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Congratulations… you’re a doctor now. Best wishes, Coronavirus.

School’s out. Forever. This week has been a surreal experience. 

Just like that, this Thursday we received an email from the head of the School of Clinical Medicine. Our final clinical exams: cancelled. All thanks to COVID-19.

For all intents and purposes, we’re doctors now.

I’m pretty sure cancelling final exams is totally unprecedented (at Cambridge, of all places). Maybe it happened during the Wars. But it’s a major step: an indication of the very real threat posed by coronavirus.

The email we received – with the conspicuous heading “Covid-19 URGENT information – YOU MUST READ THIS EMAIL” – sounded sombre and ominous:

Following on from my e-mail last weekend, the Covid-19 outbreak is now becoming a serious threat to public health, and as clinical medical students you are in a very special situation.  I am extremely sorry to have to inform you that your medical educational programme is about to be significantly disrupted, and that includes Final MB Part III exams…

… Look after yourselves and your loved ones.

Best wishes,

The Dean

Upon hearing about the cancellation, the knee-jerk reaction amongst us final years was to celebrate – none of us had ever had an exam cancelled, let alone the very final exams of medical school. We congregated outside the hospital’s education centre and congratulated each other: we were 2020’s batch of incoming junior doctors.

Before the whole thing happened, if anyone had asked me how I would feel if our exams were cancelled, I would’ve said something like “elated” or “relieved.” All the stress of revision, gone. A weight off the shoulders. Best day ever, right?

Wrong.

Those feelings rapidly dissipated. Then, the first pangs of numbness and emptiness set in. Like claws, they raked away that sense joy. We stood in a little circle, mute in utter disbelief.  We had come in that morning none the wiser. All of a sudden, all our journeys were over.

We had all been working so hard. So, so hard. We were weeks away from graduating. From making years and years of toil, over thirty exams, countless hours spent in the library… worth it. The culmination of huge amounts of work. Sure it was stressful, but the payoff would be worth it. But now we felt short-changed.

The Clinical School team must have had spent several agonising hours discussing the pros and cons of each course of action. Indeed, looking back, did they have any choice? The clinical exams are a mixing pot of doctors, patients and students. Patient safety is paramount, so exposing patients to infection risks which aren’t strictly necessary is a big no-no. Plus, many of the examiners are senior clinicians who might be needed on the frontline.

The psychological effects of this weeks’ events will take a while to sink in. I don’t think I’ve ever felt such a mixed set of emotions and it’s going to take me some time to work through them. My worry is, given all the stress and uncertainty, I’m not going to have much time to do that. Burnout is a very real thing, and I’m nervous about fizzling out.

Sometimes, medical training can feel like an escalator. You get on and generally, you don’t ever get off. You’re constantly thinking about the next destination. You don’t take time to stop and think: “Wow. Look at what I’ve achieved.” I was hoping graduation would give me that pause. The mental space to process everything that’s happened over the past few years. That respite has gone now.

In the meantime, the mind invariably turns to the future. We’re going to be doctors very, very soon.

Everyone graduating from medical school has some sort of crisis of confidence. A.J. Cronin put his best in his novel The Citadel, as the main character, Dr Andrew Manson, deals with his first unwell patient:

… as he approached the bedside with a fast-beating heart he felt, overwhelmingly, the significance of this, the real starting-point of his life. How often had he envisaged it as, in a crowd of students, he had watched a demonstration in [the] wards! Now there was no sustaining crowd, no easy exposition. He was alone, confronted by a case which he must diagnose and treat unaided. All at once, with a quick pang, he was conscious of his nervousness, his inexperience, his complete unpreparedness, for such a task.

But the ‘usual’ levels of nervousness have been compounded. First, there is a palpable sense of stress, urgency and uncertainty amongst the entire hospital. The mentors and senior clinicians – usually bedrocks of skill and confidence – seem shaken. The junior doctors are unsure where they’re going to be from one week to the next.

Second, the strain that the health service will be put under means training and supervision will likely suffer. The anticipated influx of cases of viral pneumonia will require immense levels of effort to deal with. What happens to other clinical areas and all the ‘usual’ medical emergencies? Will newly minted doctors be expected to hold the fort, and if so, how? Will I be able to get help when I need it?

A vortex of uncertainty has swallowed up any plans for our imminent futures. Are we going to be sent home from our placements? Will we be spending weeks out of clinical medicine, de-skilling before we start our jobs in August? Will we have to start work early? No-one has the answers. The cognitive effort of tossing, toing and froing between all the different possibilities, is exhausting. So is the thought of the immensity of the tasks we will face as new doctors.

My thoughts have also turned to graduation. The last, big occasion where our whole year gets together to celebrate everyone’s monumental achievement. Finishing a medical degree is nothing short of a gruelling marathon, and at the risk of being self-indulgent, it deserves a bloody good send-off. Surrounded by family, close friends and the teachers who have guided you along the way. The thought of letting go of that is painful.

In amongst the fear and doubt, there is a core of warmth, comradery, support and compassion from colleagues and friends: medical students, nurses, junior doctors, registrars and consultants. I feel solidarity with all my colleagues, and I hope they feel the same about us final years as we are thrust into the deep end. We are one team.

Whilst we can, many of the final years are resolute to continue going in and helping out. The NHS is on the warpath and the enemy is coronavirus. Our most precious institution is going to need all the help it can get. The power of everyone coming together is needed so we can weather this storm.

We’re ready to give something back.

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