The hospital has been divided into "clean" and "dirty" wards and so doctors become likewise "clean" and "dirty". But the clean and the dirty doctors are not being confined to their respective clean or dirty wards. On the contrary, they move between clean and dirty wards from shift to shift, possibly creating trails of further disease wherever they go. And there is no way of knowing whether the clean doctors, and indeed the clean patients, are clean; there was no routine testing for COVID-19. There has not been enough testing capacity in general for NHS staff. It is terrifying to imagine that one might be an asymptomatic spreader of infection to colleagues and vulnerable patients.
Part of the redeployment process has meant increasing the numbers of doctors on all wards and in A&E. The Trust have tripled the usual number of hospital staff at night to cope with the demands of COVID-19. Our copy of this new rota came without an explanatory key, and there was no way of knowing initially what each role on it actually entailed. One of my shifts on the rota was entitled 'ghost night shift'; disappointingly no haunting was required, just turning up to work as normal.
Tripling the number of doctors for the night shifts, and increasing the number of doctors on the ward in the day, has been a really positive change to normal rotas. COVID-19 patients deteriorate very rapidly and more intensive cover is needed to handle this. It is also invaluable having more consultant support available in tackling this pandemic and helping to make the difficult decisions about resuscitation where there may be limited resources of critical equipment. The severity and unpredictability of the virus, coupled with our limited knowledge and understanding of it, means that whilst we are all providing the very best care to patients, one sometimes feels helpless because no cure is on offer.
We are dealing with more death and practising more palliative medicine than ever before. Tragically, we cannot spend as much time as we would like providing emotional support to these patients because of the understandable emphasis on minimising exposure to patients unless there is clinical need. Some of our palliative patients have voiced their fears about dying alone. Families and spouses and friends are currently being deprived of the opportunity to say proper goodbyes to their loved ones. I am making, and receiving, heart-breaking phone calls. I am being asked to pass on "I love you" messages from the spouses of very elderly patients, some of whom have been married for over 65 years.