Showcasing Science: Life of an APT

Lara-Rose Iredale, Senior APT

As an APT, I am responsible for continued care of the deceased. I work in an NHS hospital (APTs also work in Council/Local Authority run public mortuaries). Our day-to day- job involves admitting and releasing deceased patients, assisting with post-mortem examinations, facilitating families visiting their loved ones, alongside the administration and maintenance of the mortuary environment.

I could write several essays and talk for days about the challenges I faced, both personally and professionally – the prolonged intensity of the work, the separation from loved ones, the uncertainly of every aspect of work and home life – for us key workers, Covid was all consuming.

January seems like a lifetime ago. When news first started breaking about this new coronavirus with pandemic capabilities, I can’t honestly say that I was worried from a work perspective. We are well versed in handling excess deaths – we do it every winter –but as the virus spread and death tolls were increasing across the world, we started to get concerned about our ability to cope with the projected death rates. From mid-March, it was clear that this was on a scale like we had never experienced before. We received out first Covid patient in the mortuary on the 14th March, and less than 3 weeks later had reached capacity. Our day to day job became that of management of the deceased.

I do not think there was a single aspect of our work that was unaffected by Covid. Driven by unknowns about a novel virus, the primary concern was keeping our staff safe, whilst also maintaining dignity of the deceased. Luckily we are all aware of infection prevention and control, and had access to the necessary PPE, but it was very hard to not get swept up in the panic surrounding the contagiousness of Covid – we were reminded of the worst-case outcome daily. Post-mortem examinations were focus of much debate – guidance was provided very early from the Chief Coroner regarding Covid-19 deaths with the aim of avoiding a post-mortem examination if the patient had Covid. The landscape changed daily as we gained a more scientific understanding of the virus.

Things that I have never really given a second thought about – both in our department and the bereavement centre – had been thrown into compete chaos because the hospital completely shut down to visitors.

For example, how to deal with the property of the deceased soon became a major issue – usually this was collected by the next-of kin when they attended the bereavement centre, but this was no longer possible. Add to this the concerns that property could be “contaminated” by Covid, and there was an extra layer of complexity to deal with. Bereaved relatives could no longer attend the hospital to pick up the necessary paperwork, nor were they allowed to spend time with their loved ones on the ward, and all mortuary visits were stopped. Having to deny families the opportunity to say goodbye to their loved ones was heart-breaking, especially as we knew that, in the early days at least, they would also not be able to do this at a funeral directors. Coupled with the knowledge that the extent of funeral services had been severely limited, we all know that hundreds of families were going to be experiencing a grief unlike anything we could imagine.

On the 26th March, The Coronavirus Act 2020 received royal assent which was effective at streamlining and enabling swift death certification and registration. The Pandemic Multi-Agent Response Team (PMART) was established to respond to deaths in the community, and agencies came together to increase mortuary capacity in London, with temporary facilities being set up in a very short space of time. Work began trying to maintain business as usual whilst getting to grips with the new daily routines of online/phone meetings, sitreps about capacity and PPE provision, and trying desperately to maintain adequate capacity.

This is one event that really put the efforts of mortuary staff and funeral directors – people whose jobs are usually hidden – into the spotlight. We are used to being left to our own devices and are self-sufficient department in many ways. I have often complained of the mortuary being “forgotten about”; we are seen as mysterious, operating under a cloak of misery in the basement of the hospital. I found myself suddenly thrust into the world of higher hospital management, feeding into Gold Command and having daily dial-ins with Very Important People. Everything was so fast-paced and parameters moved almost daily; it was very difficult to keep track. I soon realised that we in the mortuary were very much being included in decision making, and that we were in fact the experts in our area of work and our input was invaluable in driving the needs of the service.

The one thing that really stood out for me during the pandemic is the solidarity and support that we received from others working in death care. Almost immediately we had offers of help with capacity issues from funeral directors (little did we all know back then just how hard hit everyone was going to be). I had friends in the industry privately message me asking for advice around PPE and I was able to share the latest guidance with them as this was a constantly evolving landscape.

Being a member of the AAPT was especially useful as we were able to access and share resources in almost real time. Any time new PPE guidance or advice on best practice was published by the Royal College of Pathologists, HTA or Government, it was published on the AAPT Website and on our Facebook group. We could all interact with each other and share advice on practical issues offer each other some emotional support in the process.

This blog was published as part of our Showcasing Science: Behind the scenes of COVID19 series. Read the rest of the blogs here.

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