Corona onslaught in the NHS # 2

My shift started 8.00 and that’s when I arrived into the theatre department. Which meant I was late. In Corona times you need to arrive at least 15 minutes early. First to get changed into scrubs and then to put all the protective gear on. Takes bloody forever. Especially as you no longer have an abundance of young south European nurses rushing to your assistance, full of admiration for your courage going into the makeshift intensive care units. Things have changed. As people die like flies or almost die like almost flies, more and more of ordinary theatre staff now find themselves working in these units, doing just whatever they can.

The vast majority of Corona cases have a flu at home and go through it. Or just get on with it like the English would say. But of the small minority that touch on the gravely ill many end up in the ITU and half of those who do won’t come out alive. Finally dressed and protected I enter theatre 5. Normally a place for hernia repairs or knee sorting outs, it’s now home for three sick Corona patients.

Inside I meet the intensive care nurse I said good night to the evening before. He’s been working through the night looking after three ventilated patients with help of one non-specialised theatre practitioner. He starts hand over with saying that no one has been turned or moved during the night. A scandal in normal times, but not now. Corona has entered our health service and its patients are spreading through the hospitals faster than you can say “Is it true that Boris get better care than other people?” Fortunately, intensive care beds are freed up at impressive speed. By patients who turned the corner and go back to the ward and by patients who didn’t and continue to the morgue.

Corona has entered our health service and its patients are spreading through the hospitals faster than you can say “Is it true that Boris get better care than other people?”

The nurse hands over the information from the night, someone’s heart rate had been on the raise and all the various things done about it, such as speeding up the fluids or increasing sedation, had not had any effect at all. And the temperature was up. Paracetamol was pointless, ice-cold towels pathetic. He hands me the latest blood gas, a printed-out paper strip with the results from an arterial blood sample, which seems to show that the patient has become acidotic; the PH-level has dropped from just below normal to significantly lower levels.

When we breathe we inhale O2 which is met by blood in the lungs and then transported around the body, sitting on the back of red blood cells. O2 is the fuel used in all the work done within the cells. The waste product from these processes is CO2 which is transported away, riding back in the same way on the red blood cells, back to the lungs where it’s exhaled, to give space for more O2 and around it goes. Until it doesn’t.

I start my care of the lady. There are drugs to be given. There are big syringes to be prepared and inserted into the pumps. As patients get poorly the infusion rates of the drugs are all pushed up a notch or two, making the syringes emptying quicker. The lady probably had five different syringes connected, plus two or three ordinary drips hanging from bags above.

On each syringe a sticker has to be attached with my initials, dates, times and god knows what else. The huge ITU-paper charts should be filled in. Different colours for different information. I copy the numbers from the flimsy paper strip onto the chart with a black pen, switching to red for the O2 related info and then green for the CO2. I try hard not to roll my eyes. When in Rome you do as the Romans and all that and currently I’m in intensive care, a unit that normally wouldn’t have me but beggars can’t be choosers and now we’re at war. Everyone who can muck in is welcome.

I copy the numbers from the flimsy paper strip onto the chart with a black pen, switching to red for the O2-related info and then green for the CO2. I try hard not to roll my eyes.

My female colleague starts mopping the floor and she answers my raised eye brow with explaining that it seems that the ordinary cleaning staff don’t seem overly keen on entering these infected premises. As I contemplate the ethics and morale of this I look at the floor which, under all the packaging waste thrown around and among all the plastic bags and boxes, really is rather dirty. Oh well, never mind. It’s time for turning and washing the patients. This is something that’s not always happening in the current climate. The work load is unprecedented and frequently patients just aren’t moved or cleaned an awful lot, simple as that.

Soon we were three people around the bed. My lady was a big one, 120 kg, and we lowered the head side of the bed slightly. Washed her down the front and then carefully rolled her onto her side and cleaned her back and changed her sheets. During these manoeuvres one person is solely in charge of the airway, the plastic tube that connects the lungs to the ventilator, making sure it doesn’t move or dislodge. But the lady didn’t like our efforts. She protested through dipping quite dramatically in saturation, the oxygenation of the blood, and we quickly had to put her back in the original position. It didn’t help much and not until one of us had been flooding her lungs with 02 with extra pressure through pumping manually with a breathing balloon for what felt like forever, did the lady eventually acknowledge our efforts and the numbers on the monitor slowly came back to almost agreeable levels. The boss, an intensive care nurse from Spain, simply said “no more turnings for her” and that was it. In hospitals airway and breathing take priority over everything else.

Everyone who can muck in is welcome.

The morning passed. A colleague needed help with a pump, new blood samples were drawn, the phone was answered; someone’s relative wanted to know how things were going, was there still hope? There’s always hope, dear.

Or is there? My lady’s heart seemed to just beat forever faster, her temperature climbed stubbornly to new heights and her blood sugar levels threatened to burst through the roof, completely ignoring the huge levels of insulin injected into her veins.

And now she was also acidotic. This, if you’re already on a ventilator and on all sorts of medication and sedation, is a bad sign. It usually means that the body has stopped paying attention to all you’re trying to do for it.

The work load is unprecedented and frequently patients just aren’t moved or cleaned an awful lot, simple as that.

A junior doctor comes by, looks at the lady, reads my chart and checks the result strip from the blood sample. He orders some minor adjustments on the ventilator settings. Before he goes he says he doesn’t think my lady will last long.

I look at her. She was born the year of Beatles album Revolver or was it Rubber soul? I always mix up the two. She was older than me, but not by an awful lot. More importantly, she was exactly double my weight. Being obese while getting infected with a serious virus can prove problematic. An obese person becoming poorly in hospital will get worse still. This is particularly true for anything related to breathing, lungs and chest. She was also diabetic and while I have no statistics an awful lot of Corona patients seem to be diabetic.

She had come into hospital less than a week previously with breathing difficulties, after two days there was a sudden deterioration and next thing she was intubated and ventilated. This is a common scenario with Corona patients. Things turn unpredictable, sudden and move fast.

At lunch I’m shuffling in my rice like a robot, paying no attention to the conversations around me. My finger is carefully touching my sore and red nose. Despite spongy dressings it’s getting its share of the Corona onslaught. I’m worried my colleagues will start thinking it has to do with my alcohol consumption, which might has gone up as of late.

When I come back the lady’s heart rate has increased to 140 and the temperature is over 40 degrees Celsius. I call for a doctor. One comes and assesses and discusses, mainly with himself and then heads for the door.
“Wait,” I go after him, “isn’t there anything… Anything I… We… can do?”
“Well if you really want to you can give her 250 ml of fluids,” he says, smiles and leaves the room. I put the fluid up and let it go in fast, but as I see her swollen hands, the diminishing urine output and the out of control numbers on the screen, it feels like the most useless bag of fluid I’ve ever hung on a drip stand.

The blood sugar is now 25 despite us giving continues intravenous insulin. It should be more like 5. The team leader orders me to double the dose in one go which means that the big syringe that normally lasts a day now will run out in two hours. I tend to see myself as a reasonably experienced man, but this kind of extreme medication administration is new to me. I put a cold and wet sheet over her boiling body. It feels utterly stupid.

I put a cold and wet sheet over her boiling body. It feels utterly stupid.

A smiling ITU consultant comes in together with the junior from earlier. “Has the patient opened her bowels?”
“Bowels? Er… No, she hasn’t.”
“Then we prescribe some laxatives for that,” says the happy consultant on autopilot. “And,” now turned to the junior doctor, “let’s request a multi-disciplinary team meeting with the other consultants.” The junior looked bewildered and asked rather daringly what the consultant thought would be accomplished from that. What could they add to the current…?
“Oh, just another opinion,” answered the consultant who already had his eyes on next patient.
“Well, I think this lady won’t make the night,” mumbled the junior, walking grumpily after his happy boss towards next patient.

Soon after the doctors leave her blood pressure drops. We put up strong hormonal mimicking drug infusion to boost it which works until it doesn’t and we have to increase the dose further. The temperature is now 41 degrees and her heart is beating like a hammer in her chest. The Spanish team leader stops by the bed and gives the lady a look over. He then crosses himself.
“It doesn’t look good, David.”
“No,” I agree and we start chatting. He’s standing leaning with his back towards the side of the bed. I’m looking into his Latino eyes above the mask and have to agree with my friend who said that he’s one of the better-looking ones in the department. Thing is, most people look better in face mask. Our eyes tend to be pleasant enough, noses and mouths often not so much.

Suddenly the woman starts to move behind us. She sits up and bends her upper body forward, breathing tube sticking out of her mouth. Terrified the team leader spins around and just then the woman becomes still again. For a second or two we just stand there, like scared idiots. It turns out he’d been leaning against the bed control and had involuntarily pushed the head-up button. Nervously we giggled about this for longer than we probably should have but laughter is a stress relief, right?

Meanwhile the happy consultant must have moved on from his autopilot state because a message reaches me that the family has been spoken to. If -when- the lady goes we’re not going to do anything. There would be no point and no life quality possible to achieve through what is referred to as “full escalation.”

Was there still hope? There’s always hope, dear. Or is there?

Towards the evening, her blood pressure simply refuses to answer to the medication. With a temperature of 41.4 and a heart rate just short of 170, the highest numbers I’ve ever seen, the woman is consumed, burned up, by a virus set on destroying her. Eventually the blood pressure starts to drop and the figures are dwindling on the screen. The heart rate finally, after relentless speeding through the whole day, starts to follow suit. The heart itself is now failing and eventually there’s no detectable blood pressure at all. In hospital language this is called loss of output and it’s very bad.

When the lady has no detectable blood pressure and no palpable pulse, just an electronic one that occasionally shows up on the screen like a ghost, only to disappear again, she is clinically dead. As we lay her flat, big grey blotches come up all over her face and neck.

I look up at the clock on the wall, it’s five to eight. The night staff comes in. Different team now.
“Ok, hand over your patient please!”
“Well… She just died.” I say and look at the fairly young woman who stands beside me, glancing down on my charts. Tough cookie who have seen it all before.
“Ok, not much to hand over then.” She proceeds to join her colleague beside the neighbour patient instead.

Someone hands me a couple of forms to fill in. A doctor comes to do the formal death recognition and certification. Later as I cycle home on London’s quiet roads it dawns on me that I didn’t even hold the lady’s hand when she died, all alone like all the others. Maybe I’m not such a great NHS-hero after all.