A doctor I spoke to recently cried as she told me she had seen more deaths of patients in a month than in the rest of her career. Their lives ended with no loved ones by their side, in the new and brutal world of Covid-19. She felt devastated at the difference between the death of her grandmother, with the family by her bedside, and those on her ward, alone.

I’ve heard many similar stories over the last few months from exhausted, overworked doctors who have been brought to the brink by the demands of the pandemic. We doctors usually thrive on stress, but the emotional overload and mental fatigue wrought by the first wave of Covid-19 – and the looming prospect of the second – is impossible to overstate.

As the pandemic hit, back in the spring, the feeling throughout the health service was: “Let’s just get stuck in.” If we are not careful, I fear  it’s now more likely to be: “I can’t bear this, I need out.”

Last week, we learned that a number of intensive care nurses have been sectioned under the mental health act as a result of the “psychological trauma” they experienced during the first wave. Others have received counselling for post-traumatic stress disorder. In May, when intensive care units were under most pressure, NHS staff took more than 500,000 sick days due to mental health issues.

NHS Practitioner Health, the service I set up 12 years ago to support doctors suffering mental or emotional distress, has never been so busy. A year ago, around 60 doctors per week referred themselves to us, seeking a safe space to express their anxiety or needing treatment for more serious mental illness or addiction. Now it’s 125 – and we’re just talking doctors in England here – with numbers creeping upward every week.

Almost everyone suffers in lockdown. As a GP, I am learning from personal experience that working from home can result in back pain, weight gain and insomnia. This needs to be factored in when the government makes decisions about lockdown. Mind and other mental health charities are predicting a “second pandemic” of mental health problems if people are left to struggle on alone.

Doctors and nurses, working directly with patients, are the most vulnerable, but just at this point of maximum stress the pressure is being ratcheted up again: some 40,000 nursing posts are unfilled, putting strain on the remaining workforce. Intensive care nurses, who traditionally care for critically-ill patients on a one-to-one basis, have been told that – due to staff shortages – that rule is to be suspended so they will have to look after two.

A female doctor I talked to over the summer had not been home for three months. I was the one in tears as she described her lonely life living in a hotel in order to protect her family and be present for her job.

I’ve talked to doctors who are buckling under the stress of doing too much, and others consumed by guilt at not doing enough. A young doctor who had taken a few years out to do research came forward to help, only to be sent to a call centre to advise people who had been asked to “shield”. He felt bereft at not being able to use his skills in emergency or urgent care.

On top of the fear, exhaustion and loneliness comes the very real prospect of picking up the virus. More than 100 healthcare workers in Britain have died after contracting Covid-19, some 25 of them doctors.

The majority of our new registrations at Practitioner Health are young women, aged 30-39. They tend to be of training grade, so they are working long shifts and many are juggling family with work while still struggling with exams. They have a double whammy of  incredibly difficult jobs and additional responsibilities. They may be working long hours but we know who (generally) cooks dinner and when the washing machine breaks down, who has to wait in for the repair man. No wonder the emotional impact of the work they have to contend with on top of it all sometimes becomes too much.

When I was training, we were taught to conceal our feelings and not to show horror or fear. The first time I saw cancer, I went to the loo and vomited. By the next day, I had started to learn some psychological defences. The day my mother died I had to finish a busy clinic. It was too late to delegate the session to someone else (though I imagine that says more about my failure in accepting vulnerability than management’s response if I had cancelled). Despite my grief I had to focus on my patients. On the way to an evening surgery, I was knocked off my bike. Instead of abandoning ship and going to the accident and emergency department I hailed a taxi and completed the clinic with blood oozing from my foot and in great pain. It did not cross my mind that I could have cancelled and sought help.

Doctors are hard-wired to think themselves invulnerable, to step up when everyone else is falling down. My father, a beloved local GP, used to tell me that “sleep is an imperfection of nature”. He meant that it was important to work hard, give back something to the country that had given you an education – especially as we were an immigrant family – but human beings need rest, both physical and mental. Never allowing yourself to relax, never reflecting on what you have felt or seen, never letting your real feelings show can result in intolerable pressure. The medical profession has an unenviable record of suicide and, as a clinician working in Practitioner Health, I have encountered doctors alleviating stress through alcohol abuse and addiction to drugs.

In my new book, Beneath the White Coat, I try to unpick these problems and suggest ways of alleviating them. Most doctors who come to the service – which offers talking therapies, medication and in-patient treatment – present with depression, anxiety and symptoms indistinguishable to post-traumatic stress disorder. A small number have bipolar disorder or other psychotic illnesses. Where doctors differ from most people is that they often present for care late, or following a drink-driving offence.

That, thankfully, is changing. This generation is much more honest about its mental health and young doctors I meet today are more honest about addressing their own needs alongside the needs of their patients. To them, showing vulnerability doesn’t mean showing weakness.

I learned the hard way, by coming to a crisis that meant I almost left medicine. My sons, now grown up, were aged around six and ten. I had worked full-on while they were little and I suddenly had an overwhelming sense of grief at losing their childhood. There wasn’t a term for burnout then, but that’s how it would be described today. I sat in the consulting room and thought “I can’t cope”.

If you are a good GP – and I think I am – the problems your patients bring into the surgery stay with you. I was seeing a lot of people with drug problems or who were homeless. They had longstanding, intractable problems. What could I do to help them? I couldn’t find them jobs or repair their broken relationships. I felt washed out.

I took a four-month sabbatical to write a book about drug misuse which meant I was home over the summer. The boys probably didn’t even notice but it mattered to me that I was there, and the stress of trying to make arrangements for their care over the holidays was lifted. More importantly, that time taught me I wasn’t indispensable, my patients could survive without me, I had more to life than the practice and when I went back I limited my patient-facing sessions. I continued to work hard but in a different way.

It may seem odd to be talking about doctors in despair when we have so many of the things that usually ward off anxiety and depression – good social networks, high status, financial stability – but I think everyone can appreciate the impact of long shifts on a cancer or Covid-19 ward without support.

This is the key. I trained at a time when self-sacrifice was the norm but the system looked after you. I had study leave, hot food at night and accommodation on site, so my “commute” to work at the hospital was the distance from the average bedroom to living room. We had doctors’ dining rooms and doctors’ messes where we could talk in private, share experiences or tell bad jokes.

As we enter the next stage of the pandemic – the short days and long nights of winter – we have a moral imperative to improve the mental health of the whole workforce, both to lighten its lot and to prevent doctors and other health staff from getting to the point of thinking “enough is enough”.

If you put an individual into a toxic environment no matter how much padding or physical PPE you put around them they will still fall over, so we need to look at these long, intense, 12-hour shifts. We should be halving those shifts, bearing in mind that taking breaks is difficult if you are wearing PPE. We should double or even treble up on teamwork so it’s possible to hand over to someone else and as an individual, we don’t feel it’s all dependent on us.

We need to provide decompression rooms, so every single front-facing, doctor, nurse or physio, or other clinicians has a supportive space so to talk about the emotional impact of work, to normalise the distress they feel so they don’t have to take it home. In addition, they need easy access to psychological support. Perhaps we should make taking holiday compulsory.

The picture isn’t wholly bleak. I have been impressed by how so many doctors have coped with their lives being turned upside down. Across the world, healthcare staff have been applauded and I like to think that appreciation of doctors, nurses and carers might be a lasting legacy of the pandemic. Some doctors have reported feeling re-energised, in control and connected to their colleagues by Covid-19.

NHS England is trying to address all this by creating resilience hubs and some hospitals have re-created doctors’ messes, decompression or welfare rooms indistinguishable from first class airline lounges. Staff can have free access to refreshments, recliners, massages and counsellors if needed.

This is the way forward if we really want to support our hospital staff. Fatigue, fear and grief are not in themselves mental illness but they feed into a sense of hopelessness. That’s bad for anyone, but if you are a doctor or nurse it’s really demoralising. We’re seeing a lot of that feeling at the moment. Let’s not let Covid-19 create any more.

As told to Margarette Driscoll

Beneath the White Coat: Doctors, Their Minds and Mental Health is published by Routledge, £22.99, with royalties donated to the charity Doctors in Distress.

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