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At 19:30, I start a 12-hour night shift on the intensive care unit at Royal Papworth Hospital. We have around 60 patients needing intensive care at the moment, so the ward round which usually takes less than an hour takes five hours. We have expanded our intensive care unit to nearly double its usual capacity, so we really have two separate intensive care units – both of which are busy. As I go from patient to patient, it strikes me that the junior doctors and nurses caring for patients at the bedside are the real heroes in all this – without them we just wouldn’t be able to care for people the way we are. I delegate responsibility to different team members and coordinate any urgent actions.
We are admitting lots of critically ill patients from other hospitals all the time. One of them is in their teens which is particularly tough, but we keep calm and carry on. Everywhere I look I see different team members, from physiotherapists to perfusionists, working together with a real sense of camaraderie. The healthcare assistants are amazing, keeping the unit running by supplying Personal Protective Equipment and getting rid of used supplies.
Consultants from all disciplines come and see patients in intensive care. We even have a consultant cardiologist volunteering as a nursing assistant tonight – people are just doing whatever is needed, no matter what their usual role is. We are all scared, but no one shows it. Everyone is just calmly going about doing their jobs. The NHS is stretched, but morale is holding. We hope this will be over soon but there is no end in sight yet.
We are seeing much higher demand than normal for particular medicines and equipment, due to the sheer number of patients needing intensive care. It is especially tough because COVID-19 is such a new disease and there is no known cure, no magic bullet. Every now and then I just get this feeling of helplessness, and that takes its toll.
I feel really proud of the junior doctors on shift tonight. They come from all over the world and have stepped up to being intensive care doctors, whatever their speciality. They all make an important contribution. I get asked “how do I volunteer?” by junior doctors every day. Nurses are stretched more than I have ever seen before. But they carry on calmly, looking after each patient carefully. I’m amazed by how well our patients are being looked after – no aspect of basic nursing care is being compromised.
We deal with a lot of different situations throughout the night, including patients suddenly becoming hypoxic (deprived of oxygen) and needing to be intubated (this involves inserting a into their airway) so they can be put on a ventilator.
At one point during the night, our ECMO (extra corporeal membrane oxygenation) team go out in an ambulance to bring back a sick patient who is struggling on a ventilator and needs to be put on an ECMO machine (this basically oxygenates their blood for them when they can’t breathe by themselves any more). As one of five ECMO centres across the country, we have vehicles and staff on-call 24/7 to pick up patients from other hospitals for whom ECMO is their only chance of survival.
Throughout the night, I see the 'proning' team going from patient to patient. This is a group of allied health professionals (including physiotherapists, speech and language therapists and dietitians) who work day and night to put patients in the “prone” position on their front to improve oxygenation – this seems to be particularly helpful to patients with COVID-19.
During the night, one patient who was in the prone position had a dangerous rise of C02. We had to perform a bronchoscopy (a procedure which allows us to look into the lungs and airways) in the prone position which is very difficult. The thin tube which is passed down the throat and into the lungs was blocked due to lung secretions and we had to unblock it.
At the same time, the wards were having the usual "routine” emergencies like patients going into cardiac arrest.
Some of our consultants have had to self-isolate at home because they are in a higher risk group. Despite this, they do whatever they can to help, taking referral calls from other hospitals. I think one of our doctors took 20 calls at home tonight.
I finally finish my shift at 08:00. We all leave with marks on our faces from the masks we have to wear. It’s not easy, but there’s such a fantastic sense of teamwork in the unit at the moment – we’re all in this together. I’m tired, but still smiling.
Our charitable appeal is aiming to raise vital funds for staff support, research, and patient welfare. Find out more about The Royal Papworth Hospital COVID-19 Appeal.