James- The Volunteer (narrative) by Rowan Marcus

JAMES – THE VOLUNTEER by Rowan Marcus
James had been looking forward to a well-earned break; he had been on placement for 6 weeks now, and he was exhausted. It was what he had always wanted; he had, after all, just spent the better part of 4 years of his life studying in order to become a trained and registered doctor in a hospital – but a short respite would certainly be welcome before the final plunge into the chaotic world of emergency medicine. 

Then Covid came, and everything changed.

* * * * * * * * * * * *

His graduation had been the first change. Instead of sitting in an auditorium with hundreds of other students graduating alongside him, he had sat alone in his lounge room in front of a screen, finishing his course with a Zoom rather than a bang.

Instead of an afterparty lasting far into the night, he was in bed with the first of the stars, because he needed to be up before the rising of the sun. Like many of his fellow students, he was now in between the end of his course, but before attaining the registration that would allow him to practise, and be paid as, a doctor. Along with many of his fellow graduates, however, he had volunteered to return to the same London hospital in which he his placement had been, to help with the current crisis. He had a very early start in the morning.

James might not be officially registered yet, but he had all the training required, a small handful of experience, and could assist the registered doctors and nurses where others could not.

“If I can do something to help, why not? I would only be sitting at home otherwise,” he had responded to his mother’s objections. Outwardly she was worried about the risk of him becoming ill by entering the Covid wards, inwardly she was also proud of his decision, and altogether torn between the two.

* * * * * * * * * * * *

James began his shift in what was known as a “Clean Ward,” the part of the hospital dealing with patients who were not suffering with the virus. Working under the supervision of a registered doctor, he was able to see a number of patients and take the pressure off the enormous load on the “Covid wards,” the part of the hospital consumed with the fight against the virus.

Three patients that day turned his experience upside down: 

The first was a woman who had come in walking in with great difficulty. Under the watch of a registered doctor, he examined her and was able to conclude she had suffered a stroke. She had delayed coming in by several days, and it was evident in her difficulty in moving. The damage, now delayed, might well be permanent.

“You really ought to have come in straightaway,” he remonstrated. “We could have done so much more…”

The woman gave a jumbled explanation about not wanting to be a burden, and also being worried about catching the virus. James and the doctor looked at one another and could not hold in an exasperated sigh.

The next of the three patients was at completely the other end of the spectrum; he marched in through the Emergency doors, clutching his jaw and announcing, with utter lack of medical expertise, that he had the virus.

“An entire hour lost,” James muttered bitterly. With the patient’s declaration they had needed to clear the entire medical bay at once, removing all the patients, and wait for it to be deep cleaned by the cleaners. It was only after they had gone to all this trouble, that the man explained that he had a toothache, and was worried he might have the virus because he had a slight fever. His fever was, in fact, nothing more than an almost imperceptible rise in temperature, caused by the pain he was in.

“Thank you, Glennys,” said James as they all filed back into the room, and the cleaner emerged, on the verge of racing off somewhere else. James watched her walk unsteadily away, and a look of concern spread across his face. Glennys did not look right. Knowing she often worked on deep cleaning in the Covid wards, he made the decision to go after her.

“Help!” his walk across the bay to follow her was interrupted by an urgent call from the desk, and he turned to see a new patient, who unlike the man with the toothache, looked in genuine medical emergency. He was barely able to keep himself upright, and was coughing wildly as he called for assistance. Glennys, alas, was gone, out of sight and mind, as James worked to deal with assisting one of the registered doctors in examining the young man.

It took some five minutes just to find out the man’s name and to get the briefest sketch of his condition, as he was wracked with regular violent fits of coughing, and when he was able to recover from those, he had to stop after every few words to catch his breath. Once again, the ward had to be evacuated and deep cleaned, but for this time with good reason: this young man had Covid-19.

* * * * * * * * * * *

“Scrub up, you’re on the Covid ward now,” James was informed. He had been detailed to take the patient to the appropriate ward, and now he was being roped in to working on the ward himself. 

Usually patients who came in with Covid were brought in by an ambulance, as their conditions had by then become so serious that their symptoms were life-threatening. How the man had managed to walk through the Emergency Doors under his own steam James would never know: but once in, James doubted whether this man could have walked the few feet across to the waiting room seats. James had commandeered a wheelchair, and brought the patient to the Covid ward. And now, he was required to stay.

“Just the way it is,” he told himself as he held his hands under the water, turning them over and over and rubbing soap into every pore. The hospital was so busy with this crisis that everyone had to be flexible; he had to drop what he’d been doing and work here, and the registered doctor he’d left behind would have to make do without an assistant clinician.

James washed his hands, and washed them again, and then, feeling uncertain, went back and washed and scrubbed a third time. He then hung a large paper apron around his shoulders, and over his head went a mask. Not the small face masks the public wore, that fit snugly over the mouth; this was a huge plastic visor, a large plastic shield covering his whole face and looking like something out a police riot kit. In order to draw away somewhat from the intimidating visage presented by this full body protection, he took a marker and wrote his name across the apron, with a large smiley face below; and just for an extra touch, drew it winking.

“Have you ever worked in Intensive Care before?” he was asked by the doctor who ushered him in through the doors into the Covid ward. He nodded, about to say that he had spent time here during his internship, but the words dried on his lips. The ward was unrecognisable. There were easily five times as many people as there had been before. The part of the hospital he was now in, actually, had not even been part of the ICU previously; it had been the Recovery Ward. It was almost as if the Intensive Care Unit was slowly absorbing the rest of the hospital. 

The Covid-ward was filled with the wheezing sound of ventilators breathing for people who could not, and with the ceaseless click of work shoes on the cleanly polished floor as doctors and nurses rushed back and forth to help the patients.

The worst of it was, that there was no real treatment except to fight to give the patients more oxygen, to do the most to enable their own bodies to resist the virus. One way of doing this beyond the assistance offered by the ventilators, was to turn the patients over every few hours. This had to be done for them, because patients on the ventilators were all sedated. James did not need to ask why; in order for the ventilator to deliver oxygen to the lungs against the aggressive attack of the virus, patients had to have an endotracheal tube fitted, a tube leading from the machine and going right down into the throat.

“I wouldn’t want to be awake, either,” he thought to himself. One of his regular tasks that day, then, was to help turn the patients over in order to encourage the flow of oxygen to the brain. Turning over a full-grown man was no easy task, especially when one had to take special care not to disrupt the operation of the Ventilator, even for a moment. It usually took about five of them, and it was a exhausting task.

The next few hours were a blur of busy activity, of intubations, reading charts, turning over patients and running errands for doctors. His nascent headache had given birth to a full-blown migraine, fed by the ever-increasing pressure caused by the heavy visor hanging over his head. Every moment James believed he could not go on to the next, but in the next second he believed the same about the coming moment, and yet somehow he just kept moving through each of them. He was certain that he was not managing well, struggling to keep up with the pace, but if he could only have stood outside himself, he would have seen a complex ballet of movement, in which all of the participants including himself simply got on with it.

Finally, what turned out to in fact be 12 hours later, James walked out of the hospital – and he would be doing it all again tomorrow. By the end of the week he will have done a good 60 hours, almost twice that of many jobs. Today was meant to be his rostered day on the Clean ward, but that would mean nothing tomorrow – he would still have to complete his scheduled shift on the Covid ward.

For the next few hours, at least, he could place his head on a pillow and leave the world behind.

CONCLUSION

Whilst James is not real, the elements of the story are all true. Some people come in to hospitals presenting with minor ailments that could be managed from home, and place an unnecessary burden on an NHS in crisis; others who have very real problems and who genuinely require attention, have in some cases been delaying treatment for fear of infection.

The volunteering of final year medical students is also a very real phenomenon, and this cohort represent another group of unsung heroes in this time. These young men and women, having completed their degrees but without the registration to be paid for their work, have volunteered to go in to the Covid-wards and use the knowledge and experience they have gained to help flatten the curve of the virus. Both they, and the registered doctors and nurses, regularly work 12 hours a day, and often as much as 60 hours a week, in order to keep the wheels of medical attention turning.