Chapter 4
When Healthcare Transforms Overnight
Within days of confirming our first COVID case, our entire department transformed. A&E expanded across a whole floor, creating separate "hot" (COVID) and "cold" (everything else) areas. With just three days' notice, my entire work schedule changed. Policies evolved daily as we learned to diagnose and manage this new disease, interpreting unfamiliar chest X-rays and positioning techniques.
The constant guesswork and evolving evidence made everything terrifying, unlike our usual confidence in treating familiar conditions. In A&E, I was accustomed to patients coming in unnecessarily-with spots or common colds-but COVID was different. Patients could deteriorate within fifteen minutes, and my anxiety skyrocketed when sending someone home who seemed fine but had symptoms. The foreboding sense that I might harm someone through incomplete knowledge haunted me constantly.
Our work routine transformed completely. Shifts now began with team meetings where consultants assigned us to "hot" or "cold" areas after ensuring we'd been properly fit-tested for masks. The PPE process was exhaustive-hand washing, double gloves, full-sleeved apron, respirator, goggles or visor. While I felt safer in PPE, it was brutally uncomfortable-making conversation left me breathless, the mask bruised my face, and I felt claustrophobic. Simple tasks became ordeals; bathroom breaks turned into fifteen-minute journeys due to the one-way system and careful doffing procedures.
The worst part was losing the ability to convey empathy when patients could barely see my face. I wrote my name on my apron since colleagues were unrecognizable, and had to consciously tell patients I was smiling. After six consecutive shifts in isolation, I was desperate for a break-colleagues looked aghast when they learned how long I'd been in the COVID area.
As March progressed, normal life disappeared piece by piece. My twenty-mile race became a tense affair with audible gasps whenever someone coughed. Cinemas closed, then Parkrun was cancelled, removing another social cornerstone from our lives. A colleague's wedding was postponed when lockdown was announced on March 23rd, though we celebrated via Zoom with everyone posting pictures in wedding attire. I missed Mother's Day with my mum, grateful my sister had moved home to support her through grief and isolation.
Chapter 5
The Hidden Mental Health Pandemic
The psychological toll of COVID-19 became increasingly evident in our emergency department. One day, I encountered a woman in extreme distress, fixated on her phone where she'd written "Wash hands" repeatedly. Her husband reported she'd been completely normal the previous day before going to her job as a supermarket delivery driver. After ruling out physical causes through blood tests, ECG, and brain scans, mental health specialists diagnosed stress-induced psychosis from her overwhelming fear of contracting and transmitting the virus.
This alarming case showed me coronavirus would impact far more than just the infected. In the following weeks, we saw a surge in anxiety-related chest pain and mental health crises, while our regular patients disappeared. The virus affected everyone-friends losing jobs, people trapped at home without their usual coping mechanisms, and devastating economic instability.
The messaging around coronavirus shifted rapidly. Early hospital communications emphasized deaths were among elderly patients with "underlying health conditions"-a phrase that initially provided false comfort. Soon these individualized reports stopped, replaced by anonymous statistics as numbers grew. Then we discovered the pink hash marks in our system indicating deaths of patients in their twenties and thirties-people like me, without pre-existing conditions.
My own anxiety manifested physically-chest pain and breathing difficulties that mysteriously appeared on my drive to work and disappeared after shifts. A colleague reported similar symptoms, and I realized these were anxiety's physical manifestations. Despite considering myself mentally resilient, cracks were forming in my well-being as dark thoughts about colleagues or myself falling victim to the virus became harder to ignore.
Sleep became elusive as the death toll climbed past 5,000 in UK hospitals. Even when I managed to sleep, work invaded my dreams-my husband would text me recordings of my sleep-talking about blood and loneliness. Time off felt like no break at all as I processed the deaths of fellow healthcare workers. I feared not just for myself but for potentially infecting my husband.
By early May, I was seeing a massive influx of patients with mental health problems who'd never had them before. Some presented with chest pain but no medical cause, others with severe anxiety attacks. One supermarket worker hadn't slept for three days, hyperventilating with fear about coronavirus. COVID-19 was having a colossal impact on mental health-even young people in their thirties were presenting with anxiety-related chest pain. In one day, I saw four patients who had attempted suicide.
Chapter 6
Healthcare as It Should Be
As April progressed, we nervously awaited the pandemic's peak while daily deaths in England regularly exceeded 1,000. Our A&E isolation units expanded from two to three, occasionally threatening to require a fourth. The corridors that once overflowed with patients now maintained an eerie efficiency. Despite the mounting death toll, the department remained surprisingly manageable-a stark contrast to our typical winter conditions when even minor surges would overwhelm our resources.
The difference between pre-COVID winters and the pandemic response was striking and revealed much about our healthcare system's potential. Previously, our emergency department functioned as an impromptu ward-overcrowded with patients awaiting beds while staff struggled to maintain care standards amid demoralizing conditions. Elderly patients would spend days on trolleys, basic dignity compromised by our inability to provide proper beds. Junior doctors would juggle impossible patient loads while consultants fought battles over bed allocation.
During COVID, everything changed dramatically. Healthcare professionals from different specialties eagerly assisted rather than resisting referrals. Orthopedic doctors ran our minor injuries units as elective surgeries were canceled. Cardiologists helped in respiratory wards, and dermatologists volunteered for general medicine rotations. This breaking down of traditional specialty silos demonstrated how artificial these divisions had become.
Staffing increased from our usual four doctors per shift to around twenty, transforming patient care. Instead of four-hour waits, I could see patients within ten minutes of their arrival. The impact was immediate - better pain management, faster diagnoses, and reduced anxiety for both patients and families. Patient flow became a slick process, with clear pathways and protocols. People moved through the system efficiently, not staying in A&E a minute longer than necessary. For the first time in years, nurses could provide the comprehensive care people deserved, spending time with patients rather than just managing crises. Staff finished shifts feeling fulfilled rather than defeated.
The PPE situation created immense anxiety and exposed systemic vulnerabilities. I was shocked to see my trust posting on Facebook requesting donations of full-length coveralls - a cry for help that revealed how unprepared we were. Healthcare workers nationwide were desperate for protection-some nurses resorted to wearing bin bags while some paramedics refused to enter homes without adequate equipment. The guidelines seemed to shift with the wind, changing twice in one day at one point, creating confusion and frustration among frontline staff who simply wanted to stay safe while caring for others.
The pandemic forced difficult ethical decisions throughout healthcare, revealing the moral complexity of medicine in crisis. Though I hadn't faced particularly vexing choices yet, colleagues were grappling with them daily. COVID patients stayed sicker longer, requiring extended intensive care stays. ICUs were filling, and staff were stretched thin, leading to impossible decisions about resource allocation. Intensive care doctors had to make increasingly difficult judgments about who would receive ventilator support, weighing factors like age, comorbidities, and likelihood of survival. I was relieved these decisions weren't mine to make. I remembered a patient with a severe head bleed whom I was certain was dying-I'd told her family to say goodbye, only to find her sitting up eating and drinking four days later, ready for discharge. Some people are remarkably resilient in ways we can't predict, making these life-and-death decisions even more challenging. This experience reinforced the humbling nature of medical practice and the importance of maintaining hope even in seemingly hopeless situations.
Chapter 7
The Vulnerable Left Behind
When examining a woman with neck pain, I discovered her partner had tried to strangle her-not the first occurrence. Though her injuries weren't severe, I referred her to the domestic abuse team. With A&E quieter than usual, we worried about people avoiding medical care and domestic abuse increasing during lockdown.
I'd recently seen another abuse case-a woman escaping sexual exploitation who needed refuge placement. After eight years in A&E, I recognize when injuries don't match stories, like the young woman with a bone fracture inconsistent with her "jumping off a fence" explanation, whose intimidating boyfriend refused to leave her side. Despite my concerns and private questioning, she denied abuse. Many victims return to abusers, making an average seven attempts before leaving permanently. Lockdown exacerbated these situations, with perpetrators home constantly, increased alcohol consumption, and heightened tensions.
One of our regulars, Bertha, had returned after a COVID-related absence. She'd been in and out of mental health services for years, even sectioned for a period. Now she visited A&E almost daily, making vein cannulation increasingly difficult-this time requiring placement in her armpit. Many regulars become part of the department's fabric, and I feel sad when they die. Some take massive overdoses or are alcoholics with blood results barely compatible with life. These patients come from all walks of life-one wealthy woman whose father gave her money to push her away only fueled her drinking habit. When regulars die, I feel both sadness and compassion, hoping they've finally found peace from their demons.
I was seeing more complaints linked to excessive alcohol consumption. One man admitted drinking fifteen beers daily for two weeks to cope with coronavirus anxiety. Friends on video chats discussed their increased drinking too-everyone was doing it, even I made cocktails with Ed one evening. I understood why people turned to alcohol but consciously reminded myself it was better to go without.
My colleagues weren't immune either. Veteran nurses broke down in tears, many staff had moved away from their families to avoid bringing COVID home, and everyone was exhausted. The trust offered support-daily well-being emails, prayer rooms for Ramadan, decompression advice-but burnout loomed large.
Chapter 8
Challenging Cases, Challenging Times
Dealing with angry patients requires a delicate balance of empathy and professional boundaries. I've learned through painful experience that telling someone who's furious to "calm down" only escalates tensions. While sharing personal experiences can sometimes build rapport, it's a technique that demands careful judgment. One particularly memorable case involved a regular patient whose volatile behavior was affecting her children. When I attempted to address this sensitively, suggesting the impact on her family, she erupted in a way that made me question my approach. This taught me that even well-intentioned interventions can backfire spectacularly. Sometimes, despite our best efforts and professional commitment, personality conflicts prove insurmountable, forcing us to acknowledge our limitations as healers.
Pregnancy cases generate unique anxiety because they inherently involve multiple lives. One case particularly stands out - a pregnant woman presenting with chest pain and shortness of breath during the pandemic. The diagnostic challenge was immense: distinguishing between COVID-19 and a potentially fatal pulmonary embolism (PE). This reminded me of a harrowing previous case where a heavily pregnant woman with multiple PEs nearly arrested in our care. The complexity of medication dosing in pregnancy had even rattled my usually composed colleague. Now, as the physician in charge, I had to consider worst-case scenarios - would we need to perform an emergency cesarean while attempting resuscitation? When discussing imaging options, I maintained strict professional neutrality, methodically outlining risks and benefits without personal bias. Her decision to wait overnight proved wise when we later confirmed and treated her PE.
The pandemic transformed our usual clinical challenges into logistical nightmares. The constant reorganization of "hot" and "cold" zones created unprecedented cognitive burden. The absurdity reached new heights when our trust recalled defective PPE goggles, forcing already stretched staff to conduct hospital-wide equipment checks. The personal toll was equally heavy - while I couldn't visit my mother and sister in their time of grief, I watched others meet family members at the government's prescribed two-meter distance with a mixture of resentment and understanding.
COVID-19 presented unique challenges in patient care. I treated a diabetic, asthmatic patient in his sixties who was convinced his positive diagnosis was a death sentence. Drawing on emerging survival statistics and his stable oxygen levels, I provided measured reassurance. Another case involved an elderly patient discovered collapsed, presenting with confusion and diarrhea - atypical COVID symptoms we'd been warned about in geriatric patients. Perhaps most challenging was managing a terminal cancer diagnosis in a man who served as primary caregiver for his wife with advanced dementia. Though imaging revealed widespread malignancy, I carefully avoided premature disclosure, respecting the protocol that such life-altering news should come from specialists in a properly supported setting. These cases highlighted the complex interplay between medical knowledge, emotional intelligence, and ethical responsibility that defines modern medical practice.
Chapter 9
Finding Hope Amid Despair
I arrived early to check on previous patients, particularly Shirley who had deteriorated rapidly with COVID-19. To my delight, her records showed she'd survived and been discharged-a miracle worth celebrating amid the constant news of death. Meanwhile, care homes struggled with varying approaches to protecting residents. One elderly man arrived in A&E feeling suicidal after weeks of isolation from his wife, while my godmother had finally tested negative after weeks confined to her room.
The medical hierarchy frustrates me deeply. Despite years of experience as an ACP, I still can't request vital imaging that a newly qualified doctor can order on day one. I've had specialists demand to speak with doctors rather than me, and patients who dismiss my advice only to accept the exact same information when it comes from a doctor. It's demoralizing. Many nurses have decades of experience and can diagnose patients on sight. Though the hierarchy has flattened somewhat and the pandemic raised nursing's profile, we still battle outdated stereotypes.
My week off brought relief from hospital work but not the rejuvenation I needed. Instead of our usual adventures, Ed and I took local walks in waterproofs, meeting friends distantly and finally reuniting with my mother and sister for an emotional outdoor picnic-our first meeting since Dad's funeral in February. Despite the break, I wasn't refreshed. My dreams worsened, filled with images of deceased patients-their waxy, yellow skin, sunken features, and gaping mouths. Most haunting was a recurring dream of my father's death, seeing him on the floor where he died, congealed blood visible, the smell vivid. I'd wake with tears streaming, my husband noting I'd been whimpering like our dogs.
The pandemic had revealed people's true nature with blistering clarity. I'd been moved by public celebrations of the NHS and felt truly seen. I wondered if my role caring for others at their greatest moment of need was my true purpose-no greater privilege existed, even when overwhelming. COVID had amplified social inequality-I saw it in beaten women, struggling single parents, and trauma survivors whose safety nets had vanished. While everyone wanted the pandemic to end, our circumstances varied dramatically. The voices of those most affected remained largely unheard.
Despite unimaginable loss, there were tales of survival and hope. Would this pandemic ever truly end? Perhaps not, but endings are complicated and messy, much like the pandemic itself-and life.
