‘Look of panic’: one dentist’s experience working on the COVID-19 frontline
Jamie Durrant-Fellows is a clinical lead for periodontics and facial aesthetics who has been working as a senior house officer (SHO) in general medicine as part of the COVID-19 effort.
He talks to Dentistry Online about his time on the frontline, spending time away from his children and the biggest challenges of his experience so far.
How did you land yourself the role?
I realised the pandemic had the possibility of being bad in the UK when all I could see coming from Italy was film after film of ventilated patients being nursed prone (on their stomachs).
Prior to dentistry, I was a senior ED nurse in the NHS and the Queen Alexandra’s Royal Naval Nursing Service. I was aware from my nursing career that when you prone a patient it’s a ‘bad’ sign – and that’s when it hit me that this could be bad.
I still have close friends in emergency care and knew it was rising fast in London and the midlands from what they were telling me. Initially, I tried to get in touch with the Nursing and Midwifery Council (NMC) to go back is as an ED nurse but I’d been off the register too long. The NMC advised me that my skills ‘were not needed’ and ‘out of date’, which was frustrating.
One of my close friends mentioned his trust. A DGH in the midlands, 306 beds and understaffed like many NHS trusts. He pointed out that, as a GDC registrant, with maxillofacial (maxfax) SHO experience – albeit nine years ago – and previous critical care experience, I had skills that could be refreshed and used. So I stopped with the NMC and looked at other options.
Ben got me in front of the medical director at the trust he worked in. After a short, to-the-point interview, I was asked to start that afternoon as a ‘Medical SHO’ after registering with NHS Professionals as a ‘pandemic doctor’. This was on the 30th March 2020. We last worked together 20 years ago when we were fresh faced baby medical assistants in the Royal Navy Working at the Royal Hospital Haslar. It has been a blast from the past working together in the same hospital again.
I was rotated around upper GI, acute medicine, CCU, respiratory and underwent ICU upskilling. This was alongside many other health care professionals. I was monitoring CPAP and the completion of death certificates was thrown at me (for disclosure, I’ve not certified anyone). On week two, I went straight into nights – the first lot in nine years – in ED2, assessing sick suspected COVID-19 patients.
I will say the trust were very aware of my skillset, background and experience and have bent over backwards to accommodate and support me.
What do your friends and family make of it?
Many of my friends are in acute and emergency care. They basically laughed that I was late to the party. However, they are also proud that I put myself out there.
The practice team at VIDA have been nothing but supportive. Obviously patient commitments needed to be met and they have rallied around to free my commitments so I can focus on this – they really are a great team.
I’m sure many other practice teams across the country are also supportive but they really have gone above and beyond. I even received a surprise ‘morale’ boost organised by one of the hygienists in the form of delivered brownies. They went down a treat.
My family have also been nothing but supportive. I am now working away from my home. I don’t get to see my children as often. My mum moved in with me on the Sunday before lockdown (we knew it was coming) to help out with childcare so that their mum could have some down time. It also meant she could have some quality time with them on her own why I was away working.
More importantly though, it means that they are home – albeit in bed – when I get home after a 12 hour shift and a two and a half hour drive. Without this I would have even less time with them at the moment. My girls (aged eight and nine) just think it’s funny that daddy has gone from a ‘tooth doctor’ to the hospital helping with ‘the virus’. Their rainbow pictures in the window a couple of weeks ago were a great surprise to come home to.
I’m living with friends when I’m in the midlands. They have been nothing but supportive and instrumental in getting me through the initial transition of re-learning acute medicine in weeks. I can’t thank them enough.
What does the role involve?
I’m an SHO in general medicine – but I’m never alone. I’m assessing, prescribing, interpreting test results – including the odd little haematological disturbances that COVID is causing.
I can now assess a chest x-ray, know what’s normal and what COVID-19 looks like along with other abnormalities. I can confidently listen to a chest again. It’s been a while since the stethoscope was used. Although again, don’t think this isn’t being supported. The consultants, registrars, my SHO colleagues and the F1s are there every step of the way.
Shifts can be 9am to 5pm, 9.30pm to 9.30am, 9am to 9.30am and the new sneaky 2pm to midnight shifts alongside our medical colleagues. It’s a total change to the normal working pattern of general practice. It’s so far from what I was doing eight weeks ago you can’t compare it.
On my last shift this week, I was on AMU as the ‘doctor’ looking after a bay of patients. Two strokes, an infected exacerbation of COPD, a gentleman suffering from a multitude of neglect-based issues (on top of his yet to be confirmed COVID) to highlight a few.
I was off this bank holiday weekend and myself, the girls and my mum took advantage of the good weather. This week I’m working on the general medical wards from Monday to Wednesday and then back onto nights on-call for the weekend. This is the ’new normal’ for the time being.
The CDO in her webinar stated we were ‘head and neck specialists’ and I feel the same. The amount of medicine we cover in our education is huge. Of course, I am not a medic but I think the level of knowledge we all have is sometimes underestimated.
It’s not taken that much to flip the knowledge from how it affects the mouth to actually focusing on the disease process.
How have you found the experience?
Stressful, exhausting, humbling with what has been undertaken but really enjoyable professionally. It is a massive learning curve. I’ve had to deal with some really critically ill individuals and it’s at those times that the knowledge and training kick in.
The support people have given me is astounding. The amount of ’thanks’ I’ve received for taking the plunge is a little odd. I didn’t do it to be thanked by the professionals I went in to support. I want to thank them, and especially the clinical director for taking the plunge to do what I think is possibly a totally unprecedented move. But it’s working.
In terms of the patients, I’m acutely aware of telling people: ‘Hi I’m Jamie, one of the medical team’. The majority of the patients respond: ‘Oh, you’re one of the doctors?’ and my response is always: ’No, actually I’m a dentist…’. Many of them are a little surprised. However, I normally break the ice with a joke about it and to date, they have all accepted it.
I’ve had a couple of people ask me once I’ve done whatever it is I am doing if I can look at their dental issues. Sometimes they want to talk about when they can have their filling finished.
But so far, it’s been a great experience. This is an unprecedented time and we have not had to deal with anything like this in recent years. It’s good to be a part of it.
What have been the biggest challenges?
There have been a few as I’m sure you can imagine, but I’ve never felt I have been put or will be placed in a situation that I cannot competently deal with. The obvious one is bringing acute medical management back into the forefront of my mind.
There is a protocol, pathway, app or guideline for the management of most admitting complaints. One of the biggest challenges is finding them and working through the paperwork. This again has been really well supported throughout.
I suppose the biggest challenging I had to overcome was when I had to deal with my first ARDS (acute respiratory distress syndrome) patient. Myself and a really experienced F1 had been called to a ward to assess a fit and healthy 43 year old who was short of breath. He had been admitted with COVID-19 but at the time was awaiting the swab results.
One of the biggest challenges I have had to accept is how quickly this virus, if you are affected wit it, can make a patient deteriorate. Initially he was needing 15L of oxygen, his saturations were 90% on this and his temperature had spiked. The pair of us arrived on the ward and started our assessment.
I listened to his chest and he wasn’t moving enough air. It wasn’t silent but there was a lot of wheeze. We ordered the urgent portable chest x-ray and started to manage his observations. We had already called for ICU outreach and they were going to come up as soon as they had finished with a patient they were stabilising.
His portable chest x-ray was taken – it was a total white out. The kind of thing you see in a text book and think: ‘I’ll never see anything that bad’. Sadly, his condition deteriorated – his saturations plummeted and he wasn’t able to breath. There was a look of panic in his eyes.
Thankfully, the ICU nurse and the team got on with what was needed and stabilised him using a CPAP machine. He was on CPAP for four days intermittently. Fortunately, he was one of the lucky ones that didn’t need full ventilation and walked out of hospital. I’ll never forget that man.
It has been a challenge but there is a large team and that’s the thing I think we are not used to in dentistry. Those of us in general practice are used to, for the majority of time, being the clinician. Yes, we have our team but as dentist we tend to manage our patients alone due to our area of medicine. In general medicine it’s a team approach in a totally different way. It has been great working with such a great team.
What has it taught you?
I could list thousands of things. From the medicine to the structure and process of the hospital to coping with sleep deprivation. But the biggest thing I will take from this experience so far is that we can support our health care colleagues in a way that might not be realised. There is sometimes a lack of understanding in what it is we do and learn. It’s time dentists came to the forefront in acute medicine. I’ve had the opportunity, I hope – at least in my current trust – to break down some barriers.
I’ve been asked to assess some facial trauma. It’s been a while since my maxfax SHO days but an orbital blowout still looks the same on x-rays. I’ve been able to educate medics as much as they have educated me– I think we ned more cross cover and training.
One of the funniest moments to date was a conversation with one of the medical consultants and the team. They were concerned the patient had osteomyelitis after assessing a swelling. It is always a concern but it wasn’t that impressive. I had a laugh with the consultant – he has become a friend – and the other SHOs about how all medics think a swollen face is the notorious osteomyelitis.
He took it in the sprit it was given and we then spent a good portion of time discussing the extraction and satisfying drainage I felt that it would produce. Some of them went a bit green.
So what next?
To be honest, I don’t know. I appreciate as much as they do that a dentist working as a medical SHO won’t continue forever. At some point we will be able to re-start dentistry again, whatever form that will take, and life will return to some form of ‘normal’.
We have concerns obviously that the lifting of restrictions will cause a second spike. There is a real sense of ’this isn’t over yet’. It will be interesting to see what the consequences of people not staying at home. We did notice local a small spike in attendances after the lovely easter weekend.
And the roads are getting busy. I’ve really noticed it over the past couple of weeks driving home, which is essential travel to see my girls. At times the A34 had seemed almost as though it was business as usual. I’d like to think it was all key workers travelling across the country but I’m not that naive.
I’m currently seeing more symptomatic patients and CPAP – although thankfully that is falling. However, I am concerned what is possibly to come. Hopefully it will be all as it has been for the past few shifts and it will burn itself out. Only time will tell.
I miss practice and I know I have patients that are in need. At the moment I can’t plan from one week to the next – it’s the same as all of us. All I can do at the present time is put my scrubs on, grab my stethoscope and see what the shift throws at me.
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