Even in our hospitals, there is hope that the worst is over. But as one frontline NHS doctor reveals in her latest diary, the heartache and tragedy go on…
He just wants to go home to die
Since the crisis began, I’ve been drinking too much coffee to try to stay alert. I’ve suffered heart palpitations as a result, so I’m going to try detox this week – or at least that’s what I’m telling myself.
The peak in the hospital seems to have been a couple of weeks ago, and we are starting to see an influx of regular patients. We still have Covid to contend with – it’s just that we aren’t overwhelmed.
This morning I’m asked to see a man in his 60s in a side-room on the regular ward. He has bladder cancer and has defied the odds for the past couple of years – he was originally told he had only months to live. But a routine check-up scan has shown that the cancer is much more widespread. To add insult to injury, the scan has shown likely Covid in his lungs.
His time is now very limited and he understandably wants to go home to die. Where he dies is the one thing he has control over.
Since the crisis began, I’ve been drinking too much coffee to try to stay alert. I’ve suffered heart palpitations as a result, so I’m going to try detox this week – or at least that’s what I’m telling myself. Pictured: Staff at Hairmyres Hospital, East Kilbride, during an overnight ICU shift
He has no family and lives alone. There is an issue with discharging patients who are contagious and in need of support from hospice carers, but it seems inappropriate to keep him here while cancer and Covid work together to topple him.
Sending him home is the only right course of action. We need to make arrangements for the carers – who are the great unsung heroes of this crisis – to treat him. They will ensure he’s as comfortable as possible in his final days.
But he is concerned about having people come into his home. It isn’t unusual for people to be wary of carers – usually it’s because they are embarrassed about their place being a mess. He eventually agrees.
Cancer patients are going to be one of the biggest sufferers from this crisis. It’s one thing for the Government to call on patients to return to hospitals – but arranging cancer care is not straightforward. It takes time, planning and a great deal of care. I only hope that many won’t die as a result of staying away.
An alcoholic nearly blows us up
The weather has taken a bad turn – it’s amazing how rain can instantly darken moods. The Tube seems busier – is normal life returning?
On my journey, I read a news story about a New York doctor who has killed herself from the pressures of Covid-19. It’s all very jarring. The pressures have been horrendous for medics. It’s easy to blank it all out and forget just how bad it was a few weeks ago.
One of my patients, a lady in her 70s, died overnight. She was battling coronavirus while suffering various underlying health issues – so we established her ceiling of care (the level at which we stop medical treatment) last week. Her family saw her yesterday to say goodbye – that’s something at least.
At 11am, there was a minute’s silence for the frontline staff who have died since this crisis began – but I’m so busy rushing around treating severely ill patients that it isn’t until close to midday that I realise I’ve missed it. A sinking, depressive feeling washes over me at the notion I’ve missed my chance to pay my respects to those colleagues who’ve made the ultimate sacrifice in trying to save others.
At 11am, there was a minute’s silence for the frontline staff who have died since this crisis began – but I’m so busy rushing around treating severely ill patients that it isn’t until close to midday that I realise I’ve missed it
In the afternoon, there is a panic when a man in his 40s with alcohol issues tries to light a cigarette on the Covid ward. Often alcoholics get confused when they go cold turkey. He’s quickly stopped, but it’s a hair-raising moment. With the amount of oxygen in the room, he could have blown the whole place up. He’s given some nicotine patches to calm down.
Later, a man in his 70s in the Covid ward is desperate to leave. He’s taken his oxygen mask off and is half-dressed when a nurse apprehends him. I’m paged to come and calm the situation down. By the time I get there he’s at the ward’s entrance, coat half-draped over him, with his wife – who he had called to pick him up – loitering nearby trying to calm him down. ‘I’ve had enough,’ he says, panting as he struggles to breathe.
It’s the last thing I need. ‘Please, sir, if you don’t go back and put an oxygen mask back on you could be dead shortly,’ I say, trying to sound caring and authoritative at the same time. ‘Please, darling,’ his wife chimes in from a distance. ‘Think of the grandkids.’
He eventually agrees to go back. As annoying as he is, I don’t blame him for wanting to leave. I would feel the same.
In the afternoon, there is a panic when a man in his 40s with alcohol issues tries to light a cigarette on the Covid ward. Often alcoholics get confused when they go cold turkey. He’s quickly stopped, but it’s a hair-raising moment. Pictured: Staff work through the night at an ICU at Hairmyres Hospital
I refuse to let my parents visit
I’ve got a rare day off. We are being encouraged to start using up annual leave as soon as possible. I suspect it’s the fear of the second wave that is driving it, so people don’t take time off if the proverbial hits the fan again.
The summer is usually a quieter time for hospitals – winter is when it goes crazy. But I suspect we are in for one the busiest summers we’ve ever had.
I wish I could lie in to catch up on all the lost hours of sleep but body clocks always put an end to such aspirations – and anyway I need to do some shopping.
Even with the earlier NHS opening hours, shopping is a depressing spectacle – it’s hard to follow social distancing guidelines. I suspect everyone feels the same.
The summer is usually a quieter time for hospitals – winter is when it goes crazy. But I suspect we are in for one the busiest summers we’ve ever had. Pictured: A lab technician at the Corona Test Centre, Hammersmith, processes results
After shopping, I go for a long run through the empty streets of Central London. Every bus stop seems to have a ‘Thank you to our amazing NHS staff’ advertisement or one calling on people to ‘Stay at home, save lives’. God, what I would give right now to see a normal perfume advert.
Later on, I call my grandfather who is in a home with mild Alzheimer’s. The ONS figures this week regarding care home deaths are horrendous. The thought of our old people dying from Covid-19 alone and without any support is almost too much to bear. When this is all over we really should examine how we have ended up with such an appalling social care situation.
He’s confused by everything but seems fairly bright otherwise. If lockdown continues, God only knows when I will next see him…
My parents want to drop some things off in the evening and have a conversation from the end of the drive – but I can’t bear the thought of them coming anywhere near me. I’ve seen too many people their age to know they must stay away, as painful as that is. I can hear the disappointment in my mother’s voice when I refuse to back down.
Did patients catch COVID in hospital?
There is increasing concern among staff at the sheer volume of regular patients coming in – it is going to take a long time to clear the backlog.
One of the big problems is keeping the hospital clean, because Covid appears to be in the air. This is despite the excellent efforts of the cleaning team. They have been working flat-out, putting themselves at grave risk, doing a job few of us would want to do for a basic hourly rate. When people clap on Thursday nights for the NHS, these are the heroes who should be at the forefront of their minds.
Late morning, an elderly lady is moved to the Covid ward despite originally coming in following a bad fall several days ago. Yesterday her breathing became laboured and her swab has come back positive. Worryingly, she most likely caught it here.
There is increasing concern among staff at the sheer volume of regular patients coming in – it is going to take a long time to clear the backlog. Pictured: A member of Hairmyres Hospital ICU in PPE
In the afternoon, I treat a patient in her late 20s with serious learning difficulties. She was in hospital last week with abdominal pain and was discharged fairly quickly. She has come back in today with a high fever. We are treating her with oxygen while we wait for a swab result, but it looks like she has Covid.
Just like the elderly lady, did she catch it when she was last here?
Her mother is distressed on the phone – I try to reassure her as best as I can. It is made worse by the fact that she can’t visit her. We are not meant to be allowing visitors because of the PPE shortage – unless it is to say goodbye, and even then it is being rationed.
I’m left feeling empty. If the boot was on the other foot, I am not sure how I would cope.
A negative swab but I don’t believe it
This morning I tend to a man in his 50s who came in suffering from confusion. It is a symptom we have seen among Covid-19 sufferers so we are keeping him in an isolated room. His swab has come back negative, but it seems almost certain he has Covid-19 – the tests are simply not reliable. We re-swab him and treat him as if he’s positive.
The alcoholic who tried to light a cigarette in the ward earlier this week dies. He’s only in his 40s but with the amount of damage he’s done to himself, he couldn’t be salvaged once Covid-19 struck.
In the afternoon, I discover that we’ve run out of the forms we use to inform colleagues that a patient is not to be resuscitated. We have none on the ward, so I am forced to go on a wild goose chase around the hospital to find one. There have been so many of these forms used since the crisis began that, just like body bags, we were always going to start running dangerously low.
In the afternoon, I discover that we’ve run out of the forms we use to inform colleagues that a patient is not to be resuscitated. Pictured: Members of the Ambulance Service watch on Westminster Bridge on April 23
In the afternoon, one of my previous Covid patients is readmitted. An elderly man, he was first hospitalised here in March for a broken hip but was discharged to another hospital for rehab where he developed Covid-19 symptoms. He tested positive and was subsequently returned here. Earlier this month he was discharged to his nursing home after he appeared to get better. In the past week, however, he has stopped eating and drinking.
He shouldn’t have been brought back here, but we need to treat him as best as we can. We’ll give him 24 hours to see if he improves.
I try to get hold of his sons to let them know their father is likely approaching the end of life – but neither answers the phone. I leave messages, but I don’t hear anything. I only hope we get hold of them before it is too late…