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A year in the life of Dr Mary Miller

I am a consultant in palliative medicine at Sobell House, having worked here for 25 years. My clinical work is with the hospital palliative care liaison team seeing dying patients across Oxford University Hospitals, but focusing mainly on the John Radcliffe Hospital. The other job I have is as the director of the Oxford Centre for Education and Research, a small sister charity to Sobell House Hospice charity. We focus on improving care for those who are dying through education and research.

This past year was unlike no other in my 32 years working as a doctor. There have been other challenges – a passenger plane crashing off the south coast of Ireland killing all on board when I was a medical student, or the HIV epidemic which swept through Dublin as I started working in the hospice there – but nothing like this pandemic.

This diary was written in March 2021.

March 2020
Like many others, I watched the news from China at the start of 2020 and I hoped that the UK might escape the worst as had happened with swine flu in 2009. I started to feel scared about what was coming as I watched the reports from Italy and heard the number of deaths continue to rise – both patients and healthcare staff.

I returned to work in the John Radcliffe at the start of March. Walking through the crowded waiting room on my first morning back and hearing coughs, I remember thinking ‘I am very likely to catch this disease – what will that mean for me, my family, and the hospice’. I was ill with Covid-19 from mid-March putting further strain on a short-staffed medical team – this first lockdown passed me by.

May 2020
The Hospice had settled into a rhythm to some extent. The high numbers of patients were in the acute hospitals; our ward which is usually full was quiet and community patients mostly preferred telephone calls to visits. So the Hospice service refigured to meet the need where it was – moving staff to the hospitals. We were offered support from Katharine House Hospice and Helen & Douglas House, several medical staff offered sessions, and staff were redeployed to us from other areas of the hospital. A retired nurse came back to help! Fabulous and speedy collaboration.

Local symptom control guidance was developed, as well as national guidance, to help staff look after patients and ensure they were comfortable. Learning from the palliative care staff in London, which took the brunt of the first wave, was shared across the country. The hospital team staff proactively visited the Covid-19 wards across the hospital, learning what to expect of deaths from this disease and how to ensure people were comfortable while they fought the disease or as they died. We got used to the alien world of PPE (personal protective equipment) and phoning families instead of seeing them face to face.

July 2020
July saw beautiful sunny weather and a reduction in the case numbers of Covid-19. The Hospice ward was busy again and our hospital team was back to its core members of staff.

Two things stood out in July. We looked at the case records of those who had died from Covid-19 – pulling out the learning about symptoms, medicines used and doses needed to keep people comfortable. We discovered that the symptoms were easily managed with low doses of medications we commonly use in palliative care. We published the results – one of five UK hospices to do so. A sobering finding was that only 18% of people had a family member or a person they loved at their bedside as they died. They did not die alone but they died without those they loved.

The second thing we noticed was that people were now coming in to hospital with advanced disease – it has been many years since I have seen three people over the course of two weeks lose the muscle power in their legs and become paraplegic. Perhaps people were scared of catching Covid-19 in hospital or perhaps the focus of the health service was on Covid-19.

September 2020
Our work days become more ‘normal’ and staff take this opportunity to catch up on their leave.

The area of the Hospice that continues to have the biggest change to its service provision is the community team. The staff are doing remote video consultations instead of visits – communication skills are being honed in a very different environment to normal.

November 2020
I chair the first lecture of the Oxford advanced course in pain and symptom management. This flagship course has run for over 30 years and is one of the foremost national and international palliative care courses. It usually runs in June and July annually. In 2020, it was postponed and moved online.

We watch the rising case numbers through November with trepidation. A third lockdown is inevitable.

January 2021
The UK is in lockdown and we have a very busy hospital – most wards are red areas with patients who are having treatment for Covid-19. The treatments are more effective and we are confident about the care people need who are dying of Covid-19. Notably, people who are frail and older find it hard to regain strength and independence after a Covid-19 infection.

This time, the hospice ward is as busy as usual and the community service is very busy! Resilience is low; in families, in social care providers and in healthcare staff. Staff are tired and are struggling to recover after being infected with Covid-19.

Our team are very lucky to receive the first dose of vaccine and I feel more hopeful for life in 2021.

March 2021
I’m writing my year-long summary on the first day of March, and we are looking forward to spring, summer and the gradual easing of lockdown. The vaccination programme has been very successful – over 20 million people have received their vaccine. In 12 months we have learnt new skills and how to manage an unknown disease.

We remember the 703 people who have died of Covid-19 in Oxfordshire, the 123,000 people in the UK, and those that will die in the coming months. We especially think of so many people who have not been able to be present at the bedside of those they love and alongside them as they died. The past 12 months will cast a long shadow.