The flick of a Biro on a flimsy red tick box form decides who will live – and who dies...

Nothing captures the horror of Covid-19 more vividly than this soul-baring diary by a female NHS doctor

A DOCTOR’S dispatches from the Covid-19 frontline have brought home the grim reality of life in the UK’s overburdened NHS hospitals. Here, in her latest diary, she reveals how telling grieving relatives that they can’t say goodbye to loved ones dying alone has become yet another heartbreaking responsibility of the job.

MONDAY MAKING CHOICES NO DOCTOR SHOULD HAVE TO MAKE

I HAVE minor symptoms but not severe enough to get tested or to stop working. If I insisted on a test, I would need to get to a drive-through centre on the other side of London. I don’t have a car so I don’t bother.

Thankfully, the Tube carriage is much emptier than it was last week. On arrival, I discover that several of my patients on the normal wards have died since Saturday. These people all came in walking and talking. They should have been treated and walked out again. But they caught Covid-19 in here and that, as they say, was that.

Unfortunately for their loved ones, visitors were officially banned over the weekend. It feels gut-wrenchingly inhumane.

I call the husband of a lady in her mid-70s who is not responding to a continuous positive airway pressure (CPAP) machine.

These are used as the final treatment before a patient is so bad that they need to be fully intubated – put on a ventilator which breathes for them.

Taken by surprise, he responds: ‘We’ve got our golden wedding anniversary in September.’ It breaks his heart, and mine, when I explain he can’t say goodbye.

There are now far too many patients. It is just not safe. A nurse might normally have one or two patients to deal with. Now it is a minimum of eight.

These are some of the sickest patients in the hospital. Many are so confused that it is a battle just to get them to keep their masks on.

In the afternoon, an email comes through from the Royal College of Physicians to say one out of four doctors is off sick.

To be honest, I’m surprised this proportion isn’t higher.

There is a shortage of ventilators and CPAP machines. If a patient does not improve quickly, then their treatment is halted.

There are no official guidelines on this from the government so we are using our own frailty score – a tick-box questionnaire called a Treatment Escalation Form.

This flimsy piece of red paper demands the answers to a series of simple clinical questions.

The more ‘yes’ answers a patient gets, the more chance they have of continued treatment. Those who fall below the threshold are left to die.

It’s not an exact science but you have to draw the line somewhere. We are practising medicine by numbers – not care.

It’s undoubtedly brutal and absurd that such grave decisions are made on the flick of a Biro but the volume of patients leaves us with no choice.

I get out at 9pm and fall asleep on the Tube.

TUESDAY GRIEVING LOVED ONES CAN’T SAY GOODBYE

IT’S another beautiful sunny morning but at the high dependency unit, I discover it has been a horrendous night and several patients have either died or gone to intensive care. The majority are men and one is in his early 30s. Yesterday he was ticking along nicely with oxygen. In the early hours, however, he was found unresponsive. Doctors aren’t sure what happened, a common Covid-19 refrain.

People would like to wish Covid19 away as some sort 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’s going to be all right, right?’… ‘How did this happen?’

It isn’t fair. God knows what they had planned for the rest of their lives together – now it’s all ebbing away. I’d love to say we’ll fix him but we simply don’t know what will happen. Patients like him are going to be in intensive care for weeks in induced comas, machines giving their lungs a chance to recover.

One of the hardest things is having these conversations over the phone. We are trained to pick up on non-verbal cues and body language to break bad news in the kindest way possible. That’s all gone to pot now. In the afternoon, a woman becomes hysterical when I call to say that we are to stop treating her husband, who is in his 70s.

‘You can’t give up on him! He’s a strong man. He’s fit. You can’t do this. This is cruel. We can’t even visit him.’ Her tearful son comes on the line to plead too but it’s clear that there isn’t much hope. Have you seen a coronavirus X-ray? It’s impact on the lungs isn’t pretty.

I call the family back. It’s one of the worst calls I’ve ever had. Tears well up in my eyes. I should have been doing this in person – and she and their son should have been able to say goodbye. She starts sobbing. She’s got every right to – her husband is a comparatively fit man, only recently retired, active and independent. Now he has been condemned to his death. It is a national emergency, though. We don’t have the luxury of choice.

WEDNESDAY PATIENTS ARE GETTING YOUNGER

RUMOURS are swirling of staff fatalities, fuelled by news that a doctor elsewhere has died. The mood is further darkened by the death of a 13-year-old boy at another hospital. Will we have a victim as young here? Who knows.

Those being admitted are becoming noticeably younger – in their 40s and 50s. In the afternoon, a man in his early 40s who isn’t responding to CPAP refuses to be transferred to intensive care for intubation on a ventilator. He has no medical history besides being overweight, but he is effectively signing his death warrant. His fears are not unfounded. The idea of being put to sleep and kept alive by a machine is nightmarish.

‘If you don’t go to intensive care, you will not leave this hospital,’ I plead with him, to no avail. I call his dad on speakerphone. The scene is absurd. There are several of us in full personal protective equipment huddled over him, having a muffled conversation on an iPhone through our masks. It might be sleep-deprivation but it feels like I’m in some sort of dream sequence. Finally, the patient agrees.

Later, we break hospital rules by allowing the children of a man in his 70s to say goodbye. Because of their ages, they are low risk. I get them PPE (an increasingly tricky task). Of course, it isn’t good to flout rules but I’m finding the notion of people dying alone too much to bear. Unfortunately, they want to FaceTime 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 consent – so we refuse. I can almost hear my dad, who hates any authority, muttering ‘Jobsworth’ in my ear. But this man is totally conked out and can’t consent.

And anyway, what good will it do? Throughout the afternoon there is a stream of ambulances bringing people struggling to breathe. An alarm sounds before each arrival – it doesn’t stop. Hour after hour after hour. Late evening, I walk into the clear night. For the first time all day I can breathe.

THURSDAY IT TAKES ALL THE MIGHT IN THE WORLD NOT TO CRY

I DON’T recognise myself in the mirror. Dark bags beneath my eyes, blotchy skin. People don’t realise how heavy and hot the personal protection clothing is; you’re left drenched in sweat. It’s a good job I will not be seeing my boyfriend for a while. I feel guilty even thinking about my appearance when there’s so much misery around. There’s some good news: a woman in her late 70s, who caught the virus on a cruise and was admitted weeks ago, has recovered and can leave. By the afternoon, however, black clouds return. A lady in her late 60s, a frequent visitor in recent months with various problems, dies from Covid-19 which she caught in the hospital.

When she came in last week, she tested negative but was found to be positive when we re-swabbed her on Monday. Coronavirus particles seem to be taunting us, dancing into every corner of this place.

You develop relationships with such patients. ‘Me again, honey,’ she would joke. I had to tick the ‘do not resuscitate’ box on her form, unthinkable only weeks ago. I told her husband what I had done and he was incredibly understanding.

When she was feeling good, she would be up and around the ward on her Zimmer frame, a glint in her eyes. ‘You’re a pretty doctor, why aren’t you married?’ she would sometimes tease. And if her sons were visiting, she would remind them of my unmarried status to embarrass them – and me.

Now, as I sit holding the phone preparing to tell her husband she has gone, I need to compose myself. When he answers, it takes all the might in the world not to cry. Towards the end of the conversation, my voice wavers slightly. ‘It’s okay,’ he says reassuringly. ‘Thank you for taking good care of her.’ But we didn’t. She caught it here. We failed her.

When I leave, I have an overwhelming urge to hear a human voice. I call my mum and try to sugar-coat everything. There’s no point causing her any unnecessary anxiety. I know she’s worried sick about me as it is.

FRIDAY ‘HOW DID THIS HAPPEN? YOU’VE KILLED MY DAD!’

THE government announced mass testing last night – I’ll believe it when I see it. The absurd guidelines to get tested as medics haven’t changed. It’s jarring how many colleagues – including myself – can’t smell, one of the Covid-19 symptoms. A young doctor tells me she moved out of her family home for fear of infecting her elderly parents.

This morning, three patients who’ve been here over three weeks are being discharged. At times, battling this virus has felt like playing a rigged Whac-A-Mole arcade game, so this feels like a huge achievement. By early afternoon, alarms sound in every ward to warn us the oxygen supply is low. If we run out, it’ll be catastrophic. There is a shortage of space in the mortuary – bodies are being kept in side rooms.

Mid-afternoon, a man in his early 80s is found unresponsive. I had amended his red form, like so many others, to ‘do not resuscitate’ when he tested positive for coronavirus, after being admitted for something else. His daughter screeches at me on the phone. ‘How has this happened? How? Tell me how! He came in last week without it and now you’ve killed him!’ It’s a grief reaction but it’s still unbearable. She has every right to be in shock.

As a medic with minor symptoms, did I kill him? Another member of staff? God knows. On the Tube, there’s not a soul in sight, just old adverts for holidays, plays and concerts. I feel like I’m living in an apocalyptic horror film. I dread to think what awaits next week.