MONDAY: Making choices that no doctor needs to make
I have minor symptoms, but not serious enough to be tested or to stop working.
If I insist on a test, I would have to go to a drive-through center on the other side of London. I don’t have a car, so I don’t bother.
Fortunately, the Tube carriage is much emptier than last week.
Upon arrival I discover that several of my patients in the normal wards have died since Saturday. These people all came to walk and talk.
A nurse wearing a protective mask and equipment comforts another as they change shifts on March 13, 2020 at Cremona Hospital, southeast of Milan, Lombardy
They should have been treated and walked out again. But they caught Covid-19 here and, as they say, it was.
Unfortunately for their loved ones, visitors were officially banned during the weekend. It feels heartbreakingly inhumane.
I’m calling a mid-70s lady who’s not responding to a machine with Continuous Positive Airway Pressure (CPAP).
These are used as the last treatment before a patient is so bad that they have to be fully intubated – put on a ventilator that breathes for them.
Surprised, he replies, “We have our golden wedding day in September.” It breaks his heart, and mine, when I explain that he can’t say goodbye. There are far too many patients now.
It’s just not safe. A nurse normally has one or two patients to treat. Now there are at least eight.
These are some of the sickest patients in the hospital. Many are so confused that it’s a struggle to get them to keep their masks on.
In the afternoon, an email comes from the Royal College of Physicians stating that one in four doctors is ill.
Frankly, I am surprised that this percentage is not higher. There is a shortage of fans and CPAP machines. If a patient does not improve quickly, treatment is stopped.
There are no official government guidelines on this, so we use a fragile score form – and a check mark questionnaire called a Treatment Escalation Plan.
This thin piece of red paper requires the answers to a series of simple clinical questions.
The more ‘yes’ answers a patient gets, the more likely they are to continue treatment.
A woman with an unknown condition is assisted by an ambulance at St Thomas’ Hospital on March 30, 2020 in London, England. Hospitals across London are facing huge demand
Those who fall below the threshold must die. It’s not an exact science, but you have to draw the line somewhere.
We practice medicine by number – we don’t care. It is brutal and absurd that such serious decisions are made in an instant, but the number of patients leaves us with no choice.
I get out at 9 p.m. and fall asleep on the metro.
TTODAY: Mourning lovers cannot say goodbye
It is another beautiful, sunny morning, but in the High Dependence Department I discover that it has been a terrible night and several patients have died or gone to intensive care.
The majority are men and one is in her early thirties.
Yesterday he tapped nicely with oxygen. But in the early hours he appeared not to respond.
Doctors don’t know exactly what happened, a common Covid-19 chorus. People like to wish Covid19 away as a kind of flu.
But young, fit, healthy men don’t just stop breathing from influenza. I speak to his partner on the phone.
There is a sense of disbelief. I don’t blame her. I would be the same. Her questions are scattergun: “He’ll be fine, right?” … “How did this happen?”
That’s not fair. God knows what they had planned for the rest of their lives together – now it all ebbs away.
I’d like to say we’ll fix it, but we just don’t know what will happen. Patients like him spend weeks in intensive care in induced comas, machines that give their lungs a chance to recover.
One of the most difficult things is making these calls over the phone. We are trained to pick up nonverbal cues and body language to spread bad news in the friendliest way.
That’s all in the pot now. In the afternoon, a woman becomes hysterical when I call to say that we should stop her husband, who is in his seventies.
“You can’t give up on him! He is a strong man. He is fit. You cannot do this. This is cruel. We can’t even visit him. ‘
Her tearful son also comes on the line to plead, but it is clear that there is not much hope. Have you seen an X-ray of the coronavirus?
The impact on the lungs is not nice. I’ll call the family back. It is one of the worst phone calls I have ever had.
Tears well up in my eyes. I should have done this personally – and she and their son should have said goodbye.
She starts to sob. She has every right to it – her husband is a relatively fit man, only recently retired, active and independent.
Now he’s sentenced to death. However, it is a national emergency. We don’t have the luxury of choice.
WEDNESDAY: Patients are getting younger
Rumors of fatalities have spread among staff, fueled by news that a doctor has died elsewhere.
The mood is darkened by the death of a 13-year-old boy in another hospital. Shall we have such a young victim here?
Who knows. Those admitted are noticeably younger – in their forties and fifties.
In the afternoon, a man in his early forties who did not respond to CPAP refused to be transferred to intensive care for intubation on a ventilator.
He has no medical history other than being overweight, but in fact he is signing his death warrant.
His fears are not without foundation. The idea of falling asleep and being kept alive by a machine is nightmare.
“If you don’t go to intensive care, you won’t leave this hospital,” I beg him in vain. I call his father through the loudspeaker.
The scene is absurd. There are some of us in full personal protective equipment over him, a muffled conversation on an iPhone through our masks.
It may be lack of sleep, but it feels like I’m in some sort of dream sequence.
Finally, the patient agrees after listening to his father. Later, we break the hospital rules by having the children of a man in his seventies say goodbye.
Due to their age, they are at low risk. I get them PPE (an increasingly difficult task).
Of course it is not good to ignore rules, but I notice that people die too much alone to endure.
Unfortunately, they want FaceTime to their elderly mother so she can say goodbye too.
The feeling among staff is that patient confidentiality means we don’t know if he would give permission – so we refuse.
I can almost hear my father, who hates any authority, mumbling “Jobsworth” in my ear. But this man is completely cheated and cannot give permission. Anyway, what’s in it for you?
All afternoon there is a flow of ambulances that make it difficult for people to breathe.
An alarm sounds for every arrival – it doesn’t stop.
Hour after hour after hour. Late in the evening I walk into the clear night.
I can breathe for the first time all day.
THURSDAY: It takes all the strength in the world not to cry
I don’t recognize myself in the mirror. Dark bags under my eyes, blotchy skin.
People don’t realize how heavy and warm the personal protection clothing is; you remain drenched in sweat.
It is good work that I will not see my friend for a while. I feel guilty even when I think about my appearance when there is so much misery.
There is good news: a woman in her late seventies, who contracted the virus during a cruise and was admitted weeks ago, has recovered and is able to leave.
A great result. However, by noon the black clouds return.
A lady in her late sixties, who has been a frequent visitor with various problems for the past few months, dies of Covid-19 she contracted in the hospital.
When she came in last week, she tested negative, but was found positive when we wiped her again on Monday.
Coronavirus particles seem to challenge us, dancing happily in every corner of this place. You develop relationships with such patients. “I’m darling again,” she joked.
I had to check the ‘do not resuscitate’ box on her form, unthinkable a few weeks ago. I told her husband what I had done and he was incredibly understanding.
When she was feeling well, she sat on and around the ward on her Zimmer frame with a glimpse in her eyes.
“You’re a handsome doctor, why aren’t you married?” she teased sometimes. And when her sons were visiting, she reminded them of my unmarried status to embarrass them and me.
Now that I’m holding the phone as I prepare to tell her husband she’s gone, I have to calm myself down.
Truly salt people, they made so much longer together. If he answers, it takes all the strength in the world not to cry.
By the end of the conversation, my voice is waving a little. “It’s okay,” he says comfortingly.
“Thank you for taking good care of her.”
But we didn’t do that. She caught it here. We let her down. When I leave, I have an overwhelming urge to hear a human voice.
I call my mom and try to cover everything with sugar. There is no point in giving her unnecessary fear. I know she’s so worried about me.
FRIDAY: “How did this happen? You killed my father! ‘
The government announced mass testing last night – I’ll believe it when I see it. The absurd guidelines for being tested as a physician have not changed.
It’s shocking how many colleagues – myself included – can’t smell one of the alleged Covid-19 symptoms.
A young doctor tells me that she moved out of her childhood home for fear of infecting her elderly parents. This morning, three patients who have been here for more than three weeks will be discharged.
Sometimes fighting this virus felt like playing a rigged Whac-A-Mole arcade game, so this feels like a huge accomplishment.
By early afternoon, an alarm will sound in each department to warn us that the oxygen supply is low. If we run out, it will be disastrous.
There is a shortage of space in the morgue – bodies are kept in side chambers. In the middle of the afternoon, a man in his early 80s does not respond.
I had changed its red shape, like so many others, to “Do not resuscitate” when it tested positive for coronavirus, after being admitted for something else.
His daughter screams at me on the phone. “How did this happen? How? Tell me how! He got out of it last week and now you killed him! ‘
It’s a grief response, but it’s still intolerable. She has every right to be in shock – this morning she was told her father was fine.
Now he’s dead. Did I kill him as a doctor with minor symptoms? Another employee?
God knows, there are plenty of us with symptoms that have to work through this. There is no soul to be seen on the Tube house, only old advertisements for holidays, plays and concerts.
I feel like I’m living in an apocalyptic horror movie. I am afraid to think about what’s to come next week.