Dominic Pimenta - Duty of Care : One NHS Doctors Story of Courage and Compassion on the COVID-19 Frontline

For Dilsan, Ayla and Zach

CONTENTS

Calm waters

I have had the same recurring dream since early childhood.

I am standing on a beach, curling my toes into soft, warm sand like fine brown sugar. The sky is an endless, untouched, pristine blue. Families and couples dot the shore. Sometimes my own family is there with me sometimes my parents, sometimes my wife and kids and sometimes no one at all.

On the horizon, the sea and sky merge in a blurry haze. As Im staring out across the water, something moves. I strain to see the distant event, my eyes ache and my chest knots, as the horizon lifts and swells. Bigger and bigger, a black wall of water rises and rises. Sometimes I shout and no one moves, sometimes we stampede away from the shore, sometimes I can do nothing at all. The wave gets closer and closer until it plunges the beach into darkness and fills the world. Sometimes it hits. Sometimes, just as its about to, I wake.

This time, I wake from the dream with my heart racing well over 150 beats per minute. As a heart doctor, a cardiology registrar, Ive started to wonder if this is some sort of nocturnal arrhythmia, pounding in my chest. I try the manoeuvres I ask of my patients forcing my breath out with mouth closed and nose pinched, splashing my face with water and even the ones I do myself, like massaging my carotid artery as it pulsates at the angle of the jaw, trying to trick the knot of autonomic nerve tissue there into resetting my heartbeat but nothing settles it, except time.

My wife, Dilsan, mutters something and rolls over. Its 5 a.m. and my alarm is about to go off anyway. Our two kids, Ayla and Zach, could go off at any time from now until 7 as well. I get out of bed, shower, get changed. Despite my shuffling about and our creaky floors, no one is up yet. At 6.30 a.m., Im out the door. Its the middle of January and its still pitch-black. A brisk walk on icy concrete, pit stop at Costa, and Im plonked on the tube, winding my way through the bowels of London to my job at a specialist heart hospital.

Trying to avoid social media, I use the hour-plus commute to learn some coding or to write, putting some words together for one of the newspapers I occasionally contribute to or sometimes just jotting down some nonsense. I work on my Notes app on my phone, penning whatever the flavour of the day happens to be: a novella about a Frankenstein-like child that grows into an insatiable, power-hungry tyrant; a childrens book for my daughter about a detective hunting lost triangles; or a memoir Id mothballed after probably too few rejections. Meanwhile, the train skips and whispers through the stations.

I jump up the stairs of the hospital, usually still attached to my phone, picking up another coffee if I have a free voucher, and then through the doors to cardiology, a large unit on the top floor. Im there at 8, or earlier, on days Im on call. We have multiple subspecialty departments of cardiology, each a centre of excellence in its own right, and as a middle-grade doctor, half-way through specialist training, I rotate through all three. My last rotation, specialty cardiology, is where everything that doesnt involve inserting stents in heart arteries (specialized tubes designed to keep the arteries open) or dangerous heart rhythms ends up.

The handover from the previous shift takes place in a tiny room for the nurses, plus me and one doctor more junior than me, a Senior House Officer (SHO). The night nurse in charge will rattle through the list of patients their histories and plans, any problems or updates, and who might fall or have an infection. They occasionally intersperse the handover with a joke or a jibe, usually at the expense of another hospital tribe for example, referencing difficult radiologists, the slow porters or the hard-headed surgeons and cardiologists. Most nurses will spend their working lives on a single ward, and many of them have worked together for over a decade. They are a family of sorts. In those handovers, as junior doctors, we are ever the interlopers, and just as we begin to know names and faces, we often move on.

The handover breaks up and we start the round. The consultant (the senior doctor, who has worked their way up through their chosen specialty) for that particular week will join us most days, sometimes to see every patient and sometimes for a quicker review of the new patients. We make our way round at what an old boss would call a physicianly pace. You can do medicine good, or fast, she would often say, but you cant do both. Our professional personas are patchwork cloaks of the seniors we have learnt from and the mistakes we have made, and this one got sewn into mine. Another boss, another patch on the cloak, would always go through every single aspect of each patient every day: history, blood tests, ECG, chest X-ray, vital signs, patient symptoms, examination, plan and review. These are the examples I try to live up to, but its a lot harder than it looks.