We hope this special edition of Alumni Notes finds you healthy and in a good place despite global uncertainty.
We love hearing the stories of our alumni connecting with each other during Covid-19 lockdowns. It seems that every Thursday through Sunday a group of alumni are on Zoom, cocktails in hand, sharing stories of the past and present and planning for the future. Supporting each other has never been so needed, and we’re delighted you are finding joy in these moments.
For years alumni have asked for a place where they could connect with fellow alumni and share information. We’ve recently launched the TASIS Alumni Forum on Facebook, which aims to provide a space for our alumni to reach out to one another. Maybe you’ve moved to a new city or need an intern or a mentor. This is the place! Join us!
It’s that time of year again! We are collecting Alumni News for TASIS Today, which comes out in September. Let us know what you’ve been up to!
Stories from Covid-19 Wards
We’re so grateful to those in the TASIS community who are working on the front lines. Below are stories from two alumni working at different hospitals in London. We thank them so much for sharing their powerful stories, and we hope you find them as moving as we do.
Jake Figi ’14 is in his final year at the University College London Medical School. He has been volunteering on the Covid wards at a major London hospital since his clinical placements were canceled in mid-March.
A Day in a Covid Ward
A normal day looks like this: handover at 8:30, run up to the ward and start prepping notes for the ward round. We split up (usually two doctors and me) and take half of the 22-bed ward each. We begin the notes for all the patients and then go see them. In the past, we'd note as we saw each patient, but now to limit contact we prep everything in advance. At the end of these we usually reconvene around noon and go through the list with the nurses and other doctors. We'll put together a jobs list for the rest of the day and get to work on the more urgent things. The first few weeks of Covid this would usually take us up to around 2:30 PM. The rest of the day we take care of the jobs: taking bloods, cannulating, catheters, referrals for scans and tests, communicating with various departments, handling calls from family members, or calling families for updates on patients who are approaching end of life.
On Being a Volunteer Medical Student in a Pandemic
It seemed they were going to keep everything fairly normal until one day in mid-March when we showed up to a neurology intensive treatment unit (ITU) session, and we were sent away and told we should expect an email later in the day telling us all clinical placements were off for the rest of the term. It took a few weeks from then for UCL to send us information on the options to volunteer for the NHS, but they've always made it clear to us that it is completely optional—and actually most people I know have gone home, away from London, and aren't able to work.
I think we've been prepared as best we can be. For me, I enjoy and pride myself on my practical skills. Taking bloods, cannulating, suturing, assisting in surgery. Right now my medical knowledge isn't essential—the responsibility for care ends with the doctors I work with, so if I have a gap in what I know they will always be able to fill it (or refer to the hierarchy above us). But, with my clinical skills I can be useful. The most time-consuming jobs are all things I am well equipped to do—a patient who has poor veins can take up to 45 minutes to get the proper blood sample. Or writing a discharge summary is easily another 45-minute job.
End of Life (EoL)
The most difficult thing we come across is death. I think I can speak for everyone that that has been the hardest, and two things in particular.
The first is the separation and isolation for the patients and their families. Elderly, dying patients tend to have old and vulnerable spouses and even children. When someone is EoL (end of life), we offer the family a chance to come into the hospital. Because I work on a Covid ward the rules are only one person may be in at a time for up to 15 minutes. Swaps can happen every hour. And this is only offered to EoL patients. But, because of the age and vulnerability of the family, many wisely opt to not come. So, the family is stuck at home while their husband or wife, father or mother is dying. And that person dies alone. We try our best to get around this. We were donated a tablet, and I've set it up so we can use Skype. But the usual protocol is that I'll go in, check on the patient, make them look a bit better (comb their hair, sit them up) and then a colleague will pass me the tablet and I'll introduce myself to the family. I'll warn them that their relative will not be very responsive, if they have a mask on for oxygen, or if they are agitated, and then I'll hold the tablet for as long as they need to essentially say their last goodbyes.
The second difficulty around the deaths is when we have young people dying. Specifically, we had one young person (mid 30s) come in before Covid even hit the UK. They ended up catching it while in hospital, recovering, then a few days before discharge they got a separate infection. They needed surgery but would require an ITU bed to be allowed the surgery. The ITU team deemed them unfit for a bed on ITU, so they were stuck on the ward with us with no options. They had already deteriorated severely, and all we could do was work closely with the palliative care team to try to make them comfortable. Our patient held on for quite a few days and every day it was terrible watching the suffering. A few of us on the doctor's team would help the nurses with changing the patient just to try to give an extra helping hand. This patient didn't die from COVID, but they certainly died because of it. If ITU beds were more readily available they could have had surgery and at least a chance of recovery. Yes, the pre-existing conditions were severe, but during ‘peacetime’ we would have been able to pull out all the stops and try everything we could.
Mental Health: Something To Do, Someone To Love, Something To Look Forward to
Something I read once is that you need three things for happiness: something to do, someone to love, and something to look forward to.
Something to do can be broken down into a lot. It may take many components to completely fill up the 'something to do' category. Maybe your job or studies can only fill 25% but takes up half your time. So you need to find how you can fill the rest. When isolation started I read a lot, five to six hours a day. I was actually pretty content with that and it satisfied most of my 'to do' part. But maybe you also need some video games and some gardening, some exercise. Try to keep a balance—and no matter who you are, some form of exercise is essential to help keep you happy. Never underestimate the benefit of endorphins. For this, a schedule is key. On my off days from work, if I don't plan my day I will get next to nothing done. I'll sit in front of the TV for a couple hours, have a proper Italian lunch that'll last two hours (but every course is unhealthy and non-Italian...), barely squeeze in my rowing training, and maybe manage an hour of studying. Days when I plan it out I'll get a load of work done, eat healthily, be efficient with my training, get some Netflix in, and even find time to clean or do some chores. And at the end of the day I feel better because of it.
Someone to love can be anyone. It can be a Skype call with your mom or dad, your best friend, spouse. Just get the human connection in. Even if it's playing an online game with your friends (I've been hearing a lot of my medical colleagues have spouses picking back up the controller and getting on Call of Duty with their friends). Just always push for that connection.
Something to look forward to is almost easier right now than it was before. We all have this unknown date in our head when we can finally get out of our houses and go to the pub or a restaurant or anywhere. I bet most people can know right now the very first thing they'll do once lockdown is over. There's nothing wrong with making plans for the future, real or imaginary. Put that post-lockdown trip down on paper. There is hope that this will end soon, so embrace it and find something fun to do for when it does end. But these things to look forward to don't just need to be far off in the future; make plans for now too.
I have a lot built in to my days that helps promote my own mental health. I continue to train for rowing daily. I have work, which allows me actual contact with other humans (this has been a lifesaver because I'm currently living on my own while my flatmates have gone back to their family homes). I maintain my studies on my days off. I try to set little rewards after long days or long weeks, so I might have a few beers on a Sunday night after work or on a Wednesday after a hard training session. After too many ready meals I'll try to do a fancy meal once every week where I'll put more time into my cooking. I keep in close contact with my friends and parents, trying to FaceTime at least a little bit every day.
One of the biggest things is just learning how to be a doctor. I know I am not a doctor of course, but since lockdown I've learned more about how to be a doctor than the last 4.5 years of med school have taught me. I've got to put into practice the compassion, empathy, communication, and so many more skills we are taught to develop. Holding the hand of a scared old lady who is in pain and waiting to die. Bringing in a tablet with Churchill's VE day speech on the 75th anniversary of the event to a patient who remembers listening to it live. Telling families how their relatives are doing in a way that they can understand and in a way that gives them the appropriate amount of hope or expectation. Further to that, practice in keeping my head calm and my hands steady in emergencies. Close close experience with death and the process of dying. This has taught me a great deal about how to help someone who's dying. What to look for in their pain or movements so they can be given more medication. How to make them more comfortable and give them as much dignity as we can provide.
Thursday Clap for the NHS
Every Thursday at 8 PM from mid-March, for 10 weeks, people in the UK stood at their front doors or hung out their apartment windows and applauded, played instruments, or banged pots and pans to pay tribute to care workers and others keeping the country going during lockdown. Affectionately known as “the clap,” these five minutes every week gave people a chance to check on neighbors and come together to honor people like Jake. – Editor
I didn't actually realize it was a thing my first week. I was on my rowing machine and thought I heard a weird noise through my headphones, but I didn't really think anything of it. The second week I went outside to listen, thinking it was kinda funny that they did it, but then actually seeing the people outside smiling—a grandmother, mother, and young daughter walking down the road banging a pot really hit home. It felt like for once everyone actually appreciated the work of the people in the NHS. It was also off the back of a pretty heavy week for me so it felt pretty good to see. Really felt like people were coming together and appreciating the gravity of the situation.
So that brings hope as well. All the donations have been immense too. We aren't seeing a load of the scrubs (I think the bureaucracy is holding everything back) but we've gotten these cute face masks donated by school kids (designed by them and made using their school 3D printers), although I've given up on using face masks now! Harder to see through, adds more time to get into PPE, plus I think I've already had COVID (or if not, my blood must hold the cure because the number of times I've been coughed directly on by my COVID patients...!). One of the huge donations we've been getting is food though. Every day some sort of donated cold food is available for us to take home and microwave for dinner later, and most days someone will donate hot lunch as well. There are constant donations of essentials, snacks, and moisturizers that are brought around the ward twice a week. All of this has been so useful and so appreciated. The time we save by not needing to cook most days is great. It really makes it seem easier to work. If the NHS were always like this I think being a doctor in the UK would be a much more desirable job!
I never was the most academic at TASIS. I think I maybe barely scraped into the Dean’s List once in middle school. But for me TASIS was my cultural education, and I've benefited from that nearly every day since I left. And it's so relevant in a place like London where multiculturalism is everywhere you look. When it comes to medicine, it just adds to the confidence in interacting with people from other places. It is easier to connect with someone because you may have gone to their home country on In-Pro, or your best friend from TASIS was from the same town as them. The number of people I've met who have lived in Switzerland, even!
Shila Tursini ’05 studied medicine at University College London before getting her M.Sc. at the London School of Hygiene & Tropical Medicine. She had been working as a clinical fellow in reproductive health in London before being shifted to a major hospital to help with Covid patients.
On Being Moved to the Frontline
To be honest, I was very unhappy to be deployed to medicine; I was not one of those who was happy to be thrown into the midst of a pandemic, but I knew it was important and that my seniors needed me to be there, and I’ve done my best to have a positive attitude.
Everything has been changing daily in this pandemic. We had no idea what it would look like for us; I think I was a bit in denial. There was also this sense of wanting to help on the "frontline" (although I think we need a better term for this as this is too reminiscent of war), but also fear and anxiety about being deployed into hospital. They came up with a week of training sessions to refresh us on basic hospital skills and discuss personal circumstances and then we started on the wards. My hospital put us on a rota that covered accident and emergency (A&E), acute medicine, and ITU, but we would basically rock up at 8:00 AM, and then they would spread us where they needed us. They were really supportive of hours; I have a 2-year-old and they scheduled me to work only nursery hours, which was such a relief.
For the first few weeks it was basically only Covid patients in the hospital. We were all taking precautions. The hospital underwent daily changes to manage Covid; wards would be moved, screens installed. Then, with time, we slowly started seeing more non-Covid presentations, and sadly, we saw a lot of people who were really sick coming to the hospital very late. A lot of people waited at home because of fear of coming into hospital, and by the time they arrived they were quite sick, which was heartbreaking. We got to the point that the A&E and paediatric teams were tweeting and disclosing statements telling the public to please come into hospital if they were unwell. Never in my life have I seen doctors begging people to come in.
How it Feels To Be Working on the Frontline
From a team perspective, it has been challenging. I work with different people every day, and am very much a stranger, so it has been quite lonely. It is a weird combination of scary, heartbreaking, tragic, and lonely work. At the same time, there is a sense of wanting to be at work and helping people. There is also definitely a dichotomy between being at work, where so many lives are being lost, and then coming home and seeing people sitting in the parks, drinking beers, and ignoring social distancing. I have been asked on several occasions "Is it actually serious?" and I think the government is inflating the numbers of deaths," and I have no answers to this. This is a tragedy that is unseen by many groups of people.
The mood has changed greatly since the beginning. Speaking to some colleagues on ITU, the first two weeks [of Covid] were some of the hardest in their career. I think there was a lot of fear and anxiety at the start, hearing about shortage in protective gear, uncertainty about this virus, our own mortality, and how to treat patients affected by this. But we have developed protocols and support systems so the mood and the job has improved. We feel that we can tackle the issues a bit better, and we know a bit more about what to expect. Because we have redeployed so many doctors, it is actually really well-staffed, which allows us to focus on each patient better, carry out conversations with families, and look after each other a bit more. But there is definitely a fear of a second wave and what that might look like.
On Being Prepared for a Pandemic
I do not think anything could have prepared anyone for this, but there were a few things in my background that helped me a bit. A few years ago I started doing a diploma in conflict and catastrophe medicine. Strangely, I find that it is the concepts more than the actual information to be useful. They taught us a different approach to medicine, more from the point of view of military medics, and they talked about managing infectious diseases like cholera in unstable settings. I think a lot of the principles should have been applied early in this pandemic management.
Medical school, in a way, prepared me as well, not just because it taught me how to be a doctor but also because it taught me to take things one step at the time. We were all very anxious and overwhelmed, especially at the start, and if you try and tackle everything together, you would just crumble. But one of the skills you learn as a doctor (to be honest, probably true of many jobs) is to break tasks down into manageable chunks and focus on performing these.
Finally, from a point of view of understanding the great amount of information that was churned out daily, I think having done a M.Sc. at The London School of Hygiene & Tropical Medicine, which included epidemiology, was helpful.
These Are Weird Times
My daily saying is, “these are weird times.” Everything is weird, all of this is unbelievable. Certain governments’ responses to this situation have been unbelievable. The amount of loss, the tragedy that has affected so many people, and how people cannot grieve as they normally would be able to. People not being able to attend funerals of their child who died alone in intensive care. Losing your patient despite having used all the best supportive therapy and medication available. Your patient never seeing your face when you speak to them because you are wearing layers of face masks and visors. Nurses unable to go to the bathroom for many hours because they are in full PPE. Politicians who have never ever even come close to PPE telling us how to use it and that we should only use one per shift. Almost running out of oxygen in a modern hospital. Approaching national shortages on critical care medication. I never thought these things would happen when working in a developed country.
I write this with the knowledge that it is easy to criticize when you are not in a position of leadership, and with hindsight. One thing I have learned is that during times of crisis, it is important for leaders to listen to your juniors. I think a lot of managers were overwhelmed during the start of this pandemic and failed to listen to the people on the front line. I hope that in the future if I am ever in a position of leadership, I will remember that I do not need to do everything myself but can delegate and ask for input.
I also learned about the importance of honest and clear communication from our leaders. I saw two types of communication; I saw one pretend that things were fine and everything was under control, and I saw another admit uncertainty and the need for patience. Honest communication was much more effective and elicited more faith. I was also surprised how little collaboration there was in the beginning and how little sharing of expertise, and I hope that in the future, I will be able to remember that others might know something that I do not and seek help from others. Honestly, I think the most important skill during this pandemic was humility. It did not matter what grade of doctor, what specialty, or what your views were—at the start of your shift, you just had to fulfill that role to the best of your ability.
This pandemic has definitely shown some incredible sides of society; people coming together to sew scrubs and make visors has been so touching. I have been lucky that I have not directly experienced PPE shortages, but I know a lot of colleagues who have and it is unbelievable. Again, as doctors, we are told to treat every patient as if they were a member of our family, and I would extend this advice to the government, to treat NHS staff as if we were part of their family. Would they accept such PPE shortages for their loved ones?
I think it is critical to ensure we sleep well; I feel that everything is a bit better if I sleep well. I found it very hard to sleep in the beginning of all of this, so I found that using the app Headspace, reading light fiction, or even watching movies in bed (I know, horror, poor sleep hygiene, and all that) really takes my mind off things and allows me to sleep. Also, I find that carrying out activities that keep you in the moment to be very helpful: cleaning the house properly, decluttering, fixing things that need some TLC—basically creating small windows of happiness. Watching a lot of rubbish TV can be very distracting and a nice break.
For those who are staying at home, it cannot be said enough times how helpful keeping a routine is. Wake up at the same time and shower, no matter what, shower. Wash that hair. Do a little self-care Sunday: a face mask or a home manicure or whatever makes you happy. Social media is a double-edged sword I think, but keeping in touch with friends with video calls is super important. I make a virtual play date every Friday so that my child sees her friend and I see my friend. It's lovely to have that. Exercising is also incredible. I find it difficult to do long sessions of exercise when I’m home, so I do short sessions with Joe Wicks or Move Your Frame and try to do one session on the days I am home. Having a child is also quite a nice distraction because it keeps you pretty busy! I try to take her out once a day and take her to the park, which does both of us lots of good. I think if you are feeling a bit rubbish, that's ok.
I do not know if others would agree with this, but TASIS taught me a lot of self-discipline and humility that have helped me every day though this pandemic. Regarding self-discipline, I definitely do not have as much as I would like, but TASIS taught me tricks to getting my job done and about the importance of completing my responsibilities.
I think the key thing I learned at TASIS, however, was humility. I made so many mistakes, as you should when you are a teenager, and I was supported and guided through them by wonderful teachers and friends. TASIS taught me about teamwork and that there are times when you need to be a leader, and times when you need to be a good follower. It definitely taught me the importance of a good attitude, even when that is the last thing you want to have.
Also, the ability to live with people from all different cultures and backgrounds has definitely been helpful, as I’ve worked with different teams every day during this pandemic. This is going to sound so cheesy, but I was lucky enough to meet Mrs. Fleming when I was at TASIS, and I truly admired the passion she threw into everything she did. On darker days, I try and channel some of that unadulterated passion into what I do. If that fails, I follow her second tip to a long and happy life: Jack Daniels.