12 The Times Magazine
was exhausted, and there was no more she
could do. It was time for us to take over, and
she knew it. As the intubation team assembled
their equipment and carried out the checklist,
I knelt by her bed, took Tricia’s hand and ran
through the plan. She gripped my palm and
nodded as I tried to reassure her, her eyes
trained on the ceiling above her head. I
explained that we’d spoken to her family and
would do so again once she was asleep and
safely on to the ventilator. I promised we’d
look after her and then stepped back to let the
intubation team do their thing.
By now we were starting to get some
data, and the headline was that nearly half
of ventilated Covid patients did not survive.
These statistics made every Covid intubation
a poignant and sobering moment.
LATE APRIL
A low point for me. I had had enough.
I couldn’t face more people dying. I wanted
to keep everyone going, to rescue them all,
however bleak it looked. It was a new disease,
and we didn’t know the future, so we should
keep trying until their hearts actually stopped.
I tell myself that this was because I wanted
to give every patient every possible chance,
and it was to a large extent, but I was also
dealing with my own moral injury and if
I am completely honest I was fretting about
our outcomes. When this was all over, our
mortality rates would be compared with other
hospitals around London, the UK and the
whole world. We were all treating one disease,
so for once we could be compared. We were
using different clinical strategies, and rumours
were already circulating that certain hospitals
were doing better than others.
I was also worried that we were at risk of
slipping into a pandemic mindset. Rather than
treat every patient as an individual, with a
unique set of reasons to live, we might start
to view them as a herd. There were so many
patients and they were so sick that there was a
danger in my mind we’d get too used to death
and become too accepting. I was scared we
might start viewing it as normal and inevitable.
APRIL 30
Today Tricia, who had accepted her situation
with such stoicism and dignity, reached the
end of the line. Her lungs were still getting
worse, her kidneys had failed, and her heart
was requiring more and more support. There
was nowhere else to go. We had turned her on
to her front, we had tried fully ventilating her
and we had tried letting her breathe (she’d
always been far too sick for a tracheostomy).
We’d tried anticoagulation, antibiotics,
steroids, plasma exchange, kidney support and
different regimes for the heart, but nothing
had changed her trajectory. She was dying
but she was under my care again, and I was
struggling to accept it. Like everyone else, I’d
run out of options, but I couldn’t let go. There
must be something more we could do. I talked
to several colleagues, but the conversations
just confirmed what deep down I already
knew, so I called in her family.
During the hour and a half it took for
Tricia’s family to travel up from Broadstairs,
I started to dread the conversation. What
would I say? Would they be angry? Would
they be medical and question our decisions
and treatment? She was only 60; a few weeks
before she’d been fine, the head of nursing for
haematology and oncology at GOSH.
By the time I walked into the relatives’
room I was anxious and paranoid, already
second-guessing what they might ask.
There were six or seven of them in the room,
including her husband, 20-year-old daughter,
Emily, and 17-year-old son, Luke. They looked
shattered, but they smiled at me warmly as
I perched on my customary bin. I introduced
myself and carefully explained the situation,
and they listened quietly and nodded. I said
that Tricia was still on full organ support, but
nevertheless deteriorating and that if things
continued on this course she was unlikely to
survive the night. When I’d finished, I paused
and waited for their questions, but there
weren’t any, so I added that we’d of course
make sure that she didn’t suffer and offered
them a final visit to the bedside. Again they
nodded and silently wrapped comforting arms
around each other.
Eventually her husband looked up. “We
understand,” he said, “you’ve done all you can,
but this is just what it is. We know. Thank you.”JUNE 27
Our final Covid patient (of the first surge)
was discharged out of ICU. When we finally
analysed the data, it emerged that our patients
did roughly as well as those in most other
large centres. Approximately two thirds of our
critically sick Covid patients survived. Like
everyone, we got better at treating the disease
as the pandemic progressed.
We had been frightened and anxious, deeply
upset at times, but that first surge was without
doubt the biggest challenge of our careers,
and the sense of purpose and achievement
was undeniable. We’d been at the heart of it
from the start, facing an unprecedented threat,
and we’d come through it. Not unscathed –
I had got things wrong, was haunted by some
of the decisions I had made, and the prospect
of another winter surge filled me with dread- but we had shared a cataclysmic experience,
we’d been pushed to our limits and we’d
not been overwhelmed by it. The support
and camaraderie on those night shifts was
like nothing I’d previously experienced in
medicine. I saw the best of my co-workers
and, at times, of myself.SEPTEMBER
I telephoned the families of my patients to
ask permission to write about their loved
ones. It turned out to be an educational and
humbling experience.
Adam’s mother described Adam as a “great
son and devoted father, who was missed
desperately by the whole family”. She also told
me that she had been overwhelmed by the
number of people who had contacted her after
his death to tell her how kind and generous
Adam had been to them. He was, she said,
“a people person and a gentleman, who had
made her so proud”.
Tricia’s husband, Andy, described both Tricia
and the process of losing the love of his life
with heartbreaking insight and candour. He
said that Tricia adored her job at GOSH. She
was a force of nature, combining a natural
ease around children with an intellect and
determination that led to publication in
The Lancet. She embodied the GOSH motto- “The child first and always” – but also
brought just as much fearless vigour and
energy to her other roles of school governor
and magistrate. She was also a wonderful
mother, and life had been unbearably hard at
times since her death, but despite that Andy
was grateful to have had the chance to spend
so much time with his two precious children
over the subsequent six months.
At the end of the call he told me a quick
story. Last year, Luke, their son, had applied to
join the navy but failed the eyesight test due
to an abnormality of his colour perception
and so was rejected. Tricia, who’d taken him
for the test, was not at all convinced by the
process and left determined to take him back
for a second go. Tragically, Covid intervened,
but as so often, she was right.
Haydar was improving all the time, his
daughter told me, and delighted to be able
to walk down his street again unaided. His
family tied a thank you letter to the post
outside the front entrance of UCH. It was
there for weeks and lifted the spirits of
countless staff members. n
Life Support: Diary of an ICU Doctor on the
Frontline of the Covid Crisis by Jim Down is
published by Viking on March 4 (£14.99)‘The level of tragedy is
exactly like last time’
Jim Down talks to Andrew Billen about
the second surge in T2 next week