Reflections from the Frontline of Critical Care (ICU doctor at Charing Cross Hospital)
COVID 1:
“They all keep dying.”
I look up at Nico, surprised. The grizzled Bulgarian has been an ICU nurse for longer than i’ve been a doctor and I didn’t expect to hear the emotion in his voice. His hands move steadily with practiced motions over the rapidly cooling body of Mr. S – but his eyes are unfocused and far away.
“We’ve had a couple survive.” I shrug, unsure what else to say. Was there any point dwelling on how crap the survival rate of intubated COVID patients is? Then again, his train of thought doesn’t surprise me given we’re cleaning our fourth corpse of the day. It’s not a doctor’s job, but since we’re absolutely barebones on nurses…
I sigh and soak another cloth in warm cleaning solution. Nico doesn’t meet my eyes until we zip the body bag.
**
“Anaesthetic Emergency, Intensive Care Unit”
I’m too tired to even lament another wasted cup of tea. At least I got a few sips down this time; the last two attempts had to be abandoned before I even got the milk out.
Even the sprint from the office to the Unit is becoming routine.
Two nurses are waiting at the door with a full set of personal protective equipment opened and ready, so I can don as fast as possible and get inside. It still takes two minutes. Two minutes on the stopwatch kindly provided free of charge by my heartbeat. If the patient is having a hypoxic cardiac arrest then he’s already dead.
The monitor on Bed 6 shows a heart rate of over two hundred regular beats per minute. I let out a breath I hadn’t realised I was holding.
I can fix this. Or, I have to fix this – because even this thirty-four year old’s heart can’t keep this up for long.
I fall back to line one of the IT tech support manual, ‘turn it off and turn it back on’. Human hearts aren’t so different from misbehaving computers. I call for adenosine to my hand and there’s a pregnant pause. These off-brand ward nurses drafted in to my ICU to cover staffing gaps don’t know where it is. They’re flapping, and the alarm keeps blaring.
Heavy footfalls and Nico is there, cracking open the emergency drug box from the crash trolley. I give him a wink and I think he smiles back at me – his respirator makes it hard to tell.
Inhale and push six milligrams Adenosine, everyone stops to watch the cardiac monitor.
Two hundred beats become zero and the alarm blares a different tone. A second passes, or was it five? Electrical activity returns. Eighty beats per minute.
Exhale.
But now there are too many irregular beats. Part of the heart, probably the ventricle is trying to generate it’s own rhythm. That’s a problem because it can lead to –
“He’s in VF. Sarah, start CPR please. Jimbo, get the pads on quickly.”
I ignore whichever idiot asks where the consultant is. I can hear ribs popping like bubble wrap. Would someone please silence that ****ing alarm?
Two shocks don’t get him back. Dr. Jay arrives at some point. He sees high viral load Covid aerosolised over the whole team with each chest compression. He calls it. Doesn’t he know the patient has two young kids at home? Of course he does, before we put him to sleep and intubated, we stood patiently while the patient breathlessly told his kids on the phone that he loved them and would see them soon. But the virus doesn’t care.
I head toward the exit, it’s only been a few minutes and my tea might not even be cold yet.
The alarm on Bed 4 goes off.
COVID 1:
“They all keep dying.”
I look up at Nico, surprised. The grizzled Bulgarian has been an ICU nurse for longer than i’ve been a doctor and I didn’t expect to hear the emotion in his voice. His hands move steadily with practiced motions over the rapidly cooling body of Mr. S – but his eyes are unfocused and far away.
“We’ve had a couple survive.” I shrug, unsure what else to say. Was there any point dwelling on how crap the survival rate of intubated COVID patients is? Then again, his train of thought doesn’t surprise me given we’re cleaning our fourth corpse of the day. It’s not a doctor’s job, but since we’re absolutely barebones on nurses…
I sigh and soak another cloth in warm cleaning solution. Nico doesn’t meet my eyes until we zip the body bag.
**
“Anaesthetic Emergency, Intensive Care Unit”
I’m too tired to even lament another wasted cup of tea. At least I got a few sips down this time; the last two attempts had to be abandoned before I even got the milk out.
Even the sprint from the office to the Unit is becoming routine.
Two nurses are waiting at the door with a full set of personal protective equipment opened and ready, so I can don as fast as possible and get inside. It still takes two minutes. Two minutes on the stopwatch kindly provided free of charge by my heartbeat. If the patient is having a hypoxic cardiac arrest then he’s already dead.
The monitor on Bed 6 shows a heart rate of over two hundred regular beats per minute. I let out a breath I hadn’t realised I was holding.
I can fix this. Or, I have to fix this – because even this thirty-four year old’s heart can’t keep this up for long.
I fall back to line one of the IT tech support manual, ‘turn it off and turn it back on’. Human hearts aren’t so different from misbehaving computers. I call for adenosine to my hand and there’s a pregnant pause. These off-brand ward nurses drafted in to my ICU to cover staffing gaps don’t know where it is. They’re flapping, and the alarm keeps blaring.
Heavy footfalls and Nico is there, cracking open the emergency drug box from the crash trolley. I give him a wink and I think he smiles back at me – his respirator makes it hard to tell.
Inhale and push six milligrams Adenosine, everyone stops to watch the cardiac monitor.
Two hundred beats become zero and the alarm blares a different tone. A second passes, or was it five? Electrical activity returns. Eighty beats per minute.
Exhale.
But now there are too many irregular beats. Part of the heart, probably the ventricle is trying to generate it’s own rhythm. That’s a problem because it can lead to –
“He’s in VF. Sarah, start CPR please. Jimbo, get the pads on quickly.”
I ignore whichever idiot asks where the consultant is. I can hear ribs popping like bubble wrap. Would someone please silence that ****ing alarm?
Two shocks don’t get him back. Dr. Jay arrives at some point. He sees high viral load Covid aerosolised over the whole team with each chest compression. He calls it. Doesn’t he know the patient has two young kids at home? Of course he does, before we put him to sleep and intubated, we stood patiently while the patient breathlessly told his kids on the phone that he loved them and would see them soon. But the virus doesn’t care.
I head toward the exit, it’s only been a few minutes and my tea might not even be cold yet.
The alarm on Bed 4 goes off.
