I have been a doctor for more than 15 years but I cannot remember the last time I felt like this.
Before the coronavirus pandemic, the days were long and demanding, but nothing compared with what it is like now.
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I am a GP – or family doctor – in a busy inner-city practice in the north of England. There is a lot of social deprivation in this area and patients are from a variety of ethnic backgrounds.
We also care for patients in several nursing and care homes in this area. The people who live there are vulnerable, elderly people usually with other long-term health issues. They are the kind of people who, if they get the coronavirus infection, are likely to develop more serious complications and, sadly, die from it.
Our local hospitals are filled to capacity with the numbers of patients they can manage. Difficult decisions have to be made.
The brutal truth is that elderly people living in care homes are much less likely to benefit from being tended to in intensive care units than younger, healthier people. They are even more unlikely to come off a ventilator alive. It is tough, but that is the sad reality of the situation we find ourselves in today.
That is where I come in. My job has had to be adapted to manage these patients in the community when, under normal circumstances, they would be cared for in a hospital.
It was only ever a matter of time and, now, that time has arrived: There has been an outbreak of coronavirus in one of our nursing homes.
An elderly patient there had tested positive for the virus when admitted to the emergency department at the hospital and was sent home to be cared for there. This put the care home in a predicament: He needed care but it also put the rest of the residents at risk.
The patient was isolated in one of the rooms in the care home and the staff were careful about wearing personal protective equipment (PPE) when caring for him, but despite all of this I received a call a week later to say three more patients in the home were running a temperature and had a cough. I put on my own PPE and went to the care home to assess them.
Many of the elderly residents at this care home have dementia. The new coronavirus patients found the sight of me in my mask and goggles greatly upsetting. They could not understand why they were being confined to their rooms, why family members could not visit them or why there was a strange man dressed in PPE trying to examine them.
They were all showing symptoms of the virus, were all frail and elderly with lots of other health problems and would not benefit from a stay in hospital.
At the time of writing this, GPs in the UK still have no way of testing patients in the community for COVID-19; these tests are reserved for hospitalised patients only.
Furthermore, until very recently, the statistics from the UK government detailing the numbers of deaths from coronavirus only related to deaths in hospitals, so patients who were dying in care homes were not only being left out of the testing strategy but being left out of the national statistics. They have truly been the forgotten victims of this virus.
I had to make the agonising decision of assuming my elderly care home patients had coronavirus and keeping them at home. My focus turned to keeping them comfortable.
After examining the new patients, I went back to my practice and rang each patient’s husband, wife, son or daughter. Under normal circumstances, I would call these people into the clinic and talk to them face to face, but these are not normal circumstances.
Social distancing measures mean I have to consult with them on the phone, losing that vital human element of the consultation. I told them their loved one most probably had coronavirus.
Every single one of them cried as I explained that hospital treatment would be futile and so we were doing our best for them while they remained at home.
To add to the heartache, I had to tell them they could not visit their loved one because of the risk of spreading the virus further. They would not be able to hold their hand, or calm them through their darkest moments.
They all asked me whether or not their relative would be likely to survive the infection. That was the hardest part. I thought about giving a standard “doctor” answer of how nobody knows and sometimes people defeat the odds, but this time it did not feel right. So, I told them that I would make sure they were comfortable at all times, that they would not suffer and, above all, I would strive to maintain their dignity, but that, yes, there was a good chance they would die.
Before ringing the next family on my list, I reflected on each case. It is not unusual for me to have to tell families that their loved ones are dying and, although always sad, I had done it enough times to not find it difficult.
But those cases are usually just the one or two peppered among numerous other patients I can treat and make better. The difference on this occasion was the volume of calls, each one terribly sad in its own way. Each one accompanied by a story: How the patient had met his wife, how he had proposed, how a mum had driven her son to his first dance and what a grandfather had bought his grandson for his fifth birthday.
I checked in on these patients every day. Sometimes I would do this by telephone; on others, I would don my protective gear and go to see them in person.
If they were struggling with their breathing, I would increase their medication to help reduce fluid on the lungs. If they were agitated because of low oxygen levels, I would give them something to calm them. If they were in pain, I would increase their pain relief.
The care they received from their carers and the nurses going in to see them cannot be faulted. But these patients were deteriorating nevertheless.
Five days later, the first patient diagnosed with coronavirus at that care home died. Four days after that, two more elderly patients died. Today, as I write this, a further three have passed away. At the end of the week, I am exhausted. Now, when I go home, I think about these patients. I think about their stories.
This is the story of care homes across the UK and the world. This is the way our jobs as family doctors have changed with this virus. I suspect these changes will stay with us forever.
They will certainly stay with me.