After almost a year on the front line caring for severely ill Covid patients, Dr Rachel Clarke’s post-work ritual has now become ingrained.
Every night, when she gets home from a 12-hour hospital shift, she sanitises hands, door handles, keys and mobile phone, runs straight upstairs and undresses. She puts her clothes in a bag ready for a boil wash, then jumps into a scalding shower.
Nothing deflects her from this rigid routine. She does not talk to her husband, Dave, or her children, Abbey, ten, and Finn, 14 — they are kept at bay until the cleansing is complete. ‘I don’t interact with the family,’ says Rachel. ‘If Abbey comes too close, I remind her to stay away. In the shower, I try to scrub every speck of infection from my skin. The water cannot be too hot or too forceful.
‘Hospitals are infection hotbeds, but it’s not just about making sure I don’t bring Covid into the home. The ritual of scrubbing myself is at the same time mentally purging myself of the day’s images: patients gasping for air through waterlogged lungs; faint flickering pulses fading to nothing; the helpless grief of the bereaved. The disease is implacable.
‘And in this second wave, the patients are sicker, younger; the conditions in hospital are so much worse. It doesn’t matter how much I try to wash them away, the experiences are indelible. And we are not yet at the peak of the numbers dying.’
Dr Rachel Clarke (pictured) works at Horton Hospital in Banbury, Oxfordshire, on the Covid frontline
I look at Rachel’s pretty face, bereft of make-up, her hair pulled back in a ponytail. ‘Are you exhausted?’ I ask. She pauses. Smiles. ‘Yes,’ she says.
‘There’s a high risk I might cry,’ she adds. ‘I don’t feel embarrassed to admit it. At work we all keep going to the highest of professional standards, but the only way you continue to do this is by letting other things slide.
Sometimes I’ll drive home and think: ‘I don’t have the energy to interact with the children, to play Lego with Abbey, to chat to Dave.’ And I feel terribly guilty. I love them so much but I’m shattered.
‘I have my hot shower and Dave is incredibly understanding. He knows I’ll just slump on the sofa to begin with. And insanely we’re both doing dry January, so I sit with my little bottle of zero-alcohol beer and pretend it gives me a pick-me-up.
‘And eventually I’ll hang out with the children, feeding off their energy. And they’ll remind me why I’m doing this: to help other families stay alive.
‘But the toll this is taking on NHS staff is unimaginable.
‘During the first wave, we were full of fire and commitment, but now we’ve been working with Covid and its terrible effects for nearly a year and the second wave has left us wrung out. Some staff are suffering from depression, anxiety, post-traumatic stress.
‘Almost 50,000 are off work with Covid. Two porters and a lovely nurse at my hospital have died from the virus. So the NHS has a small number of more exhausted staff doing their utmost to deal with a more deadly variant of the disease that is tearing through the country.’
She sits quietly reflective for a moment. Abbey pops her head round the door to ask if she can have some screen time. Rachel says yes, but soon she’ll be done. She has promised her a family bike ride. The push-and-pull, the compromises: they are all part of being a working mum.
She lives with her husband, Dave, and her two children, Abbey, 10 and Finn, 14, and has been juggling work and family life
But for a doctor in palliative care, as Rachel is, the moral dilemmas have all been magnified by the pandemic.
She used to work three days a week, solely at the Katharine House Hospice in Oxfordshire, deploying her blend of compassion and professionalism to steer the dying and terminally ill towards a dignified and peaceful death.
Then the pandemic came, and although she is a wife and mum to two young children, she volunteered to work for the Oxford University Hospitals NHS Foundation Trust to care for those dying of Covid.
When I express surprise at her altruism — it’s one thing to be in a job already that involves grave risk, quite another to step up to the plate and plead (as Rachel did) to do so — she admits a huge weight of maternal guilt tugged at her compulsion to go where she was most needed.
‘It was brutal, almost like a maternal betrayal,’ she admits. ‘But so many of my colleagues felt exactly the same, that we wanted to be in the place where we could help most of all, and because I specialise in palliative medicine, that was working with Covid patients in hospital.
‘And at the start, of course, there was no vaccine, not enough PPE and I was going in to work with these risks in my mind. The children were old enough to understand that there was a chance of them losing their mum.’
Indeed, one evening, soon after she started working on the Covid wards, she came home to find Dave — a furloughed pilot, transformed overnight by the pandemic into a full-time, stay-at-home dad — agitated. Abbey, he told her, was crying; afraid her mum would die of coronavirus.
‘I had caused the little firecracker I love so fiercely sufficient pain to reduce her to tears,’ Rachel recalls. ‘I could imagine her thinking: ‘Who does Mum love most? Her patients, who she’s never met before, or us?’ ‘
Every night, when she gets home from a 12-hour hospital shift, she sanitises her hands and showers so she can’t pass anything on to her family. Rachel is pictured in 2016
After her shower that night, Rachel went to Abbey’s bedroom, sat with her and talked gently to her. She recalls her daughter’s voice, uncharacteristically ‘harsh and hostile’, her insistent, perspicacious questioning.
‘Why do you have to be the one who sees all the coronavirus patients in the hospital? Why can’t it be someone else who doesn’t have children so if they die, it isn’t as bad?’ Abbey asked her.
‘For a second I considered lying. But then I thought, ‘What kind of example am I setting if I do that?’ So I told Abbey the truth; that I’d volunteered, that I wanted to be the one helping these patients. I said I didn’t think I’d die, but she cut in before I could say anything else. ‘Well what if you’re wrong? You don’t know that, do you?’ She was starting to cry.
‘And I didn’t. ‘You’re right, I don’t know, but I’m not working in the most dangerous part of the hospital. That’s called intensive care, where the sickest patients are. I’m on normal wards where it’s not so risky.’
‘And we debated back and forth as I tried to articulate the nature of duty in terms a child could understand; the irresistible tug to use my training to help in a crisis. ‘But what about your duty to me and Finn?’ Abbey asked defiantly.’ Did her resolve waver as she faced her daughter’s distress?
‘The desire to help was desperate. It overrode my guilt,’ she says. ‘Thousands of mums and dads working in the NHS have done the same or more.’
But the awful dilemma persisted. ‘It’s one thing to weigh your own risks of infection, but quite another to know that by going to work you might endanger those you love most dearly,’ she says.
Each day she walks through a set of double doors emblazoned with warning signs: ‘Stop. Do not enter without appropriate PPE.’
It is Rachel’s job amidst the tangled tubes and the eyes flickering with fear to palliate, to reassure in an atmosphere that throbs with dread. ‘The only way I know of managing my fears is through action, trying to help, focusing on one patient, and then another, and then the one after that.’
As we near the anniversary of the first lockdown, it seems miraculous Rachel, 48, hasn’t succumbed to the virus. But she has survived so far, and her daughter’s worries have eased.
Finn had felt afraid for his mother, too, but being a ‘taciturn’ teen had not articulated it as his sister had done. Now, however, both are ‘totally blasé’ about their mum’s job and its risks.
‘They were both deeply affected during the first wave but children have an incredible ability to adapt to anything. They’re inexhaustibly resilient, so even though things are so much worse in hospital now, they’re bored with Covid and oblivious to what I’m doing at work and that delights me.’
It helps assuage Rachel’s guilt, too, that her husband has embraced his new role as stay-at-home dad with enthusiasm. For Dave, 50, the chasm between his professional life and that of a house husband couldn’t be greater.
Before he started flying with commercial airlines, he was a fighter pilot: ‘He was a Top Gun of the skies, a quintessential man of action, so lockdowns are a challenge. Overnight he turned into a 1950s housewife,’ laughs Rachel.
To begin with he found it ‘incredibly difficult’ to cope with the fact that Rachel — whom he was hard-wired to protect — was putting her life in danger on a daily basis.
‘For him, it really struck at the core of what it was to be a man. He did try to dissuade me. But I said, ‘I know if you were in my position you’d do the same thing,’ and he said, ‘Yes, you’re right.’ He knew I wouldn’t be the person he’d fallen in love with if I hadn’t wanted to do it.’
Dave’s unfamiliarity with his new, domestic role ‘was compounded by the daily horror of homeschooling,’ she adds, smiling.
‘I had to completely opt out of it. I just didn’t have the bandwidth to cope with the children or make sure that they were fed and dressed and did their homework. ‘Taking care of them was Dave’s way of helping. And as the weeks went by, I would come home and he’d say, ‘I’ve had such a gruelling day’, and we’d laugh at the absurdity of it.
‘He couldn’t even go out and have a beer with his mates and the children became more and more feral. They used to have their pyjamas on all day and eat nothing but Pringles and marshmallows.
Rachel (pictured on the news last December) has written a book Breathtaking: Inside The NHS In A Time Of Pandemic which describes her time on the frontline
‘They’d be sitting in their beds doing their homework and poor Dave would try forlornly to twist their arms to eat their greens.
‘Now he’s pitched right back into it again and it’s even harder, and I know he’s proud of me going into the fray every day. And really he’s entered into it magnificently.
‘He drags the children on their bikes up hills to have picnics and forces them to run around fields and that’s how they have all stayed sane and healthy.
‘And I can come home and collapse in a heap knowing he’s done these amazing things with them, even if they’ve ridden their bikes in their PJs.’
The sacrifices she has made for her job are, she insists, far from rare. ‘They are reflected right across the NHS and there are many who’ve done more, who’ve left their families and stayed in hotels, perhaps to protect a child with a severe condition.’
The stress, however, has taken its toll on Rachel: she has awful insomnia.
As the virus raged and surged in the first lockdown and she lay sleepless in the early hours, she began to use her keyboard as a form of nocturnal therapy. She started to write about her work; sometimes until dawn.
‘Writing helped distil my fears,’ she says. ‘I’d come home and everything I’d seen in the day started spooling round in my head, a horrific cinema reel. I lay awake reliving it, so writing was therapeutic.
‘I also wanted to chart what was happening: the impact of Covid in terms of lives lost and grieving families is so profound, but people can’t understand because they’re shut out of hospitals.’
Her insomniac’s diary became a book, just published, in which death and darkness are illuminated by bursts of light — the mobilisation of an army of volunteers bringing food to the vulnerable, the children’s rainbows, 99-year-old Captain Tom raising millions for the NHS. And of course the saucepan banging and clapping that marked the initial lockdown.
The first time she heard this cacophonous welcome as she approached her own home, the tears streamed down Rachel’s face: ‘I could have fallen to my knees at the sound. Its kindness and sweetness overwhelmed me with raw gratitude.
‘In the first wave — and it’s still the case — the majority of communities pulled together for the best of everyone. There was this extraordinary groundswell of resolve.’
Today, however, she is appalled by a small but vociferous minority that are claiming coronavirus is a scam. She has been the target of a torrent of vitriol on social media.
‘I’ve had rape and death threats, a constant stream of abuse, just for saying Covid is a grave public threat,’ she says. ‘I’ve been called satanic; a child abuser; Hitler. And there’s a nasty streak of misogyny in this: female doctors are more likely to be targeted.
‘I don’t actually believe I’m physically in danger, but the people who do this deliberately use the most dreadful, vicious language to try to silence you. What they write is personal. It’s designed to be as unpleasant as possible. It’s the only thing that’s more infectious, more virulent than Covid.’
And yet, I say, I know you would treat your abusers with the same professionalism as any other patient if they were admitted with the disease. ‘I would give them the same care,’ she says.
Will she be silenced? Of course not. To Dr Rachel Clarke’s list of inestimable qualities — humanity, altruism and sheer grit — we must add courage. ‘If I block people on social media so I don’t witness this, they’ve achieved their objective. I’m there to try to protect us all from harm and if I stop saying what I need to say as a doctor, they’ve won,’ she says.
Fellow doctors, she says, have emerged exhausted from hospital shifts, intubating patients in intensive treatment units, to face ‘a deluge of abuse’ from placard-waving demonstrators.
She insists, however, that talk of heroism is inappropriate. Damaging in fact. ‘It’s dreadful being demonised,’ she says, ‘but being lionised has its own unintended harms, too. It depersonalises you, and makes it easier to forget we’re not superhuman. We’re just everyday people doing our jobs with quiet, sometimes desperate, determination and to the best of our abilities.’
She is heartened by the vaccine and has had her first jab. ‘We have to keep going. I’m clinging on to the hope it gives us. The end is in sight,’ she says.
Breathtaking: Inside The NHS In A Time Of Pandemic by Rachel Clarke is out now, published by Little, Brown (£16.99).