Covid made me play God

I tell him he’s doing great and hold his hand. But soon he will die. All alone

The elderly lady was struggling to breathe and her chances looked bleak. There were 11 other virus victims more likely to survive. In a harrowing diary, a woman doctor at a London hospital reveals how she’s being forced to make choices no one should ever have to make

LAST week, in a devastating dispatch, one terror-struck doctor at a major London hospital told how she was forced to watch helplessly as patients died in agony. Now, in a chilling new account, she reveals how medics are at breaking point as they face a tsunami of new coronavirus patients and crippling equipment shortages.

MONDAY

I WOULD love to say I am returning to work well rested but that would be a lie. I have worked as a medical doctor for more than a decade and last week was unlike anything I have experienced.

Just getting to work today was terrifying – my Tube is packed. In every carriage there will be an NHS worker just like me, likely to be carrying coronavirus because of the sub-standard personal protection equipment (PPE) we’re using.

The NHS’s view is if you don’t have symptoms, you carry on. I feel deeply uneasy, squeezed against people, potentially killing them and them bringing death to me. Yet what choice do I have?

There is camaraderie among staff in the hospital. ‘Keep talking and smiling and we’ll get through this’ seems to be the unofficial motto. But the sense of doom is palpable.

There remains a PPE shortage. Even basic scrubs are in short supply and I am forced to wear a pair several sizes too large.

A number of my patients died at the weekend. I am relieved I wasn’t there to see them die. There is only so much death one can take at the moment. One nurse tearfully tells me they can’t cope with managing beds because of the tsunami of new patients. Meanwhile, the geriatric ward is full of confused dementia sufferers who have no idea what’s going on.

They are all Covid-19 positive. They will all likely die.

I’m called to tend to an elderly patient who is dying but he’s not in a Covid-19 bay. He has developed a fever. He’s clearly caught the virus. ‘Here we go again,’ I think, as I stand before him with no PPE. We take him to a side room to be tested. But honestly, what’s the point? He can’t be saved. A draining sense of helplessness washes over me. Later in the day, his breathing becomes laboured. I hold his hand to comfort him but that look of terror, deep in his pupils, is there. ‘You’re doing great,’ I tell him from behind my mask. Soon he will die. In isolation. Away from loved ones. Alone.

There is a terrible obstacle I have to face this evening that I can’t avoid: how do I discharge those who are better but still have the virus? It’s not just families to liaise with – some are being released to old people’s homes and sheltered accommodation. It’s a headache but what else can we do?

I leave at 8pm. I feel lucky to have got out after 11 hours. There won’t be many days as calm as this for a while. My dad calls. His friend has been hospitalised and is on a ventilator. My sister knows someone who today lost their mother.

TUESDAY

ANOTHER sleepless night. Even something as simple as opening the communal front door to the flats where I live feels as if I could be harming a neighbour. I use a tissue but will that help? Probably not.

Despite Boris’s pleas last night, the Tube is packed again.

There’s a pressing issue about the hospital’s cleanliness but many of the cleaning staff are off sick. The wards are becoming chaotic, with medical notes strewn everywhere and bin bags stuffed with used PPE piling up. This is not what a hospital should look like. Ambulances are queuing up outside with more sufferers. I’ve never seen so many. It is a stomach-churning spectacle. Throughout the day we review the intensive care unit set-up to cope with the influx.

Many Covid-19 patients are being kept in A&E – it is dangerous but we are at bursting point.

In the afternoon, I take a call from a nursing home about a 90-year-old woman with symptoms. After much back and forth, the decision is made to leave her where she is. I advise the home to isolate her as best as it can but she will be a risk to other residents and staff. She will probably die soon. Confused and alone. A pang of guilt pinches my insides as I think of my grandparents.

The TV in the staff room shows the makeshift hospital at the ExCel Centre. It is a chilling image.

After I get home following a 12-hour day, my dad unexpectedly drives across London to drop off a food parcel and toilet roll.

Standing at the end of the path after leaving the boxes on my

doorstep and ringing up, he chats as I do my best to stay composed. I’d love nothing more than to hug him. The desire for human contact is overwhelming, even more pronounced by the fact that I live separately from my partner.

After a few minutes, Dad wanders back to his car and disappears into the night. I turn to carry the stuff through the door to my empty flat. Exhausted, I slump against the door and put my head in my hands. An uncontrollable sob follows. ‘Pull yourself together,’ I think to myself. ‘Your grandmother survived the Blitz, your grandfather fought throughout the Second World War, this should be a walk in the park.’

WEDNESDAY

I ARRIVE at 9am to find there has been a huge intake of Covid-19 patients. It’s beginning to feel like a war zone. Reports of a nurse’s suicide elsewhere have further darkened the mood.

Before Covid-19 patients get so bad that they need invasive ventilation, we treat them with continuous positive airway pressure (CPAP) masks that help them breathe. There has been much talk about the shortage of ventilators, but there is also a frightening shortage of CPAP machines. We are overwhelmed with patients who require them.

If they don’t get them soon they could die. I’ve lost count of the times my pager sounds. I feel like one of those elastic kids’ toys that can be endlessly stretched.

Now I am forced to play God. A sweet lady in her 80s is struggling to breathe with the CPAP machine.

There is nothing I can do to help her – and because of her pre-existing conditions and age, she is simply not a candidate to take to intensive care.

Sounds callous, doesn’t it? As painful as it is, I know that those 11 other people all stand a better chance of surviving than she does. Taking her to intensive care would be a folly.

I call her daughter. She is understanding. She doesn’t say much. But no one wants to be told on the phone that a hospital is going to leave their mother to die. ‘Will she be comfortable?’ was her first response. In truth, it’s hard to be comfortable when dying with Covid-19.

While I am on the phone explaining this, my pager goes off, alerting me to yet another critical case.

I am so dehydrated I can feel my head throbbing. I don’t think I’ve had a drink all day, let alone anything to eat. Later on, I discover a 68-year-old man who is not responding to the CPAP and is reaching the end of the road. I can’t bring myself to take him off the machine just yet, though. I tell the other doctors and nurses we need to give him another 24 hours. It is likely in vain.

THURSDAY

THE flood of patients appearing on regular wards with symptoms this morning is never-ending.

I keep picturing a humongous tin of poisonous red paint being dropped on to the hospital, smashing through the ceiling and splattering everywhere. No corner of the hospital is safe.

Do I sound mad? The lack of sleep is catching up with me.

Sadly, the sweet old lady died overnight. It’s easy to ignore death statistics. But everyone who dies is someone to somebody. She was a mother and a grandmother.

We are running out of space to test patients. The side rooms where we swab and isolate people are at full capacity. It’s becoming impossible to manage.

The chaos caused a terrible accident late this morning. Patients are cleared from a regular bay after someone tests positive for the virus. Unfortunately, miscommunication results in A&E bringing up patients into the infected area. (They all subsequently test positive for coronavirus.)

It’s no one’s fault. A&E is at overcapacity and they thought they were taking these patients to a safe place. I really feel quite sick.

In the afternoon, the emergency alarm goes off and I find a non-coronavirus patient, a man in his 70s, unresponsive. After four minutes of compressions we fortunately get him back. Shortly afterwards, though, it becomes apparent he likely has the virus. The voice in my head is repeatedly screaming, ‘Oh f***’. CPR is a contagious procedure that requires enhanced PPE. Countless staff and other patients in the bay could have caught the virus during the compressions.

If I didn’t have it before, I most likely have it now. The man is in the vulnerable category with underlying health issues and is therefore not a contender for ICU – he will be lucky to make it through the night.

Shortly before I leave, a decision is made to continue the CPAP treatment for the 68-year-old gentleman who yesterday we gave another 24 hours. He isn’t responding but we give him another day.

I set off shortly before 8pm. I am left dumbfounded by the NHS applause. It’s incredibly humbling. For the first time in what feels like an eternity, I don’t feel alone.

FRIDAY

ANOTHER early start but thankfully the Tube is empty.

The man who went into cardiac arrest yesterday died overnight. The others who were in the bay next to him when we performed CPR have all tested positive.

But it isn’t all doom and gloom. Younger patients are getting better and coming off the CPAP machines.

The lunchtime news that Boris has tested positive leads to some staff joking about how he managed to get tested.

Of course he’s the PM and absolutely must be tested, but it remains shameful that exposed frontline staff are not afforded the same courtesy. The 68-year-old still isn’t responding to CPAP. We will have to stop his treatment.

His daughter, however, refuses to accept this and barges into his room without full PPE on. CPAP machines generate a lot of aerosols and there will be virus particles everywhere. It’s very dangerous for her but she is inconsolable.

Through sobs she pleads for us to save him. The ward sister eventually subdues her. Going on without a loved one is a terrible burden.

Bodies are piling up in the resuscitation area. The hospital mortuary is clearly struggling to cope.

Admin is struggling to keep up with the death rates. An oncologist calls the ward to touch base with one of their patients, only to discover they died from Covid-19 days before.

It’s not a good time to get sick from something else. Hospitals are not safe places. One doctor tells me they are concerned that a patient who likely has an underlying cancer cannot have a scan for at least three months. There is a worry this patient could become unwell in the meantime with widespread cancer.

But he’s powerless. There will be countless cases like this.

I get out late, shortly after the 68-year-old is taken off the CPAP machine. It’s been a long week.

A fellow doctor sends a message about figures from Italy saying 51 doctors have died from coronavirus. I’ll blank that one out, thanks.

I should text my mum. She’s always worrying and I won’t have a moment tomorrow as I know my pager won’t stop going off.

As I type, a cough comes out of nowhere. ‘So there you are,’ I think. ‘I’ve been expecting you. What took you so long?’

In the chaos patients are put in an infected bay. They later test positive