[Date Published: 23rd July 2020]
Some patient details in this article have been changed to protect patient confidentiality
In early January, I was in my GP clinic, and a young patient in her 20s came in, whose only symptom was a weird loss of sense of smell. I had never come across this before, so, after discussion with my supervisor, I referred her to the Ears, Nose & Throat specialists. In retrospect, I am pretty sure that was my first covid patient.
In the following six months, my GP practice nearly shut down overnight, I was redeployed to the A&E department with under a week’s notice, I treated patients with blood oxygen levels lower than I thought were possible, I admitted a nursing collegue from Resus to ITU, I broke more bad news down the phone than ever before, and I lost count of the number of my doctor friends who went off sick with the virus.
Covid has changed the world, the medical profession, and the NHS in ways we are only beginning to understand. And without doubt it has change me as a doctor- the way I practice, think and generally am at work. Here are three ways covid has changed me as a doctor:
1. A Mystery That Demands a Presence
One of the most upsetting things about being an A&E doctor during the pandemic was that hospitals quickly banned nearly all visitors and relatives from the hospital, for obvious infection-control reasons. This meant many of our patients suffered, and in some cases died, alone, with no loved ones around them. Watching so many patients suffering alone, really shook me, as I know it did my colleagues.
A few weeks in, my hospital changed its guidance to allow single visitors in full PPE to visit patients who were imminently dying. But of course, it wasn’t just the dying that were feeling the trauma of solitude. I remember treating a terrified teenage girl who had appendicitis. She spent the whole time on the phone to her (equally terrified) mother, who was sat in the waiting room, unable to see her daughter prior to admission for surgery.
One evening, I was chatting to a non-medical friend of mine about all this, and she made an off-hand comment that transformed my mindset. In response to me telling her that so many of my patients were suffering alone, she responded “well at least they have you guys”. It was like a lightbulb had gone off in my head. What I realised at that moment was that it the absence of friends and family in the hospital, it was falling to us healthcare professionals to be that precious human presence in the midst of fear and suffering. My friend and ethics professor John Wyatt often says: “Suffering is not a question that demands and answer. It is not problem that demands a solution. It is a mystery that demands a presence”.
From that moment on, I made a conscious effort to try be that human presence with every sick patient I treated. I found myself holding more hands, asking “is there anything more I can do?” more often, and simply staying at the bedside for a few more seconds, not to add any further treatment, but to just be with the patients in their suffering. I have no idea if it made any tangible difference, especially given I was often covered head to toe in protective gear. But I know that if it was my loved-one in Resus, I would want their doctor to be that presence in my absence.
2. Dying Well
One of the uniquely awful things about Covid-19 is that patients can deteriorate very quickly, usually at around day 7-10 of infection. Some patients would come in and remain quite well-looking for a number of days despite concerning oxygen levels and blood results, but then suddenly deteriorate, and potentially die in A&E or on the wards. Near the start of the pandemic, there was a noticeable increase in the number of in-hospital cardiac arrest calls in my hospital.
The disease progression of covid forced all of us in A&E to routinely have discussions with patients and/or relatives around end-of-life-wishes and resuscitation, very early in the hospital journey, for we knew deterioration may come suddenly. I would often have half a dozen or more of these conversations per day.
As emotionally draining as these conversations are, I do want to retain this routine of early discussions around death. We have to humbly acknowledge that as doctors, we very often cannot fix or cure our patients. And this is painfully true for covid; even now, the mainstay of covid treatment is still simply supporting the patient’s organs and hoping their immune system fights the virus.
And in situations when we clearly cannot win the fight against death, our final act of kindness and care ought to be to give our patients a peaceful and painless death, rather than the trauma and indignity of futile interventions. In the words of Dame Ciley Saunders, the nurse who pioneered palliative medicine: “You matter because you are you, and you matter to the end of your life. We will do all we can not only to help you die peacefully, but also to live until you die.”
3. The Pain of Separation
As mentioned already, most hospitals quickly banned most visitors to their buildings. This meant I spent a lot more time on the phone talking to relatives, especially when patients were elderly and unable to communicate much themselves. Usually, I would call relatives for information-gaining purposes, for example to find out a collateral history or ascertain end-of-life wishes. However, I quickly realised that receiving a call from the A&E doctor was an immensely precious and sought-after thing for relatives who had sent their loved-one through the locked doors of the hospital.
I remember once speaking to a patient’s daughter, who herself was a nurse, and who now had both parents admitted to hospital with covid. I gained all the information I needed in the first 10 minutes, but then spent nearly half an hour more just chatting about her parents and how she was coping with the anxiety of the horrible situation she found herself in. She ended by saying “thank you so much for listening to my struggles”, to which I replied “I really feel for you; it could very easily have been me in your situation.” I meant it.
Seeing (or rather, hearing) the impact that a phone call can have on the relatives of patients in hospital has made me much more ready to pick up the phone, not just as an information-gaining exercise, but also as an information-giving one. Calling relatives can be time consuming and emotionally draining, and on a busy shift, I have the tendency of avoiding it unless I have to. But oddly, calling relatives has also produced some of the most rewarding moments I have had during this pandemic. It is such a weird privilege to be the voice of patients to their relatives at their hour of need.
3 Ways Covid Has Changed Me As A Doctor
There are many more ways that covid has changed me as a person and as a doctor. But I want to end with one of my favourite stories from the Humans of Covid social media initiative I have been involved in, where we tell the stories of those working on the frontline. This is the interview we did with Anne, a junior doctor working in Gloucestershire:
“There was this lady with covid who was nearing the end of her life on the ward I was on. I answered a call to the ward from her daughter saying that they hadn’t heard from her for a day and were wondering if I could check her phone was on.
I went into the side room and turned on the phone and there was a buzz of text messages coming through and notifications from her family and friends.
She was weak and didn’t have the strength to hold the phone and read the messages. I asked if she wanted me to read the messages and she nodded.
‘I love you’
‘I’m so proud of you’
‘You’re so strong and we love you so much’.
‘The kids miss you and want hugs from grandma’
My voice wobbled behind my mask as I read text after lovely text out loud and her mouth formed a weak smile. We FaceTimed her family afterwards and though she didn’t have the energy to speak she smiled seeing their faces and hearing their voices.
That evening all I wanted to do was to tell all my friends and family that I loved them and that I was so proud of them and that they really mattered in this world.
I don’t think people tell other people that enough.”