DR MATHEW WELK

CONSULTANT ORTHOPAEDIC FOOT AND ANKLE SURGEON

Royal National Orthopaedic NHS Trust

I am a consultant orthopaedic foot and ankle surgeon, working at the Royal National Orthopaedic NHS Trust in Stanmore. This is a tertiary referral centre for complex orthopaedic problems. We usually deal purely with elective (non trauma) problems such as arthritis, deformity and neurological foot and ankle disorders.

When the Covid-19 pandemic began, all elective surgery was cancelled across the NHS and private sectors. The RNOH transformed from an elective centre to a trauma centre overnight, for the first time in its history. This involved an amazing feat of intrastructure transformation, from IT, to surgical equipment, ward reconfigurations, surgical team restructuring etc. We delivered consultant lead orthopaedic trauma care, with a socially distanced meeting each day to prioritise the cases by urgency.

The highs were working in a fantastic team, delivering an essential service to take trauma from all the surrounding hospitals, freeing up their bed base for Covid-19 patients. The teamwork and sense of achievement were outstanding. The support from local charities providing food and equipment was heartwarming. The lows were working outside of your usual comfort zone, in an environment fraught with risk. Whilst the country was on lockdown, we were at work every day in a busy hospital doing our best to keep ourselves, our families and our patients safe.

What was the hardest or most frustrating part of your job?

It was hard to work outside of your normal comfort zone, dealing with a case mix we were less used to. This extended across the hospital, from the surgeons, to the theatre staff, to the nurses caring for the patients on the ward. To operate in full PPE was also a huge challenge. The masks were painful to wear for long periods, and the visors made vision difficult. The layers were exceptionally hot. We experimented with different masks to overcome some of the difficulties. One such adaptation was a snorkel mask with a 3D printed connector to a HEPA filter. This sadly didn’t work as the condensation was a problem (and looked ridicuolous!)

The most frustrating, although fully understandable, were the large delays between patients in theatres as the theatres were fully cleaned, the PPE safely removed and put back on again, and the patients safely recovered after their operations. This was the case country wide and was unavoidable to keep patients and staff safe. My anaesthetic colleagues dealing with the airways of patients potentially carrying Covid-19 were exceptional in their bravery and professionalism.

How do you think the country coped with the pandemic?

The lockdown was well respected in our area. The hospitals were exemplary in their work, quickly increasing capacity and reconfiguring. The Nightingale centre has come under criticism for its cost and lack of usage, however in my opinion it was essential to have it as an insurance policy in case the numbers escalated beyond the capacity. The loss of many lives and the economic consequences are huge, however people pulled together to help others and community spirit was at a high. It is easy to criticise and feel the country should have locked down earlier, however each country is different, and I have colleagues in public health who were tirelessly evaluating the evidence to try and make decisions at the correct time to maximise the efficacy, without the benefit of hindsight.

What has been the biggest impact on your personal life and why?

My children have clearly missed six months of schooling and at eight and six years old this has some social impact. On a positive note, having more time at home with the family with less commitments, allowed us to spend some really lovely family time together.

When do you see things returning to ‘normal’? Or do you think they never will? That depends on whether we find a vaccine, and the extent the treatment of the virus improves. Certainly intensive care colleagues of mine speak of just how ill the Covid-19 patients on intensive care were with multi-system effects, however the understanding of the virus and treatment of these patients is improving.

It is hard to predict a second spike, and the extent of local lockdowns in the future. I am anticipating a year to eighteen months before things start returning more to normality.

Are you keen to return to life the way it was before the pandemic, or have you reconsidered a change in your lifestyle or even career as a result of it?

I am keen for my work life to return back to before the pandemic, to be able to operate on people with life limiting foot and ankle conditions without fear of causing harm secondary to Covid-19.

Did you experience lockdown and if so, to what extent? How did that impact your work?

My father was hospitalised with Covid-19 so due to contact with him I had to isolate at home with my family for two weeks. My pregnant wife and two children abided lockdown instructions throughout. Whilst they were on lockdown and I was at work, I would have to sterilise myself and change at work, prior to coming home to minimise risk of transmission. I was especially concerned about passing it to my wife in pregnancy and how it might affect her and the risk of vertical transmission to the baby. Thankfully all was fine and our son is now a few months old!

I am keen socially to be able to go to restaurants and to pubs without restriction. I am keen for social interaction to return, rather than to live a virtual life on Zoom and Microsoft Teams! I certainly feel some aspects are here to stay, and for me virtual consultations and meetings are likely to play a part in my day to day life to some extent.

Has anything positive come out of the Pandemic?

Kindness and compassion to others, and time spent at home as a family are positives.

What do you miss most about MHS?

I am still in touch with many of my friends from MHS and we all miss the time we used to spend together at work and at play. I miss the time we had to play sport and the excitement and anticipation of what lay ahead!