All patients are vulnerable, but some patients are more vulnerable than others. Take, for example, those with learning disabilities or mental health diagnoses, or elderly, physically disabled or dying people. These groups of patients are more likely to be marginalised, neglected or silenced. In palliative medicine, my speciality, the most extreme form of silencing occurs when a patient literally loses their voice – perhaps because a cancer has invaded their larynx, or, in the case of Covid, because they are too desperately in need of oxygen to be capable of squandering any on the act of speech.
I would meet these patients with haunting frequency on the Covid wards. Glassy-eyed, exhausted, sometimes writhing with the effort to make themselves heard. You did what you could to communicate. Your gloved hand might close around the clamminess of theirs, that a sliver of human warmth might cross the barriers of PPE. You might set up a family videocall on an iPad. Or you might shout your own words above the roar of high-flow oxygen, hoping to bring a fragment of solace. “Robert, I am going to help you.” “I’ve just spoken to Mary and she sends you all her love.” “Would you like me to give you some medicine to help you feel less breathless?”
