In response to the increasing numbers of people being tested and treated for coronavirus, King's College Hospital has been taking steps to redirect their resources.
Dr Sarah Walsh, Consultant Dermatologist, reports from this distinguished hospital.
"So, Sarah, you'll take Katherine Monk, is that ok?", said my clinical director - and so began my medical renaissance, eight weeks ago, on a Saturday morning at the South London hospital where I have been practising as a consultant Dermatologist for the last decade. Katherine Monk is regrettably not a single patient, but a 28 bedded acute medical ward at King's College Hospital, named after Katherine Henrietta Monk, the first matron of the hospital in 1884. No doubt the esteemed nursing sister would have been spinning in her grave at the thought of a dermatologist running her eponymous ward. However with a rising tsunami of patients infected with Covid-19 looming, there was little choice but to trade in my dermatoscope for a stethoscope, and knuckle down.
To say that I was apprehensive is to understate my levels of anxiety at that time. Known to other hospital specialists by the moniker, "nine to five, and nobody dies", dermatology is all I have known for the last 15 years, since commencing subspecialty training. Knowledge once at my fingertips about the management of respiratory tract infections, heart attacks, strokes, and cardiac failure had long since been displaced by the acquisition of a dizzying array of dermatological diagnoses and a very different therapeutic armamentarium.
However, with my Oxford Handbook of Clinical Medicine wedged firmly in my pocket (a pocket medical reference book of biblical importance to medical students and junior doctors, fondly referred to as "the cheese and onion" due to its yellow and green cover, reminiscent of the crisp packets) I sallied forth on to the ward. A stethoscope was draped (somewhat unconvincingly, I felt) around my neck and I had a functioning biro. I was as ready as I would ever be.
How did I manage? Well, internal medical knowledge began to emerge from the deepest recesses of my memory. The junior doctors would gently fill the lacunae, which to their eternal credit, they did with great kindness to spare my ego (they needn't have worried: I left any ego I had firmly at the door!). Of greatest importance however were the generic clinical skills that I employ on a daily basis in my usual habitat of outpatients - thorough history taking, listening to the patients, examining carefully, scrutinising test results. These skills, along with a certain amount of leadership and direction of the junior doctors, were the foundations of my survival in acute medicine.
I felt deeply grateful for superb colleagues - never before have I felt such a unity of purpose amongst the staff of the hospital. There was a willingness, a flexibility, a kindness to virtually every interaction I have had at work in the last two months. This created an environment where great patient care could flourish - and I honestly believe that every patient that came through King's in the last two months was a recipient of that. There were plenty of opportunities for informal debriefing and relieving stress - What's Apps groups circulating the funniest memes, tales recounted over coffee in snatched breaks, and some pressure-relieving games of table football in the Doctors' Mess. It was the best of hospital life, reborn, and I feel immensely grateful to have been part of it.
This week repatriated to dermatology, I began to do battle with an adversary just as dastardly and confounding as the virus: technology. The advent of social isolation, shielding and cocooning has mandated that we use video consultations to see new dermatology patients. I embarked upon this with some trepidation. Indeed the very first patient I called was in fact in bed in his pyjamas when he answered my (expected) call - a young man in his 20s, obviously entirely at ease with this genre of interaction, to the point that he had not bothered to get dressed. The clinic proceeded, largely with the patients in rather more conventional surroundings such as the kitchen table or the home office desk. At the conclusion of the morning's work in the virtual realm, I realised that I had been quite moved by many of the interactions. There is something profoundly touching about seeing a patient in their own environment - and it heightened the sense of empathy that I felt for them. I recall my grandfather, a general practitioner in Yorkshire from the 1950s to the 1980s, extolling to me the diagnostic virtues of the home visit. He was convinced that a visit to a patient in their own home always yielded information that could never be elicited in the surgery. I am beginning to see why he held such a conviction.
The tragedies and the losses intrinsic to this pandemic are undeniable - however alongside this, I feel my professional life has been in many ways enriched. I hope that all in healthcare will carry forward some important lessons learned through the current hardship".
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My eldest grandson Harry who is 13-years-old, under duress, sent me this drawing inspired by COVID-19 and the following short commentary. He is a boy of few words. "I miss playing football most of all. (I am a Liverpool fan). I normally play three times a week. Our coach still drives us hard through distance learning so that we keep fit but it is so much more fun playing outdoors and meeting friends.
Sitting in front of a computer for so many hours is hard work. I miss the interaction with my teachers and school friends. On the other hand I am enjoying my mother's cooking for lunch and supper, so much better than sandwiches and apples for lunch which gets a bit boring.
It is also so much easier to hang around in a comfortable pair of jeans and a tee shirt. No tie, no shirt, no blazer.
There are no distractions in my bedroom. In the evening I am enjoying Riverdale and find it a very exciting series.
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I asked Erika Brincat, artist, writer of verse and prose to send me something inspired by Corona. Here is her poem and a sketch to accompany it:
Stillness
Suspended in Silence
We will survive this
If we connect to our Hearts
Taking the time to heal
Taking the time to be
This Story is about
The Survival of Humanity
And how truly human we can be
Cocooned safely within our own Being
At Peace and in Divine Harmony
This may be a trial for the human race
We were all meant to face
To awaken Divine Grace
Till we meet again... as Vera Lynn sings.
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