Drowning

In my last post, I alluded to the NHS drowning under the current pandemic. I wrote about the social media morons who believe that Covid is a hoax and that the whole world has been duped into believing the falsehood to keep the populace under the government's thumb and to pour money into pharmaceutical companies' coffers. Fortunately, these idiots represent a small percentage of the population and most of us have our heads tightly screwed on so that we would rather take advice from the scientific experts than Tracy on Facebook. To those who refuse to wear a mask or stay at home, I have a few words. Yes, it may not seem to do a great deal in preventing the spread of the virus, but then maybe, if we ALL wore the masks and ALL stayed at home, we might see a difference pretty quickly.  If I thought standing on one leg and singing the national anthem twenty times in Latin would work, I'd give it a go, rather than moan about losing my civil liberties. Jeez, how would these people survive in a war?

I get my information on the current state of the NHS from my daughter who works as a doctor in an Intensive Care Unit (ICU) in a large hospital. She is facing Covid down a barrel on a daily basis, so frankly I would rather believe what she tells me in exhausted phone calls after her shift. So here are some answers to questions some people may have.

The hospitals and ICUs in particular don't look busy, so why say they are?

Unlike other wards, the ICU units are not designed to take many patients as under normal circumstances they care only for the sickest patients in the hospital who need 1:1 monitoring. They have specialised equipment and doctors (often anaesthetist-trained ones) who in many cases take over the patient's breathing. Currently, they have TWICE the usual number of ICU patients with FOUR times the usual number of ventilated ones, so ICU units are full to the rafters with Covid patients and the overspill patients are placed in cordoned-off hot-Covid bays elsewhere in the hospital, often requiring the installation of a whole second ICU unit,  but with only the same amount of staff to run the whole lot. Lots of hospitals at the moment are not running their clinics and instead are doing appointments on-line or over the telephone to keep people away from the hospitals. A lot of operations have been postponed to give beds over to Covid patients and staff are off sick too. Additionally,  you don't want lots of visitors or sick patients wandering around corridors infecting one another, so it can look like the hospitals are quiet, but they are not.

The media shows lots of staff around a patient, how can you say they are short-staffed?

ICU has the sickest patients in the hospital and this is even more true with Covid cases who struggle to breathe and need intubation. As I said above, ICU has double the number of usual patients and four times those requiring ventilation, so they have had to open additional ICU units on other wards, with only the same amount of staff to spread thinly. The patients need turning (proning) onto their fronts to help improve their lung function. This is not as simple as it sounds. It can take up to half an hour for eight staff to turn one patient. They have to prepare them first to ensure for example that their skin doesn't get sores, then they encase them and roll them slowly in sheets, making sure at every stage that all the thousands of tubes and lines attached to them don't get kinks. Each member of staff has their particular job to do in the turning. If a patient is obese (as some of the patients are) this just adds more to the time taken. Multiply that by the number of patients to be proned (say 32) and you can see where the time goes. Meanwhile, a crisis can suddenly kick off in another bed and it's all hands to the pump. These really are sick patients where anything and everything can deteriorate in a second. 

Why are they not using the Nightingale Hospitals?

Although the Nightingale hospitals have plenty of beds and equipment, they do not have the staff to run them. If they transferred doctors, nurses, physiotherapists and radiographers to the Nightingales, then there would be even more pressure on the normal hospitals in terms of staff shortage. Appeals for retired medical staff to come back into the workplace to help out did not get much take-up ...... understandable, if one is retired, not to want to go into the lion's den!

It is no worse than flu

Oh yes, it is. Flu can kill, but it usually only happens to the extremely vulnerable and we have vaccines to make this such a rare thing these days. Covid is worse to start with.  Oddly, some people have mild or no symptoms, but when you do get symptoms, it is more deadly. It is not just old or vulnerable people who are dying. Kay has seen otherwise healthy people in their 20s, 30s and 40s dying.  She has seen young colleagues die. Covid is on a level never hitherto seen with "just flu". This is why getting the Covid vaccine has never been so important to stop the infection rate.

The NHS has been struggling for years in winter, so why is this any different?

The NHS has always had more of an uphill battle in winter as more people become sick then (think of waiting times in A&E alone), but this time it is different because they have Covid patients to add to their normal pressures.  Covid hit us out of the blue and we still don't know a lot about how it behaves, mutates etc, so it has been a learning curve whilst trying to get on top of it at the same time. The different strategies used by our government to deal with it (tiers, lockdowns, closing down the economy) may seem haphazard and inefficient but it is because it is so unprecedented. Trying to implement a solution when the unfathomable thing you are dealing with is new, mutating and running amok is not easy. Countries all over the world have had the same problems. Nowhere can truly say they have solved the problem yet. 

What is a day in the life of an ICU doctor like?

I can only go on what Kay tells me but it seems to tie in with what you see on the news. She works 12-hour shifts (often as much as 13 and sometimes even 14 hours if they are short-staffed or an emergency arises that she just cannot turn her back on.) Let's say she starts at 8am.  After three hours of ward round and dealing with urgent problems,  the PPE she wears makes her feel faint. The best thing to do would be to sit down and have a drink, but that would result in more visits to the loo, something that is not a good idea, as taking all the PPE off and on again is such a pfaff, so best to keep going. Only another 9 or 10 hours to go to the end of shift and maybe a 15-minute lunch break if she is lucky. 

Proning patients and dealing with countless crises take up the bulk of the time, as well as phoning relatives with bad news. It is hard to break bad news over the phone. Not being able to see the recipient's reaction and to give a sufficient pause for them to take that news in can be a tricky thing and is emotionally taxing. The patients are not all in the ICU ward so crises can develop all over the hospital, often involving running from one place to another. The less sick ones are shipped out to hospitals further afield, some as far as 300 miles away. As fast as the patients are being shipped out,  ambulances are bringing more in - on occasions as many as six all requiring instant intubation. During all this, case notes must be kept up to date to document all changes in medications or procedures. The hands of the dying are held out of respect, as relatives cannot always be present. Death is very much the norm as opposed to a rarity. The individual stories can play on the mind, long after the shift is over.

Handover to the next shift might come at 8pm, but case updates often take time to explain or an emergency will inevitably happen which you cannot turn your back on, unlike in any other job. So with a bit of luck you get away by 9pm or even 10pm. Once home there is a meal to cook or washing to do and then fall into bed ready to start the shift all over again next morning with a forced smile. Colleagues are in tears and you feel physically spent before you've even got going. Your face is scarred with eczema and pressure sores caused by wearing masks all day. (If masks can fog up those who wear glasses, it fogs up your face too). Night shifts are pretty much the same, but the only difference is, it is dark outside and your body is screaming for sleep.

Silly things will make you cry. A nice word, a nasty word. Anything. Emotionally and physically it is relentless. No 29-year-old should have to have seen the number of deaths she has witnessed since last March. Kay has had ten days' leave since last March. A week in August to go to Yorkshire and a week with me in my "bubble" at Christmas. She was lucky to even get that Christmas week. But a few weeks back at work and she is exhausted again. I can hear the wobble in her voice over the phone.

I am sorry to have gone on so long, but it makes me seethe when I hear of those who deny Covid or say they can't possibly wear a mask in a shop for ten minutes. My reaction is to say a mask is far better than a ventilation tube. If a mask is not possible for medical reasons, then you should not be out and about anyway. I know that Covid is real and so tough for the frontline staff who put their whole lives at risk for everyone who comes through their doors. It is so demoralising for them to hear that people doubt it even exists or selfishly can't be bothered to do the right thing. 

Spread the word and make other people see sense. Wear a mask, stay at home and literally save lives. Only by doing that can we get on top of this dreadful pandemic and give my daughter (and her ICU colleagues) back the life she yearns for and deserves right now.