“I thought that the other side of burnout was a mental breakdown; but actually it’s apathy...”

..."I'm so glad to be out the other side of that."

I caught up with O, another classmate from my tropical medicine course in 2014. My paper straw in my iced chocolate disintegrated long before I first tried to use it, as we talked sitting in the sun opposite the 4th plinth in Trafalgar Square.

Since I last saw her, she has specialised in medicine; sub-specialised in gastroenterology and, now fully qualified, quit.

A man, looking very much like Dumbledore, in his red round hat, but without a beard, walked past. The sound of broad Scottish accents lifted from a medium group of people wandering slowly, staring at the gallery roof and Trafalgar pillar. We got asked for directions. “It’s nice having tourists back” she said, as a sun shower passed through. There was a busker, three seperate small protests with a few people sitting on the edge of large posters so they wouldn’t blow away, but apart from that, pretty quiet. 

“I got my Covid from a man who must have been sick with it when I scoped his stomach. It was annoying. But it wasn’t that bad” (Later she described that it took 8 weeks to recover. She worked through. A friend of hers, an ICU Reg, hasn’t returned after over 6months, with long Covid, and has been informed that they have to let her go. Let go from the job that made her sick in the first place...)

Her parents had briefly gone back to Europe in March 2020 to make sure her grandmother was doing ok, “they haven’t returned, but it’s a relief knowing they’re probably safer over there. I never really worried about me, it’s the worry for others that is more real. I was glad to have it early, I was less afraid after that.”

We talked a bit about the sharp dip in numbers - could it really be over already? or are people just sick of testing?

We wandered to an excellent Thai place in Covent garden. “Do you want us to wear masks as we walk to the table?” She asked the waiter.  “No that’s okay; we don’t need to do that anymore”

She’s taken up painting since stopping work; still does shifts here and there, but only the ones she really wants to. “[training for] Medicine’s a cult. It has to change. I couldn't even talk to people about stopping or slowing down, I felt like I had to get through to the end before I was allowed to stop.”

“I was just so tired; but not from the shifts or the hours or the understaffing. I had to get out. I quit before the second wave. There’s this thing called "moral injury"- we were being asked to do things that were wrong. I couldn’t keep doing it”

(More technically: the psychological unease generated where professionals identify an ethically correct action to take but are constrained in their ability to take that action.")

She described the first weeks of panic, and chaos. How the cleaners, the highest risk, were wearing masks but told not to: as they might make people feel scared. And then 10 days later; told they must always wear them. Treating people, smart people, as if they were stupid.

Of being instructed to send people home early. To clear the wards ready for Covid cases.

To discharge elderly home to rest homes without testing them; to units without testing facilities. To units without isolation capability.

“People are going to hold us to account. They need to. They should. We did this. We did this to them.” 

And the sickening quiet; knowing people were at home, potentially dying from strokes and heart attacks, avoiding hospital.

“We worried about that too” I told her.  Cases or not, The start was crazy everywhere. 

“I remember thinking there would be rioting and looting,” I recalled, thinking of all the glass shop fronts in Newmarket, in Auckland: full of product until Level 3 when people were allowed to duck in to their business to pull back the sun faded stock from the windows.

“Yeah it’s amazing that it took so long for people to protest. It shouldn’t really be a surprise that people are at their wits end by now. I hate it when people talk as if the protestors are stupid. They’re not stupid. They’ve been hurt. Their lives have been destroyed. If there’s another lockdown, a lot of my patients will die- they’ll kill themselves and no one will notice or care”

She went on to describe the kind of shift she *is* doing now. Clinics with GPs looking after homeless people. She follows up people with Hep C. Customises treatments. Takes scanners to them rather than expecting them to come in. Talks about alcohol use. Safety. Conversation drifts back to the hospital.

“What do you think should have been done differently?” I asked, expecting her to say something about more PPE, better politicians…

She paused. “Look,I can’t imagine what it would be like to be in charge at a time like this. And Boris; I mean; when he got sick we were all praying he would survive because as bad as he is, his second in command was worse.” She paused a bit longer.

“I think we should have put a lid on the fear. Don’t get me wrong; I was scared too; but uncertainty isn’t new in our job. We should have handled it better. But the fear, and control, threatening people not with their own lives, but their loved ones lives- it broke trust. It made the fear overwhelming”

“Like in the movies when the baddie takes relatives, or the wife/husband as prisoners-“

“Yeah!  There were these stupid phrases like “protect the NHS” we should have been protecting ourselves not asking others to do it.  “Be alert” as if people can see the virus, like what was that, seriously? Every night at 5pm reading out the death toll- what was that supposed to achieve? We watched as consultants left, didn’t return, because they were sick- not with Covid, with anxiety- there were these whatsapp groups that we all had to join for Covid planning that were full of live footage from ICUs overseas- some of it was real, for sure, but not all of it, and cmon, we were doctors: there was an absolute vacuum of leadership and it was replaced by fear. Wrong decisions happened because people panicked. 

And then, to penalise people who have no other way of feeding their own families except to go to work- to fine them and jail them as if being rich enough to get home deliveries and isolate makes you worthy of being well. As if it’s a choice.”

What do you think will happen in the next 7 years? I asked. “Oh man it’s hard to know isn’t it? You think we might learn and things may be more stable but there’s army on the streets in Sydney who would have ever imagined that? Public health can’t work without the public. Why make people even more afraid?”

We circled back, to the people she's met in what is essentially her new job. I know of a church in Auckland thats thinking of installing a shower for the homeless people in their area, I was worried it may be tokenism, not actually useful. "No thats actually really helpful." What else?  

She paused again

"Lockers for medication

An address, like a place they can get mail, doctors appointments sent to

A washing machine and dryer.

It could be any of us. We can't forget that"