Amy's story

Amy Dewar
Consultant in respiratory medicine

“I was on call on Saturday 7 March. It was the weekend the skiers came back and there were a couple of COVID-19 cases in Brighton. It was about 5pm when I was called to my first patient, a gentleman who had all the symptoms of viral pneumonia. I thought – surely this can’t be COVID-19? He was on an open ward, I was wearing my ordinary clothes and I used my stethoscope to listen to his chest. But he had florid crackles at the bases of his lungs and I thought: Oh God, it’s here. I signalled to the staff they needed to step back. As soon as we got outside I said this man needs to be isolated.

He had no travel history. He was one of the first cases of community transmission. I saw another case 12 hours later and it was obvious what was going on. From that moment we stopped seeing patients face to face. I have 1,500 patients under my care, most with Chronic Obstructive Pulmonary Disease (COPD), and 85% of them were shielding. We cancelled our outpatient clinics and our pulmonary rehabilitation groups.

After seeing that first case I was sent home for 3 days to self-isolate. But the rules changed – they were still being worked out – and I was allowed back to work.

Those early days were difficult. I worried how would I feel if I didn’t have any patients I could look after? How saddened and cheated I would feel, having worked so hard to keep my patients safe, if they were taken away from me. Would I even have a career?

For me, the greatest worry was infecting other people. I had read about families infecting each other and carers infecting patients. Of course that reflected the fact that my patients were very vulnerable. We do home visits and I was worried we would go out and contaminate a patient’s home. Thankfully, it doesn’t look like that happened. But I didn’t want my team put in that situation, that was my responsibility.

I remember one day bumping into one of my dearest colleagues outside one of the COVID-19 wards. She is Indian, in her 60s and very dedicated, the sort of consultant I aspire to be.

I said: ‘What are you doing here?’  She said: ‘My Mum is on the ward. She has got Covid and she’s dying. I think I’ve given it to her.’

She was absolutely devastated. There were others I saw like her. A lady in the emergency department who was breathless told me her husband was in ICU and she had just been called to say he had had a cardiac arrest and she didn’t know if he would survive.

Those encounters made me feel tremendously sad. I wouldn’t want to be in that situation – to feel responsible for someone’s demise.

I worked on the COVID-19 wards at the peak of the crisis. The hardest part for me was having to make decisions when patients came in about who would survive an ITU admission. I make advance care plans as part of my normal work, usually with families involved. We weren’t making decisions we wouldn’t otherwise have made, but we were having to do it at the front end.

We would say to them it was really clear they had a significant infection and that 1 in 20 patients in their condition become severely unwell and that if that happened, with their other medical problems, we feared they wouldn’t survive on a ventilator and in that instance we would make them comfortable on the ward. Most patients responded to that.

But it was difficult because we were dealing with patients who often seemed quite well, but when you looked at their X-rays they had horrid infiltrates in their lungs.

My team’s office was just outside the COVID-19 ward and because we were only allowing one person in at a time to patients near the end of life, there were groups outside our office waiting, crying and in distress. There was a pervading atmosphere of contagion and infection and people talking about death. Bereavement was hanging in the air. People aren’t dying at the moment but the atmosphere hasn’t gone away. Everyone thinks a dark winter is coming. 

I kept saying to people the best evidence for a conspiracy theory is the virus itself. I cannot imagine a worse illness.

We had to work out how to look after our patients, how to keep them safe at home, how to ensure those needing oxygen treatment could get their supplies. We set up new phone numbers so patients could contact us. 

Those in hospital were very keen to be discharged as soon as possible. We were sending people home who were still really breathless. If patients don’t feel well they normally want to stay but people were frightened to be in hospital and if their families could look after them they wanted to go. No one was going home in a state where we thought their illness was over. 

We have a post-COVID clinic and of 1,300 patients, 38% said they were back to their usual selves at 6 weeks. But 40-60% had persisting symptoms. That didn’t really surprise me. Some people were ventilated for days or weeks with the same oxygen requirement. That is something I have never seen. We have more information now on why people still felt awful.

I felt a tremendous sense of purpose – that we were there to do the right thing. But we have loads of doctors at St Thomas’ and we mobilised really well. Hospitals down the road don’t have so many. I felt an element of guilt.

What saddened me was the staff who died across the NHS. They were clustered in certain hospitals and among certain groups – BAME were hugely over-represented – and it very much felt it was associated with the availability of PPE.

I live with my husband, a gastro-enterologist at Lewisham Hospital, in Forest Hill and early on I reverted to my bike for commuting. I was not likely to get an overwhelming illness myself but I decided it was not appropriate to take the tube. I wanted to keep my patients safe.”