Palliative care during the covid-19 pandemic: reflections from a junior doctor

As a junior doctor with an interest in palliative care, I have seen more death than most twenty five year olds. Despite its place in the medical school curriculum, nothing quite prepares you for those first moments: my bleep going off on my first on call shift asking me to certify a death, running anxiously to my first cardiac arrest apprehensive of what lay ahead or breaking the bad news of a unexpected cancer to a young woman and her family. It’s a strange thing, death; it means something different to each of us, our previous experiences of death will be different and thus our reactions vary when faced with the inevitable.

Death is raw and something that we can never quite prepare for, even in cases when we are able to predict it’s arrival. However, death unites us. We are all human and can thus identify with the fear of death and also the emptiness and grief following the death of a loved one. In the bleak midst of the covid-19 outbreak, I have struggled to adapt to the changes that have occurred across all aspects of my life. However, I can learn to cope with not being able to get everything I want from the shops or cancelling plans to see my family. Instead, I am still adjusting to the challenges that we face when providing ward-based palliative care. I recently assessed a patient who was experiencing severe pain as a result of cancer. While talking to the patient through my personal protective equipment (PPE), I felt like a fraud, trying and failing to show empathy behind my hot, ill-fitting mask. So much of how we communicate as doctors comes from the way that we use facial expressions and the manner in which we hold ourselves. This patient’s situation felt desperate and the suspicion of covid-19 felt like a wall between our human contact.

The covid-19 pandemic has been hard for all of us. Hardest for those who’ve lost their jobs, their routine, their livelihood. Hard for the healthcare professionals that were forced to adapt to new roles, new environments, and have had to learn or re-learn a different set of skills. It was hard on the morning that I drove in to work, ready to park in my usual spot, only to see that the car park had been replaced by large white portacabins, ready to act as a temporary additional mortuary. Walking back to my car that night, I glimpsed them again, the luminescent white buildings standing out against a murky dark sky, producing an eerie hum which lingered in the air. 

During the covid-19 pandemic the structure of funerals and cremation ceremonies has changed significantly. Some of the patients known to our palliative care team have already planned out their funerals, a difficult task, but one that can bring comfort in the knowledge that their grieving families won’t have to organise it. It has been hard for these patients knowing that their funerals might not be able to happen as they had planned. It has also been hard on the families and friends of patients who are dying. Our hospital only allows families to visit when a patient is felt to be nearing the end of their life. Therefore, if a patient has previously been in a care home, their family may not have seen them for several months and are then faced with the decision about whether to visit their loved one when they may put themselves at risk. Many families do visit but some are understandably apprehensive of visiting due to their own co-morbidities and so are unable to be with their loved ones when they die. 

I commend all my colleagues working in the NHS for their tireless efforts in providing outstanding patient care during the past few months. I am immensely proud of the resilience and team spirit that I have seen on the wards, undeterred by the challenging working environments. During our stressful and time-constrained shifts may we continue to be a companion for those in turmoil, those who have no one. May we endeavour to set aside a little time to show compassion and kindness for all patients, as we hurry around in our flimsy plastic aprons and masks that hide everything but our fearful eyes. Finally, may we continue to do our very best as healthcare professionals, and ultimately as humans to metaphorically and/or physically hold every patient’s hand but particularly those who are approaching the end of their life. 

Catherine Roberts is a Foundation year 2 doctor working in the Northern Deanery. 

Competing interests: none declared.