Karrish Devan

This page contains a winning entry by Karrish Devan in the RCPsych Future Archives Competition.

The masks we wear

My mother died unexpectedly in January 2021. It was almost a year after scientists had published the first cases of an unknown pneumonia detected in the city of Wuhan, caused by a virus that would come to be known as COVID-19. For this entry into the archive I wanted to record a typical day for me in this period. By daylight I was working as a Core Psychiatry Trainee in Liaison Psychiatry and then in the evening I would visit my mother in her hospice, whilst looming over all of us was a perpetual and ever more restrictive lockdown.  

18th January 2021 

The number of security outside the hospital ebbs and flows with the daily infection rate. When the number is high, like today, there is a wall of huge guards in neon jackets and their eyes fall like lasers upon everyone trying to enter the building. Staff are only let through after breathtakingly close inspections of their badges whereas the bewildered patients must offer their clinic letters to the burly men like holy relics. I join the long socially distanced queue and wait my turn to be inspected. Once inside the hospital I join the torrents of people following the new one-way system. Despite the staircases to the Liaison offices being tantalizingly visible, the entrance has been sealed off to ensure no-one can bypass these latest COVID measures. So I walk the long way around. Mask count: 1. 

Finally at my office, I change my mask from a reusable fabric one (which I keep forgetting to wash) to a powder blue surgical mask. Although I’ve trimmed my beard so it will fit, these masks still leave pinch points on my nose and cheekbones at the end of the day. My first assessment is in A&E, newly divided into translucent cubicles by thick sheets of plastic. Then to the surgical ward, where an agitated COVID positive patient is refusing to isolate in his room. With some reassurance, largely by the ward Matron, the patient calms down and is further settled by a tablet of Lorazepam. Mask count: 3. 

Paperwork fills the rest of the morning. One of my fellow trainees comes to my desk and invites me to lunch. I haven’t told the whole team yet about my mum, so when he asks what I’ve got planned for this evening, I find myself lying. It feels easier to say the usual (watching TV till my eyeballs melt, like everyone else in lockdown) than the truth (visiting my dying mother). We eat in one of the new Wellness Centres that was created at the start of the pandemic in the hospital. A boardroom that is now covered in Mindfulness posters and at the beginning of the pandemic was overladen with free groceries and hot meals, donated by private companies. That well of generosity has dried up now and all that is left is the increasingly tired staff and usually just a bowl of anaemic apples. My pager goes off, so I leave. Mask count: 7. 

Finishing my notes on time, I race out of the hospital. The bin by the exit is overflowing with discarded face masks, one of which is picked up by the wind as I open the door. It flies out into the darkening streets of London. I head to the station to catch the train to the hospice. The carriage, in fact the entire train, is empty as it slowly rumbles out of the station. Mask count: 8

My dad calls me when I reach the hospice. He has already visited earlier in the day and between him and my brother we have to perform, what he calls, ‘the dance of the two guests’. Due to the regulations, only two visitors maximum a day can visit a patient in the hospice. Of all the new rules, this is the one that feels the most arbitrary. So unnecessarily cruel. Mask count: 9. 

Mum looks like she is sleeping in the hospital bed but she does not stir when I enter her room. Then I notice her breathing, growing wetter and louder each day. I know from my medical training, and the faces of the hospice staff, that her death will come soon. I hold her hand briefly, but she can no longer hold me back. Instead I start to talk to her, something I felt so embarrassed doing when she was first admitted here but now comes so easily. No news, I say, pandemic is still going strong. 

Suddenly, I notice her arms twitch slightly. I am filled with an instant horror before she starts moving in a more aggressive manner, shaking her arms and legs. Before I can even press the buzzer a nurse has come in. We call this agitation, the nurse says as she goes to open the medication cabinet. She produces a small ampoule of clear liquid. This is Lorazepam, it’ll help, she says calmly before drawing it up to give to mum. 

I can’t remember the last time I cried, but then my eyes start to burn in a way that feels so familiar, almost adolescent. I get up to leave. I haven’t told the hospice staff that I’m a doctor (it doesn’t seem relevant) but I feel some almost professional conflict at the thought of crying around them. In the courtyard of the hospice I feel the fabric of my mask grow heavy with tears. As it grows more sodden, fibres start to fray. I feel them bristling and spiking my cheek. I take it off, breathing in the cold evening air. The nurse comes out to find me, placing her hand on my elbow in a gesture that is unfathomable in its kindness. I realise that it’s the first time I’ve been touched all day. Soon I will have to leave, to get the last train home but also to give myself some time before tomorrow. To put all of my masks back on. 

For S. Lal (1963-2021)
 

Get in contact to receive further information regarding a career in psychiatry