Coronavirus: 'Many said goodbye to loved ones in an ambulance'
When Dr Nigel Kennea talks of the "unexpectedness and awfulness" of deaths in his hospital in the past six weeks, he tempers it with a positive focus on helping bereaved families left behind.
As a medical examiner at St George's Hospital, in south London, his job is to advise clinical teams on completing death certificates, then support relatives through their grief.
But like so much during this pandemic, none of that is straightforward.
"The most harrowing thing is knowing that many said goodbye to their loved ones in an ambulance," he says.
Despite staff "going above and beyond" to support patients in desperate times, using mobile phones and iPads to connect seriously ill patients and their families, contact is just not always possible.
Even after a patient's death, social distancing has meant grieving relatives are left in limbo.
"Normally, registering a death is done face-to-face with relatives," Dr Kennea says.
"They come in, talk through the admin and how to plan for after death.
"Now, it's all done on the phone."
'Share the burden'
Dr Kennea's job is to take an overview of all deaths at the hospital. It's a relatively new role in the UK, introduced last year, which is independent of trusts.
Previously he was a specialist in the care of newborn babies.
Now, Dr Kennea discusses each death at the hospital with the doctors and nurses involved in that patient's care, making sure death certificates are completed correctly and consistently.
With Covid-19 deaths so closely scrutinised, there is added pressure and "some are complicated", he says.
There is still so much doctors are learning about the virus and its effects on people's bodies - such as heart failure, thrombosis, kidney problems and pneumonia.
But, Dr Kennea says: "If a test for coronavirus has been carried out and is positive, that goes on the death certificate as it is likely to have contributed to the death."
And the hospital aims to report these deaths to national bodies on the day they happen.
Although those that seem unnatural or have no certain cause must be referred to a coroner.
But the role he is most proud of is supporting bereaved families - talking to them about what is on the certificate, the care the patient received and next steps for the funeral.
"We share the burden together," he says.
These conversations with families are when life stories are told and memories shared. There is often laughter too.
And there is now more demand than ever for hospitals to have good communication skills and show sensitivity towards families.
"We are better at this than we were six weeks ago," Dr Kennea says.
"So many people are so grateful for our support.
"And they often say they appreciated the human touch," he says.
St George's Hospital had its first Covid-19 death on 12 March.
Since then, 250 people have died with the illness at the hospital, while more than 600 have recovered and been discharged.
In the worst week, 60 patients died with Covid-19.
By turning normal wards into intensive care units and training up staff to work there, this large hospital has coped through all the turmoil.
And it has even been able to take Covid-19 patients needing dialysis from other London hospitals.
But there has been immense pressure on front-line staff, kitted out in personal protective equipment day in, day out.
When Dr Kennea goes into Covid-19 areas, he too wears full PPE - but it has its limits when communicating with patients.
"It's hard to share a smile behind a mask and goggles," he says.
Now, 60 patients with Covid-19 are being ventilated in the hospital's intensive care unit.
At the peak, it was 120.
There is a sense the situation is improving and that is "really gratifying", Dr Kennea says.
Yet there is so much from the past few months he will never forget.
He has marvelled at human powers of recovery - sometimes in the most unexpected places, such as among the very elderly.
But at the same time, he has seen younger people whose lives have been cruelly taken.
"It is just a violent tragedy," he says.
"It is such an exceptional time for lives being snatched away."