Her vivid reports of a hospital struggling to deal with the coronavirus were equally terrifying and heartbreaking. Read here, in the doctor’s last diary, how the weight of patient numbers means that normal procedures to save lives are as good as abandoned …
MONDAY: A man dies, but it is not an emergency these days
Boris went to the hospital last night – he must be very, very bad and needs oxygen urgently. Picture a sponge – that’s how the consistency of your lungs is normally. With the virus, they can be like a sponge dipped in a bucket of water – heavy and congealed.
I really hope he gets through it. We are very tight today – almost a third of employees are ill. We had to close a section of the High Dependency Unit (HDU), so I’m treating an acute Covid-19 unit.
Medical personnel are seen outside the NHS Nightingale Hospital at the Excel Center in London as coronavirus disease (COVID-19) continues to spread, London, UK, April 11, 2020
We have a range of patients, from those who go home, to those who are dying, and those who need a lot of oxygen but cannot get to the HDU because there are no beds. Many patients are in side chambers.
The windows are smeared with bleach and difficult to see. In my morning ward, there is a man in his seventies in a room that no longer looks – half an hour ago he was fine.
My heart sinks when I feel a heartbeat and waits in vain for it to breathe. Nothing. “Oh God,” I mumble. I know from his notes that when he was admitted yesterday, he was marked as “not resuscitating”.
You see several underlying health problems. Before this curse, there would have been an emergency call, with doctors desperately trying to save it.
Instead, there is nothing. Nada. Zilch. I have to call his wife, but I want to be quiet for a few minutes. There is a residing calm in failure, even when a corpse is in front of you. The line is creaky. Just my luck.
“What do you know so far?” I ask her carefully after I introduced myself. “Well, he was very sick and we came in yesterday,” she says uncertainly. “Has anyone talked to you about the ceiling of care and resuscitation?” I react.
She shoots back. “No, no, they don’t.” I just have to tell her now – there’s no turning back. “Given all that was going on, he wouldn’t be a candidate for it now. Is there someone with you? ‘
“Yes, my daughter is here. Why?’ “I’m very sorry, but I have to tell you that I didn’t find your husband responsive and he died.” A deafening silence follows, interrupted only by the crackling of the line.
Medical personnel practice loading and unloading a stretcher from an ambulance outside the NHS Nightingale Hospital at ExCel center in London, a temporary hospital with 4,000 beds
Finally she speaks and starts to stoically discuss the next steps. I tell her to call back whenever she wants.
Thank you, ”she says with a tearful quack and hangs up. I turn around and continue the rest of the round. More dead and more phone calls are waiting for me. Later, when I leave for the day, my phone buzzes with a news alert: Boris is in intensive care.
TUESDAY: Junior doctors are hit hard
I am awakened early by beautiful birdsong – how quickly spring has appeared amid the chaos. At least it’s something to see cherry blossom on my walk to the station. Tube ads disappear, leaving gaping holes.
Who would have thought that an empty advertising space would generate a feeling of grief? As soon as I arrive at work, a colleague informs me that a patient who has been in the house for several weeks has died in the early hours.
He was one of those I got to know fairly well. He was a sweet man. We are all tough on this stuff, although junior colleagues find it more difficult and understandably wear it up their sleeves.
In the coming months, many depressed physicians will have to work out coping mechanisms if the delayed trauma hits them. I hope the ExCel Center will take patients soon, because we will soon run out of space.
The fan that will save lives in the newly established Nightingale Hospital
In the afternoon, our policy changes so that anyone with suspected Covid19 is immediately placed in a Covid positive department, even before their swab result returns. Until now, we isolated them in a side room or bay and waited for the results, but we no longer have the space to do this.
We can send people who don’t have the virus to wards where they can get it guaranteed. The virus has spread so much through the hospital that it is now almost impossible to find space to isolate and treat people without it.
In the afternoon, a man in his fifties with symptoms is admitted. He seems very confused – I’m starting to realize that’s normal. I say this without specific authority, but we see a lot of people admitted with encephalitis – encephalitis caused by an infection or by the immune system accidentally attacking the brain causing confusion in the patient.
I suspect that at some point it will be assumed that this is a symptom of the virus. Normally, if a patient with encephalitis presents, I would have an MRI scan to find out what was going on, but now we assume it is coronavirus.
St John’s Ambulance volunteers arrive to do their bit in the new Nightingale Hospital
One of the worst things about working in the hospital right now is the lack of ventilation in the Covid wards. It feels so repressive to be locked inside and wearing personal protective equipment (PPE) all day while these toxic, invisible virus particles are spinning all over the place.
It is going to be very claustrophobic. But at least I can leave at the end of the day. The patients here are not so lucky.
WEDNESDAY: Porter passes by with a body bag
It’s a relatively quiet morning and several Covid-19 patients are being discharged – great to watch. I meet a colleague in the hallway. We are afraid that those people will get sick from other things.
We are so focused on this pandemic that follow-ups, tests and clinics have been put aside. Over the coming months, possibly even years, the task of overtaking will be a daunting task.
I also can’t help but allay the concern that people’s inactivity during lockdown can cause more cardiovascular issues, such as high blood pressure, obesity, and diabetes.
While we’re talking about this (two meters apart, of course), a doorman passes by with a body bag on a trolley. Even in such a hospital it is unusual. A body can normally be left in a room for a while until there is a discreet, harmless moment to take it to the morgue.
But we are dealing with more bodies than ever before. It is a surreal moment and my eyes cannot but fixate on the outline of the head in the bag. In a parallel world that could be a lover of mine.
I watch for a few seconds as the doorman casually strolls down the hall with the latest Covid-19 victim. Tracking many patients who all use different amounts of oxygen is challenging.
People can deteriorate very quickly from scratch – just like Boris would have done before he was taken to intensive care. In the afternoon, a man in his mid-sixties, who has an average amount of oxygen, suddenly shows up.
It becomes clear that he can stop breathing unless he moves. But there is no room in intensive care. Instead, we rush him to HDU to be placed on a continuous positive airway pressure (CPAP) machine – a respiratory treatment used before a patient is so bad that they have to be fully intubated on a ventilator.
Later there is a woman in her early 70s, who we put in a Covid-positive department immediately upon entering yesterday, but her cotton swab came back negative. However, there is a degree to which we can trust the test results.
The feeling is she sure has it – she has all the symptoms, and her X-ray shows undeniable signs. Understandably, her husband is not happy when I call to update him and he discovers the result of the Pap smear was negative.
He thinks we sentenced her to catch it. “You can’t do this, you just can’t … what are you playing with?” he shouts on the phone.
I have to keep the phone away from my ear. Later, when I walk to the Tube, I am speechless as a jogger strides past me before spitting on the floor.
Is it a surprise that coronavirus is everywhere?
THURSDAY: The virus is hitting entire families
One of the most tragic aspects is that the coronavirus afflicts entire families. It is bad enough to lose one person, but we have seen cases where several family members were hit. In the morning, I tend towards a middle-aged man who has a lot of oxygen but is stable. His brother is in intensive care.
Their father died earlier this week. One-way extubation has been chosen – the medical term for the removal of the breathing tube. Such terms allow us to distance ourselves from calling a shovel a shovel: we stopped treating him and let him die.
The widow is understandably distraught on the phone when I call to update her sons. She has symptoms of her own but does not require hospitalization. What comforting words are there?
It is also extremely difficult for people who have admitted both parents. In the afternoon I speak to a middle-aged man whose father is in intensive care and his mother is on oxygen.
The son is distraught and braces himself to possibly lose both parents. He keeps repeating that he could have given it to them. He may have done it – who knows? We also seem to see an increasing number of Covid-19 patients with abnormal liver functions.
Obviously, this virus likes to make itself known. Blood tests further down the line will need to be done to see if any permanent damage has been done. When I leave the hospital, I call my grandfather, who is in his nineties, to see how he is at his retirement home.
I feel guilty for not calling him in a while. But it’s not easy to comfort someone with early-onset Alzheimer’s after days like today.
“You know you shouldn’t come and see me – they don’t let visitors in or even let us out of our rooms,” he says almost immediately after responding in a slightly panicked tone.
“Not Grandpa, I know,” I say, trying not to cry while the emotion of the week catches up to me. “I probably won’t see you in a few weeks.” If I ever see him again, then.
FRIDAY: Another death … I’m thinking about my parents
Boris Johnson is no longer in intensive care now – a great boost and lots of welcome news for the country. There is calm before the storm as we approach what some have predicted as the peak mortality period.
Later that morning we have a real struggle with a man in his late seventies. He’s been on a CPAP machine for three days, but he just won’t tolerate it – he’s restless and constantly tries to take off his mask.
Why? Because the infection can become very restless in some patients if their brains are not getting enough oxygen, a condition known as hypoxia. There is simply no way to calm him down.
Every time he succeeds in taking off the mask, he gasps for air. It is a terrible sight. The decision was made that we should take it off the machine today. There is simply nothing more that can be done for him – and other patients need it.
We seem to have a permanent carousel of machines these days. As soon as one person dies, clear the machine and move on to the next patient. We simply don’t have the luxury of time and patience on our side.
At least his family understands. In the afternoon his son comes to say goodbye. We try to give a family member 15 minutes to say goodbye to loved ones. When the son’s time is over, he leaves stoically and thanks us.
It feels uncomfortable to be thanked when you are about to let someone die. In these moments it is difficult to block your own thoughts: how can your mind not wonder if it is saying goodbye to your own parents? We remove the mask.
Despite a cocktail of tranquilizers and pain killers, he gasps for air for a while. It is an uncomfortable death to watch. Another day at the office …