“You know the wave is coming but you can’t quite believe it”
“There was this testimony coming from Italian doctors that was just appalling, the system was overwhelmed, everything was broken,” says Dr James Fullerton, a 38-year-old specialist registrar at University College London Hospitals NHS Foundation Trust (UCLH). “But in London at the start of the epidemic there was a strange patch of serenity. It was like a tsunami where the sea goes out and everything is calm – you know the wave is coming, but you can’t quite believe it.”
Fullerton splits his time between academic and clinical work. In early February he was working night shifts in A&E, and looking forward to several months focusing on research. “Our waiting rooms are normally rammed on a Friday and Saturday night with people who’ve drunk too much or are acutely unwell,” he tells me. “But you could see that the fear had started to spread, way before the stay-at-home orders, and suddenly hospitals were empty. Even serious medical conditions like heart attacks and gastrointestinal bleeding didn’t seem to be coming in and it wasn’t obvious where these patients had gone. They must have been staying at home.” When he diagnosed his first cases of Covid-19, he says, he was taken aback that it had really arrived.
Before long, Fullerton was brought in to a new High Dependency Respiratory Unit that had been created on the hospital’s seventh floor. “I was sitting with consultants drafted from multiple areas, including those who mainly did research and undertook predominantly outpatient work: those who didn’t normally see acutely unwell patients,” he says. “It was like being mobilised for war, we were waiting for our orders on where we’d been assigned. It was fascinating and I felt pride that I was part of it. But it was also intimidating and scary, you could see the concern in some people’s eyes – ‘Is this really going to happen?”
UCLH was totally reconfigured, normal medicine services and surgery were cut back, the stroke and paediatrics units were moved to different hospitals and the Intensive Care Unit was doubled in size. “We geared up really effectively,” says Fullerton. “There was a strange psychological shift and a camaraderie that was built very quickly.” Suddenly the wave rolled in.
Fullerton tried to go about his work in as normal a way as possible – albeit wearing heavy protective equipment. “What has been different about this is the sheer rate and volume of death,” he says. “I’ve seen a lot of people die in my life and normally there’s a build-up, a prior illness and some time to prepare mentally, but here people get sick on a Monday and by Friday they’re dying. Even worse, their families can’t come in and see them, they can only communicate by iPads. You’re not used to seeing this happen to healthy 50- or 60-year-olds. And it’s hard because they’re dying of lack of oxygen, it’s effectively like drowning. We do our best to manage the symptoms with palliative meds but it can be pretty harrowing.”
In April, Fullerton developed a persistent new dry cough. “I had the test for Covid-19 and it came back negative but you remain uncertain,” he says. “We’ve got patients whose lungs have been severely affected and they’re still getting negative results, even though we feel sure they’ve got it.” For the doctors in Fullerton’s unit, believing they’d already had the disease became part of their coping strategy. “I hope I’ve had it, I definitely want to think I have,” he says. “Part of this is a way of dealing with it – if I go in thinking I’ve probably got immunity it’s a kind of kidology, it makes me believe I’ll be fine. I can’t help but admire those who continue to work despite knowing that they are at higher risk were they to be infected.”
When Fullerton left work each day, he headed home to comb through hospital reports for clues as to why patients weren’t getting better. “I worked at it every spare hour,” he says. Like other researchers, he’d spotted a link between Covid-19 and high levels of blood clotting: he hopes the UCLH data set he’s helped produce will aid our understanding of the disease and its outcomes.
“People get sick on a Monday and by Friday they’re dying”
London’s Covid cases fell steadily throughout late April and May. “The acute case numbers have dropped and there’s now a need to care for the survivors, the people who had a long stay in intensive care units,” says Fullerton in June. “These patients have lost muscle mass and the ability to undertake what they previously considered basic functions: swallowing, talking, walking. We’re realising how long their journey to recovery will be.”
While a drop in acute patients is good news for society, it’s bad news for research. “The West has scrambled to set up clinical trials to try to find how best to treat Covid,” says Fullerton. “The problem is that we’re not getting enough cases to be enrolled in all these trials to get meaningful answers. The fear is that if the second wave does come we’ll have the bed capacity but not the knowledge on how to treat patients differently.”
As the hospital begins to deal with a backlog of appointments – the number of those on NHS waiting lists in England is predicted to hit 10 million in 2020 – Fullerton and his colleagues have taken a moment to look back on their time on the front line. “It was a compelling experience to be working with a team of very motivated people all addressing the same thing,” he says. “To be able to say to all the tasks you don’t want to do in life, ‘No, sorry, I’m fighting Covid’, that’s actually quite nice. Already, though, it feels slightly like a distant dream. I suspect that’s your brain trying to compartmentalise the experience and to put it to one side. That said when you do think about them, those memories do burn very brightly.
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