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  • Richard Cree

Critical List

15th January 2021

UK COVID Deaths – Daily 1280 / 7-Day average 1066

Total UK COVID Deaths within 28 days – 87,295

Total UK Deaths with COVID-19 on the death certificate – 89,243 (up to 1st Jan)

James Cook Hospital – Total COVID deaths – 432

All COVID cases within South Tees Hospitals Trust – 212

James Cook Critical Care

COVID cases – 37 (15 ventilated)

Non-COVID cases – 23 (8 ventilated)

We have seen fewer COVID patients admitted to the hospital in the last 48 hours which is something to be thankful for. However, we are still admitting about 30 patients each day and the total number of patients in the hospital continues to rise, albeit at a slower rate. Another COVID ward has been opened, meaning there are now eight wards at James Cook and one at the Friarage Hospital that are now part of our ‘red pathway’.


The number of Critical Care patients continues to grow. We now have just under twenty patients who are receiving CPAP on the ward but increasing numbers of patients are requiring admission to the ICU. We have had to open yet another COVID ICU by converting the Cardiothoracic ICU into a ‘general’ ICU. The Cardiothoracic ICU normally looks after patients who are recovering from cardiac and thoracic surgery, such as coronary artery bypass grafting, heart valve surgery or lung cancer operations. They are stopping their routine surgical programme in order to allow some of their beds to be used for our non-COVID patients.


This means we can move the non-COVID patients from our 17-bedded High Dependency Unit (HDU) and use it for the care of COVID patients instead. The end result is that ICU 2, ICU 3, HDU and the Female SAU are all now all COVID units. We used to think that we were unlikely to admit enough COVID patients to occupy all these beds but that plan appears to have been thrown out of the window, given a good kicking and had its wallet stolen some time ago. The COVID patients now occupy every single 'regular' ICU bed and have filled our emergency extra ICU as well.


We have plans to create yet another ICU in the theatre recovery area and anticipate opening this within the next few days. The problem with relentlessly expanding your Intensive Care Units is not finding the space, its finding the nurses, doctors and equipment. This is why the Nightingale hospitals were not really ever a solution to the problems that Intensive Care would face from COVID-19. By the time it became necessary to use them, having to take doctors and nurses away from the regular hospitals would create just as many problems as it would solve.


We now have many more patients than we are used to dealing with and trying to remember all their details is beginning to get very difficult. It doesn’t help that most of them all have the same diagnosis with the same clinical picture, the same CT scans and the same X-rays. They are on the same treatment and tend to have been ill for the same duration of time. We all have to refer to a computerised system called ‘Ward Watcher’ to help us remember who is who and where they are. This is probably the only time we’ve ever had anything resembling a ‘Critical List’. This term is often used by older relatives when wanting to know just how ill their family member is. They often ask if their loved one “has been placed on the critical list?” The trouble is that none of us really know what they mean. From what we can gather it appears to be a list of the patients in the hospital who are extremely unwell and may not survive. It’s obviously bad news if you are placed on it and good news if you are taken off it. I don’t know who is supposed to be in charge of this list or where it is kept and I don’t even know where the idea came from. Even my older colleagues are baffled. I wonder if it is something that used to happen in hospitals in the 1950’s when Intensive Care had just been born? Perhaps it originated when lists of casualties were made following disasters like floods, earthquakes or train crashes in days gone by? Maybe it used to feature on TV dramas like Emergency Ward 10 or Doctor Kildare and has crept into the public consciousness? Wherever it came from, it certainly seems reminiscent of a bygone era and the use of the term always makes ICU doctors and nurses smile.


On Wednesday we had to say goodbye to one of our consultant colleagues, Luckasz, who is leaving us to take up a new job in Exeter. He is moving for family reasons, but it’s worth pointing out that sunny Devon has one of the lowest COVID-19 infection rates in the country. We’re upset to have to lose him, not least because we need everyone we can get at the moment. We’re also just a little envious, although whether he will find work any easier is debatable. He is likely to have more experience of ventilating COVID patients than anyone else in his new department and he may find his talents being put to good use.


As the workload increases we have also moved onto a different shift pattern. It was getting too busy to work standard on-call shifts as a large number of us were ending up working in excess of 24 hours at a time. The new shifts will hopefully allow some periods of rest before we need to be back at work again but it does mean that Nicky and I will potentially return to seeing even less of each other at home. Still, we can always meet up to enjoy a baked potato in the Volunteer Coffee Lounge every now and then. Who says romance is dead?


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