Hospice Doctor rises to the challenges of Covid

During the Covid pandemic news bulletins have been filled with stories of heroic doctors and nurses putting their lives on the line. The focus has mainly been on NHS intensive care units, but hospice medical staff have also shown remarkable courage and compassion.

Dr Laura Holtham was working full time at ellenor hospice in Northfleet during the height of the pandemic and is full of praise and optimism.

She says: “Everybody worked together during the pandemic. If there were staff shortages, we filled in. For instance, I would help the nurses with a syringe driver or help to wash a patient. We were all trying slightly different roles to help out.

“I think the nursing staff were the most affected, but everyone was so adaptable and happy to have a go at tasks they were not used to doing.

“Before lockdown ellenor volunteers were also able to do all sorts of things to help in the inpatient unit, from folding the laundry to talking to the patients and making them tea and coffee. Without them it felt like there was no buzz.”

Darenth Valley Hospital has also been transferring its “step-down” patients to ellenor. These are people recovering from a serious illness but no longer needing acute care.

Dr Holtam said: “It had been a while since I had practiced acute medicine – we all felt we had more responsibilities and new challenges. Also, from the point of view of those step-down patients, they were worried about coming into a hospice as people tend to think they are where you come to die. In fact, they might just be with us after their hospital stay because their elderly spouse is shielding, or they are having a key safe fitted at home.

“A big positive is that those step-down patients and their families are now more aware of the hospice and have an insight into what services we actually offer. ellenor does not just provide end of life care.

“We know the economy is going to be massively hit by Covid and charities are likely to lose out so anything to increase awareness is important, especially as ellenor relies on fundraising and donations.”

Another big change has been face-to-face meetings being shifted to phone calls and Zoom.

Dr Holtham said: “Having to have those difficult conversations with relatives over the phone was awful. It caused emotional upset for a lot of relatives – and it goes against everything you learn about palliative care. But on the plus side, we have found other ways to communicate, through video calls for example. In fact they have worked well, with patients being able to chat to relatives who live miles and miles away on an iPad in the ward. Being able to see their relatives’ faces is so much better than a traditional phone call. Video calls are definitely something ellenor will keep from the pandemic.”

Covid fears brought a number of complex challenges including hospice patients being reluctant to go into hospital for more specialised care.

“There were psychological barriers, with people unwilling to go to hospital for fear of catching the virus,” says Dr Holtham.

“Although the hospitals never turned them away, they would often rather stay at the hospice. This meant we had to think outside the box a bit more and see if we could manage things in different ways.”

Covid restrictions also put a stop to face-to-face treatments from ellenor’s complementary therapists.

Dr Holtham says: “It was not ideal but we were able to find ways around the problem, working out how we could still treat our patients holistically, via video calls for instance. Some of the things to come out of this have been very positive. One example is mindfulness sessions via Zoom for the staff -- hopefully this is something that can continue in the future.”

Dr Holtham, whose husband is in the Services and has two young children, has recently taken up a new position as a medical practitioner at Brompton Barracks in Chatham. But she was so impressed by the hospice during her time there that she will be covering a weekly evening shift plus some weekends as part of our flexi-bank of medical staff.

Her time in palliative care has been a real eye opener for Dr Holtham.

She says: “At the beginning of the pandemic the policies that came out were centred around the acute side of things and aimed at hospitals – there were no clear guidelines for hospices, and I felt the NHS underutilised the skills of people in palliative care.

“But now lessons have been learned. We will all be better prepared should this happen again. Also, I feel more people have an insight into what hospices are about now and how important they are to the community.”