Interview: Kate Jordan, NHS Doctor (Part 1)

Kate Jordan is a scientist, medical doctor, and mother who holds a BA from Colby College, USA, a PhD from Warwick University, UK and an MBBS from Imperial College, London. Kate is originally from America and currently lives in London, UK with her husband and two small children. She works as a medical doctor at St George’s Hospital and has been frontline during the COVID pandemic. Dedicated to equal opportunities for woman and children, Kate has participated in youth mentoring schemes, was a founding member of the Warwick Women in Science group, and currently represents less than full time trainee doctors at a local and national level.

Mina: I'm speaking with Kate Jordan: a medical doctor and a generally great person. I was wondering if you could begin by introducing yourself?

Kate: Of course. As you said, I'm a medical doctor, though I came into medicine a little further in my career. I already had a PhD in molecular and developmental biology. My first degree was in English and biology. In between undergrad and going into medicine, I was doing some research - that is very common in America - and then was offered an opportunity to do a PhD here in England. I took the opportunity, which meant that I did medical school here as well. So although I'm further in years, this is only my third year as a medical doctor.

Mina: Well, that's a pretty worthwhile route. I remember you getting an award for your PhD! What made you want to be a doctor? 

Kate: In America, you do all subjects until you go to university. You don't have to identify what you want to do as early as you have to in Europe. I was always really good at English; it was my best subject. When you're a kid, and you're good at something, naturally, you are pushed towards that subject or hobby. There was this assumption that I would do something in English or with writing, but actually, I always found science really interesting. Comparatively, I wasn't as good at science. But in part, I think that’s because I wasn’t prompted to explore it as much.

When I got to university, I decided to double major. I realised the thing I like about English is the communication aspect - speaking and connecting with people. The best way to apply that to science is actually to do medicine. You can communicate with people but also have this scientific route. Medicine, in itself, doesn't advance because of medicine; medicine advances because people outside and within the medical field also do scientific research.

Medicine, in itself, doesn't advance because of medicine; medicine advances because people outside and within the medical field also do scientific research.

That really interested me because I thought I was going to do oncology. My dad, unfortunately, died of lung cancer. It was about 15 years ago, and it was very much a death sentence. Back then, oncology was very much an emerging field. I found it really interesting, and I thought, if I'm going to be a good doctor, I have to be able to combine the two: science and medicine. That was really what prompted me to do a PhD.

Mina: Are you still involved in research at the moment?

Kate: I am, yes. I don't do research in a lab, but I'm doing small studies in the hospital. Everyone in medicine now does quality improvement, but I'm also doing a study with Public Health England on neonates and looking at neonatal infection with varicella. Basically, it’s focusing on mothers who get chickenpox while they're pregnant, how that affects the baby, and whether it would be appropriate to put the chickenpox vaccine on the UK vaccination schedule for these women because, although chickenpox itself isn't necessarily dangerous to children, women are more likely to get it. If they haven't had it as a child, they're more likely to get it when their own children get chickenpox.

Since women often have multiple children, they may get chickenpox for the first time when pregnant with their next child. That can be very, very dangerous. So we’re looking at the effect that chickenpox has on the population who get the virus, but also the effect it has on the people around them. 

Mina: This brings us neatly to my next topic. Having done medicine, you were starting your career as COVID hit. You were working full-time hours and placed into many difficult situations. How have you found your role? It probably was a lot more intense at the beginning than you anticipated.

Kate: It's definitely been a hard 18 months. I was in my first year as a junior doctor; the pandemic started after my first eight months. Immediately, I was moved to cover the COVID wards. After a stint on the COVID wards, they released us all back to our base wards to try and give us breaks. I had a short reprieve of about four or five months, and then the second peak came. So, I was redeployed back to the COVID ward.  Normally, junior doctors rotate every four to six months, depending on how far along you are. You're already moving every few months, but then you're being taken off of that rotation and put back onto the COVID wards.

After the second wave finished, I went to the emergency department. That was my next rotation. That was timed perfectly with the third peak. I'm now back on an adult medicine non-COVID ward, not seeing COVID patients for the first time in a really long time. I still cover a COVID ward one week a month. I still get put back on to either a week of days or a week of nights covering COVID wards just because there are still COVID wards, and they all still need doctors.

The first wave was awful because none of us knew what it was. 

The first wave was awful because none of us knew what it was. There were no treatments for it. The system became very close to meeting its full capacity. I personally was on a ward that was for patients who were not suitable to go to ITU because it was felt that they very likely would not survive. If they were intubated, they would never be extubated. So, if they deteriorated, there was nowhere for them to go. We just had to palliate them. 

I definitely did not become a doctor to watch 30% of my patients die every week. But that was the reality of it. When you become a doctor, you see people die; that is part of it. But it is a very different matter to see that volume of people die away from their families because obviously, you can't come to a COVID ward as a family member. We would be there, holding their hand, instead of a family member. Some families had to make the really hard choice of not being with their loved ones at the end of their life because it would put them at risk of getting something that they may not survive.  

During the second wave, we had some more evidence on better treatments, so the rate of people who became unwell was lower, which was great. I think we were all much more aware of what we were facing, which made it easier to be prepared. In a weird way, the trickiest part is now. We have vaccines, which are wonderful and protect the majority of people. 

There are obviously people who still don't want the vaccine and don't have the vaccine. When unvaccinated people are admitted to the hospital, I want to tell them, “You don't need to be sick. You could have had the vaccine. You are putting yourself at risk. You are putting the healthcare workers who look after you at risk, which puts our families at risk. And, you are putting the rest of the population at risk because, as we know, this is a virus that mutates quite quickly. By not having the vaccine and getting the virus, you become another host that it can then mutate in, which could put everyone at risk”. If there's a mutation that vaccines are ineffective against, then everyone is back to square one.

My colleagues and I wish everyone wanted to be vaccinated. And we wish that we weren't sending 25-year-olds to the intensive therapy unit (ITU). There's a misconception that COVID only affects the elderly, and therefore, if you choose not to get the vaccine because you're young, you're taking a calculated risk because you probably won't get sick.

That's not my experience with the Delta variant. I did a week of COVID nights a month ago, and I sent a 25-year-old to ITU. I also sent a 44-year-old, who was fit, healthy, with no underlying medical conditions, to ITU. The healthiest people on my ward are actually 75 or 80 year-olds who incidentally caught  COVID when they were in the hospital for something else. They were older, vaccinated, and although they are on a COVID ward, they're not sick from COVID because they're vaccinated. 

I don't know how much that message has really gotten across: if you're young, Delta will come for you. We are definitely seeing the effects of the pandemic on the wider NHS as well. For example, people who avoided seeking medical help because they had a minor affliction now face a major affliction. Or we have such a long wait in the emergency room because of people coming in with COVID because they're struggling to breathe. If you're 25 and you've never been sick before, and you suddenly have COVID, you think you're dying. You do the normal thing - you go to the emergency room. Unfortunately, that means that the people who are there with a heart attack have to wait longer. We are finding that the whole system is under a huge amount of strain, and everyone is very tired.

We are finding that the whole system is under a huge amount of strain, and everyone is very tired.

It's hard because you just want to get back to normal. I think there's a cultural perception that we're doing that. There's a cultural perception that everything is open, so we should be going back to our normal lives, but nothing in the NHS feels normal. Unfortunately, I think that that's a hidden burden that people aren't acknowledging because they're going out, they're enjoying the sunshine, they're going to the pub. I am genuinely jealous of people who have that experience right now. 

Mina: It's been very difficult. There was some acknowledgement during the first wave that frontline workers were experiencing a different burden. 

Kate: When I think of the first peak, people acknowledged that frontline workers were the ones bearing the brunt. Now, because everyone has had to weather this storm in their own way, everyone feels as if they have also carried a burden. Everyone has felt the brunt of this. In general, people may lose a little bit of perspective because they're having to focus on their own experience, so it’s harder to see the big picture. If someone offers you this idea that everything is gonna go back to normal, we're gonna be fine; why wouldn't you jump on that? 

And, again, I think that there's a concern that people can only maintain a certain level of energy for so long, so we don't want to scare people, and we don't want to burn them out. I actually think that underestimates people’s resilience. People are capable of a lot more than they're being given credit for. I don't think anyone's doing them a favour by saying, "No, it'll be fine. Don't worry".

Mina: I think that there's a lot to be said for making informed choices. If you only have half of the information, then your perspective of the situation and your decision-making will definitely be affected. It's a difficult balance. I guess it's been a steep learning curve for us all. 

Kate: I do hope that everyone just remembers to be kind to each other. Until everyone is protected until everyone is offered the vaccine, variants will keep emerging, and everyone will be affected. We are only as strong as our weakest country, really. I hope this is an opportunity for people to consider how their individual decisions can affect the greater population. 

Next week we will feature the second half of Kate's interview, where she lends her insight into what it means to be a woman in medicine.