Dr Martin Deahl is a consultant psychiatrist from Shropshire in the UK. He is working with the aid agency Goal at its Ebola treatment centre in Port Loko, Sierra Leone. This is his second report for the Guardian.

Morning shift in the “red zone” at the Ebola treatment centre. There is an 8am handover from the night shift – no different from any NHS ward in the UK. Things only become a little different when the task list is drawn up. On the Ebola ward the tasks (feeding and washing the patient, ward round, inserting a cannula, giving medication) are allocated in pairs. You can only enter the red zone with a “buddy”, each team member “man-to-man marking” the other, vigilant for potential risks, breaches of personal protection equipment (PPE) – the spacesuit, and their buddy’s general wellbeing.

A “T” sign made by either buddy means it’s time to get out and leave immediately, no questions asked. If a task is incomplete, it is left to the next incoming team to finish the job. Taking into account the time taken for donning and doffing PPE, there can only be a maximum of two 45-minute entries into the red zone. Everything in PPE is so laboriously slow, it feels like wading through treacle. Even simple thought processes and decision-making are slow as a consequence of the heat and humidity.

This morning didn’t get off to an auspicious start. I couldn’t get complete skin coverage with my goggles and, after several minutes of fiddling around with them, and having thought all was well, my buddy Desmond (a local community health officer) found that I had a tear in an outer glove, which I certainly hadn’t noticed. Entering the “zone” is now a matter of routine but nevertheless when your buddy quietly whispers, “may God keep you safe” as we pass through the double gated “air-lock” it gives one a frisson of anxiety.

Chlorinated aprons, goggles and gloves dry in the Sierra Leone sun. Photograph: Goal

Entering the “confirmed Ebola” ward we were greeted with a 40-year-old man who had obviously just had a catastrophic nose bleed (although blood was clearly leaking from gums and other orifices). Stuck to his bed sheets, he was unresponsive and could barely breathe. Trying to clear the clotted blood from his nose to help him breath was counter-productive, he simply started bleeding again. Ebola blood doesn’t clot easily, patients simply leak. Clinical decision: regular morphine and request to nurses and hygienists to redouble their efforts to keep him clean. Not long for this world, we could at least ensure he passed away in a dignified pain-free state. A morphine-induced mental fog is not so bad a way to go when there is nothing else to be done.

As careful as I was, and despite thoroughly washing between patients, it was a shock to find blood running off my PPE on to the notes I was trying to write for the next patient. The record sheet rapidly dissolved into a soggy pulp of blood and chlorine. Following any assessment, results are literally shouted across the fence to a scribe who copies them on to a duplicate record sheet in conditions of safety. Nothing ever leaves the red zone, everything including paperwork stays put or is destroyed. I was barely able to shout my findings before ink, blood and chlorine ran into an illegible stain.

The rest of the round was, thank goodness, less dramatic. The remaining patients – most of them from the same household – were all sick but stable, and needed simple rehydration to combat their (substantial) fluid loss from vomiting and diarrhoea. One, Mohammed, a footballer, refused the medication. He said we were poisoning them, and their deterioration since arriving in the centre was our fault. He incited his brother-in-law in the next bed to refuse his tablets as well. It would have been inappropriate for me to be dismissive. My 45 minutes was nearly up and I hadn’t got time to argue. After I left, I sent in a member of the psychosocial team after I left to educate, encourage and cajole.

My colleague reviewed Kati, the little girl that I had admitted on my first shift, who had left such an emotional impression on me. She was worse, less responsive, no more hand squeezing, and in pain with every attempt to move or sit her up. She had become even more dehydrated, and five agonisingly painful attempts the previous day to put up a “drip” and give her fluids intravenously had all ended in failure. She was so unresponsive, we thought she might die on at least a couple of occasions in the middle of the ward round. Secretly relieved that I didn’t have to assess her. I was still very upset. Before leaving the zone I went over to see her, held her hand and stroked her hair. No response.

Back in the command centre we relayed our findings and set the next round of tasks for the teams going in next.

Kati, my little friend was discussed:

“The next team can try and get another line in …”

“We tortured the little girl yesterday with five attempts and we only got 125ml of fluid into her before the IV ‘tissued’, why are we likely to be any more successful today?”

“She’ll die if we don’t get fluids into her.”

“She’ll die anyway, we’re just making her suffer more, isn’t it time to call a halt and make her comfortable?”

Martin Deahl in Sierra Leone. Photograph: Martin Deahl

And so it went on. Ethical issues of life and death, the life and fate of a frightened little girl decided by an informal team discussion.

Do we leave Kati to her fate or make one last attempt to intravenously hydrate her? What are the thought processes that influence our “does she live, does she die decision”? How much is our decision-making influenced by emotion and our feelings towards our patient? Would my decision be different if she was an anonymous patient, one of many, the girl in bed 25, and not Kati, the girl who made me cry so much after I admitted her two days previously? Did it matter she was a child? Would my reasoning have been any different had she been an adult? Who am I to make these decisions? What gives me the right to be the arbiter of life and death? Diffusing responsibility among the team – “everybody should have a say” – may assuage conscience and guilt, may make me feel better, but the reality is the doctors decide.

The truth is that the emotion and intensity of the situation give us a false sense of our own omnipotence. Many Ebola patients live or die in spite of our efforts. We palliate, we relieve pain and distress, but in all honesty we rarely save. Even with the most aggressive treatment, mortality is still greater than 40%. Perhaps it’s the lot of people like my colleagues here in the centre and me to wrestle with our consciences, shed tears, lose sleep and try to make the best of a very bad, heart-breaking job and leave the rest of the world to party, get pissed and celebrate Christmas. It is indeed a topsy-turvy world in which we live. Life is never easy.

Kati died shortly after this blog was submitted. You can read Dr Martin Deahl’s tribute to her here