Mountains

Monday 4th May 2020

COVID Figures for 3rd May

UK Deaths 315 / Total 28,446

James Cook Hospital – Total deaths – 189

I thought I would let you know how my friend Gary has been getting on over the past week. Gary has now been in an Intensive Care Unit in London for over 5 weeks after becoming horribly unwell with COVID pneumonitis.

For more detail, please see my previous post that summarises what he has been through –

https://www.nomoresurgeons.com/post/the-long-road-to-recovery

I am pleased to report that the infection that Gary was developing appears to have not caused much of a setback. He continues to make good progress, weaning from the ventilator and has got to the point where he can now breathe by himself for most of the day. He still needs the ventilator overnight but this represents fantastic progress. He has been communicating non-verbally but the nursing staff have had trouble trying to lip-read and understand him.

In an effort to restore his voice they have deflated the balloon cuff on his tracheostomy. This should allow some air to travel through his vocal cords so that he can talk. Unfortunately due to a combination of Gary still being very weak and the tracheostomy tube being a reasonable size, he cannot talk very well and is very quiet and difficult to understand.

He has been having swallowing difficulties, again in part due to his weakness and the effect that the tracheostomy has on his adjacent oesophagus. He is therefore still tube fed.

Gary’s weakness is due to a number of factors. In part it is due to the effects of being unconscious and bed-bound for weeks. Part of it is due to the kidney failure that he suffered but it is also due to his illness directly affecting his muscles and nerves. This is called Critical Illness Polyneuropathy (when nerves are involved) and Critical Illness Myopathy (when it affects muscles). The exact causes of these conditions are unknown but they are due to the inflammatory effects of severe systemic illness, possibly exacerbated by some of the drugs used in ICU. There is considerable overlap between the two syndromes. Whether there is a direct coronavirus effect as well we do not know. There is no specific treatment, just time and physiotherapy. Most patients will make a full recovery although there will be a long period of rehabilitation.

Gary’s wife Jenni called to ask if I could speak to him. This could be done through one of the Lifelines tablets that I have talked about previously. Jenni explained that Gary was now completely aware of his surroundings and his situation and had become worried how weak he was, that he was unable to swallow and couldn’t talk. He was understandably concerned that this could be a permanent situation and wanted reassurance. He has previously stated that if he was ever severely disabled as a result of illness that he would not want heroic medical attempts to prolong his life; he was frightened that this is what had happened.

I had to download the secure app on my phone and then register. Once completed, I had been listed as one of Gary’s ‘contacts’ and then could text Or take audio or video calls.

A few minutes later, Gary’s nurse called and there he was on screen before me. Now, I am used to seeing people who have survived long stays in ICU but it’s different when it’s close to home. Gary was very pale, gaunt and looked extremely frail. He smiled faintly when he recognised me and began talking to me but neither I nor the nurse could understand exactly what he was saying.

I told him how good it was to see him and how pleased I was with the progress he was making. I told him that none of his current frailty, weakness or other problems would be permanent and that he would be able to recover to get his life back. I told him that this would take an awfully long time, that it would be a year to 18 months before he would stop improving.

I’d like to say that he looked reassured but he just nodded and then said something that I and the nurse couldn’t hear. The nurse asked him to repeat it and she told me that he was asking how I, Nicky and the children were. I told him that we had been busy at work but were all in good health.

Gary’s nurse was great. I asked her to pass on my thanks to all her colleagues for all their hard work in looking after Gary. After a few more minutes, the nurse suggested that we had probably talked enough.

Gary and I became friends through mountain biking. He is a strong rider and is always at the front of the steepest climbs. I joked that he would probably need an e-bike for a while until he got his strength back. He looked at me, smiled weakly, slowly shook his head and clearly mouthed the word ‘NEVER!’

Gary has a mountain to climb but he’s good at that. In that one moment I knew that if anyone could do it, he could.