Are you daunted by the prospect of three more weeks in lockdown? Read this week’s searing diary of a doctor working on the coronavirus front line – and then count your blessings…
One mother’s unbearable call to her boys
We have been asked to re-use disposable surgical gowns – they’ll be laundered but I am not sure the plan will work as they are made of very flimsy material. I’m still walking around with bin bags over my shoes.
Whatever Matt Hancock says about there being enough PPE, it’s not true. Our visors are wiped with bleach after every use, which means that when you put one back on, the grim stench hits you like a train – and stays with you for the day.
We are doing everything we can to keep patients in the high dependency unit and not send them to intensive care because there is only a 50-50 survival rate there. This morning, a patient in his late 30s is not tolerating continuous positive airway pressure (CPAP).
This is delivered by a large mask attached to a machine that pumps oxygen. It can be extremely uncomfortable and claustrophobic – and many patients get very agitated and anxious wearing it.
A medical staffer holds up a phone in front of a Covid-19 patient for a video call with relatives
We use it as a final breathing treatment before a patient becomes so ill that they need to be intubated on a ventilator. I try to reassure him as he lies on his front, writhing in distress.
He suddenly jolts up and pulls it off before vomiting everywhere. His oxygen levels are so low that he needs to put the mask back on but the tears are welling up. ‘No, please, no more,’ he begs as a stand-off ensues.
‘It’s like having my face being held to water and almost drowning.’ His oxygen levels aren’t bad enough for him to be fully intubated on a ventilator just yet – but if he doesn’t play ball that’s where he will end up.
We sedate him with Lorazepam, an anti-anxiety drug, so we can get the mask back on. Tears are still welling up in his eyes but his stubbornness eases as the drug pumps through his system.
It’s all very distressing. In the afternoon, a woman in her late 40s nosedives despite being on CPAP. She has to go to intensive care where she’ll be put into an induced coma so she can be placed on a ventilator.
She FaceTimes her two young sons and their stepfather before going under. It’s unbearable. ‘I’ll see you in Heaven,’ she says between gasps as the call comes to its natural end as the anaesthetists appear. That night I can’t sleep – the ‘see you in Heaven’ remark swirls around and around my head.
Patient who refuses to be a burden
It’s no surprise that there have been severe outbreaks in old people’s homes. We’ve been doing all we can not to admit very elderly people who have symptoms. Why? Because it would be a one-way ticket.
We call carers to advise them to isolate individuals in their rooms. Have we abandoned our elderly like lambs to the slaughter (as one former politician has claimed)? I can’t dwell on that.
There’s too much on my conscience already. What concerns me even more than our elderly is where all the other patients have gone? We’ve had a stark drop in admissions for patients we normally see with illnesses such as heart attacks and strokes. Are they dying at home?
Paramedics wearing PPE take a patient into St Thomas’s hospital in Battersea
In the afternoon, an alarm sounds because the heart rate of a man in his 50s is crashing. A normal heart rate is 60 to 100 beats per minute – his has dropped to 25 because he took his CPAP mask off.
We frantically get a crash trolley ready to resuscitate him should his heart stop. I can barely breathe in this stifling heat as I rush around in all these layers getting ready for resus. It’s a hair-raising moment.
I stand over him watching him through my bleach-smeared visor as his heart rate begins to recover once the mask is back on. Later in the afternoon, I try bargaining with a distressed man in his late 60s who won’t keep his CPAP mask on.
He seems to have a death wish, insisting he doesn’t want to go on a ventilator or be resuscitated. But he’s in charge of his faculties so we can’t overrule him. ‘I don’t want to be a burden on my family,’ he says tearfully.
I only wish he could see our facial expressions – to see some hope and warmth in our faces. But he can’t. We are little more than soulless masks to him. Not long before the end of the day, a man in his late 70s is coming to the end of the road.
Various health issues mean he isn’t a candidate for intensive care. I call his daughter. ‘Your dad’s not doing well and he’s requiring more and more support. I don’t know how much longer we can continue.’
Silence follows, apart from her breathing down the line. ‘We may need to think about making him comfortable and ending treatment,’ I add gently. She knows he isn’t a candidate for intensive care but she asks anyway – fortunately, there isn’t a fight.
We’ll give him tonight and see how he is in the morning. These telephone calls have become almost monotonous. Sounds terrible, doesn’t it?
We’ve stopped being doctors
The decision is taken in the morning that we need to give palliative care to the gentleman from yesterday. He hasn’t improved overnight at all – and just isn’t responding to CPAP. It sounds awful but on a logistical level, we need the bed and the CPAP machine back. I try to comfort him as best as I can.
There is a power in touch – sometimes. Just not today. While stroking his hand and telling him how well he is doing, he takes the mask off and whispers ‘juice’ several times between unbearable gasps.
Even something as simple as getting a drink is a hard task these days – it’s difficult to communicate from a distance in PPE, across a bay, to a nurse who is also encased in PPE. But eventually, after much hand-signing, she brings a small carton of orange juice. I hold it up for him to drink from the straw.
It’ll probably be the last thing he consumes. As he’s drinking, another patient in the bay starts waving frantically at me. It becomes apparent he is trying to flag my attention because the gentleman’s catheter bag is leaking all over the floor. The bin bags around my shoes are soaked in urine.
What a way to come to the end of your life. I call his daughter again to let her know it is time. Understandably, she wants to say goodbye – along with her four siblings and a number of grandchildren. The trouble is that if they all come in, they will be using up valuable PPE and we don’t have the resources.
Between us, we agree that each sibling can come in for five minutes at their own risk – but we can’t allow the grandchildren in too. After their visit in the afternoon, and just before taking the mask off, it is time to draw up an anticipatory drug chart – a plan to keep him comfortable in the last hours of his life with sedatives and painkillers.
I cross off all other treatments on his form – and his mask is removed shortly afterwards. It feels like we have, in many ways, stopped acting as doctors. At no point do I actually examine him – I just look at the various numbers on his charts and know that his time is up.
Have we become little more than glorified vets? He’s gone by the time I leave. I’ll let a member of the night team make that phone call – I can’t face any more today.
A flash of hope in a period
There are new safe distancing markers on the Tube. The irony, of course, is that as soon as I’m at work, social distancing is nigh on impossible. Hospitals at the moment are difficult places for everybody but especially for vulnerable people.
There is one lady in her late 30s on the Covid ward who has severe learning difficulties. She has been here for several weeks. This morning she is particularly distressed, crying out in discomfort.
Communication is almost impossible – she can’t speak and her mother, who acts as her carer, isn’t allowed in because she is elderly and has underlying health issues. Our masks make calming the patient very difficult.
Even without them, we’re not sure how much she understands. Although she has been improving and hopefully will be discharged soon, she can’t swallow, so she has a tube in her nose administering nutrition.
It’s uncomfortable and adds to her distress and confusion. She’s trying to say something but there are multiple alarms going off and I can’t work out what she wants or needs. I just stand there thinking how awful it must be for this poor girl.
I try holding her hand to comfort her but she is writhing around. I have a backlog of patients to see – I can’t stay for ever. The figures in the afternoon detailing how many people have died and how many have the virus suggest we’ve already hit our peak – which seems to correlate with the mood here.
We are less wildly busy, though it could be because staffing levels have improved. When is the next peak, though? Is this the new seasonal flu? Could it run and run? That’s the fear. The unpredictability is very difficult for a control freak like myself (most medics are control freaks).
But today we can’t control anything – not at work and not in our personal lives. Men aren’t even in control of their facial hair – all the doctors and nurses I am used to seeing with beards and moustaches have shaved them off to ensure their masks fit properly. Some are hardly recognisable.
There’s some good news in the afternoon – a lady in her early 70s who has been struggling for a couple of weeks seems to be making real improvements. To see someone who has been so low now pull through is wonderful.
Her son is very grateful on the phone – he’s almost overwhelmed. I can’t emphasise how nice it is to have flashes of hope during this dark time.
Body bags wait to be collected
Some of the staff have now been admitted with the virus, including several in intensive care. There are other staff members who have loved-ones in the hospital. It’s horribly close to home.
Despite this, there is a sense the black cloud which has been looming over the hospital has lifted slightly. Compared to when the crisis began, it feels less like a war zone. That said, the sight of body bags outside the intensive care unit, waiting to be collected, still jars every time – including this morning.
One of my patients, a man in his mid 60s, is doing really well and can be released today. He is very philosophical and starts talking about leaving his City job when I let him know the good news. ‘I’ve had a scare,’ he says, half-biting his lip.
‘This is my wake-up call. ‘I’ve got a grandson now, Doc. It’s about time I spent my time with my family. Some things are more important than money.’ In the afternoon, I tend to a patient in his early 70s who can’t speak English but keeps handing me his phone which is set up in another language.
I hand it back to him and go call his family contact, who does speak English, to let them know to call him. He’s one of a few non-Englishspeaking patients we are seeing. Normally they wouldn’t be entitled to such prolonged NHS treatment but we are politely avoiding asking any questions.
As medics, our job is to save lives, not get muddled in politics. But I can’t help but feel a slight pang of discomfort that we have rationed beds and treatment for those who have contributed to the NHS all their lives.
There is talk among staff in the afternoon about vaccine trials. It’s hoped they can be rolled out by the end of the year. Could this be our way out of this mess?