‘This is why I’m a doctor’

“It was a really funny moment,” says Dr Sandra Hoeboer, who treated him when he was admitted. “It’s those little things that move me. Yes, there’s a lot of sadness in the job, but focusing on that sadness every day would make it hard to do your work.

“The strange thing is, it’s hard to see people leave in good health, too. You’ve been their only human contact for a couple of weeks and they haven’t really seen you because you’re wearing a mask and a gown. So, when they do leave, it’s actually the first time they get to see your face. It’s a bit emotional – this strange tie you get.”

Hoeboer is on the frontline in the Covid-19 war. She works evenings, nights and weekends at Amsterdam University Medical Centre. She makes rapid decisions about whether a patient should be intubated and go to the intensive care unit or “wait it out” on the ward.

It wasn’t a position she envisaged she would be in a few months ago, when she was on the final stretch of her MBA at London Business School. But her agenda was “wiped clean” and she did a rapid 180-degree turn.

“I didn’t expect to return when I did, the way I did,” she says. “But a couple of weeks before Covid hit the Netherlands I could see it was heating up in other parts of Europe, so I talked to my supervisor back at the hospital. We saw the wave coming. I realised I had to leave the UK and there was literally no other place for me to be than return to the Netherlands and do my job.”

Fast innovation

Hoeboer is in a perfect position to see how Covid has changed the way hospitals operate and is particularly impressed with the “can-do” mentality where she works.

“Before I left, people were willing to co-operate, but everyone had to fight for their patients and for diagnostics to be done,” she says. “It could be hard to get people to work together in the most effective, efficient ways. But as soon as the coronavirus hit, I felt a pull towards a common goal. I’ve seen so many people step up to the plate – paediatric nurses joined the adult team and helped on the Covid ward and the pulmonologists and internal medicine teams set up this great collaborative ward where we treat all Covid patients.

“There’s such a mutual understanding about each other’s expertise. Within a few days, the hospital processes were rebuilt and redesigned so we could deal with the new caseload. Normally, this would have taken decades to change.”

Hoeboer paused her training to become an infectious diseases consultant in 2018 to do the MBA. She wanted to combine her medical knowledge with business skills in order to find new ways to innovate, improve and execute healthcare. The MBA helped her prepare for the Covid crisis and look at it differently from her colleagues.

 “Healthcare has been left behind in so many ways compared to more commercial industries,” she says. “It’s a perfect storm for me – the infectious diseases training and the MBA. I’ve developed a wider view of the pandemic than just the medical view. I’m very interested in the socioeconomic side of it and seeing how they tie together. How do you protect a population against an immediate health threat, but also from the economics that will turn into a health threat in the end as well?”

The MBA also gave her time to reflect and made her feel calmer. “I was impressed with how quickly I plunged back in and moved from my MBA, thinking about, say, price shares and e-commerce, and went back to electrolytes, ECGs and the routine of clinics. There’s this knowledge you develop as a doctor or a nurse. You look at a patient, you see the numbers, but there’s also this feeling about how sick they are – deciding whether you need to take action or just sit on your hands. I was pleased with how quickly I could pull back that feeling, that knowledge.”

Curtailing the course meant the global development exchange part of the MBA was cancelled, which in Hoeboer’s case would have meant going to Brazil for five weeks to visit companies and do consulting projects for startups (something she hopes she can do in the future). She also regrets not having time to visit more of England and cycle the “rolling hills of Surrey”, which she loves, “and leaving my fellow students so quickly meant we didn’t have the chance to ‘hug it out’,” she says.

Rebuilding

Hoeboer is enjoying seeing how her LBS stream is rebuilding and making the most of things – and finding ways to make the remaining part of the course, which is now online, meaningful. “There are just two virtual classes left and we have this small internal learning going on. So, it’s a mix of fun, mental support, but also continued education through each other.”

Providing mental health support to frontline staff is hugely important at the moment and Hoeboer is impressed with how her hospital has handled this. She is also moved by the emotional and practical ways her colleagues look out for each other:

“It’s 8pm and you call a colleague at the other end of the hospital because you need a consultation from them and you can just tell they’re overloaded with work. You ask, ‘Did you eat?’ And often the answer is, ‘No, I haven’t,’ and you say, ‘Just go sit at your desk, do your job, I’ll get you a meal. What can I get you?’

It’s these random small acts of kindness from co-workers who hardly know each other that are so heartwarming. But also, all the lovely initiatives from people outside hospitals. Sending us flowers, thanking us for taking care of their friends and relatives. Even though none of us really needs that, as this is what we’ve been trained to do, it’s really nice to see how appreciative people are.”

Going forward, Hoeboer believes a lot of planning and organising needs to be done to create a sustainable situation in healthcare. “I’m taking my time to figure out where it’s best to help out,” she says.

“Because, yes, it’s an infectious disease, but I’m not a scientist, I’m not a researcher, I’m not going to crack the cure for Covid, others will. So, I’ll just take care of my patients and find ways to apply the learnings from LBS and optimise both Covid and non-Covid patient streams. I’ve seen a lot of the theories I learnt come into practice, where the next bottleneck might be, the next challenge.”

Care matters

The Clap for Carers phenomenon, in which Britons showed support for the estimated 1.3 million staff who work for the NHS, was launched by Dutch-born Londoner Annemarie Plas, who felt inspired after seeing a similar tribute to health workers in the Netherlands. “I really appreciated the clapping,” says Hoeboer, “but also let’s see how we can really, truly help those working in healthcare. If this leads to more people thinking, ‘I did this degree, but now I think I should be a nurse because then I can be more useful’ – I would applaud that.”

Being actually able to provide care has touched her immensely over the past few weeks. “We are focused on cure, but now I’ve seen the importance of providing care for those who can’t see their loved ones and are scared,” she says. “You don’t always get a chance to do that when you’re working in clinic.

“I’ve seen so many great things during this crisis. You often second- guess yourself – am I doing the right thing, at the right time, in the right place? And then to see someone come out the other side of critical care and make it through really moves me. This is why I do it, this is why I work at night, this is why I’m here at 3am.”