Generations: a covid conversation

‘Game Changer’ by Banksy. It appeared on a wall in Southampton General Hospital, May 2020.

 

The year is 2052: a 17-year old asks her grandfather about a career in medicine.

*

‘Hello Jess. Your Mum said that you were thinking twice about medicine. What happened? You were so keen when we last met.’

‘I was reading about the pandemic of 2020. The deaths. The doctors who died, the nurses. And it was all so… tragic. There are other jobs I could do. Mum asked me to talk to you. So you could talk me out of changing my mind, I guess. So here I am. All ears!’

‘Okay. That’s fine, I’m happy to chat, but it’s not so simple. I’m not going to try to persuade you one way or the other Jess.’

‘Then just tell me the truth. What was it like? What did you do?’

‘Oh, I wasn’t on the front line day after day, I was lucky. But I was there. The covid-19 pandemic of 2020 crystallised all that is good and bad about being a doctor. Many questioned their decision to become one during the worst of it, especially those who were exposed repeatedly to the grief of others, but of course they had no choice but to attend to the sick. The power of duty was too strong, even when doubts grew over the quality of personal protection. When doctors and nurses began to die, that fear grew even stronger, but it was never strong enough to counteract the duty to care. Every single healthcare worker felt fear. Very few, if any, turned away.

‘But Jess, it was not a wholly negative experience. That may sound callous, but if you want to be a doctor you must understand how working in close proximity to pain, suffering and loss must, in some way, prove fulfilling. Remember, before and after the pandemic, there were other diseases, equally cruel and capricious in their choice of victims. Covid-19 was the cruellest, in the way it chose the frail and the elderly, and, for complex reasons we eventually came to understand, the poor, the overweight and those from minority ethnic backgrounds. It was as though the disease made a conscious decision to hold a mirror up to our society, asking hard questions in a shrill voice about the extent to which it valued those groups. And later, there was a judgment of sorts. As you know, the government fell at the next general election, even though we had ‘won’. Rather like Churchill, who led us to victory but was expelled in 1945 after the second world war, our leaders during the pandemic could not escape blame for the great cost in life and wealth. A new voice was wanted. It was ironic, the prime minister worshipped Churchill. But I bore you!’

‘No Grandad, you’re not. You were talking about the positives.’

‘Not all doctors are fortunate enough to live through the emergence of a new disease. Doctors are inquisitive, they investigate, they like to make observations and find patterns. Covid-19, with its unexpected manifestations and subtle presentations, afforded many such opportunities to doctors, not just academics and laboratory scientists. Family doctors noticed rashes, blood specialists analysed its effect on coagulation, neurologists reported new syndromes, kidney doctors, gut doctors, heart doctors, palliative care doctors… they all contributed to the cathedral of knowledge that we know beleive is complete.  We lived on a high, speeding wave of knowledge. For some, it was exhilarating, even though they experienced fear and watched colleagues succumb. Those who worked during the early days of HIV – it’s been eradicated now, you’ll need to read up on it – must have experienced something similar. But that was over seventy years ago, and I was still at school. They were part of the story, even if they were not personally involved in defining the disease or finding a cure. In the same way, we were part of the story of coronavirus. When, if, you become a doctor, you may have the privilege of treating patients with a brand new disease. It is innervating.’

‘Is it true that people stood in the street and clapped for the doctors and nurses?’

‘Yes. They clapped for everyone in a caring profession, in fact anyone who worked in any capacity for NHS1.’

‘Who started it? The clapping.’

‘I have no idea. Someone on the internet probably. You see Jess, when life was normal, and NHS1 was dealing with everyday diseases like cancer or heart disease or bacterial infection, doctors and nurses were already well respected, but that respect was not displayed overtly. Doctors (I’ll focus on them for now) were rewarded well in a number of ways, and didn’t need daily reminders of their virtue. But during the pandemic, that respect found a voice. Every Thursday at 8PM people came out onto their doorsteps or balconies and clapped for five minutes, or they banged saucepans or beat drums. It was a sight, to see the people on your street lined up like that.

‘Some of us were cynical, saying it was a government ploy to distract from their failures or to smother criticism with a feel-good blanket, but those who clapped were not part of a conspiracy. They meant it. As a doctor, it brought home how special your job was. That feeling was emphasised when you went to work in the morning, on an otherwise empty bus or train. Only you and a few others, those whose jobs were essential – the key workers. The feeling of specialness could go too far. All jobs are essential, otherwise they would not have been created; they are essential to someone… the waiter to the hungry customer, the film-maker or the writer to the lover of culture, the accountant to the businesswoman. We need all of them. Doctors are not intrinsically better, but during the pandemic, society had an acute dependency on healthcare workers. Society relied on the doctors and nurses to get up in the morning and go to work, even knowing that they were putting themselves in danger.

‘When the pandemic was over, that sense of specialness, I won’t say heroism, persisted for a time. It’s largely worn off now, the old arguments over pay and conditions have been rekindled, many governments have been and gone, NHS2 was invented – like it or not – and the economy has fluctuated, but those who worked during the pandemic remember how, deep down, society does value us. You will sense that value, if you choose to study medicine.’

‘But what if there is another pandemic? I don’t want to run the risk of dying. I want to have a choice, to be able to say no, I’m not happy with the protection or whatever… can you say no, if you are a doctor?’

‘This is the calculation you need to make. I would say no, you do not have a choice. Like the policeman wondering whether to enter the dark alley, or the firefighter outside the burning house, or the soldier on the field. The privileges you win come with a hard duty, to attend to the sick according to the conditions set out by the state. Of course, if those conditions are obviously inadequate, you have the right to protect yourself. But if it is a question of degree, yes, you will have to step up. It may never happen. And anyway, we are better prepared now. There’s a good chance your career will go unblighted by danger. But remember, with the danger comes a true examination of what is important, to society, and to you. I’d do it again, if I was in your position.’

‘Did you catch it Grandad?’

‘Yes, I caught it.’

‘Is that why you have a scar on your neck? From the breathing tube?’

‘Never mind that. So, have you decided?’

‘I don’t know.’

‘No. I don’t expect you to know. Just think about it, that’s all. The decision you make will be the right decision, by definition.’

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