Diary of an NHS doctor: ‘Patient’s family asks me not to tell him his twin brother has died’

We are beginning to see light at the end of the tunnel, but the battle goes on in our hospitals. Now read the latest heart-rending diary of a doctor on the Covid-19 front line…

Monday  

In the middle of an ethical dilemma 

I’m returning to work with a sense of dread. I was thinking last night about the past five weeks and all the people who have died. There were too many faces to recall.

It seems to be accepted we have hit the peak of the virus – but who is to say it won’t get worse at some point? I can’t shake a sense of fear in the pit of my stomach that something is lurking around the corner.

The hospital, at least, is relatively calm this morning. The Tannoy alarms in A&E are still sounding but it isn’t the same constant that it was several weeks ago.

Late morning, I’m met with an ethical dilemma when one family asks me not to tell a patient, who is in his late 50s, that his twin brother has died. The patient, who was in intensive care himself but has since recovered, is ready to leave in the coming days.

The trouble is that the brothers lived together, along with the deceased’s wife. She is very concerned about breaking the news and is very scatty, talking about how this news will kill him too, and pleads with us not to say anything.

Morally and ethically, I shouldn’t be pretending someone is alive. Please don’t think I am being a jobsworth – it’s just this isn’t a white lie. It’s about life and death.

I manage to get her to agree to tell him over the phone – and that I’ll be there to comfort him.

I stand with him as she talks on loudspeaker. She’s crying down the phone to her brother-in-law.

‘He didn’t make it,’ she says, spluttering. A loud wail ensues as this man starts sobbing. My gloved thumb rubs his as I try to console him, to little avail. His twin was clearly his entire world.

I can feel tears starting to build up behind my eye mask. Constantly trying to be there for patients is draining.

Later, as I walk to the Tube, I’m struck by how many couples seem to be walking around. It’s pathetically bitchy, but God it’s irritating. It’s just a permanent reminder that I haven’t seen my boyfriend for five weeks. I’m all on my own for the foreseeable.

Even just a hug would make the world of difference right now.

Tuesday

Will kids be left without a mum?

There seem to be a few beds in the ward that are bad omens. I’m not superstitious but anyone who stays in them seems to take a bad turn and end up in intensive care.

A patient I met yesterday seems to be the latest casualty and was moved to intensive care overnight.

We’ve been inundated with families wanting to bring in items such as food and clothing but we have to turn them away. Why? 

Because we’ve only just got control of the hospital again – and we can’t risk having the virus potentially brought in. 

Late morning, a girl who can’t be much older than about 20 tries to drop off food for her mum, a kind lady in her late 50s, who is overweight and not in the best shape. She is on quite a lot of oxygen.

The girl insists, so a nurse took it and probably binned it. She’s clearly quite a stoic kid and has various younger siblings. With no dad around, she has had to assume the role of head of the family.

Shortly before the end of the day, her mum is found unresponsive after an emergency alarm sounds. Despite high doses of oxygen, she looks as if she is going to arrest.

‘Get me a trolley, now!’ I yell through my mask. ‘F***, f***, f***!’ I repeatedly mutter. The voice in my head is screaming at me to save her. I can’t cope with the thought of motherless children.

She eventually responds to the chest compressions. The fight-or-flight wave of exhaustion washes over me. We aren’t out of the woods yet, though. The patient clearly needs to be intubated and intensive care staff come to take her.

I’ve got to call the daughter to let her know. Nothing like a quiet end to the day. ‘We are doing everything we can. Your mum is in a safe place,’ I tell her as reassuringly as I can. 

She’s incredibly strong on the phone, doing her best to fight back tears. Her mum should be very proud of her. I promise to update her in the morning.

Wednesday

Battle won but war’s not over

One very encouraging thing this week is that parts of the hospital are returning to some form of normality – makeshift Covid wards are returning to regular wards. 

I’m loath to use a war analogy, but it does feel as if we’ve won the first round on the front line: the peak has evidently passed. 

The worry now is not just the second wave but the shock of dealing with all those patients who have stayed away.

I am starting to hear stories from colleagues that non-Covid patients on regular wards are getting aggressive if someone in their bay has a test done.

One doctor tells me of a particularly nasty incident – someone threatened physical violence against a nurse who went into the bay to swab a non-Covid patient we wanted to discharge. 

While the patient had no symptoms, because he lives in sheltered accommodation his carers needed to know he had tested negative. The other patient got spooked and became extremely aggressive.

As we increasingly treat regular patients again, there will probably be flare-ups like this.

I am worried that the test kits we are using are not reliable. There is a patient in his late 60s on the Covid ward who has had four negative tests over the past two weeks. 

We have been treating him for Covid because of his symptoms – and because an X-ray showed what appears to be Covid in his lungs.

The patient, who has various health issues, has been bed-bound for most of his time here and seems to get high temperatures on and off. Today he finally had a positive swab. If the general public are using similarly unreliable testing kits, then God only knows what the real rate of infection is.

Late afternoon, there is a man in his late 70s who has become increasingly frail over the past week and has underlying health issues. 

Today, he is working so hard to breathe that he is panting – I can see his abdominal muscles see-sawing with effort. 

Because of his frailty and poor health, he is not for escalation to intensive care or the high-dependency unit.

While the virus is not discriminatory, it does hit the frail population especially hard.

He is clearly dying, so we decide to give him palliative care. He has no next-of-kin, so there is no news to break to anyone. He will be as lonely in death as he was in life.

I give him some morphine to make him comfortable. He’s alive when I leave but he won’t be in the morning. 

Thursday

The hidden human cost of Covid 

When I arrive, I check the computer log to see how my patients are doing from the night before. Unsurprisingly, the man we palliated died last night, while another patient has died and one has been moved to intensive care.

Even though we are very used to it by now, my heart still sinks. Another day at the office…

We have a backlog of paperwork to do, which, as things quieten down, we need to start on.

When a patient dies, we write the death certificate and then write to their GP. When the crisis began, the law guidance changed so that the death certificates could be done online to speed up the process. But there was no amendment in how GPs are notified.

Back in the day, you wouldn’t normally leave the hospital until you had filled out the death certificate, cremation form (if there is one), and the GP letter. But these days? We have a backlog of hundreds and hundreds of GP letters to send. The mortuary really has been overwhelmed and the paperwork is a stark reminder of that.

There are murmurings that we are seeing more alcoholics in the regular wards than usual. They are coming in with complications – confusion, seizures and gout. The effect of lockdown on the vulnerable in our society is going to be the hidden human cost of the crisis.

There is still a deeply uneasy feeling that people are worried about coming in because of Covid. Stories swirl around that people are dying at home from heart attacks and strokes – even with the normal wards reopening. It makes you feel very powerless as a doctor. 

In the afternoon, we discover that a Covid patient in his early 60s also has a brain tumour. 

He came in this morning with Covid symptoms but was also confused and had weakness in his legs, so we scanned his brain. It is hard not to feel a sinking feeling looking at his results.

To be frank, he is screwed. We are still waiting on his Covid swab result but he is requiring a lot of oxygen for breathing, so it is a given he also has the virus. How on earth do we manage this?

Friday 

Virus is virulent… and sadistic with it 

Another beautiful spring morning – it feels as if someone is playing a joke on us at the moment. For the second time this week, I’m confronted with a dilemma. 

A man who came in yesterday as I was leaving has died. The family wants the death certificate immediately so they can comply with their Jewish faith and bury him within 24 hours of death.

The trouble is, I never spoke to him – and it’s very hard to do a death certificate if you don’t know a patient and their medical history.

The Medical Examiner, who sorts death certificates, agrees to refer the case to a coroner. 

I call the family back and let them know we are doing everything we can to get it done as soon as possible but warn them it is very unlikely they will be able to bury him within 24 hours. I feel desperately sorry for them.

Many families have mentioned the horror at the prospect of lonely funerals. The idea of friends and family not attending doesn’t really bear thinking about.

In the afternoon, a lady in her 50s, whom we were hoping to discharge imminently, takes a bad turn. Her heart rate and temperature have shot up. This virus seems to sadistically enjoy lying quiet before attacking with various degrees of intensity. 

‘I thought she was better,’ her son says flatly on the phone. ‘She was supposed to be coming home this weekend.’ He isn’t cross or rude – just exasperated. After weeks of this, I am too.

There is a concern that the virus is still in wards that have returned to treating non-Covid patients. Of course, they have been disinfected by the brilliant cleaning staff – but Covid-19 is appallingly virulent. 

In the afternoon, there is a gentleman in his 70s who is in for a urinary tract infection. He’s on a regular ward in an open bay with frail people. He’s now developed a cough and has a temperature. He was fine two days ago when he came in.

Has he caught it here? The worry is he could have infected those around him. We take him to a side room and swab him.

It has been the quietest week so far during this crisis: admissions have dropped and we are not understaffed for the first time in a long while. There is a sense that London was ahead quite significantly in terms of hitting its peak.

But the ominous black cloud that has hovered above the hospital is still there – it just feels less intense. We know coronavirus mutates and spreads rapidly. Could it escalate out of control again?