2nd September 2020
UK COVID Deaths - Daily 10 / Total 41,514
James Cook Hospital – Total COVID deaths – 255
All COVID cases within South Tees Hospitals Trust – 3
James Cook Critical Care COVID cases – 0
Figures published this week by the UK’s statistics agencies reveal that the total number of deaths where COVID-19 was entered on a death certificate currently stands at 57,200.
In the last week the hospital has admitted two new patients with COVID pneumonitis. Both are gentleman, one in his sixties and the other in his eighties but neither has required much in the way of attention from the Critical Care team, thankfully. With cases on the rise locally it is not especially surprising that we have finally seen a few hospital admissions in recent days.
However, things have remained reasonably quiet all week on the ICU. Indeed, we have even had a number of empty beds. This is not unheard of, it is summer after all. For the rest of the year, it is often a very different story. Our Intensive Care unit is a busy one; our normal bed occupancy rate is around 94%. This means that on average, 94% of our beds are occupied at any one time. Because this is an average, we sometimes have spells where our occupancy rate dips lower than this (usually in the summer)and of course, there are inevitably times when the it tops out at 100% (usually the entire winter). The average UK critical care bed occupancy rate stands at 81% but comparing individual critical care units can be like comparing apples and pears. What this statistic does show is that we are a somewhat hectic unit when compared to others. All our trainees tell us this when they finish their rotations. This is especially true of our overseas trainees, who often find the workload demanding compared to what they are used to back home. So, on those occasions when the workload does ease a little, we try to make the most of it. We know it won’t be long before it all kicks off again.
I have spoken before about how some of my colleagues appear to be unlucky and attract work. Nicky, my wife, is no exception. I would even go so far as to say that at times she seems cursed. Her on-call shift last night did very little to dispel that suspicion. The evening seemed to start well enough, with a good few empty beds and no sign of any medical chaos visible on the horizon.
Having empty beds available for use on the ICU can be a huge relief when starting a shift. When you are summoned to deal with an emergency down in A&E or on one of the wards, it is comforting to know that all you have to do is stabilise the situation before whisking your patient off to the sanctuary of the ICU. Being on your own unit with your own staff surrounded by familiar equipment and not having to spell the fancy ICU drug you are asking for is clearly preferable. Not having ICU beds readily available just makes everything ten times worse, especially when you have to try to juggle your existing patients around in order to try to create space. It is the most frustrating part of any ICU Consultant’s job.
However, shortly after Nicky arrived at work the telephone calls began. The first was a sub-arachnoid brain haemorrhage in an elderly lady brought in by ambulance. No sooner had the team intubated and ventilated the patient than Nicky was called to the ward. This time to deal with a drug overdose in a young lady who had respiratory failure as a result of aspirating her stomach contents into her lungs. Another ventilator required.
Next up was a lady who had septicaemia from a nasty urinary tract infection and needed blood pressure support on the HDU. Then came a call to A&E to admit a long-term spinal injury patient with worsening breathing difficulties despite the best efforts of his home ventilator.
The on-call Anaesthetic Consultant rang next, asking for an HDU bed for an elderly lady who had been to theatre to fix her hip fracture earlier in the day. As a result of the inflammatory response generated by the surgery and her existing heart problems, she also required blood pressure support.
The last patient to be admitted was a young gentleman with cirrhosis and peritonitis who was starting to become very unwell and had dibs on the ventilator in the last ICU bed space.
Of course, these were only the patients that Nicky admitted. Other patients presented with diabetic ketoacidosis, community-acquired pneumonia, heart attacks and various other assorted infections. All of these were well enough to be left on the ward with our Outreach Team keeping an eye on them.
The end result of this carnage was that Nicky was now left with only the isolation rooms on the HDU now free. Realising that things were getting tight, the junior staff wisely decided to send Nicky home before she ‘found’ any more patients. The curse was promptly broken and the rest of the night was relatively calm.
In the end it was a very tired and weary Nicky who arrived home shortly after 4am. She hastily ate something before crawling into bed for a few hours. I’m reliably informed that I greeted her arrival with little more than an irritated grunt and an attempt to steal all the covers. No change there then.