Working During The Coronavirus Pandemic- A Medical Student’s Perspective
The hospital has not been named to protect patient and staff confidentiality.
A week before the UK went into lockdown, the laboratory in which I was completing my project for my intercalated degree closed down, and staff and students were advised to work from home. Following the lead of many other students in London, I left the city to live with my parents during lockdown in a more rural location. After a few weeks, feeling restless and struggling to find the motivation to finish my dissertation, I applied for a job at the local district general hospital to work as a Clinical Assistant (CA). This was a new role, created in the early days of the pandemic to prepare for the influx of coronavirus patients. It was specifically designed for medical students so that we could help out doctors, nurses, and HCAs with any jobs on the wards that we were able to do given our level of training and personal experience. We were fast- tracked through occupational health checks and basic training - how to record observations on the ward iPads, how to make ward beds, a clinical skills refresher - and I started working on the wards only about two weeks after seeing the original job advertisement.
The memory of my first day still makes my chest feel tight. I was taken onto one of the “CPAP wards” to be supervised by a CA who had already been working for a couple of weeks. CPAP (Continuous Positive Airway Pressure) is a form of ventilation that is classed as an “aerosol- generating procedure”, meaning that full Personal Protective Equipment (PPE) is required to treat these patients. Before entering a bay, we were required to don a surgical gown, an FFP3 mask, gloves, and goggles. The ward was strangely hushed, and the atmosphere held a constant tension I had never felt before on a ward. It was unnerving to see a normal ward, usually full of all kinds of patients with different conditions, now full of bays of patients with COVID-19 pneumonia on breathing machines. I felt immediately overwhelmed and out of my depth.
As medical students, I think we have all experienced to some degree a feeling of uselessness, or of being a burden, or having some kind of imposter syndrome that says that you don’t belong on the ward contributing to patient care. This was exacerbated 100-fold during my first few shifts, and I think all members of staff experienced some form of this when facing bays full of coronavirus patients that we didn’t yet know how to manage. I would like to say here that when I started working, every nurse, doctor, health care assistant, physical or occupational therapist, cleaner and any other member of staff working in the hospital had already been carrying out their daily jobs in this environment for the past month or so. I was lucky enough to be able to choose to work during the pandemic. The medical education staff who introduced the CA role kindly ensured that we felt no obligation
or pressure to work if we felt uncomfortable or out of our depth. I could choose my shifts on a locum basis, and take on whatever workload I felt I could handle. I could take a day off if I felt tired or drained, whereas other members of staff didn’t have the luxury of deviating from their rota. The respect and admiration we should all have for those who weathered the most gruelling parts of this pandemic should extend beyond a clap every week; we should work with our voices and our votes to make sure that our healthcare staff are paid and protected properly by our government, especially as the coronavirus cases decrease and we begin making our way back to normality.
It was interesting to see how the other CAs tackled work in this environment. There were a range of students working as CAs, from different countries, different medical schools, and different levels of experience. This resulted in a range of attitudes and approaches to work. Some CAs felt confident enough to attempt new clinical skills, clerk patients, or have a go at any tasks that were slightly outside their comfort zone. Others (often the younger medical students) felt less safe doing so and made sure to refuse any tasks that they were unfamiliar with, or hand over to a more qualified professional. So often in medicine, it feels like trying to find a balance between caution and confidence. It goes without saying that it is and will always be imperative to work within your sphere of competency, both to protect your patients from harm and to protect yourself from legal repercussions. However, sometimes it’s very difficult to separate your comfort zone from your sphere of competency. It’s important for students to know that, even though some of your peers may be taking opportunities to attempt new things, it’s ok to sit these things out if you don’t feel ready. However, my time working as a CA taught me that working slightly outside your comfort zone can result in improved knowledge, skill, and self-confidence, even though it may feel unpleasant at first.
There was also the possibility of transmitting the disease to factor into our lives. As CAs, we were offered free accommodation at the local university, which I didn’t accept. I couldn’t imagine working all day on the COVID wards and then going back to an empty flat to spend the evenings totally alone. My parents agreed, and after some discussion, we worked out a system where I would “socially distance” from them in our family home. Every day, after work, I changed out of my scrubs in the hospital changing rooms and placed them in a plastic bag that would disintegrate in the washing machine. I washed my hands thoroughly, drove home, and sanitised the steering wheel. I entered my home without greeting my parents, and immediately showered and washed my hair. I put the plastic bag containing my scrubs in the washing machine on a 60°C cycle, washed my hands again, and sanitised any doorknobs and surfaces that I had touched since entering the house. I would spend most of the time in bedroom away from them, and we used separate bathrooms. When we ate dinner as a family, I would sit at the opposite end of the kitchen table, about 2 metres away. If we wanted to watch a movie or contact friends or family, I would join the Zoom call or Netflix party from my own laptop in my bedroom.
Ask any healthcare professional who worked on the COVID wards, and they will recount a similar experience. I remember reading news articles about nurses who hadn’t seen their children for weeks, and feeling both lucky and guilty that my parents wanted me at home with them, despite the risk. These stringent measures that we all took to prevent the transmission of the disease were evidently necessary, as I realised when I became infected myself. I was very fortunate and only suffered it mildly for about a week, during which I locked myself in my bedroom and my parents left food outside my bedroom door. Due to the pains we took to prevent transmission, neither of my parents caught the disease, and for that I am so relieved.
Despite all of this, my experience as a student working through the coronavirus pandemic was overwhelmingly positive. The medical education staff who had implemented the CA scheme were supportive and enthusiastic, regularly offering emotional support and advice on how to protect our mental health during this period, and were happy to help us out with any problems we faced. As CAs, we organised peer teaching sessions and some of us met up occasionally for a socially- distanced lunch break, which helped us to build an atmosphere of community and camaraderie. The doctors and nurses working On the wards were all very welcoming and appreciated our efforts to help out with jobs. In particular, one Foundation Year 1 (FY1) doctor really took me under her wing and took the time to teach me and supervise me while doing jobs for the first time, so I could then apply these skills and help out other doctors during my following shifts. These simple acts of kindness boosted my confidence to no end, and I believe that it was due to her that I continued to take up shifts as a CA. If there is one thing I have taken away from this experience, it is the desire to emulate her compassion and generosity and to treat my future students and colleagues in the same way.
This job also gave me the opportunity to witness the response of the medical community to an unprecedented crisis in real time. The hospital was quickly divided up into COVID and non-COVID wards, and staff could not move between the two. Visitors were not allowed, which left the hospital car parks, corridors and canteens eerily empty. On one occasion, I visited resus, and found the whole room covered in translucent plastic drapes to separate the patient bays. It honestly felt like something out of a horror movie. Every patient who came in was immediately assessed for a Treatment Escalation Plan (TEP) that would inform the rest of the hospital staff of their ceiling of care; in other words, which treatments would be unsuitable for the patient given their health status and comorbidities. This was especially relevant for COVID, as many elderly or frail patients, or patients with respiratory conditions, were not deemed suitable for CPAP or invasive ventilation.
Every week, there was a new piece of guidance circulating. It was almost impossible to keep up. By the end of my time working as a CA, I could confidently complete a range of clinical skills. These experiences will be absolutely invaluable during the rest of my medical degree and my FY1 year, and I am very grateful for my local hospital for offering us this opportunity.