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Slowing to a Stop

Last weekend, my suspicions proved correct: it was announced that all restaurants, pubs, clubs and gyms should close. It was my first taste of lockdown, in its diet form.

Cafes were still open, but all the seating had been removed. I visited my favourite coffee shop on Saturday morning, to find it hollow, both literally and figuratively.  It’s seldom less than full every single weekend. The punters usually froth over onto the street, loitering outside, gossiping and chatting away. Now, it was empty. The only noise was the hoarse growl of the coffee machine as it brewed, and from it, the bitter wisps of freshly brewed coffee diffused freely throughout the shop. When it stopped whirring, there was a dense silence, interrupted only by the barista walking over the creaky floorboards to the till.

She smiled, more of a simper, and informed me that I was her fifth customer. “I’m guessing soon, we’re gonna be closed up,” she said, demoralised. “Even the pastries look sad.” She gestured over to the pile of pain au chocolats and croissants, usually cooked to a delicate golden brown. Today, they looked unusually pale, sickly and lacklustre.

Cambridge had slowed down but hadn’t yet stopped completely. When outside, we were advised to give each other a wide berth of two metres. This created endearing yet awkward encounters – a gauche smile or a mumbled sorry as you tried to respect each other’s voluminous state-mandated personal space. The stranger who would have otherwise just passed you by now confronts you, in a stilted social dance.

Walking around, the stillness was all but pervasive, blanketing most of the city. The din of car engines, which usually makes up the background music to life in a town, was muffled and quiet. The hums of productivity – from the pitter-patter of feet to the echoes of conversation – were now mute.

You don’t just notice the things that are absent. Your attention lands on things which have always been there, persisting in the background, but had now become more apparent. It was the mellow song of the blackbirds; the rustling of the Ash tree caressed by the breeze; the waveforms of shadow projected by the radiant sun. If you pause, it’s easy to let the spotlight of your attention wander from one thing to the next, carried by the wind just as a leaf floats, settles, and then drifts away.

Walking back to my flat, I passed the Cambridge Botanic Gardens. At this time of year, it is truly glorious: a selection of the flowers have effloresced in the spring sun. They proudly effuse their scents and display their colours amongst the trees and ferns. I have always thought that maintaining these gardens is a truly nuanced art form, striking a balance between allowing a plant to express its natural beauty, together with careful cultivation by the human hand. It has been a haunt of mine ever since I was an undergraduate – I have yet to find a better way to decompress after a hellish week of lectures or exams than to wander in the gardens.

Within one-hundred feet of the entrance, it became apparent that people had congregated to visit the gardens that day – understandably so: everywhere was closed and the weather was positively inviting. The allure of this sanctum had drawn big crowds. The problem was immediately apparent, for all the efforts to maintain social distancing elsewhere were being scuppered by the congregations of people. Needless to say, the following day it closed.

On the Monday, I spent all day indoors save for a brisk run in the afternoon. I had read online that there would be a state of the nation address at 8:30PM. After dinner, my flatmate and I sat around the television five minutes early, catching the tail end of Eastenders. Anxiety, anticipation and excitement are close bedfellows, and I was feeling all three. I imagined, just over 80 years ago, an analogous tension palpable as families gathered around radios across the country listening to a declaration of war.

At 8:30PM sharp, in classic BBC style, a backdrop of a bare, coniferous forest flashed on the screen, with the logo ‘BBC one.’ The chirping of birds was audible in the background; the only noise for a few seconds, and then the announcement:

“There now follows a ministerial broadcast from the Prime Minister.”

Then, before us in our living room was the Prime Minister, facing us, solemn and stern. His trademark scruffy hair had been patted down so the strands, although still stubbornly angulating outwards from his head, at least faced the same direction. His eyes were circumscribed with a dark, venous hue, betraying his tiredness and exhaustion.

Like a schoolmaster of old, he sat behind a wooden desk and stared down. The Union Jack behind him drooped, weary. Its colours, although clean and sharp, seemed drained. Nevertheless, its presence invoked pangs of national pride: we are a nation self-assured in its fight against this unseen foe.

Boris Johnson’s prior history of unconventional behaviour and frivolous escapades means he is hard to take seriously. On this occasion, however, the gravity of the situation was apparent in his first sentence:

The coronavirus is the biggest threat this country has faced for decades, and this country is not alone. All over the world we are seeing the devastating impact of this invisible killer…

After his preamble, explaining the basic idea of ‘Flattening the Curve,’ he delivered a stark ultimatum.

A single message: you must stay at home.

It was a message we had all heard before, but seeing it on a national broadcast, in its simplest terms beamed straight into your living room, was reaffirming. It was clear what we needed to do.

The PM’s announcement signified that the UK was now in lockdown. You could only leave the house for four reasons – shopping for necessities, one form of exercise a day, medical needs and travelling to and from work when it is absolutely necessary. The latter point created some confusion, as the term ‘absolutely necessary’ needs some point of reference. Is that absolutely necessary for the government? Or is it absolutely necessary to feed your family? Indeed, for several days afterwards, builders were still working on construction sites. Matt Hancock later made some confused attempt at clarification, saying that ‘absolutely necessary’ referred to jobs where it isn’t possible to work from home, rather than a job critical to the functioning of the country.

The effects of the restrictions were manifest immediately. The following day, the streets were no longer just quiet, they were deserted. The noise of traffic was now absent. Joggers’ rhythmic steps would occasionally punctuate the silence, echoing down the street. The older bicycles would clunk past as their gears rattled and jolted, with the mechanical whirring now audible far and wide. The noisy commotion of wood pigeons fighting would now resonate from the tree canopy.

There were noticeably more police, although still few in number. In his announcement, the Prime Minister had given the police the power to fine people who were outside for no good reason, and to disperse groups of people. Although my description sounds like something you would expect to see in a fascist police-state, it doesn’t feel like that. The arrangement seems to work based on mutual goodwill rather than any heavy-handed enforcement of the rules.

When you are compelled to stay at home, with nowhere else really to go, it no longer feels like a refuge. It becomes a space where you just exist, your life confined to a discrete number of rooms. I became mindful of the little flaws around the house that I hadn’t noticed before – the chips in the wallpaper, the dust in the spots I had missed, a single cobweb on the lampshade.

After a couple of days, the air takes on an unusually stale quality. It feels thick, dry and tasteless. Opening the window to let in some fresh air provides some respite. I’m lucky enough to have a south-facing window. Each day, around lunchtime, I could sit in the sun and feel pulses of its heat bracketed by cold, frigid breezes.

Isolation is also surprisingly tiring. I found myself ruminating about what to do, how best to spend my time, what (if any) ‘new skills’ I should be learning. I felt like the physical confines have also begun to confine my mental workspace: my thinking has been slower and my affect blunted. I think, in part, this mental sluggishness because I’m spending less time with my friends. I call them frequently on video chats, but in the transformation of their speech and image into bytes and pixels on a screen, some of the intimacy also percolates out. The stimulation of face-to-face conversation just isn’t there.

Physical escape from the house was in the form of a single dose of state-approved exercise – usually a run or a walk, and the occasional trips to the supermarket. Even when I’m out for a jog, I still feel compelled to stay inside: in part from the social pressure – it feels like you’re being watched from the moment you step out of the door – and in part due to anxieties about contracting the virus.

Aside from the seismic shifts in everyone’s way of life, this week also saw some progress in the final few steps for me to become a junior doctor.

As a final year medical student, there are two things that need to happen before I can qualify as a doctor: the first is graduation from medical school, and the second is pre-registration with the General Medical Council.

It had become apparent in mid-March, following the cancellation of our exams, that the first step – graduation – was being expedited. This Tuesday, we received a communique from the Clinical School detailing the work they were doing to prepare us for early graduation. They were going through all our files, checking we had met all the requirements various august bodies (like the GMC) stipulate before we can receive our medical degree. I expect to hear the result of this early this coming week.

I still haven’t fully recovered from the disappointment of not having a ‘proper’ graduation. Coronavirus meant we were all graduating in absentia – the COVID cohort was leaving through the back door. I also felt sorry for the staff – the teachers, supervisors, and deanery team – who wouldn’t be able to say their farewells to a group of students they had guided through the clinical medical course. I hope, when all this settles down, we will be able to reconvene and celebrate making it through these dark times.

The second step, pre-registration, was more ambiguous. It seemed inevitable that we were going to be pre-registered soon – or at least, sooner than normal – but there hadn’t been much concrete information. Some medical schools had already been asking their medical students to sign up to help support the NHS’s front lines, without any pre-registration. Trusts in London had supposedly been drawing up contracts so final year students could get to work as soon as possible, which made it sound like pre-registration could be around the corner. The rumour mill was in overdrive, with different messages being broadcast from all over the country. 

In the same email outlining our early graduation, the Dean detailed some of the national efforts that were being made to create posts for final year medical students. We were told that a ‘pre-F1’ (F1 being foundation year 1, the first year of being a doctor) post was being created and that we would hear more about this soon. For now, we were told it was a

…paid, supervised roll being nationally designed.

To take part in the pre-F1 scheme, you’d have to be pre-registered, but beyond that, we knew very little. The clinical school, to their absolute credit, had always been prompt and clear in their communications – as much as they could be, given the rapidly moving nature of the whole situation. I resolved to sit tight, and wait to hear what the next few days had in store.

Later that same day, I received an email from the West Suffolk Hospital, where I had been on placement up until recently. We were told that we could volunteer, or accept

… a band 2 contract for those of you interested in paid work.

The band 2 role would be similar to that of a doctor’s assistant (which is usually band 3 or 4, by the way).

This was confusing, given the email we had received from the Clinical School earlier that day. It wasn’t at all clear whether this was the same thing as a pre-F1 post or something entirely different. In our group chat, feelings were mixed, with some wanting to respond to the offer and others wanting to hold back. I was of the firm belief that we should hold back and check with the Clinical School – there was no way I was going to commit to something without getting official approval first.

Band 2 pay is not great – around 16-17,000GBP per annum – especially considering we’ve been training for several years and accrued a significant amount of student debt. By the time you’ve reached final year, your skillset is nothing to sneer at – we had received training on lots of clinical skills, we had a wide breadth of clinical knowledge and we had refined our examination skills – so you feel like you’ve justified a bit more than band 2 pay. On top of all that, coronavirus means you’re entering the NHS at a time of unprecedented demand dealing with a crisis which poses a significant threat to our health and welfare too, wherever we get placed in the health service. Band 2 pay just didn’t seem to cut it.

Don’t get me wrong, I didn’t go into medicine for the money. But this is a point of principle. I want to help out, but at the same time, I don’t want my goodwill being taken advantage of – that’s exactly what this offer felt like. You have to have the guts to stick up for yourself when you don’t feel something is right. You have to back yourself because no one is going to do it for you.

I sent the Clinical School an email, asking what to do about the West Suffolk’s job offer. Within five minutes, I received an email telling us to hold off before the national situation becomes clearer. So up until that point, we had been no definite decision about when we would start work, and in what format.

Later that Tuesday, however, the Health Secretary himself added some muddled clarification. Matt Hancock announced to the press that 5,500 final year medical students would be joining the NHS at the beginning of next week.

This sounded like an official word – actually, it’s from the most official of sources. Nevertheless, the medium of delivery left something to be desired. It is disconcerting when the first word of your job posting is reported in a newspaper, especially when you’re told by the Metro that you’re apparently going to start within a week. It stoked the fires of confusion because we had been told by the Clinical Dean not to expect anything until at least the end of the week.

The effect the Health Secretary’s announcement was to make me feel like a piece in a political game. We hadn’t even entered the NHS yet, and we were being used to make a point. A soundbite he could reel off so it looked like he was doing everything in his power to help tackle staff shortages resulting from the coronavirus pandemic.

The news had come as a surprise to the British Medical Association too. They released a statement the following morning:

Last night during the UK government briefing on COVID-19, the Secretary of State for Health announced that 5,500 medical students would be brought into the workforce. This was a surprise to the BMA, who had not expected this announcement from the government.

So it wasn’t just me then. Anyway, their statement provided some clarity, outlining the steps that would be taken to facilitate our early graduation and eventual pre-registration. Again, though, it’s peculiar when your imminent future is being announced from a Facebook post. It made a number of prescient points.

Firstly, final year students aren’t obliged to work in the NHS early. It has to be voluntary. But like it or not, you do feel pressure from colleagues and friends who expect you to work and expect you to help out. I think it’s important to realise the stresses that many of us face given our expedited turnover from medical school: we no longer have a proper break; we might not be able to see friends or family, and we don’t have the psychological closure after the final year of medical school. Some students are also at home with vulnerable relatives, concerned that their work may put their loved ones at risk. No one should feel pressured to have to help, and I think it’s really important to make this an individual decision.

Secondly, when we are appointed, we need to have the same level of induction, supervision and education as any other foundation placement. This has been a big worry of mine – the coronavirus pandemic is putting unprecedented strain on our doctors and nurses, so I wonder how they will have enough time or headspace to supervise us. At least it would be mandated in our contracts. Whether this actually happens is another matter, of course.

Finally, we could have some choice over where we work: either working in Cambridge, or moving to our F1 posts due to start in August. For me, this would be St Thomas’ hospital in London. Now, don’t get me wrong, I’d love to start working in at St Thomas’ eventually: it has a great clinical reputation, lots of research opportunities and is in a prime location (I’ve never lived in London before and I want to try it out). However, right now would be one of the most testing times to move there, especially when London is the worst-hit part of the UK in this epidemic. There are all the practical barriers that come along with moving to a new hospital too, like learning the new IT system, settling into new accommodation, meeting new staff etc.. For now, it seems likely I’ll stay in Cambridge… but we’ll see.

The result of the discussions between the General Medical Council, the BMA and the Medical Schools’ Council will probably report back early next week. Hopefully, by then we will know the next steps forward.

As if all this wasn’t enough, there has been even more news this week. I can only describe life right now as being similar to one of those docu-dramas – one so ridiculous, so crazy that you can’t believe it’s not fictional (I’m looking at you, Tiger King).

In true egalitarian style, our little package of RNA had infected the Prince of Wales, who tested positive for coronavirus on Wednesday. Then, on Friday, the whole of our top brass tested positive: Boris Johnson, Matt Hancock and Chris Whitty fell foul of our microscopic foe in the space of 24 hours. That’s almost the entire core government team dedicated to dealing with COVID-19.

In what must’ve been a fond throwback to his student days, Boris Johnson was currently self-isolating in an ensuite mancave. It’s possibly one of the most expensive real-estate spots for a man-cave: right above Number 10. It’s no surprise that the Prime Minister contracted the virus, given that he declared he had been shaking the hands of coronavirus patients in the weeks before his own diagnosis.

I’ve been shaking hands continuously… I was at a hospital the other night where I think there were a few…there were actually a few coronavirus patients and I shook hands with everybody – you’ll be pleased to know. And i continue to shake hands.

Boris Johnson, 3rd March 2020

Perhaps the social distancing advice had fallen on deaf ears

Nevertheless, we must remember: these are the gallant, fallen leaders of our times. As Nelson fought and died at Trafalgar, our formidable leaders had succumbed to this invisible foe. The image of Boris Johnson puffy-eyed with a mild temperature is, however, a less valiant image than that of Admiral Lord Nelson being mortally injured in the throes of battle. In the words of Shakespeare, “Uneasy lies the head that wears a crown” – in this case, taken all too literally. Seriously though, I wish them all well.

Bizarrely, the fact that Boris Johnson had contracted the virus fostered what I can only describe as a “Blitz spirit,” certainly in myself and some of my friends. One online commentator compared his diagnosis to the bravery of King George VI when he remained in Buckingham Palace during WW2. There is a profound effect on national morale when our leaders remain steadfast in the heart of danger, whether macroscopic or microscopic.

To Boris Johnson’s credit, he had been upfront and honest about his diagnosis, which is apparently something we shouldn’t take for granted. For instance, there have been talks that the Brazilian leader Jair Bolsanaro – who was playing a pretty high-risk game by trying to downplay the severity of the virus – was hiding the fact that he had contracted coronavirus. In 1918, when the Spanish flu was running rampant, Prime Minister David Llyod George contracted influenza although his diagnosis was initially concealed from the public.

Questions were being raised about how Boris Johnson, Matt Hancock and Chris Whitty managed to get tests given that their symptoms were mild. Current advice was to reserve testing for really sick patients in hospitals. NHS staff were still not getting tested, although it was *supposedly* one of the government’s priorities and kits were being distributed across the country (wasn’t working though – see this interview). Some felt like one rule applied to them and another to the rest of us.

All animals are equal, but some animals are more equal than others.

George Orwell, Animal Farm

On the other hand, people argued that the Prime Minister of the country should absolutely receive priority testing: he’s essential to ensure the smooth running of government. He’s also in contact with lots of different people (many of whom are also key government officials), meaning he’s probably at high risk of contracting the virus.

I sympathise with both sides, but I have to admit: the PM is someone who’s probably worth testing, given that he’s the leader of the country and all. But that still doesn’t take away from the fact that we need to get those bloody testing kits out to NHS staff!

Wow, that was a long post. I’ve not even covered everything that’s happened this week. The ExCEL centre in London is being converted into a giant, makeshift hospital called the ‘Nightingale Hospital.’ True to its namesake, I wonder if it will include nurses patrolling the temporary corridors carrying gas lanterns. Seriously though, it’s worth noting that Florence Nightingale was a pioneering statistician – let’s hope that the government takes after her and rigorously collects data on this outbreak (which necessarily includes testing!) so we can learn lessons in the future.


The Lady of the Lamp

There’s been a #clapforcarers (variably interpreted as bang-your-pans for carers, fireworks for carers, vote Labour for carers) which took place on Friday, organised by a  Dutch yoga teacher. Now, I’m usually a bitter cynic when it comes to these things, but it was very moving to have the silence of lockdown interrupted, at 8pm, by raucous applause and appreciation for one of the most important, yet simultaneously undervalued, professions in our society. Clapping won’t change anything though. Perhaps the Health Secretary should consider raising nurses’ wages.

One last thing: fancying myself as a bit of a poet, I’ve written a quick one about my lockdown experiences so far. Here goes… don’t judge me too harshly…


The silence reveals:

What is not

What has always been

Your attention drifting

To things you always should’ve seen

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