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Inside the Covid ward There is nobody to comfort our dying patients

Staff at a Covid ward. Photo by Neil Hall - Pool/Getty Images

Staff at a Covid ward. Photo by Neil Hall - Pool/Getty Images



I begin my shift at 8am. Before I can even head to my allocated bay, a nurse is already asking for a doctor to help her. One of the patients won’t put on his mask and his oxygen levels are dropping. It takes me a few moments to get on my PPE before I can get to him. I try to talk to the man, but it’s difficult for him to hear me through my mask and the noise of all of the CPAP oxygen machines. He tells me that he’s tired of fighting, and that he wants to be left alone.

Through my mask I try to explain that he has been getting better, and that we wouldn’t have a place for him on the high dependency unit (HDU) unless we thought he had a good chance of survival. He tells me that I don’t understand what it’s like, desperately struggling to breathe, which is true. This goes on for around 10 minutes. Eventually, I have to take his request seriously. Perhaps it isn’t illogical for him to want to die peacefully.

In order for me to allow him to make this decision, I have to be sure that he understands the risks, so I ask him to explain to me what he expects will happen if he takes off his mask and doesn’t put it back on. He says he doesn’t know. I tell him that he has to understand that he will die and that he needs to say those words to me if that is what he really wants. Eventually we compromise; he will put his mask on for another hour, then phone his wife and tell me his decision. This man is 61.

I am allocated B Bay, in which there are five patients. My patients are mostly men, ranging from their early 30s to their 60s. This is younger than normal on HDU because — as I explained to the man — we only have beds for people with a fighting chance. I read their charts to update myself on what happened overnight.

Who dropped their oxygen saturations? Who needed their CPAP (Continuous Positive Airway Pressure) settings increasing? This comes via a tight mask that goes over your face to help you breathe by forcing air into the lungs at high pressures, keeping the airways open. I am told that it feels like you are suffocating.

Who crashed overnight and is now on the ICU (intensive care unit)? Who has died?

I then put on my PPE (FFP3 mask, hairnet, long-sleeved gown, gloves, visor) and enter the bay to examine the patients. I feel lucky to have this level of protection — my colleagues outside of the HDU only have surgical masks, which offer little protection against an airborne virus.

The patients don’t ask many questions, mostly because they need to spend all of their energy breathing. I try to work out if one of my patients isn’t answering my questions because she is delirious, because she doesn’t speak English, or because she is depressed. I work out that it is probably the latter; her notes say that her husband died just before New Year, from Covid. I try to remember every patient as an individual, since I can’t bring the notes into the bay to write as I go, but each crackly chest I listen to blurs into one. I summarise what I have found, for the consultant’s round later in the morning.

By this point, the blood test results should be back. I had been wondering why one of my patients was deteriorating — requiring more oxygen and at higher pressure — and his blood results provide me with a likely answer: a blood clot on the lungs. He is too unwell to enter a CT scanner, which would confirm this theory, so I treat him as if he has one, with higher doses of blood thinners. I corner the ICU doctor, who happens to be reviewing another patient on the ward at the same time, asking him to have a glance at my patient. He agrees that he will likely need an intensive care bed at some stage, but at the moment they simply don’t have one. I worry that my patient is going to end up with an emergency intubation, much more dangerous than a controlled one in ICU.

I now have to update relatives over the phone, since they are unable to visit. I always put this part off; I almost never have good news to deliver. Hearing people cry on the other end of the phone, knowing that I am them bringing news of the worst day of their lives, is heartbreaking. There is nothing positive that can be made from the words “your father is currently on the maximum support we can offer, and we are not sure if he is going to survive today”. I feel like a bad doctor because — to put it bluntly — I’m causing suffering rather than alleviating it. Why can’t I make them feel better?

We try to have our patients prone (lying on their fronts) since this opens up their lungs at the back and improves their oxygen levels. The patients hate proning, since the masks dig into their faces, their backs hurt and their arms go numb, and we do not have massage table-style beds with holes for their faces.

One of my patients has not managed to be prone at all. I speak to his wife, who tells me that he is very claustrophobic, and that might be why he has been resistant. She tells me that she has been pleading with him on the phone to try it, but hasn’t been able to persuade him. I ask her if there’s anything that has helped him in the past with his claustrophobia and she says sometimes watching a film on the iPad. But I don’t have the courage to tell her that he is nowhere near well enough to watch a film. She suggests a fan, so I arrange for a fan to be set up for the patient, and he manages to prone all day. I feel like a good doctor.

We have several patients who are not “fit” for ICU in the current climate. Before Covid, they most likely would have been given a chance, but not now. When we think that these patients have suffered enough, and are unlikely to ever recover, we start talking about making them comfortable. It’s partly that we need the beds for patients with a better chance, and partly that we feel it is cruel to keep these people suffering when their chances of survival are slim. It’s difficult to work out which of those is your true motivation.

The most distressing part of their struggle is the air hunger. You can spot these patients easily, as they grasp the masks to their faces with both hands and gasp visibly for air.

Once we decide to palliate someone, we give them morphine to reduce their respiratory drive, and ease this feeling. We give them benzodiazepines to lower their anxiety, antiemetics to stop them from feeling nauseous, and other medications to prevent them from needing to cough. We then take off their masks.

It is important that these medications are given before their masks are removed, otherwise they will die terrified and gasping. This decision is made for about two or three patients each day on my ward, out of 20 or so. However, this process does not always run smoothly. Sometimes these medications are prescribed but not given in a timely fashion, or at insufficient doses. With so many patients, we cannot keep an eye on them all; to watch whether what we are doing is working.

Once a patient is deemed to be dying, they are allowed one family member to see them for 15 minutes. The patient won’t be able to see their loved one’s face, since they will be wearing full PPE. Because the family member only has one shot at visiting, we need to accurately guess the patient’s time of death so that we can call them to come in. Sometimes we get this wrong, and the family never gets to see them. But all of the patients who die do so alone. There is nobody to hold their hand. Nobody to comfort them. Nobody to tell them they love them.

Towards the end of the day, two of my patients are deteriorating and destined for the ICU. Another doctor had an ICU candidate in her bay. They are all between 60 and 64 years old, none of them with significant comorbidities; all were working full time until coronavirus struck. They all now require 80% oxygen at high pressures, breathing at around 50 breaths per minute and tiring. There is only one ICU bed. I leave before the decision is made as to which of them will get the bed. I am sure that whoever doesn’t get it is likely to deteriorate overnight.

I pay for an Uber home, because at 9.30pm I can’t face walking in the January dark to the train station and spending over an hour getting back. I arrive home at around 10.15. In less than 10 hours, I will repeat the same day again.

This piece was originally published in January. 


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Michael K
Michael K
2 years ago

As gripping as all of this is, we will have to realize that respiratory diseases are not novel, and the health system operates at a high point of exhaustion most of the time by design, to save costs. One of the most tragic aspects of this story is likely the inability of dying people to say goodbye to their loved ones. It’s true that ultimately, we all die alone, but the PPE does take away much of the humanity of any visitor that would usually be present. Whether the trade-off is worth it, however, is another question entirely.
Rather than advertise any vaccinations at this point, which may or may not provide lasting protection, articles such as this should be a reminder that on the whole, health is a very personal decision. While there is never complete immunity to disease, a healthy lifestyle with a balanced diet, regular exercise and the ability to stay at a normal weight will optimize the immune system. The difference between CoV-2 (or any other respiratory disease) in a generally healthy person and a generally unhealthy person of the same age is profound. Vitamin D, of which many British people are deficient, seems to play a role in immunity as well, and it is not expensive. Additionally, with a pulse oximeter, one can personally monitor lung function during a bout with COVID-19, and call the ambulance in time.
I have personally lived through quarantine, and the complete lack of health monitoring while a person sits at home with a potential lung disease is one of the most overlooked, yet critical aspects of this whole matter.

Elaine Giedrys-Leeper
Elaine Giedrys-Leeper
2 years ago
Reply to  Michael K

“They are all between 60 and 64 years old, none of them with significant comorbidities; all were working full time until coronavirus struck”
So maybe as healthy as you are ? There is still a great deal we don’t understand about this disease and why some people get really sick and some don’t is still not clear. Of the 2 people I know who got really ill – they were both in their early 40s, healthy non smokers into running and mountain climbing. One has long covid 18 months on.
“and call the ambulance in time.”
Good job you didn’t get sick in January, then.

Michael K
MK
Michael K
2 years ago

It’s not as nebulous as you make it out to be. CoV-2 for the most part is only dangeorus when it hits the lungs (alveoli). This is when silent hypoxia occurs, as the ability of the lungs to absorb O2 is decreased, while CO2 expulsion stays the same (leading to hypoxia but with a normal breathing reflex). The lack of oxygen then weakens the body and immune system. Indeed it is not known exactly why sometimes it affects the lungs and sometimes it doesn’t, but there is a possible association with the viral load that is breathed in. This is also where one would have to ask whether the masks really do help, or whether they just transport the virus from the upper respiratory tract deeper into the lungs.
Too few questions are asked on this topic, and too little actual research is done, because many are afraid of going against the mainstream narrative, that this is a highly dangerous disease that can hit (and kill) you at any time. While that’s not necessarily wrong, it does overstate the danger somewhat.
Being healthy can be a relative thing, and “no significant comorbidities” may still include high blood pressure, which is a major predictor of COVID deaths. The average 60 year old person in the West may be seen as healthy, but prediabetes, prehypertension and silent inflammation would prove the opposite in certainly more than half of the people in this age group.
Of course, there a lot of circumstancial factors as well. Physical and psychological exertion can weaken immunity even in people who are overall very healthy. And sometimes it’s just bad luck. Many young and healthy people in the past have died from the aftermath of influenza, because they didn’t give themselves the time to recuperate, or because they didn’t even notice that their heart wasn’t well yet.
My grandfather is currently in the hospital with COVID, to which he was taken early enough because of a home pulse oximeter reading that dropped from 86 to 76 overnight. Without us noticing that, he would likely have died in his bed a few days later. With adequate oxygen support through a simple breathing mask, his lungs have managed to recover within two weeks.

Edward De Beukelaer
EB
Edward De Beukelaer
2 years ago
Reply to  Michael K

indeed a few issues:
1) run down health system (more interested in management than patients)
2) a health system that does not concentrate on making people healthy
3) a health system at the service of an industry of illness (money and politics)
no advise about the government on how to be healthy
no treatment for covid patients till they are hospitalised
A medicine that does not want to accept the notion of patient resilience and patient susceptibility. (Co-morbidities is not a good term)
A medicine obsessed with explaining illness rather than looking for the best ways to make people healthy
Medicine that is not prepared to accept system theory…
…… etc etc etc
hence: a virus like covid was always going to win with very little effort… We have the mess we have because we do not have (or are interested in) the type of medicine that could really make a difference…

Michael K
Michael K
2 years ago

Add to that an ever-present fear of death that is exacerbated through a total lack of religion, and you arrive at the mess we currently have.

Billy Bob
BB
Billy Bob
2 years ago

Thank God for the vaccines reducing the need for hospital care in a majority of patients, and reducing the need for our doctors to make these heartbreaking decisions simply to free up hospital beds

Galeti Tavas
VS
Galeti Tavas
2 years ago
Reply to  Billy Bob

The great vax conspiracy will come out one day hopefully – but as all the social media and MSM are complicit it will be a great difficulty.

Covid is not something many should need hospitalization for – if early interventions are given no more than the flu would have been needing hospitalization, well more than half – 80% of those who died would have lived – many researchers say – would have been fine at home recovering from a flu like illness if they had been given a cocktail of some of the below as an early intervention. Instead we let them reach critical before ANY early treatment is allowed. This is all about pushing the Vax, and it likely cost half a million unneeded deaths.

Ivermectin, Fluvoxamine, Regeneron monoclonal antibodies, remdesivir, dexamethasone, zinc, vitamin D, famotidine, melatonin, and aspirin and Hydroxychloroquine.

But the covid pushing prohibited seudies on these interventions as they would cause ‘VAX HESITANCY’ is allowed, and the entire plandemic was to PUSH the vax. I do not say the vax is bad, it did reduce sevarity – but pushing it cost hundreds of thousands of lives – by forbidding non-vax interventions.

Michael K
Michael K
2 years ago
Reply to  Galeti Tavas

Not sure why this is downvoted. Home pulse oximeters with early transport of people into the hospital, where they can be placed on their belly so the lungs open up, and where they can receive supplemental oxygen would have them back home with a functioning lung within just a few days (or even hours, in some cases). Hospitals wouldn’t be overwhelmed, and fewer people would die overall. Even without supposedly controversial medications like ivermectin, a simple infusion of cortisone is enough to keep the lungs from destroying themselves.
Less is more, especially if it is done early enough. Ask any doctor, it’s what they learned throughout the last two years. That info just doesn’t land in the MSM, because it would hinder vax sales. I mean, the government is literally spending your tax money on free advertisement for a pharmaceutical company. Do you people think this is normal? Do you really think the government is made up of good people who only want YOUR best?

Elaine Giedrys-Leeper
Elaine Giedrys-Leeper
2 years ago

Finally ! An honest account of end of life care in a lean and mean health care system.
If this description is typical then at least in a hospital in the UK it sounds as if one can be reasonably assured of an assisted death which is reasonably comfortable, if the drugs are titrated correctly. Not, unfortunately a given if you are 70 + in a care home.
So, many will not have had deaths like this at all, last year when no one knew what was going on and the really elderly and frail (as now) would never have been admitted to a hospital in the first place. Quite how you manage that situation as a care home assistant, I have no idea.
Moral of this tale ? Make sure your advanced directives / living wills are all up to date – makes the triage decisions easier for the health care professionals and ensures that your friends and family know what to expect.

Jon Hawksley
JH
Jon Hawksley
2 years ago

What has the government done in the ensuing twelve month to prevent ill people dying because of a lack of facilities? Formally written to vulnerable people in March to tell them they do not need to shield and a few months ago ending all advice on shielding. This in despite of the fact that elderly people still have a significant risk of mortality if they catch covid. The only reason that deaths were low with delta is that cases were concentrated in the 5-15 year olds and their parents.
It would have been very easy when omicron started to recommend elderly people shield themselves for the next few months by limiting their contact to a small number of people who test regularly. We will know very soon the cost of not doing so and of not ensuring lateral flow tests were readily available for those people visiting and supporting the vulnerable.

Galeti Tavas
VS
Galeti Tavas
2 years ago

This is proof that the response has been utterly wrong, cruel, destructive, and entirely nothing to do with health – but merely an agenda set for some goal we do not know yet..

Why make them die alone? It is not like they are going to catch anything. And as far as relatives – if they want to be there let them. Every one has their own risk/reward protocols – and if it includes the slight risk they will also die, well they make that.

But Mostly – – – why not do early interventions? Waiting till the person is in hospital is proof that this is merely to push vaccination – and NOT to save lives.

NO ILLNESS is ever not addressed as soon as possible. In USA the covid sufferers were told to do NOTHING but sit at home till their lips turned blue, then call an ambulance. Insane!

I believe it proven many early interventions would stop 80% of people needing hospitalizations. Ivermectin, Fluvoxamine, Regeneron monoclonal antibodies, remdesivir, dexamethasone, zinc, vitamin D, famotidine, melatonin, and aspirin and Hydroxychloroquine.

If a cocktail of these is given the vast majority will never need hospitalization – but this is outlawed so that people are forced to get the Vax! Studies on there are banned, and any done are to mislead.

You Vax Sheep need to watch some experts still able to penetrate the canceling = Bret Weinstein and Dr McCulloch – one to the world’s top Cardiologists and scientific researchers:

https://www.youtube.com/watch?v=-zg1j7Zquoc

NONE OF THIS ALL WAS ABOUT HEALTH – IT IS COMPLETELY A PLANDEMIC, WATCH THE VIDEO – BRET WEINSTEIN HAS BEEN ON HERE 3 TIMES.

This doctor needs to watch these and give her judgement – as this is from top scientific and medical experts. There are many similar, but they soon get pulled – this one and several allowed to stand because of the status of the persons – Joe Rogan and Dr McCulloch did one over 2 hours long on how this all is true – but Youtube pulled it – search it is on other servers… Even the total gov vax promoter Dr Campbell says vit D would save half the people’s lives – as do all the top people like Weinstein, and so many – Weinstein just did 2 hours on how D would save half all lives lost – and here that one is https://www.youtube.com/watch?v=8LFkWiNP1wQ

Laura Cattell
LC
Laura Cattell
2 years ago

It doesn’t matter how many times first hand accounts appear for people to read, the cult of denial will come out in full force.

Laura Cattell
LC
Laura Cattell
2 years ago
Reply to  Laura Cattell

Er, you have been down voted more. Where is your self-awareness?