Saturday 4th July 2020
Figures for 3rd July
UK COVID Deaths 137 / Total 44,131
James Cook Hospital – Total COVID deaths – 254
All COVID cases within South Tees Hospitals Trust – 6
James Cook Critical Care COVID cases – 3 (2 ventilated)
James Cook Critical Care non-COVID cases – 46
The pubs have been open since this morning, but by the time I left work tonight I hadn’t seen a single alcohol-related admission. I thought I’d get that out of the way from the start. I know the night is still young but when I visited A&E prior to leaving this evening, things seemed relatively calm.
The other piece of good news is that the hospital has not seen a COVID-related death in over a week. This is the longest period of time without a death since the pandemic began in March. The number of COVID cases within the Trust also remains low.
We have seen a number of patients today with problems ranging from a ruptured thoracic aneurysm, heart failure, pneumonia and a patient requiring ICU admission following surgery for a bowel perforation. My registrar, Allan and I performed a tracheostomy in the afternoon after my colleagues and I had found the time to sit outside the WRVS Coffee Shop and have lunch.
Allan and I then took one of our middle-aged patients for a CT scan which confirmed that he had suffered a large, devastating stroke. The damage was so extensive that it was not possible for him to survive and we needed to let his family know that, sadly, there was nothing more that we could do to help him.
I still find breaking such news over the telephone very difficult. It has been a week or so since I have had to do this and such conversations are now much less common than they were during the COVID surge. However, it’s easy to forget how woefully inadequate telephone or video communication is when compared to being there in person.
We are still not allowing visitors into the Intensive Care Unit routinely. The only time that family are permitted to visit is when we have to withdraw ICU support because the patient is dying. We have previously had to transfer a patient out of the ICU and to a ward in order for this to happen but have now been granted permission for a family member to visit the ICU. This is better for the patient as it means the same team of nurses and doctors can continue to care for them. It also means that, for those patients who were too unstable to be transferred to the ward, their family can still get to see them at the end.
Family members have to be made aware that there is a small risk of infection associated with them visiting, even when the patients in the ICU have tested negative for the coronavirus. We supply them with PPE but are unable to properly ‘fit-test’ them to ensure the masks are totally protective.
The other significant concern is to ensure that the relatives don’t enter the unit when they may be infected. We clearly need to protect the other ICU patients from contracting COVID-19. The family members are screened and are not allowed to visit if they are unwell or have been near anyone else who has been ill and/or tested positive.
My patient’s family arrived a short while later and I was finally able to talk to them in person, albeit behind the screen of my PPE system. It now seemed much easier to attempt to convey how sorry I was about the dreadful situation they found themselves in. I know it sounds daft but I also miss being able to offer family members a cup of tea when I am giving them bad news. There’s something about this simple act that manages to convey sympathy in a way that words sometimes cannot.
So it was, in some ways, a better day than I was expecting but I certainly didn’t feel like going out and celebrating anything on my way home.