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  • Richard Cree

Late Finish

Updated: Apr 23

Wednesday 22nd April 2020

COVID Figures for 21st April

UK Hospital Deaths 823 / Total 17,337

James Cook Hospital – Total deaths – 142

James Cook cases in Critical Care – 19 / 9 ventilated

The day started well. The first two patients I saw on the ICU had recovered from their coronavirus infections. They had both been ventilated but were now breathing spontaneously and were ready to go to the ward.

The rest of the patients all had kidney failure. We have grouped together all our patients who require dialysis on one ICU. We are getting short on dialysis fluid for our ICU machines and are having to rely on the dialysis machines used on the ward. We need specialist dialysis nurses to run these and having the patients all together makes things a lot easier.

Kidney failure is a marker of illness severity. Yesterday I reported that nationally, 80% of COVID patients who develop kidney failure will not survive.

One of our patients is a gentleman in his 60’s with COVID pneumonitis and significant underlying health problems. He has been in the ICU for over two weeks now and his condition has slowly worsened. A week ago he developed kidney failure which failed to improve despite everything we tried. By today it was clear that he could no longer survive and that our attempts to try to prolong his life were causing discomfort and distress.

We made the decision to withdraw ventilator support and I spoke to his wife over the telephone. During the past weeks, she has not been able to visit her husband. Communication between us has all been by telephone and today was no exception. Breaking and receiving news such as this is difficult enough when done in person, it is much worse when done remotely.

We told her that, after ensuring he was comfortable, we would remove the breathing tube and transfer him to a side-room on the ward. The wards can allow a dying patient one visitor, something that we cannot do in Critical Care.

After weeks on the ICU the best we could offer was that his wife would be allowed to be with him whilst he died. I apologised that all our efforts had ultimately failed to make any difference to the course of his illness.

Transferring a patient out to the ward at such a time is not something we usually do. Our staffing levels allow one nurse to care for a single patient; our nursing staff would normally continue to care for dying patients with the same degree of skill and compassion as they had previously. The pandemic has changed all that. Now transfer to the ward is the only way to allow family members to spend time with their loved ones.

I arranged to meet his wife at the entrance to the hospital and escorted her to the ward. I then returned to the ICU where Juliette, one of our most experienced nurses, removed the patient’s breathing tube before we transferred him to the ward. Once there, Juliette would stay behind to care for him.

We both watched as our patient’s wife entered the room, sat down next to him in the chair and held his hand.

There are times when, despite how hardened and jaded you have become, the enormity of the situation comes crashing down on you. This was one of those times. There was nothing else I could do. I apologised again that we were not able to help her husband and left.

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