COVID-19 dental diaries – ’16 ambulances lined up with patients waiting to be seen’
Balal Khan is a final year dental student. He talks us through what it is like having a part-time job in A&E during the COVID-19 pandemic.
‘Urgent – NHS level 4 incident, acute need for staff support’.
It’s 6:30pm on a Friday night, and I have just woken up from my pre-night sleep to an alarming number of texts from the seniors. As I make my way to work, I wonder how dire the situation may be. I turn into the staff entrance and there it is, the now iconic image that’s making rounds on social media: 16 ambulances lined up outside, all loaded with patients waiting to be seen.
How many hours have they been there? What is going on? As these questions run through my mind, I enter the department. The mood is sombre, the tension is palpable – but that’s that, there is no time to ponder. I’m in the bubble.
My first job is assigned – I will be assisting a senior consultant in triaging patients in the back of ambulances. We have to prioritise which patients will get beds and start what treatment we can outside. Neither of us have ever done this before, but then again, the NHS has never been under such unprecedented strain.
There are no written rules here, the lines are blurred. This is the second peak of COVID-19, this is Royal London Hospital, this is the last stand.
I am Balal Khan, a final year dental student at King’s College London, and this is not your ordinary part-time job. This is my diary of the challenges I face during the height of this pandemic and how I have been finding a balance between having a (stressful!) part-time job and being a full time final year dentistry student
Your not so typical shifts
Your usual Friday nights in A&E can be described as bedlam at best. But this pandemic has pushed things further into chaos. Having worked through the London Bridge acts of terrorism, I thought I would be prepared. But there is nothing that can prepare you for a pandemic on this scale.
Staff shortages are high due to uncontrollable incidences of COVID-19 among frontline healthcare staff. Combined with the sheer quantity of patients who require more than usual medical input, you face a 12-hour shift in which there is little respite.
My shift usually begins at 8:00 PM. After a brief team huddle we are given our designated work areas, and then off we go. First and foremost: PPE. We must protect ourselves before we are able to protect our patients.
An FFP3 is worn for the majority of the 12 hours, and anybody that has worn one can tell you its effects – constant pressure on the nose giving way to pressure sores and headaches – but this is our first line of protection.
Since the start of the pandemic the areas we cover are becoming larger, and we are becoming stretched thin. That’s why a key to patient safety here is the constant review of patient observations – one of my main duties – along with carrying out IV cannulations and electrocardiograms. It’s the absolute basics that we have to get right here.
Patient lives depend on it, but it becomes ever so difficult as the number of patients increase, while the number of staff decreases. This is, however, where my years of studying human physiology and disease as a dental student come into application.
I am able to see patients with high respiration rates, those with increased oxygen demands, those that are struggling to breathe, and I am able to flag this up to one of the A&E consultants. The early recognition of a deteriorating patient is vital.
For 12 hours, it’s constant. It’s relentless. It’s also essential for our patients.
Dentists in A&E? What?
This is the typical response I get from just about everybody (dental peers, work colleagues, and patients!). It is then closely followed by: ‘Whilst I’m here could you take a look at this tooth for me?’ It has been a very positive experience for me to see how both other healthcare professionals and the public view our profession.
When I mention to patients that dentists and other dental health professionals are the only ones that routinely carry out oral cancer screening, they often respond with: ‘I did not know that, I’ll attend my check-ups more often!’
I’m often asked how I manage to juggle my studying with having a part-time job as stressful as this one. But in all honesty, I find my job an extension of my studies. At dental school we are heavily focused on polishing our clinical skills, but sometimes forget to apply a holistic approach to patient care.
Working alongside world renowned clinicians in A&E, I have learned about managing patient expectations, communication, and empathy – all skills which can then apply in dental school.
Take time to reflect
Once you enter A&E, it’s almost as if you enter a bubble. I find myself walking around on autopilot; I’m seeing the unthinkable but I’m not really feeling it. I have a job to do, and that’s how my mind processes the things that are happening. Writing this article has allowed me to reflect on the things that have happened through the last three years, and more recently this pandemic.
I am ever so grateful for being given this opportunity.
On a final note, I would like to send a very, very special thank you to the staff of the NHS, and in particular those at the Royal London. You make it very easy for me to come to work every week. No pandemic will shake our morale or break our spirit.
We miss our families, we miss our homes, but there is light at the end of this tunnel. Always remember: ‘Happiness can be found even in the darkest of times, when one only remembers to turn on the light’.
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