The worst may now be over, but as one frontline doctor reveals in her latest diary, traumatised medics now have time to reflect on the life-and-death decisions taken in the heat of battle…
Monday: We’re no longer being forced to play God
Spring has come and gone – and summer is here. There are still Mother’s Day cards in the window of the locked-up card shop I pass on my way in, serving as a stark reminder of just how long we have been in lockdown.
I hope it ends soon, not least so I can see my mum again.
In the hospital, things are calmer and we feel well staffed again. A few colleagues, particularly more junior ones, have been talking candidly about their feelings and how horrible it was about writing off patients the same age as their own parents.
When we were first overrun, it was horrendous – but that’s not the case now. We’re no longer being forced to play God, deciding who should get treatment and who should be left to their fate.
Two paramedics wait to safely remove their PPE3-level clothing after treating a patient with possible COVID-19 symptoms
Now we have got more time on our hands, everyone is more reflective about the ordeal we have been through. But we’ll never know if the life-and-death decisions we made were the right ones. Anyway, I can’t afford to dwell on that – no good comes from it.
I do worry, however, that a number of us will experience post-traumatic stress disorder in months to come – from doctors making final calls, to nurses turning off ventilators and to porters transporting all those body bags.
Today, at least, the black cloud has receded. There is, however, a lurking sense that we could return to that dark place again if there is a second wave. No one knows if that will be the case, though. Of course we still have people critically ill – just far fewer of them.
In the afternoon, I see a man in his mid-70s who has dementia – and likely Covid. He’s not eating and drinking after having a fall at home. We’re keeping him isolated in a side room while waiting for his swab result – but his blood tests and X-ray imply Covid.
He is doubly incontinent – he can’t go back home and he needs 24-hour care. In this climate it won’t be easy to find a nursing home to take him… if he recovers. His wife asks to speak to him so I hold the phone for her to talk to him on loudspeaker. He doesn’t recognise her voice and stays quiet while staring at me blankly.
I can hear the pain in her voice – she may as well be talking to thin air. Weeks ago, such a scene might have raised a tear, but I have become terribly hardened.
Tuesday: It’s too quiet… are they dying at home?
The news is filled with details of how the Government is planning to get Britain back to work. It’s encouraging to finally have a sense that some normality might start coming back. God knows, it would be nice to have a sense of life around me – the quietness outside the hospital is terribly depressing. We aren’t wired to be isolated and shut away.
More than anything, we’re all very worried about the long-term health impact on keeping people locked down.
There are still fewer people than usual coming in – A&E remains relatively empty. Where have all these people gone? Are they dying at home? It’s horribly disconcerting. The crisis has been an awful time for vulnerable people, whether those with mental illnesses, addiction issues, or people seriously unwell who are too frightened to come into hospital.
Ambulance workers transport patients needing urgent treatment outside a hospital in London
All the things we once considered of pressing importance, such as care for patients with chronic conditions and outpatient support, fell by the wayside when the virus began rampaging. But as the Covid intake continues to drop, this stuff needs to come back – quickly. Lives depend on it.
Late morning, I see a patient with Down’s syndrome who has been readmitted after being discharged a week ago to his care home. He’s not been eating or drinking and the care home is struggling to look after him. He’s visibly distressed, which isn’t helped by everyone he sees wearing masks.
One pressing issue is that nursing homes are simply not coping. We’re seeing elderly patients returning to us who have already been discharged after recovering from the virus, while others are refusing to take people back.
In the evening, one of my patients in his mid-70s dies. Since coming in days ago, he had been on continuous airways pressure (CPAP) – a breathing treatment used before a patient is so bad that they need to be placed on a ventilator. He wasn’t a contender for intensive care because he had various underlying health issues.
Earlier in the evening, we withdrew care and took him off CPAP. He died within a couple of hours. A colleague offers to call the family. I’m only too happy to let them. I leave the hospital after a 13-hour shift on a flat note.
Wednesday – Months of agony…and for what?
Neil Ferguson is in the news for breaking the lockdown rules to allow his lover to visit him. It’s not for me to comment on who he sleeps with – but the hypocrisy is jarring.
Many of my colleagues and I have been isolated from loved ones since this crisis began – so it’s a bitter pill to swallow that he has flouted the rules himself.
I haven’t seen my boyfriend since the crisis began. It’s been two months of agony made worse by work being so horrendous.
Professor Neil Ferguson, who told over 60m Britons to remain in lockdown, was forced to resign this week after he broke the rules himself
Having a loved one is a great comfort at the best of times – let alone the worst of times.
Clearly Ferguson doesn’t feel the rules he is responsible for apply to him. What does that say about him? If I think about it too much, it makes my blood boil. Colleagues are livid about it too. One consultant, normally mild in his manner, uses multiple expletives when talking about it. Millions around the country will be equally furious.
I hope on Sunday Boris announces some loosening of restrictions. I’m certain I’ve had the virus so it is about time I saw my boyfriend. It’s a shame that we’re not being offered antibody tests.
Back on the wards, the care of the elderly with Covid at the moment is one of the biggest challenges we face. Of course some get better – but we have an entire geriatric ward of coronavirus patients. Many are delirious from the infection.
There should be inquiry into how we allowed the virus to rampage through our care system.
Families expect them to bounce back. You often hear from relatives that, although their loved ones are old, they are really fit, independent and strong. ‘When will they be back walking?’ is a constant question.
The reality, however, is different after this virus. The real question is: ‘Will they be able to get out of bed again?’ It takes weeks to get over being so acutely unwell – if they can at all.
There is one man in his 80s who has been requiring a lot of oxygen. It’s clear there’s not much more we can do for him. I stand there watching as his abdomen see-saws, his whole body struggling for breath. We need to palliate him.
I call his son, who understands his father has hit his ceiling of care and doesn’t protest. We arrange for him to come in to say goodbye. The wife is too old and frail to join. The virus robs people of a chance to say goodbye. That, combined with restrictions on funerals, makes closure very hard.
Thursday: the clapping seems pointless now
Incredibly, the hospital almost feels overstaffed this morning. Maybe that is because the non-Covid patients are still too frightened to come.
I find it unnerving that so many people are staying away long after the peak of this virus. It now feels as if there are many unknowns for the future of the hospital.
If there is a second wave, our whole way of working could change yet again. Or we could all just continue returning to normal if the virus is stamped out, as it appears to have been in South Korea.
NHS workers take time to applaud the work of all key workers outside Aintree University Hospital
Late morning, I have a shock tending to a man in his 70s who has come in because he is short of breath – his breathing is so bad, in fact, that he struggles to even get his words out when I talk to him.
While waiting on his swab result, we scan him and discover that he has what looks like cancer everywhere. My heart sinks looking at the X-ray. It looks as if he has Covid-19 in his lungs too.
Has he stayed away until now because of fears about coming in? The prognosis is very bad.
We have seen a small rise in the number of people coming in with overdoses – I suspect it’s a consequence of lockdown and the impact on mental health.
This afternoon, a young girl is admitted after overdosing on her antidepressant medication and is acutely unwell in intensive care, requiring very close monitoring. It isn’t the first time we’ve seen her here. It’s desperately sad.
In the afternoon, I see a patient in her 40s who is undergoing chemotherapy for cancer. She began treatment recently but she has come in today with a spiked fever and seems short of breath. Because of the chemotherapy, she has a compromised immune system. The worry is that if she has caught Covid-19, she could be in a lot of trouble. It is not good news…
It is Thursday so there will be more clapping tonight. It was touching originally. Now? It just feels a bit pointless. Have I become cold-hearted?
There was a recent letter in the British Medical Journal making the point that for years we have needed more resources. This crisis highlighted that all too painfully. The author concludes the letter by making this point: once this crisis is over, what good will come from us all clapping once a week? Will anything change? Unlikely.
Friday: if only testing had come sooner
I finally catch up on sleep, as I’ve got the day off for the Bank Holiday. It seems like any hopes that restrictions will be lifted on Sunday are going to be dashed. The switch is clearly not going to just come back on any time soon – no matter what many hope.
Still, the sun is shining and it is hard not to feel brighter because of that at least.
Late morning, I go for a run around Central London, dodging people and holding my breath as I go past them.
The city definitely feels busier, with more people out and about. Everyone has lockdown fatigue.
Some shops in the West End appear to be taking deliveries ahead of perhaps opening up again but others look as if they are now shut up for ever. The economic impact of this crisis is going to be immense. I’m not sure it has fully sunk in for people just how bad it is going to be.
There is also a lot of traffic on the road. On the one hand, it’s great to see life and the capital starting to feel more normal again. On the other hand, I can’t help but be slightly panicked about the notion of a second wave – and what could be waiting in store for us.
A protestor holds up a placard outside a hospital in London asking for more PPE access for NHS staff
Hopefully the track-and-trace app and mass testing will get us out of this mess – even if it does feel somewhat too little too late. For if we had that in place in early March, we wouldn’t be in this situation. I can’t get over the fact that for so long hospital staff couldn’t get tested and were most likely spreading coronavirus among ourselves and patients.
Were we all little more than silent killers spreading this awful virus among vulnerable people who should have been safe in our care?
This thought weighs heavy on my shoulders. Running is at least an escape from such dark thoughts.
But no one can run away from their demons for ever…