COVID-19: At the Frontline

Article by Kasra Razi, ST5 at Darent Valley Hospital.

The past 4 months have been a bag of mixed emotions for me. On the one hand, it has been one of the most anxiety evoking times of my medical career so far. On the other, it has also been one that has helped me grow the most, both professionally and personally.

Having served at the frontline and been recently diagnosed with COVID-19, I think I am more than qualified to share my experience. Over recent weeks, I have had some time to reflect on this period and try to make some sense of it from various perspectives.

A few weeks before national lockdown began and the government decided to take the situation with COVID-19 seriously, my hospital on the border of London called an emergency meeting for all junior doctors. We weren’t too sure of the exact details of the meeting, but we knew it was going to be the beginning of something significant. I don’t think at the time we thought we would be where we are now.

We had started to hear about COVID-19 through colleagues and social media, but the meeting shed some light on what we were about to embark on. It quickly became apparent that this was a very new situation.

We were dealing with very little knowledge of the virus, but we were going to do everything in our power to manage the situation.

Everyone left the meeting as if we were going to war. I attended the meeting as the representative of junior surgical doctors, and it was my responsibility to update the rest of the juniors in the surgical department.

Within minutes of leaving the meeting, various consortiums were created to help share as much information as we could with all of our colleagues. Junior doctors were organising ‘junior doctor COBRA meetings’ to brainstorm ideas about where we could help most.

Within the space of a week everything changed in the hospital: visitors were no longer allowed into the hospital, we had to go through security to get to work and if we didn’t carry our ID badge we weren’t allowed into the hospital. The hospital was divided into clean and dirty areas, and all senior house officers (SHOs) and foundation doctors (FY1 and FY2) working for the surgical department were relocated to help on the medical wards where all the COVID-19 patients were being admitted.

The virus (COVID-19) is like having the flu but on steroids

All these sudden changes meant we had to adjust very quickly, unsure of what was going to happen next. I found the transition from a predictable rota to not knowing what was going to happen the next day very stressful. To add to that, I had friends ringing me for medical advice every day, and I was ringing my non-medical friends to make sure they were OK.

Like many others, I couldn’t see my family for weeks, as my parents were both above the age of 60 and considered to be at high risk of contracting COVID-19.

Sadly, we also had to experience the death of a very well-regarded consultant colleague, whose son was also a close friend of mine. These were some of the toughest days for many of us. For the first few weeks of lockdown, my anxiety levels reached heights I had never experienced before. The only way I got through this period was with pre-and post-work runs. After 10 weeks, I had run more than 500km!

From a professional point of view, a lot changed too. As surgeons it is paramount that we get as much operative experience as possible to allow us to master the art of surgery. All elective surgery was cancelled to divert resources to fighting coronavirus, essentially meaning that my surgical training stopped.

I was worried about becoming deskilled and also missing opportunities to develop new skills in surgery. Looking to the future, I knew that at the end of surgical training, my operative logbook would need to meet certain criteria before I would be allowed to progress to a consultant.

What would happen with our training at the end of all this? Would my training be extended by another 6 months to a year? Normally, most surgeons in training like myself prefer to take their annual leave towards the end of their training year in order to get as much operating time as possible.

Kasra Razi in full PPE

The COVID-19 crisis, however, has meant that any annual leave we had organised over the last few months was unfortunately cancelled. It has been over 8 months since I last took any annual leave and I’m now starting to feel the toll of these past few months. The lack of time to rest and recover is probably why I contracted the virus in mid-June, when the incidence rate was on the decline, rather than earlier, during the peak. The virus is like having the flu but on steroids.

Even after 2 weeks of recovery, I still feel fatigued and easily become breathless after normal daily activities. The on-call shifts often included only me and the consultant, without the SHO taking referrals, which meant that I had to play the role of two doctors and it was pretty tiring.

Several of my colleagues became unwell with symptoms potentially related to COVID-19, which meant a lot of the on-call shifts were vacant for weeks and needed to be filled. So far, I have done 15 extra on-call shifts!

It has taken us some time to adjust to the new theatre attire, too. I remember one evening during an emergency laparotomy I was wearing so many layers, the heat started to build up and the sweat was dripping down my back. I was trying my best to ignore it and mentally overcome it to avoid further delays to the operation, as the person was unwell.

Eventually, however, the heat caught up with me and I started to feel nauseous and nearly vomited into my facemask and, worse still, onto the patient, which would have been a disaster! I de-scrubbed and went for a quick break to cool off and rehydrate before re-scrubbing again.

In a strange way, this crisis has reminded me why I decided to do medicine in the first place

Besides all these new changes, the most worrying aspect of the whole situation from my perspective as a surgeon was the condition in which surgical patients were presenting to A&E.

Patients were presenting with life-threatening diagnoses, often far too late, having stayed at home for days with, for example, a perforated bowel before they felt desperate enough to see a doctor.

By the time many patients arrived with us, they were unsalvageable or severely septic, requiring critical care which could have been avoided if they had arrived sooner.

Kasra Razi (R) and a colleague

To end on a more positive note, in a strange way this crisis has reminded me why I decided to do medicine in the first place. I think I speak on behalf of all our doctors in saying that it has been amazing to see how NHS staff have adapted to the situation and pulled together for a single cause.

Strangely, it has taken a crisis like this to kick the NHS out of old-fashioned ruts by, for example, accelerating the use of digital technology and tele-medicine.

Most importantly, from my point of view, we saw the appreciation of the NHS and its entire staff in countless acts of kindness from the community. Parking fees were cancelled, various discounts were offered, and every Thursday we saw thousands of members of the public come to their doorsteps and windows to clap for the NHS and essential workers.

This war isn’t over yet and undoubtedly we still have a lot to learn, but I feel fortunate enough to have lived through this, come out the other end and, I am sure, developed into a better doctor and person.

Kasra Razi

Kasra Razi MBBS BSc (Hons), PGCE (MedED) works at Darent Valley Hospital (General Surgery ST5) in Dartford, Kent, and gained his medical qualifications at Imperial College London.

He is the co-founder of the British Iranian Medical Association (BIMA), which organises networking, educational and charity events in the UK. Kasra is also a trustee of The Tom Donaldson Charitable Trust: Trust Me, I Will be a Doctor.