Dr. Nicola de Savary is a consultant in General Medicine and Elderly Care for Oxford University Hospitals in the UK. Here in an exclusive interview she tells us how she’s carried on on the front line of COVID-19, from wearing PPE (and the lack of it) to worrying for colleagues’ safety and the tremendous global effort for sharing medical knowledge throughout.
Q: Tell us about your work…
A: “I work between 2 hospital sites; a satellite hospital in Banbury and the main hospital in Oxford. Usually I run the Acute Ambulatory Medical Unit which involves me taking the phone referrals from GPs and A&E for acutely unwell medical patients (not trauma or surgical problems but things like pneumonia, sepsis, heart attacks, drug overdoses, and acute confusion). I decide on the phone what I think is wrong, whether they need hospital review or whether I can give advice to the Doctor or Paramedic on the phone. If they need to be seen by the medical team, I then decide whether we can manage them on the Ambulatory Unit with treatment during the day and then our nurses going out to give them treatment in their homes, or whether they need admission to hospital and our Emergency Medical Admission Unit.”
It’s a fabulous job – I love the diversity and pace – and I hear all kinds of stories. I have the opportunity to be the first to work out what is going on and what’s the best way to try to make it better and whilst I lead the Ambulatory Team on our unit, I also work with multiple teams of doctors, nurses, therapists and managers across the hospital. The downside is that I’m ‘A Jack of all trades, master of none’ and it can also be a rather stressful job – I have to manage diagnostic uncertainty, bed shortages and a very fast-paced environment”
Q: What’s the context outside of your work?
A: “I live with my husband Tim, a publisher, our three boys, and our badly behaved dog, in an 18th Century stone farmhouse in a village in Oxfordshire. We feel incredibly lucky that we moved to this area in a panic when the boys were all tiny. I had twins which meant I managed to end up with three boys under 2 years old. Our choice of relocation after the twins was a rushed decision but it has turned out to be a fantastic place to live; beautiful countryside, idyllic local school, close to Oxford and London and full of super fun and like-minded local friends.
“I work part-time and do the constant work/ life juggle. However, on my day off in ‘normal times’, when the kids are at school, I squeeze in some time for yoga, wild swimming, dog walks and the odd gallop on a friend’s horse. We love spending time with local friends and having friends to stay for weekends. Holidays are a big part of our philosophy and we love to travel whenever possible normally. We always go to the Canadian Great Lakes in the summer but also try to fit in some skiing when we can. Every once in a while I manage to join a yoga retreat or escape for a horse riding adventure in South America with a friend who runs Ride Andes.”
I wouldn’t say I have tremendous routine – my work is varied and my home life probably not as organised as it should be. However, overall I would prefer to maintain the opportunity for some flexibility and spontaneity. I hate the feeling of being all booked up. Yoga is a weekly fixture on a Monday and I usually do some work from home on Tuesdays, and then I work at the hospital Wednesday to Friday.”
Q: What has your day-to-day live been like during COVID-19?
A: “In some ways daily life hasn’t changed that much. I still go to work and try to keep on top of things at home. Having 3 teenage boys at home all the time and home schooling is quite full on – it’s amazing how much they eat. With no social gatherings we have definitely done more gardening and work on our home. Unfortunately we are mid-way through a renovation of our house and the builders have stopped, leaving us in a bit of a building site.”
“Work-wise, it has obviously pervaded every part of my work, but there has been excellent morale and a real sense of camaraderie. The down side is that COVID is horrible and we have lost a lot of patients and some colleagues. When I get home I go straight for a shower, put my scrubs in to wash and try not to bring work stresses or COVID in to my home.”
Q: Tell us about PPE…
A: “We all now wear scrubs and PPE to see all our patients which adds a whole other layer to our daily practice – ward rounds go on forever and my hands are so dry from all the washing. PPE is basically annoying. We’ve all learnt how to “don and doff” the kit but it’s hot, time consuming and the masks make my throat tickle – every once in a while this can lead to a coughing fit, which clearly doesn’t go down well when everyone’s worried about catching the bug.”
Q: How has the virus impacted you personally?
A: “Personally I feel very lucky that COVID has not impacted me too badly. I haven’t lost any relatives or close friends to the virus. Like everyone, it’s stopped me seeing people I love and generated a fundamental layer of anxiety. I am sad for my children – the twins are missing their last term at their school, and my eldest is missing key GCSE work and time with his friends.”
Q: How do you feel the virus has been managed in the medical industry?
A: “In the UK we were lucky to have more time to plan and get ourselves organised for this pandemic. We heard reports from colleagues in Italy that broke our hearts where they were rapidly overwhelmed and had to work in incredibly stressful situations. Locally we redeployed nurses/doctors, re-organised wards, and cancelled elective operations and clinics. This gave us space and we weren’t overwhelmed.
“However, there have been some distressing shortcomings in our response. The lack of provision of PPE, COVID testing and support for Care Homes has been terrible. They have worked incredibly hard independently to keep their residents safe but it highlights the critical need for social care and the NHS to be joined together.”
Q: What have you found most challenging?
A: “Probably following all the infection control guidelines and wearing PPE as well as working out some coping strategies so I don’t bring my work stresses home.”
Q: What have you found most worrying about COVID-19?
A: “I have worried about colleagues being exposed to the virus – especially those in the high risk groups and I have felt added responsibility for their safety. I do worry about my family too – my father is super high risk and really must not get the virus.”
Q: Are there any important insights into the virus you have noted?
A: “During the early days, there was massive uncertainty as to how we managed patients with it. We can only really offer supportive treatment such as oxygen, fluids and good nursing care. Yet even in that we didn’t know what our thresholds should be for types of assisted ventilation or if we should keep our patients wet or dry. But due to a tremendous global effort to share knowledge and experience through webinars, free articles and teaching sessions we have become more knowledgeable and have more confidence in how to provide optimal management for these patients. Something like proning patients (asking them to lie on their stomach) to improve their ventilation was new to me and is now routine.”
Q: Where are you finding hope and optimism?
A: “The national response has been incredible. People willingly isolating themselves and denying themselves their normal activities and pleasures has been extraordinary. The tremendous support for key workers and the NHS has also been fantastic. Some of the best of humanity has clearly been on show – Captain Tom (the 100 year old UK war veteran who walked 100 lengths of his garden to raise money for our National Health Service, and raised £32 million in the process) is a prime example.”
Q: What do you miss about life before COVID that you never thought you would?
A: “Freedom. Not being able to see those I love has been very hard.”
Q: What have been your coping strategies?
A: “My yoga teacher (and great friend) Nicole Page-Croft is providing weekly Hatha Flow sessions on Zoom and I attend these religiously. Dog walks are key – especially with nature being on such incredibly fine form, and forest bathing is most definitely good for the soul and I’ve just restarted some wild swimming.
I have designated my sister and a couple of friends as “go to people” for a phone call debrief on my way home, when I feel overwhelmed, and mindfulness and breathing exercises have been helpful in acute moments of stress. I’ve probably drunk too much alcohol and definitely enjoyed too much food. But I’ve managed to keep my spirits up.”
Q: What has been your mindset about how to use your time at home?
A: “I haven’t had that much extra time at home. We have definitely done more gardening and work on our house. I’m sad that I have not been able to be more creative, but occasionally I join one of my sons for a drawing session.”
Q: How are you managing your mind and wellbeing and that of your family?
A: “I have been keen that we all get out for a daily walk or exercise and have really enjoyed going for runs with boys, although they leave me for dust pretty quickly. We have played more family games and I’ve really enjoyed our meals together. I’ve been much more liberal about screen time for the boys – which they have definitely enjoyed! I’ve kept reading novels to take my mind off things but also really enjoyed Pale Rider which was an incredible account of the Spanish Flu and gave me some perspective on this pandemic.”
Q: How do you see the world changing because of this?
A: “I really hope we can incorporate some of the positives from this experience in to the future. For me the biggest seems to be the environment – we must capitalise on the reduction in traffic and unnecessary travel. In addition, the compassion for the vulnerable has been wonderful and long may that continue.
In medicine, colleagues have exhibited remarkable flexibility and compromise. I think it has made us more nimble and less set in our ways. The free sharing of knowledge, journals and remote teaching are definitely things I hope will continue.”
Q: Despite all the negatives and the brutality of the virus are there positives you feel are coming out of this – a silver lining perhaps?
A: “I think I will look back on this family time with real nostalgia. I used to worry if I did not have organised activities and plans – now we can just hang out as a family and are much more relaxed about our days. It has given us a chance to reflect on our values and what’s important to us.”
Q: What have you heard about the vaccine they are creating at Oxford University?
A: “I had signed up for the Phase 1 trial of the Oxford vaccine. I really wanted to be supportive and thought it must be good for people on the frontline who might catch the virus to be involved. Unfortunately, due to one of my screening test results I could not be included at that time.
I am so proud of colleagues in Oxford who have worked so incredibly, if not miraculously, hard to develop and test the vaccine so rapidly. Oxford is also running the recovery trial of various different treatment options, and again this was set up with breathtaking speed. I really hope the vaccine is a success but I also wonder whether the virus will just burn itself out over the next year, like other past pandemics.”
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