There’s a red phone in the accident and emergency department I work in. It rings at a pitch and rhythm that catches the attention of those who have spent long enough working here. I have not been in the department for long; two months in A&E as part of my first two years as a doctor. As a junior doctor who’s new to the department, I’m used to missing the phone’s staccato sound. The phone is used exclusively to tell us that an ambulance is about to arrive with someone who is very ill. In the past six weeks, it has been ringing a lot. Last week it went off and for once I heard it, so I dutifully went to the resuscitation bays. I waited with a nurse at one of the cubicles for the patient to arrive. He was soon brought in by two paramedics. His story was familiar: he’d come into the hospital three days before with a mild cough, feeling short of breath. His oxygen was low, but not low enough to be admitted. Now he was back. It’s common to see patients with Covid-19 readmitted to hospital after being sent home just days before. They are discharged with a small plastic probe that goes on their finger and tells them if their oxygen is at a dangerous level. At that point we tell them to call 111, or to come back in. If they don’t require oxygen, they will be seen in the minors department. Here, they are placed in one of the rooms that were previously used by GPs to assess patients. Often four or five people will have to wait in these rooms, socially distanced, to ensure they are not a risk to others. Sometimes it is so busy that you have to pull a mobile screen around yourself and the patient and speak to them in a quiet voice, trying to behave as if the person has a room of their own. The wait to be seen in this department can stretch to longer than four hours. Although long waiting times aren’t new, the problem now isn’t just the chronic underfunding of emergency services. The fact is, some hospitals don’t have space to cope with more Covid-19 patients. Outside, four or five ambulances wait with patients needing litres of oxygen a minute. As there is no space in the hospital, beds fill up in A&E, so we go out into the car park to assess patients isolating in the back of ambulances. The first time I went out, on a night shift, it was cold and spitting with rain. One of the nurses pointed to an ambulance and handed me a visor and a plastic apron. She told me that we would get the patient inside as soon as possible. During this pandemic, my fears and inexperience as a junior doctor have regularly been assuaged by the competence of other staff. In the second half of January, a decrease in the number of Covid cases eased the pressure slightly on our hospital. Last week, there was space to immediately admit the man who’d been brought in on the heels of the phone call. With 15 litres of oxygen a minute running from a mask – the most that can be given before a patient is intubated – we were able to keep the level of oxygen in his blood just high enough. But each time he moved the levels would drop dangerously low, and my hand would hover over the emergency call bell before they slowly rose again. When I read through the notes from his last attendance I saw that his partner had also arrived that day, and had died in the hospital some hours later from Covid-19. I phoned the medical team to let them know that this was someone who needed so much oxygen that they would have to stay in hospital. His medical notes showed that he had a daughter who had lived with him and his partner. It would be the medical team who would be speaking to her later, explaining what would happen next. When Covid-19 struck last year, I had been working on the medical team in my first year as a doctor. I had made those phone calls, getting used to dialling five-digit hospital numbers rather than area codes because patients’ family members were often on one of the other wards themselves, being treated for Covid-19. At the time, the frequency of those calls numbed the difficulty of making them. Now I feel a selfish relief that it won’t be me phoning a husband or a wife or, in this case, a daughter. Another doctor will have to have that conversation; the red phone is already ringing again. The author is a junior doctor at a hospital in London Source
