Treating dying people in hospices during Covid-19 is breaking me

“What’s going to happen? Tell me, please.” A patient, eyes wide, was imploring me to let her know what she was about to face. She was in her 20s and reaching her last days of life. It was a heartbreaking conversation, but one I face on a regular basis as a hospice doctor, albeit rarely with a patient so young.

I took a breath and calmly talked her through the dying process, what I expected would happen, and how we’d make sure she was as comfortable as possible. As is often the case, talking it through provided some comfort; I could see her relax a little and a weight lift. I left the room and tears filled my eyes. These discussions are difficult but they are so important, and it is a privilege to support patients at such a vulnerable time.

Related: Today I have to talk to three of my patients about dying. This is how I do it

This one hit me so much harder, however, because of the Covid-19 pandemic. The conversation was muffled by my protective face mask; the eye contact was interrupted by the goggles I was wearing; the comforting touch of my hand on hers wasn’t allowed. Most upsetting was the mobile phone sitting between me, the patient and her one allowed visitor, providing the link to her loved one who was sitting at home and hearing that his relative was going to die in the next few days.

This family member had been by the patient’s side since her diagnosis, yet visiting restrictions meant he couldn’t be there when she was admitted to the hospice.

On the way home, I switched on the radio and heard the government update about a new easing of restrictions. The relative could now go to a shopping centre, but still was not allowed at the hospice.

This is just one story. It is happening every day in hospices, hospitals and care homes all over the UK. Visiting restrictions apply to every person who is admitted, or attends for treatment, and not just patients with Covid-19.

The restrictions differ at different places. Some hospitals allow no visitors at all, or just one at the end of life. Our hospice’s current policy is a single nominated visitor for all patients, while at end of life, immediate family members are allowed a one-off, one-hour visit. Prior to admission, the patient and their family decide who is going to be that one visitor. How do you make that decision? The emotional toll on visitors is difficult anyway, but is magnified when you know you are the only who’ll be there.

And where do we draw the line at immediate family? Spouses, parents and children included, but grandchildren and lifelong best friends not? We try to be accommodating and allow in the people most important to the patient, but it isn’t always easy to draw the line.

The long-term impact on people’s grief is hard to imagine. Those moments with your loved one at the end of life are precious and make up an important part of the grieving process. Every single death during this time is affected, meaning hundreds of thousands of bereaved people are suffering even more than they normally would.

It is hitting me and my colleagues hard too. It goes against the whole ethos of the hospice and what we do. The essence of palliative care is patient-centred care, but Covid-19 is bigger, and that shifts the patient slightly out of centre. We know we are doing the best we can in the current situation, but we know it isn’t good enough.

Every day we tell distressed relatives they cannot come. Whereas normally the hospice is bustling with visitors, families gathering in the communal areas, children rushing around, now it is quiet. We don’t meet the people significant in our patients’ lives, and we have difficult conversations with distressed relatives we have never met over the phone. We tell children they can’t see their parents again, and parents they can’t see their children again. It is breaking us.

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We want to be flexible; we feel the pain these restrictions are bringing, and our hearts are telling us to bend the rules, that there are exceptional cases. But the truth is every patient’s case is exceptional. The restrictions are there for a reason, and we know how important they are because we have seen the consequences of Covid-19 among us.

As the restrictions on lockdown are being lifted, I struggle to comprehend the juxtaposition between what feels like two worlds. How can we continue to turn away loved ones when they can go to a theme park, go on a shopping spree, or even go to the pub? It is hard to hear people rejoicing about things returning to normal.

It feels that the voice of these patients, their loved ones and all of those grieving has been lost somewhere, and that feels incredibly wrong. What’s worse is I don’t know when this is going to end.

If you would like to contribute to our Blood, sweat and tears series about experiences in healthcare during the coronavirus outbreak, get in touch by emailing sarah.johnson@theguardian.com