A KIWI IN LONDON: INSIDE BRITAIN’S COVID CRISIS

DR WILLIAM RUSH

We all saw the horrifying pictures of overwhelmed hospitals and health care workers in the UK as Covid-19 swept through. Dr William Rush is a Kiwi doctor in London. He shares his experiences and observations of working in a busy hospital during the crisis.

Two and a half years ago, we moved to London with our three young children. I left my job as an emergency consultant in south Auckland, exchanging it for a post at a busy major trauma centre in East London. Far, innit?

I was told the NHS was a juggernaut, that it was unsinkable, perhaps because it was already sitting on the bottom? A complex system of bespoke solutions compounded by the British dependence on bureaucracy, queuing, and the fax-machine.

As we all know, Covid-19 arrived, ignoring Brexit, and crossing into the UK rapidly, easily, as if it were just another part of Europe. Undoubtedly, the virus had a clear intent to Remain.

Like everywhere else in the world, we dropped everything to ready ourselves for the hordes of patients dying from Covid-19. Within a week the National Health Service had become the National Coronavirus Service. House officers and registrars did not rotate as planned; most were redeployed. Some juniors, bless them, actively volunteered to switch into ED. Extra consultant shifts were created, non-clinical time was halved, daily Zoom meetings were instigated. The preferred debriefing venue – the local pub – shut its doors.

There were one or two ‘horror nights’ back in March where the ED was almost overrun, but the nurses, doctors, and other health care workers stepped up and weathered the storm just as they would have in any New Zealand ED. I thought of heading back home to New Zealand, deserting my adoptive, dysfunctional country of residence. But my Stockholm syndrome took over, I signed up for extra shifts, dialled into the next Zoom meeting, turned my camera and mic off, and bought better life insurance online at my wife’s insistence.

For us, PPE was consistently available. My clinical lead was brilliant at sourcing kit for the department, though it pains me to think how much he spent at Amazon.

Nevertheless, the near-complete lack of testing meant Captain Boris was sailing with all his usual bluster through a fog.

Thanks to the UK being slow to lock down, a large proportion of the health workforce was subject to a de facto, dumb, shortlived ‘herd immunity’ experiment. I strongly suspect that the early community spread was far greater than imagined. Many of us went off sick, to isolate, protect the NHS, and return to work after our 7–14 days were complete.

We will probably never know if that headache, runny nose, and bout of diarrhoea were from Covid-19 or not. I have three children who regularly supply me with new germs. There was not enough testing for frontline health care professionals when I fell ill.

The science was lacking, and the systems were new. We endeavoured to maintain business-as-usual standards of care. Just because this was ‘unprecedented’ did not mean we could redraw the line a little bit lower and deny people ventilation or a hospital bed. The government could artificially lower the PPE requirements, but redefining hypoxia just was not going to work for our patients. Every so often someone would say something like, ‘In times like this, we need to be pragmatic.’ I thought we should always be pragmatic, but the official line was to not alter thresholds of care until NHS England said we must.

Our own ICU capacity increased sixfold, and ventilation mega centres were opened but thankfully were never used. Despite our best efforts, some patients did not receive all the care we wanted to provide. System errors, which led to delays caused by newly derived bottlenecks, combined with a nastier and more aggressive disease than initially expected. We were left gut wrenched and angry that our patient had died before we could ‘throw the kitchen sink at them’.

Just because this was ‘unprecedented’ did not mean we could redraw the line a little bit lower and deny people ventilation or a hospital bed.

I suspect that the London Ambulance Service, those knights in forest green, complete with flimsy plastic aprons and surgical masks, bore the brunt of the surge. The hospital emptied out behind us, and finally, we were not bed blocked. Now the threat of corridor patients carried real consequence and weight.

Do I feel proud? No. I feel fortunate. The team that I am with is excellent. I would encourage them to move to New Zealand if it did not adversely affect my chances of re-employment.

We were left gut wrenched and angry that our patient had died before we could ‘throw the kitchen sink at them’.

The NHS is full of saints, working selflessly. Too many have died or been admitted to intensive care during the pandemic. The weekly clap (8pm Thursdays) is nice but will soon be forgotten as it fades into tokenism. Perhaps now the UK will value its health care professionals and bail them out like the bankers in 2008? Rounds of applause do not make up for over 10 years of fixed wages or compensate for the increased personal risk of intubation or death. There will be a national inquiry, closeddoor decisions uncovered and critiqued. Outrage will come and pass. The clapping and free food will stop, but I am confident the controlled chaos of emergency medicine, and the wider NHS, will carry on.