Into the unknown...

As I head into London on a deserted train for week 2 of the official "impact of Covid-19" I am full of questions:

- What risk am I taking by working?

- Will I get home if lockdown occurs?

- How many patients today will be potentially =ve?

- How many staff will be working when they should be at home?

- Will today be the day the wheels fall off?

Ultimately like thousands of my peers I go in, business as usual, putting patients first and my own health needs to the background. I am fit and well, I have no underlying health concerns, but I am a mum and my 4 children ask me each day "what if you get it mum..." The thought has crossed my mind of just staying at home - we run a bakery business which is still busy despite all the madness that is going on and I could quite easily focus on that and minimise my own personal risk. But it is engrained in our profession, like so many others - police, firefighters, paramedics, to put our own needs aside and focus purely on the patients.

Last week there were some difficult conversations to witness. Working on a chemotherapy unit our patients are painfully aware of their own mortality and susceptibility to infection, but the harsh reality of Covid-19 is that some big decisions need to be made. Patients were faced with being told by consultants that today would be their last treatment. The risk of continuing to balance outcomes with risk meaning that if they were to succumb to the dreaded "bigger C" there may be no ventilator for them and if so it would likely hasten their death. A horrendous thing to hear when you have been maintaining on treatment - scans showing good stabilitsation to now hear the treatment which to all knowledge is ensuring this, is being taken away because the risk of infection is greater than the risk of disease impact.

Being a private centre we have many workers from abroad - colleagues recant stories from friends in Italy having to decide in war zone conditions, from 30 patients presenting - which 10 do they treat, Colleagues who have just decided to remain in the UK following the uncertainty of Brexit now return to their country of origin as family is what is most important now and work will be found somewhere somehow. Patients that can not fly back to the UK from Europe to see their consultant for review and collect have their course of oral cancer treatment, some have planned ahead and gained enough to see them through but many have not and will be stopping treatment prematurely. Those on intravenous cancer treatment have to acknowledge that there is nothing they can do about the imposed treatment break. Colleagues returning from holidays in ski resorts and sun, having to self isolate until they are sure they are not harbouring the dreaded Covid - deplete our workforce. News that our units and wider units may be used for NHS patients brings interest but also confusion as to who these patients will be and do we have the skills to care for them. No visitors allowed on the treatment suite and so patients starting their first chemotherapy having to do so alone - we will try to support the best we can but it won't be the same as a loved one holding their hand.

The uncertainty for all could be completely paralysing, certainly if I think too much about it I find myself becoming slightly irrational and having to break everything down into small easily digestible pieces. Don't think too far ahead - deal with the information you have infront of you etc etc. I try to limit my reading on social media, hearing the news and such like to once or twice a day, but what if I miss something important? There is an elephant in the room, constantly lurking in the sluice, drug cupboards, bedside and side rooms. It feels like it will pounce on all of us at some point - it's just a question of when.

Schools are closed, yes as a key worker, mine can continue to go in but my husband and I have made the decision that as he works from home, it isn't "essential" that they go in. It astounds me the numbers of people that are taking advantage of the Key worker title and utilising it as free child care - not actually pausing and thinking about the impact it will have eventually. However, I have kept it up my sleeve to the kids - if they treat this as a holiday and don't do home schooling - I will chuck them back in without a second thought!!!

We are told to come to work - we are told to stay at home - PHE advice is extremely clear but employment policies less so and open to interpretation or misinterpretation. We must follow PHE but we also need to earn a salary... many of us including myself are not contracted if we don't work, we don't get paid - the harsh reality and yes a choice but still for some it will impact how honest they are with symptoms no doubt...

And what if I make a mistake - the risk of doing so in such unusual working conditions now, for many, is higher than normal. The NMC tells us they will take this into context but as stress levels increase, blame will also and fear is that as a means to survival the risk of referral increases with it. I can't worry about that now, time to knuckle down and do what I'm trained to do - the best way I can. In the absence of any robust PPE - we make our own...

So, this quiet journey into London is useful - it gives me opportunity to gather my thoughts and prepare for the day ahead. I can mentally plan for the "what ifs" but the reality is all the planning in the world could have never prepared us for the weeks and months that are to follow. Dame Judy Dench and others have succinctly shown us that now more than ever we need to use humour to get through and remember to be kind to each other. Time will tell if we can maintain this long term.

We can do this and we will do this.... to hide is not what we are trained for.. to step up is...

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