Im so glad that the moral injury of managing covid is at last being mentioned.1
I tried to highlight this as upcoming – around ventilators – way back in April 2020. And suggested some specific ways forward, based on my experience leading the first explicit rationing in the NHS.2
Of course its not just the public health workforce. Professor Fong’s moving testimony to the second phase of the inquiry made it clear how traumatised many staff working in ITU were.3
Im especially concerned about the most junior doctors and the medical students who acted up. Their first experiences of death were ugly, terrifying and out of control. I know of one junior resident who has changed their career choices because of this.
Im concerned that, unless we do something, we’ll have allowed a whole cohort of doctors to – understandably – be afraid of, and avoid, end-of-life care. End-of-life care in the UK is patchy and inconsistent 4 – even though death is something we will all face, and we all need support with.
So we’ve ALL got a personal interest in this.
But I feel sure we could make it much better. My very first job – a mix of tertiary oncology and HIV in those appalling pre-treatment days – could have been traumatising.
All my patients died.
And I’m in the very first HIV needle stick trial – so I was scared. Very scared.
But I learnt what a privilege and how rewarding end of life care is. My Registrar taught me how to manage pain. How to listen as well as talk. And much more. We worked together – and I became confident as well as competent.
Although I never wanted to become a palliative care specialist, I’ve really valued leaning in to end-of-life care through my career: as a GP, in ED, and in urgent care.
Lets make that happen for the Covid cohort!
Perhaps most importantly, lets not forget the spouses, children and grandchildren – all the family and friends of over 230,00 individuals who died – and are still dying – of covid. 5
The Covid wall is great.6 But it memorialises the deaths.
Instead, I’m hoping to include a Love Wall – remembering lives – in my upcoming residence in Theatre Deli in February. 7
References:
1 An effective public health response to the next pandemic demands learning from past mistakes BMJ 2025;391:r2627
2 Mawer C BMJ 2020;369:m1542 Covid-19: We need to be open about rationing ventilators
3
4 KCL Research study reveals patchy and inconsistent end of life care https://www.kcl.ac.uk/news/research-study-reveals-patchy-and-inconsistent-end-of-life-care sept 2024
5 Covid inquiry: The UK pandemic in numbers https://www.bbc.co.uk/news/uk-51768274
6 https://www.nationalcovidmemorialwall.org/
7 I had the idea of asking family and friends to share a snippet of what they loved and remembered – and then saw this in Module 1: Voices of the Bereaved: “I would prefer …to remember him how he was in life.” by Matt Fowler, co-founder of the Covid-19 Bereaved Families for Justice: https://covid19.public-inquiry.uk/reports/module-1-report-the-resilience-and-preparedness-of-the-united-kingdom/