Dr Atam Singh: We just are noticing that this is happening more and more with our patients that actually they don't seem that unwell. And they present like as if they've, they've just walked up a couple of stairs and they come in and you just look at their sort of status and they are in a very, very bad way.
Dr Rupy: I'm Dr Rupy and this is the Doctor's Kitchen podcast, the show about food, medicine, lifestyle and how to improve your health today. And my guest, Dr Atam Singh, was meant to be coming on and talking about the use of CBD in healthcare. He's a clinical associate of the London Pain Clinic and consultant in pain medicine. He actually qualified in anaesthesia before becoming a professional trained in pain management. And so we were going to be talking about how CBD is used in pain, anxiety, what exactly CBD is, where it comes from, what the legislation is, and being one of the few medical registered practitioners using CBD in clinic, he would have been an ideal person to talk about. We will talk about that subject with Dr Atam on another point. But today I want to talk about him and his experience of COVID-19 thus for, because he is one of the thousands of doctors that have been drafted straight into emergency rotas staffing intensive care units in the UK, looking after the sickest patients with COVID-19. I do want to exercise some caution for anyone listening to this. I think it can get quite overwhelming considering the barrage of news right now. And the first part of our conversation is a real gut-wrenching look at the current scenario surrounding COVID-19 and its management, his personal experience on the front line. And I would say if you don't want to listen to more of the same thing or it provokes anxiety, then please either listen to another one of our wonderful podcasts or skip towards the second half where we actually talk about the optimistic outlook and what we can learn from this pandemic. In today's episode, we talk about how his job has completely changed over the last two weeks from having somewhat of a portfolio career where he does a lot of elective surgery and pain management in in clinic and and seeing a real different genre of patients across his working day. Now his specialty is solely related to treating the sickest COVID patients because of his unique set of skills. We talk about the pressing issues regarding drugs and oxygen supplies in the UK. It's really thinking a couple of steps ahead beyond the PPE and ventilator situation. The current treatments for COVID and what's actually going on on the front line. There's a lot of talk about different medications that we've had in the past, vaccines and antiviral drugs, but he's of the opinion that that isn't going to be coming anytime soon. Coping mechanisms, and I think at this point of the pod, this is where it will resonate with a lot of people and give everyone beyond just the medics and medical students listening to this and healthcare professionals across the board, it gives a, gives us some some structure, some frameworks as to how to get through day-to-day challenges, whether it be in medicine or outside. We talk a bit about what things have best prepared him for this in terms of training, technology and and calm techniques. The positives that can potentially come from this and like I said, that's in the second half and things to look forward to as well. I also want to say that as medics speaking to each other, we don't really shy away from the harshness and the reality of the situation. Anything that we do talk about is with the utmost respect for the structure of the healthcare system right now. It's not to disrespect patients, it's not to make light of the situation at all, but sometimes we do need things to look forward to in terms of a light at the end of the tunnel, things that keep us going as medics. So, yeah, just to just to point out that, you know, I don't want this conversation to be construed as making light of a situation where it is definitely not that. It's just two medics essentially speaking to each other about their experiences on the front line thus far. We will be re-recording an episode on CBD with Dr Atam when possible, but right now, I think we're just going to be concentrating on these sorts of podcasts as well as maintaining a positive attitude to everything. Please do check out my guest's clinic in the future, the London Pain Clinic.com, and you can find them on socials on the Doctor's Kitchen podcast web page. And plus, give this a five-star review. Leave us a comment if you found it useful. We'd really, really value the feedback and join the newsletter. We're going to be giving you recipes, but also tips to help you get through this situation and lots of YouTube tutorials about breathing, about lifestyle, about staples and use of food to make sure that we are healthier when we come out of this. And that's something that I'm, I've always been passionate about, but I'm particularly passionate about now. On to our chat.
Dr Rupy: So, Atam, thanks so much for making time today. I know you've got an incredibly busy schedule. What's funny is that we were meant to be talking about a completely different topic, CBD, because considering your background in pain medicine, but since we had a chat, I think probably maybe two months ago, the whole world has turned upside down. So I thought maybe you could give us a little bit of background into what you were doing prior to COVID and how your role has changed now.
Dr Atam Singh: So, yeah, it really, it has been a massive change and something that was really unpredicted and unprecedented. Well, before this was happening, we were, I was working as a consultant in pain medicine in Northwest London in an area near Watford. I live just outside Watford and I was had a little kind of clinic in the hospital doing chronic pain sort of medicine. That was included in that job title. It was doing acute pain medicine, so dealing with patients on the in in in the hospital, but also on top of that, holding clinics, doing procedures, looking after patients, elderly patients with their chronic pain needs. This was intermittently sort of like spent some time down in Central London doing some pain sort of sessions and theatre work down in Central London, particularly in the London Pain Clinic, which was, you know, really, really kind of busy. I think we did a really good job. We provided a really, really good service. And on top of that, just as a side thing, which is what I was trained as, I was doing a couple of days of anaesthetics a day, a couple of a couple of sessions of anaesthetics in a week, which is my base sort of topic, which was my base specialty, and from that developed my specialism in chronic pain. So it was a really lovely kind of environment, kind of doing a bit of this of anaesthetics as well as that dealing with chronic pain issues. And it and it and it was busy. And at the time when all this COVID-19 broke out, just before that, there was the most recent, well, one of the biggest changes in sort of legislation regarding pain medicines was the kind of legalization of cannabis to be prescribed for chronic pain condition, chronic pain conditions. Now, clearly there was a bit of problem, there was a bit of kind of restrictions on its use, particularly because of its use within the NHS and also the cost of it, it was prohibitive for the NHS to provide it. We started to see a lot of pickup in the private sector for its use. And having had some experience with its use in different countries, in America, in Canada, we noted, and these countries clearly noted its benefit in these chronic pain individuals. And hence, I think the UK was a little bit late on picking this up. But however, in November of 2019, it legalized the use of it in sort of sort of specific conditions. But clearly, this was gently opening up sort of little clinics. We were opening up to patients use and we noted that there was definitely an increasing number of people who were just saying, could I try it? Could I try it? And I was sort of in the sort of midst of that, trying to sort of work out how we were supposed to first of all, get it into the country, then trying to dispense it, and then, you know, reviewing how these patients were were doing with it. So it was in the very early stages of its use. And then of course, it all changed and we were right in the middle of it and then it all changed and COVID-19 came along with its, you know, ugly head and changed everything. So what we're seeing now is that my sort of role has changed. We have unfortunately had to cancel all elective clinics, all elective procedures. Most private sector hospitals have had have been commandeered by the NHS for its use to deal with kind of elective patients and trying to deal with time critical patients. And hence this problem of pain medicine unfortunately has taken a back seat. We are now being rotated into an emergency rota to deal with all these critically ill patients in intensive care. So there has been a massive swap round or, you know, switch over from dealing with chronic pain patients where time critical problems were much more of a kind of a sedate manner. Now dealing with critically ill patients who are, as you are aware and everybody is aware, are are really are dying and are really are suffering as a result of the COVID-19 virus.
Dr Rupy: Yeah, I mean, there's so much in there that I really want to pick out. I want to just start off with, I know a lot of our listeners are medics and so this might be teaching people to suck eggs, but I just want to for the those who don't understand exactly what the role of an anaesthetist is, to understand what is the practice of what is the practice of anaesthetics and how does that apply to the role that you now have when managing COVID-19 patients?
Dr Atam Singh: I think, I think any doctor who has worked within a hospital setting is fully aware of what the anaesthetist does, but clearly outside of the knowledge of hospitals, I think the majority of people's view on anaesthetist is that they get is that they put patients to sleep for operations. And I think that's definitely a major part of our job. So when a patient has a surgery or elective surgery or emergency surgery, an anaesthetist is involved to provide that patient with anaesthetic, be it a general anaesthetic when you put to sleep, but also regional anaesthetic to help with various problems in certain parts of the body, and allow the patient to undergo that surgery in a degree of comfort and and to reduce pain experience post-operatively. However, the other side of anaesthetics is something that I probably is not well known. I could be, I could be wrong, but we are dealing with the critically ill patients. And I think that's that's the thing. That's that's the part that is the most stressful and and requires the most amount of intense input by an anaesthetist. So we get people coming in with chest infections, we get people coming in with, you know, for example, chest pains and heart heart attacks and things like that, or if you've broken a bone, these sort of things, if dealt with, can be dealt with without the need of an anaesthetist. But when the patient gets particularly unwell as a result of the injury that they have suffered, there is the anaesthetist is there to be called when that is required, when it's required to deal with the critically, you know, really unwell patients and and to deal with their problem in whole, you know, in in whole. So that might include having to put them to support their breathing, put them on ventilators and to aid that we put we we call this sort of act intubation, which I think probably has been heard about on the TV a lot. And that is basically the idea of putting in a tube into the mouth and into the lungs. But also on top of that, we have to provide access to the body. We have to put lines in that might include an access into the sort of central vein sort of capacitance of the patient, but also it might require the patient to be put on renal dialysis treatments. It might require, you know, intensive sort of antibiotic therapy. It might also require support for the heart. You know, should that patient be particularly very ill, we are the patient, we are the kind of specialism or the doctors that have to deal with dealing with the heart and trying to support the heart in its best as it possibly can. Now, all this sort of care is done in an intensive care unit and I think this is what's being brought out quite a lot in the news recently is that, you know, these critically ill patients, now as a result of this patient's experiencing this COVID-19 sort of virus, I think the the kind of scrutiny of the intensive care is is really under the spotlight. It really has shown that the number of patients that we are getting which are critically ill that require intensive care therapy, predominantly ventilatory help, as in helping the lungs, the number of beds out there in intensive care for us to deal with are are lacking. And I think that's that's the major problem at the moment.
Dr Rupy: Yeah. And so your day-to-day has completely transformed from doing that mixture of different, it's almost like a portfolio career you have in anaesthetics, you know, you're doing a bit of elective work, a bit of pain management. It's a really good mixture of patients you'd be seeing as well from critically ill to stable, etc. But your day-to-day now, is it purely emergency work now where you're working within the NHS?
Dr Atam Singh: It it is. So as as been as been made clear by a lot of my colleagues, and this includes surgeons and dermatologists, we're all being rotated in. Every single one of us to do emergency care. Now, obviously, other people's skill sets are are different. Obviously, the intensive care consultants who are specifically trained into intensive care, which we all are as a trainee, are basically the front, you know, we are the ones who are basically trying to deal with these very, very ill patients. The number of intensive care consultants prior to the COVID-19 were were dreadfully low. But now given the fact that there's been a huge increase in the number of patients requiring intensive care therapy, anaesthetists, as in the ones who are providing anaesthetic care for patients going in for general elective surgery or obstetrics, providing labour anaesthesia for patients who are having, you know, babies, and obviously chronic pain consultants who are obviously dealing with chronic pain issues. Our base specialty is anaesthetics, so we understand the ideas of dealing with patients who need ventilatory support, need inotropic support for their heart and all those sorts of things. So we are the first ones who have been brought into the fold to deal with intensive care. So, absolutely every day now is dealing with intensive care. So our whole rota has been, our old rota has been thrown out and a new emergency rota has been brought in. And that does include involving, you know, doing nights on call, which has been quite some time since I've done nights on call, but also during the day, doing long days and spending, you know, all the time dealing with these critically ill patients on critical care.
Dr Rupy: Yeah, I feel like it's inspiring a new generation of medics and other academics to go into epidemiology and anaesthetics and intensive care training. You know, this, I hope, if to put a positive spin on what is an incredibly unprecedented situation, is that we will get a lot more people inspired to go into medicine and perhaps the underfilled positions as well.
Dr Atam Singh: I completely agree with you. I think this, um, this whole sort of thing that's going on around globally, I think I hope out of the sort of stark nature of what's happening around us, I feel that some good will come. And if this is not going to persuade people who are on the border of doing deciding whether or not they want to do medicine, I would say that this will do it.
Dr Rupy: We hear a lot on the news, certainly people who aren't privy to what's actually going on on the front lines about the management of COVID patients. You've talked a little bit about what your role is in intensive care with providing inotropic support, so drugs to support the heart and circulatory system, as well as ventilation. What is challenging about this particular virus creating critically ill patients? And what is the main issue, what are the main issues that you're experiencing when dealing with the most unwell?
Dr Atam Singh: So, I think what we've noticed recently, and let's be clear, this is a very, very new sort of virus and we're learning things every day about it. Is that the the the quickness and the speed it takes hold of somebody. The virus seems to sort of hang around in the body for, you know, a the whole process if somebody is going to recover, it tends to take in the region of about two weeks, maybe even three weeks. I don't think the fully fatigue type symptoms and tiredness symptoms may last a little bit longer, but we normally see the sort of prodrome lasting maybe a few days. Then we see what what what what clearly people are reporting is that they have an initial sort of unwellness. They feel, they feel sort of feverish, they feel particularly very tired, they have a sore throat, and that normally when that starts, takes on in the, you know, they realize it over a period of about 48 hours. After that 48-hour period, there's normally a lull, which normally lasts about three to four days, maybe five days. And then what seems to happen is that there's the second sort of effect, and it is sort of like the five to seven day period that people start to complain of respiratory problems and chest problems. And we notice that it is during that period of time that they become very sick very quickly. Now, that's not all the case, but that's something that we've noticed on sort of individual cases that normally they present with the shortness of breath and the respiratory symptoms, normally about a week before they started to feel ill, you know, the initial symptoms. And during that lull period, they're just not, they're okay, but they're not feeling great. But during that sort of seven day, that that towards the end of the seven day period, the quickness with which that virus takes its effect is just, um, it's really, really kind of, you know, breathtaking. I mean, you know, pardon the pun, but the patient really does start to feel short of breath. And it is during that period of time that we see the patients coming into the hospital. Now, the problem is that we've not seen this before where the shortness of breath occurs so quickly. And we are taken aback by when we take x-rays of these patients and we take, uh, sort of oxygen concentrations of these patients when we put the kind of probe on their finger, they will be breathing relatively quickly, but they are kind of relatively not in the same way that you would typically expect with patients who have chronic long-term, you know, respiratory diseases like patients who have had long-term smoking, COPD, for example, or or somebody with a typical pneumonia. They seem quite calm. They may well be breathing quite quickly, but they don't seem that out of breath. When you look at an x-ray, their x-ray is full of disease. And when you put a probe on their finger to determine how much oxygen they're getting around the body, it is in the low 80s. Now, normal sort of saturations are in the 95, 96, 97, you know, probably in 99. But we're getting these patients when you're putting the probe on the finger and they're in the low 80s. And it is remarkable to see how this virus has taken effect on the patient so quickly.
Dr Rupy: Yeah, some of the x-rays that I've seen in emergency department, people presenting pretty early on have actually been quite frightening. Um, and, you know, no pre-morbid conditions as well. It's, yeah, it's, it's not a great sight.
Dr Atam Singh: It's, it's, it's, and we just are noticing that this is happening more and more with our patients that actually they don't seem that unwell. And they present like as if they've, they've just walked up a couple of stairs and they come in and you just look at their sort of status and they are in a very, very bad way. Now, the way that we're dealing with it is so different to where what we we normally deal with these things. It is now A&E resusces and A&E resus department full of these patients who seem relatively quite calm, you know, breathing quite quickly, but just looking at their monitors from the sort of central console, just noticing that their saturations are about 80, you know, 79% and 82%. We're just not used to seeing so many ill people in one place.
Dr Rupy: Yeah. And previously we were led to believe that this is a disease primarily affecting the vulnerable, the elderly. From your anecdotal intensive experience thus far, is that the case? Are you seeing it primarily affecting older generations or have there been some other experiences of yours?
Dr Atam Singh: I think, I think, yeah, I think that's the kind of impression that we're getting from the the press and it is clear that that they are definitely more vulnerable. There is no doubt that as you get older, you get other medical problems, and it is obviously clear that the majority of people in the sort of older sort of category are more at risk. There is no doubt of that. Um, and that's basically due to the fact that the body doesn't have as much reserve to fall back on. Um, and clearly that is something to be to be aware of. But, and I know that you, you know, you've it's all coming out more in the press that, you know, we're finding more and more things about this virus, but, you know, I, I, I, I'm aware that these are now and I can see it in the hospital just a few days ago, younger people are getting involved, younger people are being sort of coming in with more problems than we expected with a simple flu, which clearly this isn't. We are seeing patients who are 40s, you know, in their 30s. They may well have other medical problems. And and and what we are trying to find out is what is this medical problem that patients are suffering from that sort of puts them at risk. And we just can't find it at the moment, but we are definitely seeing younger players, uh, younger patients, sorry, in the in the um, in this kind of category who are much more susceptible, but determining who and what, we are just a little bit at a loss to determine who is going to suffer a very bad consequences of virus as uh as those who are not, you know, we just haven't been able to find that. Um, the one thing that I would say is that there is what we call and people are categorizing as a a cytokine storm. And it is basically the body's reaction to the virus. What stimulates that body's reaction to this virus and this kind of this release of cytokines and various mediators in the body to try and deal with this virus, it is that that we see seems to be the most determining thing for patients becoming ill. But we still, as I repeat, we haven't been able to determine what type of patients uh cause that and what type of patients are much more susceptible to that cytokine storm effect.
Dr Rupy: Yeah, and I feel like every week we're learning a bit more information, a lot more stuff are coming out in journals. It's actually quite incredible to see just how quickly information can be put out onto public platforms, the Lancet, a number of other journals as well. Um, from people on the front line, you know, I think we we got the first ICU audit um in the UK just last week as well, looking at the uh some some uh patients admitted to London hospitals. Um, there's a lot of talk about PPE and ventilators. Um, but what I'm what I think people are failing to see perhaps a couple of steps ahead are drugs and staff. So it's all well like converting uh your surgical arenas into new intensive care wards. It's amazing that we have the Excel centre that's going to become the Nightingale. But people don't realize a ventilation or intubation procedure requires drugs and it maintain you need to have drugs to maintain um ventilation support as well, as well as the staff to look after them. Is that something that's on your mind at the moment?
Dr Atam Singh: Um, it's, yeah, absolutely, Rupy. I can't, you know, we can't sort of um, ignore that because despite the fact that we have, uh, definitely, you know, when I'm on the wards and I'm going around the hospital trying to see and look at various ill patients and seeing what sort of needs are required, we can clearly see that there is definitely an increase in the number of ventilators that are available uh for our use. And that includes the invasive ventilators that we use in intensive care, but also those kind of those non-invasive ventilators where they put that large sort of mask on the face to try and force air into the body. Um, there is definitely an increase, but what is clear when we talk about, you know, if we take medications, for example, um, we notice that there has been, we were recently informed and I and I kind of kind of Riley sort of joke about it. Um, they mentioned that there was a lack of oxygen in the hospital. And so oxygen supplies were particularly running low. And you don't even think about these things until it's sort of said to you face to face with the kind of managers. And we are trying to now sort of mitigate for that problem. And, um, you know, if you include oxygen as a medication, we're starting to run out of, uh, morphine to sedate patients on the, on the, um, on the intensive care unit. Um, because we are just going through things that we have never gone through things before. It is just unfathomable how much medication, how much oxygen that one needs to treat so many ill patients. So, it's things that we've never really had to think about, uh, but are only coming to light as a result of these, you know, ever increasing numbers that we're dealing with. And, and, you know, and I look at, and you do mention about sort of personnel and everything, you know, going around the wards, it's clearly, it's clear to see that everybody is focused on trying to do what they can to try and help, um, the patients. But, yes, clearly people are, uh, very much, um, struggling. Uh, they are, uh, overwhelmed with the number of patients and the intensity of work that is required with dealing with one patient. But also on top of that, they are getting disheartened, they are getting upset, they're getting emotional. They are already in a very heated environment dealing with these patients. And particularly when you're covered in these, uh, personal protective equipment, it's a very, very tiring job. And it's a particularly very, very difficult environment. And, you know, personnel and skilled personnel, let's be clear, is is running short, uh, as we all are as a result of, you know, all of some of us, not all of us, are are being exposed to the virus and are becoming ill as well.
Dr Rupy: Yeah, yeah. In terms of the current thinking around medication uses for for those who are critically ill and perhaps even a preventative manner as well, are there any front runners like hydroxychloroquine or any other any antiviral that you guys have perhaps used in a compassionate sense?
Dr Atam Singh: Yeah, I mean, I think, you're absolutely right. There have been sort of ideas and thoughts as to what might be beneficial for patients in this case. And I don't think, and this is all, and this is the problem that we have is that there are suggestions, but there's no concrete evidence to say one is better than the other. Um, and the idea of hydroxychloroquine being sort of purported as being a potential sort of, uh, treatment for this problem, it's just hearsay and unfortunately, there's not enough evidence to put out there to say, right, everybody should be taking this. At the moment, we're trying to deal with patients with antibiotics. I think every COVID-19 patient is getting antibiotics just to make sure that the bacterial side of thing is dealt with. Um, there is still a question about using steroids. I gather, there is still some degree when a patient in particular becomes very unwell, uh, there's been some degree of understanding that maybe steroids might be beneficial in really quite septic patients, but again, this is still something that has not been borne out properly with COVID-19 patients. When patients are particularly very, very unwell and they are requiring heavy amounts of oxygen, you know, people are suggesting that we have to improve the blood flow to the lungs. And sometimes there is a suggestion we should use be using vasodilators or or or in or medication to try and open up those vessels to the lungs. These are all still in, you know, ideas and thoughts, but to really come out with um, an ideal sort of antidote to this is, I think the only thing that we can really look forward to is the vaccine. And I think that's just some way, uh, we're some way of getting that, unfortunately.
Dr Rupy: Yeah, I think, uh, people are expecting a vaccine to come out in the next couple of months, but actually in reality, when you look at the process of creating a vaccine and making sure that it's safe, etc, it's a lot longer than that. So, um, for now, it's just kind of each each week as it comes. I'm conscious that I want to try and get into some perhaps more positive spins on this whole scenario because it is quite dark, uh, for lack of another term. But, um, I know this is completely out of everyone's control, uh, and and out of anyone's experience of anything in the past, but out of all the things that you've done in your career, both professionally and perhaps outside of your profession as well, what do you think has best prepared yourself for this situation that you're currently in?
Dr Atam Singh: It's a really good question actually. Um, I think if you asked most anaesthetists or intensive care consultants, um, I think, I don't think we would, anyone would be able to sit there and say, oh, I was quite, I was quite comfortable with what was happening. Um, but, um, you know, these are way out of anybody's understanding and anything that possibly has been, you know, in in in previous history because of what we have got to help patients. I think when you talk about other flus and other pandemics, particularly the one at the start of the century, there was nothing like what we can do with patients back then. And and the ability to to try and help these patients with various ventilators and, you know, support for hearts. I think that gives us the hope that we can um, help these very, very ill patients. Um, I think if you're going back to the actual question, what sort of has sort of set me, well, sort of prepared me for this, I think in a way, um, you know, the whole sort of training in anaesthesia and in intensive care is to be calm, uh, and to take one patient at a time. Uh, we are obviously being exposed to a number of patients at a time because of what's happening around the whole hospital environment. Um, but what one thing, and I think that's probably true for every sort of anaesthetically trained consultant is that you can only help one patient at a time. And I think in given that sort of, uh, motto or, you know, that sort of training, um, I feel that, you know, it it gives a degree of calmness. So while everything else may well be going wrong around you and other patients who may need your help, your ability to try and prioritize who needs your help the most and to try and deal with that one patient by themselves on their own, gives you a degree of, well, this is all I can do. This is what I'm going to do. Once I've dealt with this patient, I'll be able to move on to the next. And that sort of sort of systematic approach with dealing with sort of patients pretty much, I think has stood, well, stands us in a in a in a better light when dealing with this sort of catastrophe that is happening across the whole hospitals across the world. So,
Dr Rupy: Yeah, I hope a lot of listeners, um, can actually resonate with that and actually perhaps use that in their own lives, uh, whether they're in medicine or outside of medicine, because I think that systematic, logical way of thinking through things, whether it's your to-do list, whether it's the constant barrage of news and media outlets about how bad the situation is, whether it's worrying about your parents, you know, focusing on one thing at a time is perhaps the best thing that I've learned out of medicine that I've applied to my general life outside of medicine as well.
Dr Atam Singh: I completely agree. I think it can teach you a lot of things. And I'm, you know, people have, you know, somebody's doing business or in the field of accounts, they obviously, you know, learn things from doing what they do. But yes, absolutely, Rupy, the only thing, you know, we have this kind of over-grandeur sort of idea of ourselves that we're trying to save the world, but let's be clear, we're trying to save the world, but at one patient at a time. And and I think that's, you know, and without sounding a bit too flippant about it, but you can only help one patient at a time. And I think, you know, any anaesthetist who has sort of been trained appropriately across the world will know that and and and know that they are doing their bit, uh, to try and help this, this, yeah, this pandemic.
Dr Rupy: I know you've got two young kids. Um, how how are you coping managing, being a parent, being on the front line, doing night shifts? Uh, I mean, it must be a real shock to your routine at the moment.
Dr Atam Singh: Uh, it's, it, yeah, it's a good job I've got a good wife, really. No, it's, it's, uh, it is, it is a bit of a sort of a change. I mean, I I can't, you know, with everybody's going through this right now, you know, where everything has been wrenched out of your life, every plan that you had has been taken away from you. Um, you do get a little bit stir crazy. I'm sure Rupy and, you know, your listeners will feel that they're going a bit stir crazy staying indoors. And in some ways, there is some relief going out of the of the house just to try and get some fresh air and going to the hospital to get a bit of other people's input. Um, the kids are doing very, very well. Um, maybe it's because they've sort of, uh, been provided with good, you know, good sort of school lessons and things up until today. I think now they've, they've all broken up for the Easter holidays. Um, but again, you know, these kind of ideas, and I'm trying to talk to them as a, you know, as a doctor a lot of the time, going through these sort of problems that, you know, we've never faced as as kids where they're not allowed to go outside. So I have to try and remember and, you know, try and import some of that knowledge that I have learned as a doctor to my kids. And they are at a stage where they can listen to me, most of the time they do, but, um, you know, trying to make sure that they do, you know, not expose themselves too much to to to the TV and the news, uh, that they don't just sit indoors and do what is set out for them by school. They do spend time outside, you know, an hour or so. And I do literally lock them outside so that they can't come in, which is a bit kind of, uh, you know, prehistoric, but I do suggest like you've got to get outside, you've got to get some fresh air. There's no, you know, when they are at school, they do have break time. So I make sure that they have break time here. So it is trying to maintain those things that they were doing prior to this whole quarantine. And so I think they're doing okay. They they probably are talking behind my back, but I feel that a normalizing as best as we definitely can is is the way forward. And a lot of what we learn in medicine, you know, comes to the fore. And I'm sure Rupy, that's the same with you, you know, what you've learned through medicine, how best to deal with situations like this from a mental and physical point of view.
Dr Rupy: Yeah, yeah, absolutely. I mean, I started meditating when I was a teenager. My mom and dad taught me how to meditate before my GCSEs to help me with exams. I then started again in the middle of medical school and then afterwards when I had my own health issues with atrial fibrillation. Um, and it's a practice that I've come back to time and time again in a preventative manner as well as a a reactive manner. And I'm definitely reacting to it now by doing my breath work, perhaps 5, 10 minutes a day, and then cultivating gratitude as well. Um, and, you know, if there's any positive to take away from this, I think, uh, the general public and medics alike will value self-care even more so having had this experience of being locked down and and everything being stripped away for you bare, but apart from the bare minimum, which is food, security, and medicine. And these are the main thing and then obviously connection as well and and um love and community. Um, so, yeah, I I I think that's something I'm coming back to right now and and and trying to uh cultivate a sense of calm um and uh and being grateful for everything that I have currently in this moment and and in the future.
Dr Atam Singh: I think, I think you're right. I think after this has occurred and after we have all recovered from it, um, you know, people say the place won't be the same. Um, I think in essence, I think there will be a different culture and a different attitude. And I I completely agree with that. I feel that I can see it now even, you know, not only, you know, as to towards the NHS staff and, you know, all all that is being said to healthcare workers and everything, but just generally towards each other. I can see definitely there will be a bit more concern about each other, a bit more community spirit and love. I I you know, I absolutely feel that and and if you include in that one's own personal sort of self-worth and, you know, one's own, you know, physical health, I think we will be a much better, uh, better sort of, you know, culture and society as a result of this, I think.
Dr Rupy: Yeah, absolutely. I mean, I I'm coming back to because I I was raised a Sikh, my mom and dad are Sikh and uh I'm coming back to some of the things that I was reading when I was a kid actually about Sikhism and and um the oneness of everything uh and how we're all connected. And I think it sometimes takes huge disasters and living through that to actually remember how connected we all are. And I think this is perhaps the best thing that we could have experienced following Brexit, um to put a positive spin on something that's horrific.
Dr Atam Singh: Yeah, I you know, it was such a whatever happened and for what, you know, we're not going, I'm not going to sort of talk politically about it, but it was quite divisive the whole Brexit thing. And I'm sure, uh, you know, particularly in the UK, it was a very, uh, you know, it split people down the middle, you know, even in families and things like that. I mean, it's dreadful to think that we need something like a pandemic to make this happen, but it is, it's happening. Um, and maybe the idea of bringing people together as a result of it, you know, looking at the positive sides, you know, maybe that's what's going to happen. And I, yeah, I I just hope it does and it doesn't just fade away after, you know, a few months after this is all over.
Dr Rupy: Yeah, absolutely. I mean, the NHS was incepted after World War II, 1948, and that was after like a huge upheaval of people's lives. So perhaps some some benefits will come out of this. Um, I just want to end by asking you, what's the first thing that you're going to do after this is all said and done?
Dr Atam Singh: Go to the pub. It's a myth.
Dr Rupy: That's a great answer.
Dr Atam Singh: No, honestly, I I'm it's so we normally, that's not really giving the right impression about medics, but we you know more than most, Rupy. I mean, but you seem to be a very healthy gentleman, but what we used to do, and I'm sure this is, you know, throughout the households right the way throughout the country and possibly throughout the world, what we used to sort of work all the way during the week, my wife works in a in a food company, I mean, but we used to sort of work all the way through, the kids used to be at school all the way throughout Friday, you know, up until Friday. And then Friday, we all used to meet all our, you know, we used to my wife used to pick up the kids and then I used to meet her at the local pub. And it used to be there from about sort of 5:30, 6:00 after my clinic, and we'd stay there till about 8:00. And it would be the time for all of us just to download what's happened throughout the week. And I would sit there with a with a with a pint, my wife would get a glass or a bottle depending on how she was feeling. And and we would just chat and it would be down our local pub in a in a in a friendly environment and we didn't even have to say to people like to the barman what you want because they knew exactly what we wanted and it was just that environment of just sitting there with seeing people that we knew and just sitting there and downloading and that I miss tremendously. Apart from all the other things, it's just that ability just to sort of like even do what we're doing now, talking and stuff like that, but just to be able to go to the local pub and see people. And I think that's true for everyone. I'm sure there's many other people with different ideas, but the idea of just being able to do simple things and going back to that, I think that's what everybody's missing.
Dr Rupy: Absolutely. It's that whole idea of connection, whether it's in the pub, whether it's, you know, in person, seeing your parents, meeting up with mates at the park, climbing together, whatever it is. I'll definitely be joining you at the pub though, for sure.
Dr Atam Singh: Excellent, Rupy. I'll buy, you know, I'll buy you one. Don't worry. This one will be on me.
Dr Rupy: I'll hold you to that. I'll definitely hold you to that. Rupy, what are you going to, what are you going to be doing? What is your first plan when this is all over by the way? What do you plan to do?
Dr Rupy: What I I genuinely plan to do, uh, and I've promised my girlfriend that we'd do this is go on a holiday. Uh, so, so we definitely have to go on a holiday because we got a few holiday, uh, plans cancelled. Um, so we need to definitely go on a holiday and I I just want to see my parents. Um, I know they're only up in Hampstead, but I'm not seeing them obviously because I'm working obviously in hospital and I don't want to I don't want to send them anything. Um, my my dad works in hardware, so he's an essential worker for people who need like, you know, boilers and and heating supplies and all that kind of stuff. So, you know, the the country still needs to run. Um, so I'm obviously still worried about him, but yeah, no, I I think a holiday and uh and seeing my my family. That would be amazing.
Dr Atam Singh: Yeah, I mean, we we do keep in touch with like family. I'm sure everybody does via the internet and via Skype and all that. It's, but seeing them in person is something that I think everybody's missing. I'm sure everybody's missing their relatives and loved ones. So, yeah, I think the the the M4 in particular is the one that I will have to travel will be particularly very busy on the on the day that it's, uh, that we all go, uh, yeah, this quarantine is lifted, but I'm I'm happy to do that. I'm happy to do it.
Dr Rupy: I hope you agree, Dr Atam is a breath of fresh air. He's, um, it was very, very gracious of him to give me some of his time. Like you heard, you know, he's got two young children, a family to support, um, and doing night shifts when you haven't been used to doing that for a number of years and going back into an emergency rota and doing long days, you know, it it really does take a a toll on your mental health. And I think the last thing you want to do is do extra content, um, uh, for a podcast. So my utmost thanks goes to Dr Atam. Um, just to summarize, I think there's a lot of things that we wish we knew, uh, over the last couple of months and the situation is rapidly changing and that's why I'm trying to put these podcasts out to give everyone a flavour of what's going on, reinstate the message of the importance of staying home and self-isolating, and also thinking through things that will keep us positive, uh, going forward in terms of our mindset, in terms of coping mechanisms, um, not just for frontline staff, but for also, but for also for, um, those who are not in medicine as well. I think there's a lot that we can learn from each other. Please do catch my guest, uh, the London Pain Clinic.com on socials, that'll be on the Doctor's Kitchen, uh, .com/podcast. And, uh, please do give this a five-star review if it helps. Leave us a comment. We will try and get through all your questions. And, uh, sign up to the newsletter where we give you recipes every single week and we give you lifestyle tips, particularly to help you get through this scenario. Um, I really thank you for listening to the end if you are still listening. And, uh, do give us a five-star review and we will see you here next week.
