Recovering from March 23rd, 2020.

My name is Paul. Four years ago, my life changed significantly. I’m grateful to be alive and of sound (I think!) mind despite the huge challenges faced on multiple fronts.
I have been an NHS Consultant since August 1996, initially working in Intensive Care as a part of being a Consultant Anaesthetist. As Intensive Care Medicine (ICM) began to take up more of my focus, I was also finding Anaesthesia to be less interesting and more irritating, so when the opportunity to become a whole-time Consultant Intensivist arose, I made the step in August 2004. By this stage, it had become obvious (to me, at least – your mileage may differ) that trying to work across two increasingly separate specialties wasn’t something I wanted to do. I’d first considered working in ICM as a surgical house officer in late 1985 and I’d always found my ICM attachments as a trainee to be the most challenging and rewarding. I realised that by taking this career pathway, I’d be dealing with people at the most difficult time in their and their family’s lives, which meant that I needed to be pretty resilient to cope with the impact this would have on me. Having been able to deal with this throughout my training, I felt that I was ready and I was certainly willing and able. So my career progressed well, despite many difficult challenges that needed to be faced. The patient care was the easy and enjoyable part of the job – it was dealing with everything else (difficult colleagues mainly) that was harder to manage. I survived these problems, though they did leave their marks on me. Eventually, I became Chairman of the Welsh Intensive Care Society after a pretty precipitous rise through Council, and later I became Sepsis Lead Clinician for the Cardiff and Vale University Local Health Board (Cardiff and Vale UHB). I outlasted those difficult colleagues! Medical Directors and Chief Executives came and went. We came through Swine Flu unscathed and learned a lot about pandemic planning and viral pneumonia care. I even later appeared a few times on TV and radio. Working for the NHS has always mattered above all else – it really is one of the best in the world, offering high-quality care provided by highly-trained and dedicated staff with exceptional value for money. Keeping the NHS away from those who seek to profit from the misfortune of others has always been vital to me. Seriously – the last thing this country needs is a US-style, broken and fragmented health care “system” where people die because they can’t afford insulin to treat their diabetes or can’t afford antibiotics to treat an infection. In America, don’t be ill and certainly don’t be ill and poor. In the UK, medical treatment isn’t free, but it is free at the point of delivery, paid for by general taxation. If you value the NHS, don’t complain about paying tax!

The time was mid-2018 when I first felt that I was being ground down by my job. Looking back on things, as the issues with pension tax rules started to be discussed at great length in the medical press and then in the mainstream media, I started to think about the value of continuing to contribute to my NHS pension scheme. Amongst many thoughts that accompanied these concerns were those that I was getting tired of the stresses of the day job. Maybe I needed a break. Maybe the scars of those old battles were hurting now. I certainly felt that the government (at least the Westminster “government”) wasn’t valuing the work done by doctors and was actively seeking to undermine them and the NHS in general. Years of unwarranted austerity and piecemeal privatisation of healthcare all served to show that the Conservatives viewed the NHS as a drain on the taxpayer (taxes which their biggest supporters largely avoid paying) and a cash cow to sell off to their business pals. Despite all this, the NHS is – and remains – the greatest achievement of any British government.
So, there I was with just over 3 years to retirement (able to retire at age 60) with the worry that my pension was going to get hit with a massive tax bill (thanks to George Osborne and his utter mendacity). My only option (as I saw it, perhaps incorrectly) was to temporarily leave the pension scheme. This got me thinking about retiring early in order to take my (reduced) pension early and then use the “retire and return” scheme to carry on working with the pension situation resolved. I felt this would impede or even halt some of the projects I was involved in, so I ruled that out. However, it had got me thinking about what was the best option for me and my family – I’d given so much of my time and effort to work and not enough to my family and myself. Family health issues and other worries began to drain my energy. Our pattern of working was dragging me down, even though I felt it was better than other options.

I ploughed on, basically deciding that I was now on the final lap while I took a short time-out from the pension scheme to mitigate the risk from a possible large tax bill. There were some good things happening in work that I didn’t want to give up, not just in sepsis care but also in the care of patients with a tracheostomy, another long-standing interest of mine. Having been the only hospital in Wales to be a participant site in the UK-wide Improving Tracheostomy Care Project and with that, a member of the Global Tracheostomy Collaborative (GTC), with the fantastic Tracheostomy Team agreed and funded by the UHB, we were achieving great things, winning awards from the GTC for outstanding contributions to tracheostomy care. So, despite the stresses of the day job, there was enough to keep me wanting to go to work. I planned for a normal-age retirement while not ruling out a “retire and return” to a less intense area of Critical Care, namely the Post-Anaesthetic Care Unit (PACU). The PACU at UHW came in being in 2015 in order to solve the problem of the challenge of getting high-risk elective surgery cases done with the required level of post-operative care. At first, the responsibility for looking after the patients in PACU was an add-on to the workload of the ICU consultants, which didn’t go down well as we were all working very hard already. Most of the patients coming through the PACU had a reasonably straightforward pathway, so the workload actually wasn’t that onerous. However, it was often regarded as an unnecessary imposition such that some consultants made little effort to be involved in PACU, even to the point of wanting to get rid of it from the Directorate. Fortunately, due to the skill and dedication of the PACU nursing staff, the patients did pretty well and the throughput of the high-risk cases improved. Unloved by some but proving its worth despite them, the question arose as to why would Critical Care divest itself of such an asset? Plans were being laid to introduce some standalone PACU sessions, with the suggestion that more would follow in due course, with trainees in anaesthetics and intensive care medicine being cultivated to join a group of PACU consultants as and when they completed their training. It was around this time that I was asked if I would consider a switch into taking up some PACU sessions, perhaps using the retire and return option to work there after turning 60. I said I was interested, but behind the scenes there seemed to be not a lot happening in terms of gaining the necessary funding to do so. However, after some significant challenges to improve Critical Care provision in Cardiff were given to Welsh Government and to the Cardiff and Vale UHB, plans for expansion of beds, staffing and equipment were made and began to be acted upon. Credit has to be given to Len Richards, then CEO of Cardiff and Vale UHB, for accepting the need and meeting the challenge of this expansion, given that a number of his predecessors had not made such plans despite multiple requests over the years. In reality, Critical Care had been squeezed very hard, aided and abetted by some who really should have been fighting for expansion but instead made life extremely difficult for their colleagues. In 2019, it began to look as if the Critical Care Directorate was starting down the road of expansion and improvement, escaping from the doldrums of austerity policies. Some exciting new developments were being openly being discussed. While fully supportive of such developments, I was also feeling that these were for the up and coming consultants who were still sufficiently enthusiastic and motivated to build better patient services to bring to fruition. Clearly these projects were never going to be overnight successes and would need a huge amount of work to make them work, but while I didn’t feel that I could usefully contribute to such developments I was certainly prepared to give my support. Nevertheless, my primary concern was to just to keep going with what I was doing until my planned retirement at the end of 2021. All I wanted was to serve out my time without aggravations, provide good patient care and the work to improve the care of sepsis patients and patients with a tracheostomy.

The plan was working fine until January 2020.

In January 2020 the first reports of cases of pneumonia, occasionally fatal, were emerging from Wuhan city, China. The causative agent was initially unknown but was soon discovered to be a coronavirus, similar to the ones that caused SARS – Severe Acute Respiratory Syndrome – back in 2002 and then MERS – Middle Eastern Respiratory Syndrome – back in 2012. Both of these infections were associated with a high fatality rate. Nevertheless, this new coronavirus – soon to be named SARS-CoV-2 – was an unknown quantity. It was clearly fatal in some cases, but it wasn’t known how it was spread or how serious it would be. Both SARS and MERS appeared to have a high fatality rate but this new version was an unknown quantity. It certainly appeared – initially at least – to be very similar, if less fatal. Later we learned a great deal about this virus. The biggest unknowns were the potential for asymptomatic infection, asymptomatic spread, duration of infectivity and – fundamentally – the main route of transmission. Like so many viruses, we also had no treatment options. Initially, no-one seemed that bothered as it was thought that there was little risk of the virus spreading outside China as – surely – all that was needed was to isolate anyone showing symptoms of infection and that would be enough to prevent not only a major outbreak of this infection in Wuhan city. Wuhan enforced a strict lockdown, with severe restrictions on people even leaving their own homes to fulfil basic functions such as food shopping. However, by now, the genie was out of the bottle. The infection soon began to be seen in many other countries, as it became apparent that there was asymptomatic and pre-symptomatic spread of this infection. The virus rapidly spread across Asia and into Europe. Treatment options other than supportive care and playing a waiting game were non-existent, yet there were multiple attempts to claim that treatments for other infectious diseases were effective and that it was imperative that these treatments needed to be urgently deployed. Based on the flimsiest of information and zero evidence, there were significant worries that not only would these treatments show no evidence of benefit but may even be harmful. Italy appeared to be particularly badly affected, with its health service on the verge of collapse as demand for ICU beds and even oxygen itself began to outstrip supplies. This was a catastrophe appearing before our own eyes and it was inevitable that this virus would not just arrive in the UK but would quickly overwhelm the ability of the NHS to function normally. Meanwhile the Westminster “government”, fresh on the back of a totally unmerited big win in the December 2019 general election, dithered and obfuscated as it buried its collective head in the sand about the severity of the problem and the need to take drastic action. As recent as the weekend beginning Friday 13th March (anyone superstitious here? no?) the (then) so-called “Prime Minister” Boris Johnson was claiming there was no need to do anything and that we could continue with our normal lives. He was a fool – he still is. The senior management of the NHS was thinking rather differently at this stage as there were rapidly increasing numbers of cases being admitted to hospital and to ICUs. My hospital and others in Wales effectively went into lockdown that day. The problem was that there were a number of other very significant health matters within my family that were all coalescing at the same time. In an attempt to be as prepared as we could be in this rapidly evolving scenario, increasingly frequent emails, text messages and WhatsApp discussions began to bombard us all. Rapidly, we were propelled from a state of normality into one of information overload. The biggest issue with this knowing what to believe and what to ignore. We really still didn’t know how the infection was spread, what exactly the risk to the individual victim was, and we still had no idea how to treat the infection or what the best options to provide supportive care were. We didn’t (at this stage) even know all the symptoms such as loss of taste and smell! To compound the problems, the Westminster government basically ignored the advice of the World Health Organisation (WHO) to ramp up testing for the SARS-CoV-2 virus. The Westminster “government” did the exact opposite by effectively abandoning all testing for the virus. The reasons why this catastrophic decision was taken are best discussed on another occasion – maybe the national CoVID inquiry will provide some answers.
Misinformation about how the virus spread and what factors might put a person at increased risk from the infection were the order of the day. Depending on who you were listening to, the virus was spreading by merely touching a pepper pot that had been touched some hours ago by someone already infected with SARS-CoV-2, which would then make you seriously ill or even kill you, or the virus or was little more than a common cold that was “only” a risk to the elderly, multiple-comorbidity people that have become a growing percentage of the population. As a consequence of the combination of all these factors, I became aware that I was having panic attacks at work. Naturally, I didn’t tell anyone. I was panicking because I was struggling to assimilate the information being foisted upon me from multiple angles. I was panicking because I had no idea about what might happen to me if I got infected. I was panicking thinking about the potential consequences of me getting infected and then spreading it to family members who would probably be at greater risk of bad outcomes for a variety of reasons. Even the prospect of having to isolate from my family for two weeks just through being a confirmed contact was extremely daunting. On the other hand, despite the problems with inadequate supplies of Personal Protective Equipment (PPE) that were already being reported, it seemed that we would have access to very good PPE in the ICU and we were already trained in safe donning and doffing and were fit-tested for the FFP3 facemasks. What was there to worry about? Quite a lot, as it turned out.

Patients with CoVID-19 were being admitted not just to my hospital but to my ICU. In the meantime, fuelled by the uncertainty about how this virus was spreading and by the challenges of PPE provision outside of the ICU, anxiety about treatment proposals, there were some extremely difficult conversations between the ICU consultants and others who might use certain other treatments on the general wards that had the potential to put staff and other patients at risk by increasing the ease by which the virus could be spread. Members of staff were getting infected and having to go off sick – a few became seriously ill. As March progressed, the number of infected patients in the hospital were growing steadily but there was no idea (due to the lack of testing) how many people in the community were infected, so we had to change from working out why a patient may have developed respiratory failure (i.e. not due to CoVID-19) to assuming that every respiratory failure case was CoVID-19 unless proved otherwise – which was by no means possible in the majority of cases. We were now in a situation where annual leave was being cancelled and having to run a rota with extra consultants to cover when colleagues would (inevitably) go off sick with CoVID-19 or the numbers of patients to be dealt with would exceed the usual number of rostered consultants (also inevitable).

And then it happened.

I was exposed to an infected patient who required endotracheal intubation.

It wasn’t known at the time that the patient had CoVID-19 as the reason for ICU admission was completely unrelated (a neurological problem) and the reason for developing respiratory failure was thought to be a consequence of the initial reason for ICU admission. It had, by now, been agreed that any ICU patient developing respiratory failure could be tested for SARS-CoV-2, so this patient was tested. We thought that the probability of a positive test was pretty low, so none of us expected the result to be positive.

We were wrong. The date was March 22nd, 2020. It was a Sunday.

I’d finished work at aroud tea-time, leaving other colleagues to cover the inpatients and referrals. We were no busier than usual that day, so there was no reason to stay beyond my normal hours of work that day. Around 9 pm that evening, one of my colleagues phoned me to tell me that the patient whose intubation I’d been a part of (not actually the intubator – that role was carried out by a consultant colleague in full PPE) had tested positive for the SARS-CoV-2 virus. At this point in time, the advice as to what to do as a healthcare professional and as someone at home with my family was contradictory. I contacted people who might be able to give me the current guidance – infection control, virology, etc. so that I could make a proper risk assessment, not just for myself but for my family. The problem was that no-one really knew! Advice ranged from stay at home and isolate for 14 days to just go to work as normal but look out for the development of symptoms.
In the meantime, I didn’t know what to say to my family. How much – if any – of a risk did I pose to them? What was the risk to me of becoming seriously ill, possibly even dying? Had I got this close to retirement only to be killed by something that was a direct consequence of being a doctor working in an environment and specialty where exposure to serious infection was a fairly common occurence? Was the protection available enough to mitigate the – as yet unquantified and somewhat unknown – risk of infection to my colleagues and I? My concerns over the efficacy of PPE wasn’t (at least at that time) one of availability – we seemed to be in a reasonably comfortable position at first. However, very soon it was necessary to change the supplier of FFP3 facemasks (the highest level of protection available against respiratory viral infections, otherwise known as N-100). What happened now is that the new facemasks required the fit-testing process to be re-run. Having passed on the previous design, I now failed fit-testing on the “new” mask. I then failed on our alternative mask. There was the option of using a battery-operated respiratory mask that had two filters, nicknamed the “Darth Vader” mask – the problem was there was a major shortage of the filters and the masks themselves. In reality, I would not have been able to work in an area or with patients with respiratory illnesses but that was little comfort with so many unknowns about this virus we were dealing with.

This was a perfect storm – impending burnout, huge workload that looked likely to get far worse, (mis)information overload, inadequate protection, exposure to a virus of uncertain (likely high) transmissibility and mortality risk (we didn’t even know about “long CoVID” at this stage). As for how the Westminster “Government” seemed to be handling the whole situation, I felt extremely concerned that they were mishandling the situation and were treating us all like idiots, with the then Prime Minister Boris Johnson (a man promoted far beyond his abilities) being particularly lassez-faire with his public denials and lack of action in dealing with the reality of what the country was facing. We were already aware of the disaster unfolding across Italy, yet he’d ploughed ahead with Brexit at a time when international cooperation needed to be one of the most important things needed to handle the pandemic and was denying any possibility of the country needing to go into a lockdown, telling us to carry on going to the pub to meet our friends. The stupid burns deep!
The upshot of all this for me, however, was overload and meltdown. I went to bed that night not knowing what to say or do. I was afraid and panicking – for myself and my family. I felt I was not going to able to protect myself and my family. I felt that I wasn’t going to be able to function in work, such that I might actually become a danger to myself, to my colleagues and to the patients. When my alarm sounded to wake me to get ready for work the next morning, it needn’t have sounded as I hadn’t slept a wink. I’d spent all night in a state of psychological and emotional turmoil. I was in no fit state to work that day. I was in no fit state to do anything. I woke my wife to tell her that I wouldn’t be going to work that day and nor would I be going for quite some time to come. I broke down and cried. The old-fashioned term for what I was experiencing is a “nervous breakdown”. So much for my resilience! I’d been fooling myself for far too long about pushing on through the emotional pain barrier to see out my time until retirement. I’d only been kept going in the “day job” of being an ICU consultant by the non-ICU work I’d been doing.

Nowadays, we call what happened to me “burnout”. When it moved from being a state of just being a bit jaded and disenchanted to one of being psychologically incapable of working, the transition was extremely rapid and devastating. It was a total car-crash. I’d ignored the warning signs and now I was paying the price. Phoning in to say I wouldn’t be in work was awful, but work was out of the question, even though I felt horribly guilty for what I saw as letting my colleagues down at the worst possible time. Fortunately, the person I spoke to mainly in work was our Clinical Psychologist, who understood what was happening to me and gave me the space I needed while being available to talk to as and when I needed.

The day this all happened was Monday 23rd March, 2020. That afternoon, I finally fell asleep. I slept deeply because I was exhausted from lack of sleep, I was exhausted because of the stress I’d been under for so long at work, I was exhausted from the emotional burden of events that were happening around me and in my family that I had no control over. That evening, normal life in the UK was placed on hold as the Westminster “government” finally imposed a lockdown. Finally, they were taking the situation seriously, it seemed.
In many ways, I was grateful for the lockdown. It imposed upon us all a lot of restrictions that it seemed would slow down the rate of the virus spreading. It imposed a new daily structure to my life that didn’t revolve around work but around home life. I could focus on making sense of my situation. That’s not to say that suddenly for me everything was healed and I could just pick up from where I had left off on that Monday. I disconnected from the outside world in that I dropped out of all social media sites I was usually active on. I dropped out of all the WhatsApp groups and other group messaging services related to work. I even stopped listening, reading and watching the news on radio, TV, Internet as I couldn’t handle any more information. Watching TV was limited to light entertainment only. Even going to the hospital site was psychologically challenging. I slept a lot, I cried frequently. I think it took me about a fortnight until I was able to start reconnecting with the outside world. This reconnection was also challenging in its own way. For the first time since my breakdown I was able to consider what was happening in the outside world and see how this virus was wreaking havoc across the UK and the world. Having not thought about how my colleagues were dealing with the worst crisis in healthcare ever to hit the UK, indeed the world, I began to realise that they were going through a truly awful time – a situation being repeated in hospitals and ICUs across the UK. Of course I felt horribly guilty about the predicament they were facing and the fact that I’d abandoned them, leaving them even more short-staffed than in the pre-pandemic chronic shortage. Starting to hear the garbage being spouted by the Westminster “government” was rather aggravating as their words were unconvincing and seemed to show that they were just making things up as they went along, with no cogent plan – just a stupid three-line slogan as everyone hoped that the spread of the virus would slow down. The one positive was that the weather was glorious in April 2020. I spent more time in my back garden in that spring than I’d done for some years. Of course, sourcing materials to do the jobs that needed doing wasn’t straighforward as materials were tricky to source and travel for non-essential purposes was forbidden – thank goodness for delivery services!
Although I was still angry – probably increasingly so – at the politicians who had and were continuing to do an terrible job, I began to be able to think more clearly and not to react negatively to my situation. I did wonder whether it would ever be possible for me to return to work and – with only about 20 months to planned retirement – was that such a bad thing? On the other hand, I felt I still had unfinished business. Not so much with direct patient care but with projects related to sepsis and to tracheostomy care. I began to want to return to work but I also didn’t think I’d be able to cope with simply being thrust back into the heat of the ICU. By now, the number of cases of CoVID-19 were falling across the UK and within my own hospital and ICU. Whether this was a natural phenomenon of the virus coming to the end of its first wave of infections (having swept through those most likely to get infected) or as a result of lockdown will remain a discussion point for years to come, but I do think that lockdown did contribute to that first wave ending when it did.
After about two months, I felt well enough to think more actively about returning to work. After a few discussions, I started a graduated return to work process. For the first few weeks this was in a non-clinical role, analysing and extracting data from clinical notes for a research project. As I began to consider returning to the ICU, a few options were on the table. Would I return to a role similar to my previous one? I struggled to process the situation but it wasn’t long until I was asked to take on a role as the Health Board wanted to get high-risk elective surgery properly by re-opening the Post Anaesthetic Care Unit (PACU). Prior to the pandemic, PACU had lived at the end of the ICU but rapidly got displaced as it quickly became apparent that the bed spaces were needed for the huge influx of critically ill patients with CoVID. I started this new role, working split days as was thought necessary, but no night or weekend cover. The hospital had, like many others, installed physical barriers to minimise the mixing of elective (Green) and urgent/emergency (Amber) patients. The basic premise was that the Green patients were as low a risk as possible for being infected with CoVID, having self-isolated for (initially) 14 days prior to admission to the hospital’s Green Zone. This was, of course, difficult for the patients. Some didn’t follow the rules and had their surgery delayed as a result – not ideal, but it was felt that the risks of exposure to the SARS-CoV-2 virus outweighed the benefits of surgery, with evidence showing that operating on CoVID-positive patients was associated with poor outcomes.
For the first few months of this new arrangement, PACU led a somewhat nomadic existence, using space in the Short Stay Surgical Unit, then a Green Zone Operating Theatre before moving to a larger Operating Theatre, then finally moving to a refurbished ward setting suitable for caring for these high-risk elective surgical patients. This was December 2020. Having initially worked with only nursing colleagues, a new colleague had been appointed to work two sessions per week and we also had a tier of Clinical Fellows. By now, we’d witnessed the second CoVID wave, driven by the Alpha variant of CoVID as Alpha spread rapidly across the UK. We went through a “firebreak” lockdown and tiered systems of restrictions. However, there was hope as the first CoVID vaccine trials bore fruit and the first CoVID vaccine from Pfizer became available for use across the UK. Wales led the way, with the first vaccines being delivered on December 8th, 2020. I was fortunate enough to get my first CoVID vaccine that same day – all I needed to do now was have about 14 days for a decent antibody response. The only problem was that urgent family health issues resulted in a visit to a very busy A&E department at another hospital, where my wife and mother-in-law got infected with SARS-CoV-2, presumably Alpha variant. Over the next few days, every member of our family was infected and became ill with CoVID. Initial symptoms were not recognised as being CoVID so it took a few days for the “proper” symptoms of a cough and fever to be recognised. For me, it was disappointing to get infected before my vaccine had been able to take effect. As I became ill, I was naturally worried what might happen but I was also deeply concerned as to what might happen to my wife and mother-in-law who were clearly far more unwell than I was. Fortunately, I was able to monitor their condition with a pulse oximeter – all remained good so no-one required hospital admission. Gradually we all recovered and the CoVID rules allowed us to leave the house and buy food for Christmas Dinner. We even managed to have a Christmas Day, albeit far from normal. It was no surprise that Christmas 2020 resulted in a new wave of infections across the UK. However we were either recovered or recovering so this was not a problem within the family but nevertheless caused a great deal of problems with staff sickness. I returned to work in the early 2021. We got through some difficult challenges but the service kept going. The Delta variant of CoVID came next, but by now the vaccine programme was in full swing. I took the decision to train as a volunteer CoVID vaccinator and began to work in my spare time in vaccine centres. While I may not have contributed to the care of critically ill CoVID patients, I felt that I was at least doing my part in preventing serious illness (requiring ICU admission) and death from the ongoing pandemic, even as the Westminster “government” continued to downplay the risks of infection in its attempts to prioritise the economy over the health of the population. In the meantime PACU flourished as a service for high-risk elective surgery, whether that was just a single overnight stay or longer as determined by clinical need. The success of the vaccination programme by now meant that Critical Care capacity was no longer dominated by CoVID patients. Everything began to look more positive, even as isolation periods prior to elective surgery reduced in steps from 14 right down to 3 days before being abandoned as the Green/Amber zoning became unneccesary. The Omicron wave of infection in late 2021 threatened to derail progress but it soon became apparent that this variant was far less capable of causing severe infection and death than the previous variants. Vaccination was also proving to be imperfect at preventing CoVID but actually pretty good at reducing severity of infection. Therefore, when I got my second dose of CoVID in July 2022 (thanks, Central Line, London Underground), I just felt rough for about three days with a bad cold. Don’t get me wrong – this was actually up there with the worst colds I’d ever had and not recommended to anyone. Given the evidence, it’s clear that a combination of several vaccines and two infections has substantially reduced the personal risk of CoVID to little more than a seasonal cold. Even when other family members I’ve had close contact with have had second and third CoVID infections, I’ve avoided further infection. That’s not to say that. the world has seen the last of CoVID – far from it. However, for the vast majority of people, CoVID no longer poses anything like the same degree of risk as it did in 2020. Eventually, Green and Amber Zones were abandoned, physical barriers came down and hospital sites returned to pre-pandemic configurations.
I retired officially from work at the end of 2021. In the months leading up to my retirement, a number of discussions with those in charge initiallly proceeded along the lines of no ongoing role for me but a lifeline was thrown in December 2021 with an offer to retire and return on an ad-hoc part-time basis just covering PACU as necessary to cover rota gaps. For me this was just perfect – I would work to fill thoser rota gaps but with no compulsion to do so if I wanted to not work. Alongside this, I would continue to teach on courses for the Royal College of Surgeons as I’d done since about 2000. The work has varied in intensity but has never been close to overwhelming me. Late in 2023 I even took on the role as Sepsis Lead once again, albeit for a limited time period through to October 2024. Despite many challenges outside work, I no longer feel that work is getting in the way of family life as I can always turn down offers to work if I want to, without worrying about the impact on others.
Looking back, I realise that I should have acted sooner about my burning out but it’s always easier to look backwards rather than forwards. Nevertheless, I do feel an ongoing guilt about my breakdown and the manner and timing of how and when it happened. Despite all this, however, I think I’m where I would have wanted to be in my work at this point in time. I’ll carry on for another year or two or more if I’m needed but I won’t stress about not working if the rota gaps disappear. I’ll also keep on teaching trainee surgeons for a few years yet. Overall, I’m content with my personal situation, even if I’m not happy with the state of the country and the awful climate conditions of seemingly non-stop rain for the past 3 months.

I’ve personally learned a great deal about myself in the past 4 years and also about the world that we live in. None of us are perfect but some of us – mostly those in positions of power and/or the very wealthy – are more imperfect than others. If my words can encourage people to take better care of themselves, their familes, friends and fellow human beings then I will be content.