Corona Daily 118: A Day in the Life of Alison Forde

Alison Forde checked the latest figures before leaving for the Royal London Hospital. At 6 am, 30 patients in a&e (accident and emergency) required a bed, half of them covid patients. Six people had been waiting for more than four hours. An 82 year old man arrived yesterday was waiting for 15 hours. The risk of dying increases if a patient is not treated inside six hours.

Alison’s team was shrinking. Out of her core team of eleven, three were off sick, and one was isolating with covid symptoms. In the early months, the hospital had suspended all routine work, including cancer treatment. In January, the sickest covid patients were earmarked for Royal London.

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As the Head of Site Operations, Alison’s main job is to allocate patients to key areas of the hospital. A&E is the clearing house for admissions. From there, she moves patients to respiratory wards to give oxygen via masks or nasal tubes. Or to intensive care which now has three floors (earlier one). Every day Alison was confronted with a brutal fact. There weren’t enough beds. The hospital chain had only ten spare intensive care beds. The entire system was on the verge of grinding to a halt. People who could be cured in pre-pandemic time may not survive now.

After ten months, survival rates had improved, which had aggravated the situation. People now stayed on life support for long, which made intensive care beds scarcer. Earlier, death was the primary mechanism of discharge.

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08.30 am was huddle time for Alison’s team. Here they planned the day. Now, with social distancing, the team occupied the entire corridor. Some members struggled to hear what was being said.

NHS in general, and Royal London in particular, has set capacity benchmarks. The number of ambulances waiting to offload patients, waiting patients, bed occupancy, staffing rates and such. The system triggers alarms. For example, a patient waiting beyond certain time will be sent to another hospital. But now, with all hospitals overflowing, those alarms made no sense. Alison had simply changed the parameters.

The 82-year old fortunately got a bed at 07.15 after waiting for 16 hours.

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Novel tasks were added as a result of covid precautions. Every day, piles of clinical waste from intensive care, including heaps of soiled personal protective equipment had to be disposed. They packed the store rooms to the ceiling. The logistics of disposing the waste mountains was looked over by Alison.

At lunchtime, Alison felt overwhelmed. She sat in the corner and cried a little. Her team was a little surprised to see her state. She is known as the cool cucumber.

When the pandemic started, Alison was extremely worried about contracting coronavirus. Every day, each doctor would visit her office to get three or four death certificates signed. Some hospital employees died as well. Every time she coughed, she thought she had covid. To avoid the Tube, she started cycling to the hospital. She fell off, fractured her jaw, cut her lip, ligament and wrist, and needed two operations. But her fear of covid disappeared since.                                                                                                                                                                                                                                                                                                                                                                                                                                                            

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The hospital is considering adding another unit. That would mean diluting the nurse-patient ratio further. Normally one nurse for two is the maximum allowed; now one nurse takes care of four.

At 4.30 pm, 31 patients were waiting for more than four hours in a&e. By 8 pm, more than sixty.

Alison’s 12 hour shift finished at 08.30 pm, but she can never leave before 9 pm. She caught the bus home, had a cup of tea, a quick cold sandwich. She did a bit of cleaning, more to distract herself. After checking the morning alarm, she went to bed.

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P.S. For 1843 magazine, Simon Akam interviewed Alison Forde, who described her 15 January 2021. This article presents it in a compressed form. For health administrators in Brazil, India and other developing countries, working days are even more terrible. Fortunately for Alison, the situation in London has now improved.  

Ravi