During the last few weeks, new rules have come into play at hospitals across the country which put a blanket ban on family and friends visiting their loved ones in hospitals. As a result, for many patients it can feel incredibly isolating right now, and the same feeling applies to their family and friends. To try and reduce some aspect of that, families and friends can still bring bags of belongings (often supermarket plastic bags) to the hospitals, which volunteers can take up to the wards. Many relatives have come everyday bringing home-cooked food, snacks, drinks, books, phones, tablets, and anything else they can do. A large proportion of the patients are unable to make the most of these items; many are not in a position to eat or read a book. But fundamentally, to see these as just the items themselves is missing the point; they're there mainly to serve as a reminder for both sides, that they're thinking of each other.

I've been thinking a lot about solitude vs loneliness vs isolation. All 3 words mean the same at face value but can imply different experience to different people. I started with the centre image after thinking about how solitude, to me, felt like a peaceful experience. I then thought about how the image would change if it was showing loneliness or isolation which further led to how the image felt different in different colours. I think it's so important to understand these shades of solitude when we interact with others, knowing when to give space and when to give your time. I think during this time of COVID it has been difficult to find the balance - I find online messaging exhausting but not constantly engaging in group messages leads to feelings of guilt. I have several friends going through incredible personal difficulties during this time and I want to know they're ok without inserting myself into their space, when I know how overwhelming unread messages and emails can feel. It has been a learning curve but, hopefully, a reflection I can take into future practice.

Throughout lockdown I have felt as if I have been so removed from the outside world, as if watching a film or suspended from reality. Everything is seen at a distance, filtered through screens. Seeing so much pain, fear and injustice without being able to do much made me feel a bit hopeless and isolated. Having screens everywhere meant you were so pressed up against the news it was suffocating. The feeling of being separated by a screen was also reflected in my personal relationships which all suddenly moved online. My screen was also a lifeline. This piece shows a hand pressed up against a screen unable to reach out. I'm still and unsure what side of the screen the hand is on. Whether it is on the inside reaching out for help, or the outside unable to help.

Like many medical students, I worked as a HCA throughout the beginning of the COVID pandemic. My patients were very unwell and, without families being able to visit, were often alone and afraid. But the risk that we might become ill ourselves made it difficult to provide the emotional care that we would have liked. This image was created to reflect the sense of helplessness and guilt that came from this enforced separation from my patients. There is in some ways little interpretative work in creating this image – I wanted to document a real situation that was so bizarre it is hard to put into words. Working closely with patients with dementia, I usually hold people’s hands and talk to them for hours. But with prolonged close contact difficult, the chair where I would usually sit is empty. Half-hidden by the door, my masks turns me into a frightening rather than reassuring figure. The patient has a call bell but this is for mostly physical needs; the emotional care that I would usually provide is missing. I found that I was forced into the role of voyeur. I kept thinking of Bentham’s prison panopticons, with my patient being watched by ever-present but distanced observers. But at the same time I was constantly aware that my patient must be watching me. This is why I wanted to reverse the image, to see myself through my patient’s eyes. The result reflects a huge amount of guilt: the sense of having watched from an enforced distance is one I think many of us will struggle with.

My creative enquiry was inspired by a BBC report on doctors using mixed-reality (augmented reality or AR) headsets during the Covid pandemic.

The doctor, when visiting the patient on the ward, would be fitted with the AR headset plus PPE, and in real time a large group of other healthcare professionals in a separate room would see the patient on a screen and be able to discuss and plan the patient’s treatment. The doctor would also be able to overlay holographic images of CT, MRI or X-rays, or share data in real time.

Of course I can see the positives of this; reducing the number of healthcare providers at the patient bedside reduces PPE usage, lowers risk of infection to front-line staff, also it may increase efficiency and enable opportunity for a larger team of healthcare professionals to collaborate on a larger number of patients’ care. However, it also struck me as some sort of dystopia, a patient not even meeting most of the doctors who would be making decisions on their care. And this is what I hoped to explore in my painting.

The human side of medicine is to my mind crucial in optimising patient experience. The danger of this technology, is that it alienates both physician and patient from fundamental face-to-face contact (both verbal and non-verbal) which is important for building rapport and trust. Indeed, if AR medicine becomes the norm, where doctors interact with patients from afar, as if in a computer game, the medics may dissociate from the patient, and their suffering, and might even lose empathy and understanding, which is vital in patient care. The risk is that if doctors are so removed from the patient then the patient has even less autonomy, because they are not even in the room when decisions are being made about their future, which could also reduce trust. Finally, technology such as this raises legitimate questions of consent, if a patient does not even meet the doctors treating them.

In my painting I depicted the patient as a distant body reflected on the doctor's goggles, which also forms a screen that a group of doctors are watching. I wanted to try to convey the disjunction of the individuals making decisions about the patient being so removed physically from the patient, and how they are almost like distant players immersed in a computer game.

This poem is about the day that I told my family about my struggles with mental health which was also the day I went to the GP and was started on medication. It's 4 years on now and the day still feel raw and fresh. It was six months later when I saw the notes made by the GP that day which just read 'tearfulness', the contrast between my memory of that day and seeing it written down with one single word was jarring. It made me realise how isolating medical language and how we frame disease can be. When we reduce a patients experience to a word or a summary we can make them feel more alone, we can add to the isolating feeling that living with any illness can bring. I wanted to reflect on that using my own experience to remind myself that isolation and solitude is about more than just being alone but about being heard, understood, and seen.