End of Life
Updated: May 13, 2020
Wednesday 1st April 2020
COVID Figures for 31st March
UK Hospital Deaths 381 / Total 1789
James Cook Hospital – Total deaths – Total 15
James Cook Hospital confirmed cases on wards – 77
James Cook Hospital Critical Care cases - 23 (3 suspected) / 13 ventilated
A day off today. I need to spend some time with the children before they turn feral.
Nicky is at work today and is taking over care of the High Dependency Unit (HDU).
There have been a few more COVID admissions overnight, all of whom seem to be getting sicker.
Yesterday on ICU, Nicky was involved in the withdrawal of intensive care treatment in two patients. There is nothing unusual in this; the majority of patients who die in an ICU do so following a withdrawal of the treatment they have been receiving.
Advances in medicine mean we are able to keep people alive for long periods of time but sometimes there is no hope of recovery. In other words, we are good at keeping people alive but sometimes less good at getting them better.
The goal of initial ICU treatment involves a short period of aggressive organ support to allow improvement of the patient’s condition. What then follows is a period of review to determine the effectiveness of this treatment and whether survival is still possible. In general, treatment withdrawal would be considered when death was felt to be inevitable.
If it is clear that the patient cannot survive, then ongoing intensive care is usually not felt to be in the patient’s best interests. Intensive Care Units can be uncomfortable, distressing places for both patients and their families. Very few people would wish to subject a loved one to such an experience in the days before their death knowing that such treatment will ultimately be futile.
Most critically ill patients are not able to participate in a discussion regarding the appropriateness of continuing their Intensive Care treatment. This is a result of the sedation that is used or the severity of their illness. Ultimately, a decision to withdraw treatment rests with the medical staff. However, the patient’s family are always involved in these discussions and withdrawal of care is carried out with the agreement of the family.
Withdrawal of treatment does not mean withdrawal of care. Great steps are taken to ensure that the patient is comfortable, pain-free and not distressed when they die. Usually the patient will remain in the ICU until the very end with the same nurses caring for them.
Before the pandemic the patient’s family would be present during the process of withdrawal. They would stay with the patient during their final moments and would be able to see that their relative was comfortable throughout. This is a vital part of grieving.
Currently, patients are not allowed any visitors. We are undertaking end of life conversations over the telephone. Breaking news as bad as this should be done face-to-face. It feels wrong to have to do it by ‘phone. It is hard and draining, more so than usual. But however hard we find this, it is nothing compared to the ordeal that the nursing staff are going through. They are the only person left alone with the patient in their final moments. This is the same patient that they have tried their hardest to save over the past few days. It is heart-breaking.