Friday 17th July 2020
Figures for 16th July
UK COVID Deaths 66 / Total 45,167
James Cook Hospital – Total COVID deaths – 254
All COVID cases within South Tees Hospitals Trust – 5
James Cook Critical Care COVID cases – 1 ventilated
James Cook Critical Care non-COVID cases – 43
The last few days at work have been busier than expected. Our single COVID patient is slowly recovering and we have not had any COVID-related deaths at the hospital for over two weeks. We have seen many more ‘regular’ patients and have come close to running out of Intensive Care beds on more than one occasion. When this happens we have to start thinking about where we can look after any new patient until an ICU bed becomes available.
At any one time we have a handful of patients who could be transferred to the ward. Sometimes discharging them can take longer than we would like due to logistical delays. These delays can sometimes last hours or even days when the hospital is busy. If there’s no bed immediately available we cannot admit a new patient.
If the new patient is in a location like Accident and Emergency then a short delay isn’t a huge problem as we can remain where we are and provide Intensive Care in the Resuscitation Room. If the location is a ward then providing ICU care can be challenging. Under these situations we are forced to find an environment that can cope with the demands of looking after a very sick patient.
Invariably this means transferring the patient to the Theatre Recovery area. This is where patients awaken following an operation. Most of the patients here are just routinely observed but the staff have experience of dealing with some very sick patients who have undergone emergency surgery. The staffing levels and equipment make it the best place in the hospital to act as a surrogate ICU.
That’s not to say that the situation is desirable; ICU patients in Recovery require extra theatre and ICU staff to look after them, they may delay routine surgery and at the moment their presence turns the whole area into a PPE zone.
It’s far from a surprising revelation that we simply do not have enough Intensive Care beds for our workload. Now that the COVID threat has diminsihed we have returned to our regular ‘footprint’ and are beginning to struggle with finding space for every patient who needs our help.
The most frustrating part of any ICU Consultant’s job is spending a significant portion of each day trying to balance the discharge of existing patients against the need to admit new ones. There are times when it is soul-destroying/ These are usually the days when you are needed in several parts of the hospital at the same time and resent any time wasted on the telephone or in bed-meetings trying to make the system work.
Oddly enough we were able to forget about all this during the COVID surge as we were presented with resources the like of which we had never seen before. Nurses were coming out of the woodwork and we were opening new beds left, right and centre. Of course this was only made possible by the fact that the rest of the hospital had ground to a complete halt and COVID-19 became the only game in town.
Only three months later, we have found that we had all forgotten about juggling beds and had just concentrated on seeing patients. The resumption of this ‘regular service’ has, to be honest, depressed us all.
The one thing that did put a smile on my face the other day was the arrival of a Home Ventilation patient onto the ICU. The Regional Home Ventilation Service looks after patients in the North of England who require long-term ventilation in the community. These patients have chronic health problems that mean they are not able to breathe adequately. Most have neuromuscular problems like muscular dystrophy or a high spinal cord injury, such that they cannot use their breathing muscles properly.
Most of their patients only require overnight ventilation via a face mask but there are a few who require full-time ventilation via a tracheostomy. They use special community ventilators that are portable, allowing these patients a degree of independence. When they are admitted to hospital they need to stay in a clinical area that is familiar with these ventilators. Often this means they have to stay with us, even if their problem would not normally require admission to ICU.
A couple of days ago we were expecting such a patient who required some fairly straightforward adjustments to their medication and some close observation for a short while. We were expecting them to be delivered by the ambulance crew as usual but were amazed to witness the patient enter the ICU on their mobility scooter, complete with their portable ventilator riding shotgun.
I immediately saw an opportunity to earn some extra pocket-money and asked them if they were interested in our valet parking service. I was also hoping to have a little play on the scooter but the patient clearly saw straight through me. They insisted on parking the scooter themselves and hiding the keys. Attempts to hot-wire the vehicle proved fruitless and so I was forced to finish my ward-round on foot.
I have promised my eldest daughter that I would post a picture of the cake she baked today. She’s rightly pleased with her ‘showstopper’ and I can testify that it tastes as good as it looks. It’s a caramel rocky-road cake and diabetes is guaranteed with every slice.
We now have two weeks off work and are off on holiday tomorrow. Thanks to COVID-19, we have had to change our plans and are staying in the UK. Nicky and I are both in desperate need of a holiday so are looking forward to putting our feet up for a while, if the children let us.
And yes, the cake is coming too.