Her vivid accounts from a hospital battling to cope with coronavirus have been terrifying and heartbreaking in equal measure. Here, in the doctor’s latest diary, read how the sheer weight of patient numbers means normal procedures to save lives have been all but abandoned…
MONDAY: A man is dying but these days it’s no emergency
Boris went to hospital last night – he must be very bad and in desperate need of oxygen. Picture a sponge – that’s what the consistency of your lungs is normally like. With the virus, they can be like a sponge soaked in a bucket of water – heavy and congealed.
I really hope he pulls through. We are very short-staffed today – almost a third of staff are off sick. We’ve had to close a section of the High Dependency Unit (HDU) so I’m covering an acute Covid-19 ward.
Medical staff are seen outside the NHS Nightingale Hospital at the Excel Centre in London as the spread of the coronavirus disease (COVID-19) continues, London, Britain, April 11, 2020
We have a range of patients, from those going home, to those who are dying, and those needing lots of oxygen but can’t go to HDU because there are no beds. Many patients are in side-rooms.
The windows have been smeared with bleach and are difficult to see into. On my morning ward round, there’s a man in his 70s in a room who looks unresponsive – half an hour ago he was fine.
My heart sinks as I feel for a pulse and wait in vain for him to take a breath. Nothing. ‘Oh God,’ I mutter. I know from his notes that when he was admitted yesterday, he was marked as ‘do not resuscitate’.
Various underlying health conditions, you see. Before this curse, there would have been an emergency call, with medics desperately trying to s ave him.
Instead there’s nothing. Nada. Zilch. I need to call his wife but I feel like being still for a few minutes. There’s a resigned calmness to failure, even when there’s a dead body in front of you. The line is crackly. Just my luck.
‘What do you know so far?’ I ask her cautiously after introducing myself. ‘Well, he’s been very unwell and we came in yesterday,’ she says uncertainly. ‘Has anyone had the discussion with you about the ceiling of care and resuscitation?’ I respond.
She fires back: ‘No, no they haven’t.’ I’ve just got to tell her now – there’s no going back. ‘In light of everything going on he wouldn’t now be a candidate for that. Is there someone with you?’
‘Yes, my daughter is here. Why?’ ‘I’m really sorry but I need to tell you that I found your husband non-responsive and he has passed away.’ A deafening silence ensues, interrupted only by the sound of the line crackling.
Medical staff practice loading and unloading a stretcher from an ambulance outside the NHS Nightingale Hospital at the ExCel centre in London, a temporary hospital with 4000 beds
She eventually speaks and starts stoically discussing what the next steps are. I tell her to call back any time she needs.
Thanks,’ she says with a tearful croak and hangs up. I turn around and carry on with the rest of the round. More death and more calls await me. Later, as I leave for the day, my phone buzzes with a news alert: Boris is in intensive care.
TUESDAY: Junior doctors are being hit hard
I’m woken early by beautiful birdsong – how quickly spring has appeared amid the chaos. It’s something, at least, to see cherry blossom on my walk to the station. Tube adverts are disappearing, leaving gaping holes.
Who would have thought a blank advert space would elicit a sense of mourning? As soon as I arrive at work, a colleague informs me that a patient who had been in for several weeks passed away in the early hours.
He was one of those I got to know reasonably well. He was a sweet man. We’ve all become hardened to this stuff, though junior colleagues are finding it more difficult and understandably wear it on their sleeves more.
In the coming months, there are going to be a lot of very depressed medics who will need to work out coping mechanisms as the delayed trauma hits them. I hope the ExCel Centre starts taking patients soon, as we are rapidly running out of room.
The ventilator that will helps save lives at the newly created Nightingale Hospital
In the afternoon, our policy changes so that anyone with suspected Covid19 is immediately put in a Covid positive ward even before their swab result comes back. Until now, we’d isolate them in a side-room or bay and wait for the results but we no longer have the space to do this.
We could be sending people who don’t have the virus to wards where they’re guaranteed to get it. The virus has spread throughout the hospital to such an extent that it’s now virtually impossible to find space to isolate and treat those without it.
In the afternoon, a man in his 50s with symptoms is admitted. He seems very confused – I’m starting to realise that’s common. I say this with no particular authority, but we are seeing a lot of people admitted with encephalitis – inflammation of the brain caused by an infection or through the immune system at-tacking the brain in error, causing confusion in the patient.
I half-suspect, at some point, it’ll be accepted that this is a symptom of the virus. Normally, if a patient presents with encephalitis I would arrange for an MRI scan to find out what was going on, but now we just assume it’s coronavirus.
St John’s Ambulance volunteers arrive to do their bit at the new Nightingale Hospital
One of the worst things about working in the hospital at the moment is the lack of ventilation in Covid wards. It feels so very repressive being cooped up inside, wearing Personal Protective Equipment (PPE) all day with these poisonous, invisible virus particles swirling everywhere.
It’s becoming very claustrophobic. But at least I can leave at the end of the day. The patients here are not so lucky.
WEDNESDAY: Porter goes by with a body bag
It’s a comparatively calm morning and several Covid-19 patients are being discharged – great to see. I bump into a colleague in the corridor. We’re fearful for those people getting sick with other things.
We’re so focused on this pandemic that follow-ups, tests and clinics have been brushed to one side. In the coming months, possibly even years, the task of playing catch-up will be vast.
I also can’t help shake off the worry that people’s inactivity during lockdown could create more cardiovascular issues, such as high blood pressure, obesity and diabetes.
As we chat about this (two metres apart, of course) a porter goes past with a body bag on a trolley. Even in a hospital like this, it’s unusual. A body might normally be left in a room for a period until there is a discreet, inoffensive moment for it to be taken to the morgue.
But we are dealing with more bodies than we’ve ever had to deal with before. It’s a surreal moment and my eyes can’t help but be transfixed on the outline of the head in the bag. In a parallel world that could be a loved one of mine.
I watch for a few seconds as the porter nonchalantly strolls down the corridor with the latest Covid-19 victim. It’s challenging monitoring lots of patients who are all on different amounts of oxygen.
People can very quickly deteriorate from nowhere – much like Boris would have done before he was taken to intensive care. In the afternoon, one man in his mid-60s, who is on an average amount of oxygen, suddenly nosedives.
It becomes apparent he could stop breathing unless he’s moved. But intensive care has no space. We rush him instead to HDU to be put on a continuous positive airway pressure (CPAP) machine – a breathing treatment used before a patient is so bad that they need to be fully intubated on a ventilator.
Later, there is a woman in her early 70s, who yesterday we put straight on a Covid-positive ward when she came in, but her swab has come back negative. There’s a degree, however, to which we can trust the test results.
The feeling is that she most definitely has it – she has all the symptoms and her X-ray shows unmistakable signs. Understandably, her husband is not happy when I call to update him and he discovers the swab result was negative.
He thinks we’ve condemned her to catch it. ‘You can’t do this, you just can’t… what are you playing at?’ he screams down the phone.
I have to hold the phone away from my ear. Later, as I walk to the Tube, I’m left speechless as a jogger brushes past me before spitting on the floor.
Is it any surprise that coronavirus is everywhere?
THURSDAY: The virus ravages entire families
One of the most tragic aspects is that coronavirus is ravaging entire families. It’s bad enough to lose one person, but we’ve seen cases of multiple family members being hit. In the morning, I tend to a middleaged man who is on a lot of oxygen but stable. His brother is in intensive care.
Their father died earlier this week. The decision was made to have a one-way extubation – the medical phrase for taking out the ventilator tube. Such terms allow us to distance ourselves from calling a spade a spade: we stopped treating him and let him die.
The widow is understandably distraught on the phone when I call to give her an update on her sons. She has symptoms herself but she doesn’t require hospitalisation. What words of comfort are there?
It is also extremely difficult for those people who have both parents admitted. In the afternoon, I speak to a middle-aged man whose father is in intensive care and his mother is on oxyge.
The son is distraught, bracing himself to potentially lose both parents. He keeps repeating that he could have given it to them. He very possibly did – who knows? We seem to be seeing an increasing number of Covid-19 patients with abnormal liver functions too.
It’s clear this virus really likes to make itself known. Blood tests further down the line will need to be carried out to see if any longlasting damage has been done. As I leave the hospital, I call my grandfather, who is in his 90s, to see how he is in his old people’s home.
I’ve been feeling guilty that I haven’t called him for a while. But it isn’t easy trying to comfort someone with early-onset Alzheimer’s after days like today.
‘You know you mustn’t come to see me – they are not letting any visitors in or even letting us out of our rooms,’ he says almost immediately after answering in a slightly panicked tone.
‘No grandad, I know,’ I say, trying not to get tearful as the week’s emotion catches up with me. ‘I probably won’t be seeing you for a few weeks yet.’ If I ever see him again, that is.
FRIDAY: Another death… I think of my parents
Boris Johnson is now out of intensive care – a great boost and some much welcome news for the country. There is a calm before the storm as we approach what some have predicted to be the period of peak deaths.
Later that morning, we have a real struggle with a man in his late70s. He has been on a CPAP machine for three days but he just isn’t tolerating it – he’s restless, constantly trying to take off his mask.
Why? Because the infection can cause some patients to become very agitated if their brains are being deprived of adequate oxygen, a condition known as hypoxia. There is simply no way to calm him.
Every time he succeeds in getting the mask off, he is then gasping for air. It’s a horrible sight. The decision is made that we need to take him off the machine today. There is simply nothing more that can be done for him – and other patients need it.
We seem to be running a permanent carousel of machines these days. As soon as one person dies, you free up the machine and it is on to the next patient. We simply don’t have the luxury of time and patience on our side.
His family is understanding, at least. In the afternoon, his son comes to say goodbye. We try to give one family member 15 minutes to say goodbye to loved ones. When the son’s time is up, he stoically leaves and thanks us.
It feels uneasy being thanked when you are about to let someone die. In these moments, it is hard to block out your own thoughts: how can one’s mind not start to wonder about saying goodbye to your own parents? We remove the mask.
Despite a cocktail of sedatives and painkillers, he gasps loudly for air for a while. It is an uneasy death to watch. Another day at the office…