A doctor from Kingston sent a heart-rending open letter to Prime Minister Boris Johnson describing scenes from the frontline line of NHS workers' battle against the coronavirus.

Doctor Faisal Idrees is a consultant ophthalmic surgeon at Ashford St Peter's Hospitals NHS Foundation Trust, and lives in Kingston.

On April 13, he wrote directly to the prime minister describing in frequently poetic and at times desperate lines the situation faced by NHS nurses, doctors and other essential staff during the Covid-19 pandemic.

Faisal told the Comet he penned the letter after learning of the death of Dr Anton Sebastianpillai, a longtime associate of Kingston NHS Hospital who died after contracting coronavirus.

The Kingstonian said he hoped the letter would resonate with Johnson, himself a Covid-19 survivor.

In it he encourages the Prime Minister to increase government efforts to strengthen the NHS during the crisis amid pre-existing pressures and current, widespread reports of shortages of staff and essential equipment.

"I wrote a letter to the Prime Minister (April 13), spurred on by the challenges to get adequate protection for staff, seeing nursing staff in my department as they faced the tough decisions being redeployed to care for confirmed infected and unwell patients as well as our position as doctors of having to continue to see patients with very limited protection in the face of shifting guidelines.

"I also used it to highlight the other challenges working in the NHS that are often overlooked but have a bearing both on patient care as well as staff and that are all too easily ignored or inconvenient to be acknowledged," Faisal said.

Faisal's letter describes the "Valley of Death" NHS key workers at his Trust are currently facing by caring for patients suffering from the highly infectious strain of coronavirus.

He references their "gentle determination" at dealing with the pandemic and its implications, and their refusal to bow to the pressure.

Descriptions of the wards where coronavirus patients are currently being treated are also included.

The letter recounts the "drones of ventilated, drugged patients...with thunderous coughs...tortured under laboured gasps and feverish cries, with erratic breaths..."

The Kingston doctor said the hospital he works at was "doing its very best" in dealing with the massive influx of patients battling symptoms of Covid-19.

Nevertheless he explicitly references the strains the NHS system is currently under, describing pre-existing pressures as an "existential threat" associated with a lack of complimentary political values.

"Our society and organisations, especially the NHS, face an existential threat which has little to do with the 'COVID-19' pandemic.

"The threat to us as individuals, institutions and nations is ever present and it is to our values, that which we truly believe in and thus how we respond for ourselves and others," the letter reads.

"We need leaders with the curiosity to look deeply within themselves and their organisations, to hopefully understand objectively all the problems faced.

"This contrasts with those who sit with blinkers around their eyes in a large echo chamber populated only with others like themselves, repeating the mantra that their rigid views must be held aloft."

It concludes:

"No one can or will get everything right, every time but we do look to you, and others, to do your best as we will do ours in the Valley of Death."

The Kingston doctor's open letter to Boris Johnson is reproduced below. 

Bernadette, Ann, Elizabeth and Louisa* have said their goodbyes in these days that slip by.

Over the passing days they, like other nurses and staff, have learned of their calling to join the gathering ranks caring and battling in the expanding zones spilling out across hospitals and soon the Nightingale will sing. With them, many more will soon ride further under the shadow that draws ever near from the Valley of Death.

Were they dismayed? No, in all their stoic faces remained the gentle determination to play their part alone and within teams. The same determination they have always had in their work for the NHS has only been reinforced now in this Nation’s time of need with the call to go further, further forward.

Yet their faces, eyes and the hesitation in their voices, spoke of the inner conflicts fought within their hearts, minds and souls, as they wrestled with what it would mean for them and their families, were they to ride further in to the Valley of Death.

Ultimately, they will do what they feel in their Hearts they must. Some without question, others without hesitation but with trust, even if it means to do and die, for they will all hope that there will be some who remain to dare to ask, why they and others in this way must die, with this their light charge in the Valley of Death?

Will I see them again someday, to care for our mostly absent patients, young and old, perhaps here in this same surreal Eye Department, or there? For where is there, but bodies with thunderous coughs like cannons let fly, tortured under laboured gasps and feverish cries, with erratic breaths that mark that place where the invisible foe multiplied, breaching their walls and gates.

There too, nearby, are the regular, drones of ventilated, drugged patients that now lie still, whose minds restlessly wander alone in the unknown, perhaps in pain, confused with fragmented dreams of life and death, light and dark. All the while in those rooms, in which many lay, the unseen enemy fired in shot and shell within the clear battery-smoke all around, rests heavily laden in the air ready to strike those unaware, there deep within the Valley of Death.

Our society and organisations, especially the NHS, face an existential threat which has little to do with the ‘COVID-19’ pandemic. The threat to us as individuals, institutions and nations is ever present and it is to our values, that which we truly believe in and thus how we respond for ourselves and others.

For some it has and will continue to merely mean professing these values superficially on the lips or upon empty banners held aloft, without living in hearts and souls. For others who strive to live their values rather than bending them to chance or circumstance, they will demonstrate them despite the challenges and ultimately may be prepared to die for them. Within that subtle difference will rest the hopes and heights humanity can reach and the depths inhumanity may fall, failing one another as well as our responsibilities for the wider world and all that live within it.

In time everything changes and so too will life, individuals, society and organisations including the NHS when we come out the other side of trials. Before the crisis, some seemed to change at a glacial pace if at all, whilst others moved rapidly in directions that were of concern. No doubt this crisis will be used as a pretext to accelerate transformations that may need challenging.

At all times, especially now, we must look to those who hold positions of power and leadership to set an example as we face increasing challenges and the need to change.

An essential task of a leader has always been about building and retaining, or at times when necessary, restoring confidence that they are both in control of the problems faced, not just the headline issue and that they can be trusted to deal with all matters with integrity.

Each nation depends upon so many parts working together. The focus is now squarely on those within the Health Service however many other Services keep working to keep the nation safe and running. For some, we depend upon them to protect us from threats both domestic and foreign. Others, including the emergency services also have an integral to play and we would want them all to be heavily, rather than lightly, resourced to be safe and fulfil their goals.

Attention during this crisis, is on the doctors and nurses. Like the hands of a mechanical wristwatch they have a vital, central and visible part to play particularly in harm’s way in the Valley of Death. As for any intricate watch movement, many parts remain out of sight, and without them, we as doctors, nurses and other healthcare professionals would not be able to do all that we can each day.

Inevitably, as each nation continues as always, to vie - one against each other for supremacy and to prove that it deserves the leadership of mankind or at least the resources that the world has to offer, this the ‘Greatest Game’ is played out on all stages and within all organisations even within the NHS. What we need is the best of all mankind, what we have always needed is the best from all nations, but best in whose eyes?

We need leaders with the curiosity to look deeply within themselves and their organisations, to hopefully understand objectively all the problems faced. This contrasts with those who sit with blinkers around their eyes in a large echo chamber populated only with others like themselves, repeating the mantra that their rigid views must be held aloft.

We need the confidence in individuals and organisations in power at every level by ensuring they have truly embraced candour and transparency and hold no fear of scrutiny, recognising its value to improve what they are charged to do towards true excellence. Robust, reliable and genuine governance systems that enjoy complete confidence by everyone must be in place.

Much is at stake including life, when power rests with those who ignore contrary views then actively suppress, undermine or erase any narrative that runs counter to theirs, perceiving it as a threat all round and thus they continue to slide down to mediocrity. Sadly, the NHS is no different and the consequences can be profound.

Many challenging decisions and actions will need to be made daily in the coming days and these will need each person taking responsibility for their part. We can only continue our duties by genuinely and honestly believing that we are doing our best for those that we are responsible for, whilst we have confidence in those who hold positions of leadership and decision-making.

How can we honour or remember those who fall during the charge in the Valley of Death and elsewhere? Not by a roll call of fallen but by ensuring that those who make weighty decisions of consequence are held to account, without the comfort of hiding behind a balaclava.

As no person or system is perfect, we must all strive hard, for when the hour strikes, we as doctors must act and give opinions professionally retaining integrity, working with heart and soul, curbing anything that takes away a patient’s chances to life arbitrarily whether it is age, gender, race or the like. As always, patients will turn to us and want us to be honest and to have done our best with what we have.

A return to business as usual in the NHS after this challenge recedes will be a betrayal since it represents a return to the ‘fighting one fire after the next’ philosophy that so riddles it to its core. However, history is replete with many such examples so why should this be any different? Whom are we to rely on during this crisis and what follows next?

Within the Health Service here and the world over, as in any organisation, layers exist. Almost all within these layers work for patients, colleagues, the organisation and the nation. Sadly, toxic elements often exist that primarily serve themselves usually to the detriment of others including the organisation. Far from incompetence they may have great expertise. Believing they are beyond true scrutiny, they close ranks, collude to cover-up, coerce others to join them and have no scruples or shame to intimidate or subvert policies and procedures to abuse and increase control. When threatened, they inevitably create a hostile environment for those who stand in their way. Whether in research or clinical work, the practitioners of the dark arts of ‘ToxDocs’, and too many exist, represent peril in matters of life, death, survival and careers.

I started writing this under the Pink Full Moon of April, but how many of us will not see the next full moon or the one thereafter? As each day passes, it makes it more likely that I too may succumb at work. Perhaps, I could have written less in this letter but I feel time has caught up with me. As it is, how many of the 2020 words I have written should I have struck down? Perhaps 600 riders with horses, but which?

Time and medicine, especially surgery, remain inextricably linked and their beauty, precision and the need for accuracy in what we do as doctors, play important elements in our profession. However, we live not just in days measured in hours, minutes or seconds but within each of our heartbeats and breaths, defining who we are. We have to make each breath count whilst we live and remain conscious, for there may come a time that we will fight for every breath for it may be our last. Therefore, just as the light of the three white nights guides us in the stillness of the night each month, so too must we seek to perfect the light of our souls with each breath. For our faith and hope may be all we have in the darkness facing us in this Valley of Death and those others, I am sure are yet to come.

The world watches their own brigades, all over the globe charge in to the Valley of Death whether in Milan or Marseilles, Madrid or New York, Istanbul and Seoul. Our NHS will see many like Bernadette, Ann, Elizabeth and Louisa* who may eventually join the ranks in whatever way they can. Will any remember that they came from Ghana, South Africa, the Philippines and England to join together as many have done from across the world in the NHS each day, for seven decades?

Nothing lasts forever. All things come to an end, eventually. So too, hopefully, will this pandemic pass, God willing. Before this ends, much Blood, Sweat, Tears, Sputum and Meconium will have been shed in the fight to keep others alive. Some of those around the world, who formed this, our Charge of the Light Brigade into the Valley of Death will have fallen. How will it be seen in years to come, success or failure?

Let us not forget the real threat that remains, but hold on to what we believe to be true till the very end. It will make how we lived our lives ultimately of value not just to us but also to those we will leave behind. If we can remember those who suffer as individuals even in the darkest hours, however hopeless it may seem, we may overcome anything that desensitises us to them as fellow humans and with it hold on to our compassion towards them, even in their or our last breaths.

No one can or will get everything right, every time but we do look to you, and others, to do your best as we will do ours in the Valley of Death.

Then let not those who survive the shadow cast near and wide by the Valley of Death, drift back with tired eyes only to find themselves in a world that has changed, to one gripped in the Valley of Fear.

Yours sincerely,

Mr Faisal Idrees

Consultant Ophthalmic Surgeon and Member of the National Health Service (NHS)

The names of the nurses (*) have been changed to protect their identity.

The handwritten letter is for postal delivery to the Prime Minister. As a precaution, this PDF of the typed letter is for email transmission for the Prime Minister’s attention.

This represents an open letter in that copies of this PDF have been sent to selected medical organisations, media and my local Member of Parliament.