Tuesday 7th April 2020
COVID Figures for 6th April
UK Hospital Deaths 439 / Total 5373
James Cook Hospital – Total deaths – 59
James Cook cases on wards – 110
James Cook cases in Critical Care – 20 / 10 ventilated
I’m looking after the emergency admissions to Critical Care again today. The one thing everyone is talking about is Boris Johnson’s admission to Intensive Care at St Thomas' Hospital. I am getting fed up with being asked whether I think he will end up on a ventilator. As if I would have any better idea than they do, given the complete absence of any clinical information?
What I can say is that it is highly likely he will have been moved to the ICU earlier than most patients. This will partly be for security reasons as the ICU is an easier place to limit access and make secure compared to most hospital wards. I remember when US President George Bush visited Sedgefield back in 2003. We were to be the receiving hospital in the event of any untoward medical incident. Our isolation room on ICU 2 was chosen as the most secure place where the President would be admitted, even if he did not require intensive care. One of our Senior Sisters politely asked what would happen if someone was already in the room for medical reasons. She was told firmly by the intimidating Secret Service Agent: “That will not be a problem, Ma’am”
In the end, Mr Bush’s visit passed without incident and we didn’t get to meet him. As far as I can recall, the only dignitary we have ever had visit the ICU was Prince Andrew, many years ago now. There’s a plaque somewhere. Although, now that I come to think of it, I haven’t seen it in a while…
Joking aside, Boris is now in a similar position as countless other patients we have in our hospital: stuck in an isolation room, breathless and frightened. I suspect that unlike our patients, the Prime Minister will not be left by himself. He may even be allowed the odd visitor, which will make his plight more bearable than most of our patients at the moment.
On the wards, the situation remains busy but calm. The Outreach team are continuing to 'name' the Trilogy Ventilator/CPAP machines we have lent to the wards to make sure we don't loose them.
We are referred a number of suspected COVID patients over the course of the day who are between the ages of 40 to 80. This is not as many patients as were expecting and is due to the excellent work being done by the Acute Medicine team. They are managing their patients very well and are only referring those patients that they believe would benefit from Intensive Care support. What this means is that those patients who are frail, elderly and have existing severe medical conditions are initially treated aggressively to see if they respond. If treatments like high-flow oxygen or CPAP fail, then as I have discussed before, further attempts at treatment in the Intensive Care treatment cannot help them. Such patients are allowed to die peacefully, in comfort and, unlike on the ICU, with a family member present.
The only non-COVID patients I got to see today were those on the Spinal Injuries High Dependency Unit (HDU). James Cook is the site of the Regional Spinal Injuries Service and receives, treats and rehabilitates spinal injury patients from across the North of England. Sadly, many of the patients who have broken their necks and have a high spinal cord injury are unable to breathe properly due to muscle weakness.
We have previously stolen all their usual ventilators. They had four proper ICU ventilators, (not things that have been knocked up by a Formula 1 Team or vacuum cleaner company) and we need them elsewhere. They are having to use what are called ‘home’ or ‘community’ ventilators, the sort that patients can take home with them if they are left with long-term breathing issues. However, these are still pretty capable machines and are more than up to the job.
I planned to review the patients and check everything was OK. However I soon found out that the Spinal HDU and indeed, the whole Spinal Injuries Centre had isolated itself from the rest of the hospital. There was a red and white chain across the corridor with a ‘Danger Keep Out’ sign. My ID swipe card wouldn’t work and I was told that I had to walk around to the main entrance before they would consider letting me in. One of the porters suggested that they must have a huge stockpile of toilet roll hidden inside. By the time I worked my way around to the main entrance I was expecting to have to swim a crocodile-infested moat before gaining entry but it turns out the establishment was guarded by just one (rather fierce) receptionist.
Eventually I got inside and determined that all was well. It turns out that, rather than bunkering down for the Zombie Apocalypse, they are trying to protect their vulnerable patients from potentially infected staff (like me) who might wander through on the way to elsewhere.
I returned to the ICU, tactfully taking the long-way around, and attended another planning meeting. We currently have enough Intensive Care beds for COVID patients but to our surprise, are having to create space for more of the ‘regular’ non-COVID ICU cases. More on that tomorrow.
To CPAP and beyond....
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