Panel-Coates, chief nurse, said the trust had worked hard to accommodate staff seeking a break “so they do not leave the profession”. But she also highlighted the number who were reassigned to critical care at the height of the crisis and have chosen to remain: a phenomenon she calls “post-traumatic growth.”

Although the staff come to terms with what they have endured over the last two years, everyone is eager to emphasize the extraordinary benefits of their work.

Batho said: “Our teamwork was such that more people survived in our intensive care unit than people died and you are there and witnessing people coming through and you are there and talking to the families.

“It was they who showed this resilience and hope … so often when I talk to them [my] family and friends, I want to say ‘you do not know how lucky I am to see it’. “

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