Not long ago, medical memoirs were still regarded as a hot new publishing trend. Ever since the neurosurgeon Henry Marsh’s Do No Harm came out in 2014, there has been, every few months, a new first-person bestseller exposing raw truths about the NHS front line, from This is Going to Hurt (2017), the comedian Adam Kay’s diaries from his time as a junior doctor, to the former nurse Christie Watson’s The Language of Kindness (2018). These are moving and gripping stories from a health service beloved by the British public, written by the few medics whose prose is better than the handwriting for which they are traditionally derided.
Now, in the midst of a pandemic, such works are less a wave for literary agents to ride than a public service in themselves. Away from the patriotic rhetoric of politicians and stilted warnings of government scientists that have dominated our broadcast news since March, it is most compelling to hear from the people who know what’s really going on.
Gavin Francis – a GP in Scotland and a veteran doctor-writer who has worked across four continents as a surgeon, an emergency doctor and a medical officer with the British Antarctic Survey – is one of those voices. In Intensive Care, we join him on a grim chronological journey through the progress of the virus, as it directly and indirectly affects his patients: in Edinburgh, at his GP practice and a homeless clinic, and on the islands of Orkney, where he does locum work.
[see also: Journal of a plague year]
Conversational and personal (at one point, the author notices his bike helmet strap rubbing his cheeks – he has been so busy he hasn’t shaved for weeks), Francis’s book documents how the policy failings that made headlines in 2020 impacted the day-to-day lives of GPs like himself, his colleagues and his patients.
We read how he resorted to browsing eBay for PPE (his colleague eventually made a bid for hazmat suits in the absence of adequate protection); noted with stoicism the July 2016 swine flu-era expiry date on his face mask; and waited in frustration during the protracted “containment” phase for the government to instruct the public to self-isolate. Social distancing measures, he argues, should have come earlier, “to buy us time”.
Quoting emails and letters from NHS management and other officials, Francis weaves together primary source material that clearly demonstrates the sluggishness of the government’s response. “Not yet, not yet, was the refrain… But it felt wrong,” he writes. “We’d been like toddlers on the beach, fascinated by the waves edging ever closer up the sand, but who still squeal with shock when the water rolls over our toes. None of us could be persuaded to jump back until the disease was already on us.”
Yet when they eventually arrive, the restrictions, too, cause devastation. A 16-year-old calls him in quiet despair: she cannot imagine when life will return to normal, and has begun scratching herself with nail clippers out of distress. A great grandfather with dementia, who has no garden or balcony from which to see relatives, has become “listless and anxious” by July. “I think we’re getting to the point when we have to ask what we’re keeping him safe for,” Francis tells the family, who decide to visit again. An ill cab driver on a zero-hours contract says he cannot afford to self-isolate for two weeks because “if I can’t work for two weeks I’m bankrupt. Homeless, too, as I won’t be able to pay my rent.”
In June, along with a number of other medical professionals, Francis drafted a letter to the Scottish Education Secretary John Swinney imploring him to reconsider the school closures: “We feel that the government has acted to mitigate a measurable harm (Covid-19 deaths among adults) by perpetrating innumerable less measurable harms on those in our communities with the least autonomy, and the least to fear from the virus.” Two days later, more than 1,500 paediatricians wrote to Boris Johnson with the same demand.
[see also: “Unless we adapt and change, we are brittle”: Julia Samuel on healing from trauma]
In keeping with this holistic perspective, Francis writes that he hears from grieving relatives of people lost to coronavirus “from time to time”, but finds the “more pressing griefs” in the first week of August are those of teenagers with their exam results downgraded, and young professionals “losing their jobs as the economic recession began its axe work”.
There is despair, too, at how Covid-19 has warped his own work. Echoing the sentiments of the NS medical columnist Phil Whitaker in his recent piece, “Journal of a plague year”, Francis suspects an “enduring ideological shift” towards online consultations and telephone triage because it’s “cheaper”. One official email he receives (whose author he does not reveal) advises him to embrace a “digital first” model “by default”.
“If telemedicine prevails, those relationships forged in person will become more remote, and the medicine GPs practise will become more perfunctory, based on the avoidance of being sued rather than on what’s best for the patient,” he writes.
Doctors like Gavin Francis, and the other health workers he describes, should be the ones to reflect on what’s best for the patient – having been there with them through the worst.
Intensive Care: A GP, a Community & Covid-19
Gavin Francis
Profile and Wellcome, 208pp, £16.99
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This article appears in the 06 Jan 2021 issue of the New Statesman, Out of control