Thursday 23rd April 2020
COVID Figures for 22nd April
UK Hospital Deaths 763 / Total 18,100
James Cook Hospital – Total deaths – 142
James Cook cases on wards – 134
James Cook cases in Critical Care – 22 / 10 ventilated
I’ve been back working on the same COVID ICU today. We have gathered together all the patients with renal failure into one place. ‘Kidney Alley’ smells a lot better than it sounds but it does make for a challenging day. The COVID patients who require dialysis are usually the sickest patients we have and they also have the lowest chance of survival. They are a challenge to look after.
However, one of our patients admitted overnight to our side room is recovering well. He has tested negative for coronavirus but his lung CT scan has some COVID changes so we are treating him as positive until we can be sure.
He is a young man who was in hospital until just a few days ago. He took his own discharge against medical advice and left hospital in a hurry. He still has an intravenous cannula in place from that admission. We suspect he has been injecting drugs through it as he has come into hospital profoundly unconscious. He has done this sort of thing before. It looks like the likely coronavirus infection is coincidental. He is more stable this morning and we need to wake him up and take out his breathing tube.
The only problem is that he has a history of assaulting medical and nursing staff when he has been woken up before. Now on the whole, we do not expect gratitude for what we do from anyone, but we do expect to be able to do our jobs without being punched or kicked. We therefore do the only sensible thing and call Gary…
Gary is one of our hospital security supervisors. He is a lovely guy but he is ENOURMOUS. Kind of like mixing Geoff Capes with The Hulk only more fluffy and less green. Gary won ‘Britain’s Strongest Man over 40’ competition last year and has previously come third place in the ‘Europe’s Strongest Man’ competition. You get the picture.
His is an extremely reassuring presence in situations like these. Unfortunately, our patient is located in downtown Covidland and so Gary has to wear PPE. This is a problem. Like me, he has to wear one of the ventilated hood systems. This only serves to make him look even taller. Supplying him with a gown is more of an issue. Even a XXL gown will not fit. We soon discover that the only way we can cover his huge frame adequately is to get him to wear two of them – one worn forward and another one worn backwards!
Once our patient’s breathing tube is removed, Gary and his team remain present to ensure there is no monkey business. In a rare display of wisdom, the patient decides to remain placid. Very wise, given Gary’s many ‘powers of persuasion’.
The rest of the day goes well. The amount of time and effort it takes to do anything in Covidland is not to be underestimated. One of our patients who needs dialysis is having problems with vascular access. In order to undergo dialysis on the ICU you need what is called a Vascular Acccess Catheter or ‘Vas Cath’. These are very long, very thick cannulas that have to be inserted into large veins in the neck, the top of the chest or the groin. Our patient has had many of these and as a result he has developed blood clots that have blocked off most of these large veins. We are now at the point where we are no longer able to insert these lines at the bedside in the ICU. Instead we have to call our Radiology Consultant collegues who can insert such a line under ultrasound and x-ray guidance down in the radiology department.
This is normally straightforward but not anymore. We have to put PPE on in order to get the patient ready for transfer. We than have to remove that PPE before putting on new, clean PPE so we can transfer him to radiology without contaminating the rest of the hospital. We have to take him on the most convoluted route possible in order to minimise exposure to the ‘non-COVID’ part of the hospital whilst warning people to keep clear as we pass. Then we have to transfer him from his bed to the x-ray table, remove our PPE again before we can enter the ‘clean’ observation area to avoid unnecessary x-ray exposure. After my Radiology Consultant colleague, Dr Milburn has swiftly and deftly inserted the line we have to put new PPE back on before heading back to the ICU via an even more complicated route.
Finally we have to settle the patient back onto the ICU before ultimately removing our PPE and heading for the coffee-room for a much-needed cup of tea.
Blimey!