13th January 2021
UK COVID Deaths – Daily 1564 / 7-Day average 1060
Total UK COVID Deaths within 28 days – 84,767
Total UK Deaths with COVID-19 on the death certificate – 89,243 (up to 1st Jan)
James Cook Hospital – Total COVID deaths – 427
All COVID cases within South Tees Hospitals Trust – 208
James Cook Critical Care
COVID cases – 31 (16 ventilated)
Non-COVID cases – 30 (10 ventilated)
Yesterday got off to a bad start when I was hit by a car on my way into work. I was on my bike after mistakenly thinking the roads weren’t that icy. I’d only ridden a few miles when I realised that I’d made a rather stupid mistake. I was just thinking I should turn around when I lost the front wheel on a bend and hit the ground. Unfortunately, the car behind me also lost control and hit me. Fortunately, I only received a glancing blow and escaped with just cuts and bruises, some ruined cycle clothing and a dent to my pride.
It was immediately obvious that I hadn’t done anything serious which was a huge relief to both me and the driver who was pretty shaken up after running me over. I was more relieved that I didn’t have to suffer the embarrassment of attending my own hospital’s A&E department for yet another cycling accident. I gingerly made my way home, cleaned and dressed my wounds in the sloppy way that only doctors can, before heading to work in the car instead. By now it was getting lighter and it was only whilst driving in the daylight that I realised what an idiot I’d been. The roads were horribly icy and I soon realised I’d done pretty well to get as far as I did before coming a cropper.
I had been tempted to think that the day might not get any worse, but I was about to be proved very wrong. The hospital had experienced a hectic night and a total of 47 COVID patients had been admitted in the preceding 24 hours. I joined the Outreach team to review the CPAP patients on the wards. We quickly identified a couple of patients who were not looking particularly great. Worried that they might soon need intubating and ventilating, we arranged for them to be transferred to the ICU. Unfortunately, they had to join an already growing queue. There was a gentleman on one of the surgical wards with severe pancreatitis who had dibs on the first available bed and even as we were deciding in what order to admit the others, yet another COVID patient arrived in extremis requiring our attention before joining the others in an ICU holding pattern.
Over the last couple of weeks, I have been struck by the fact that a lot of the COVID patients seem to be younger than those we saw during the first wave. It’s possible that this perception may be inaccurate or just a coincidence as there is not yet any definite evidence that younger patients are becoming sicker. However, it is something that many of us are noticing and commenting on.
Not surprisingly, finding staffed ICU beds is becoming more and more of a problem. We ran out of ICU nurses some days ago and no longer have enough to allocate one trained ICU nurse to each patient. We are receiving help from a large group of theatre nurses who have been redeployed to the ICU. This means that one ICU nurse can look after two patients with the help of our new recruits. The ‘new guys’ are very fresh and enthusiastic in a way that the rest of us are not. Their arrival has only served to bring into sharp focus just how weary we all are.
I was on the telephone to the ‘ICU Command’ team, trying to find beds when I received a page from Emma, my registrar, to let me know that the A&E Resus Room had just received two Red Trauma Calls. It will come as no surprise to learn that a Red Trauma Call is not a good thing – either for the unfortunate patient or for us. They announce the imminent arrival of a patient with life-threatening injuries. If they have not already been intubated and ventilated by the helicopter emergency medical team, then they are likely to need intubation by us and subsequent ICU admission. Both cases were road-traffic accidents and both were already intubated and ventilated by the time I arrived in the Resus Room. One of my Anaesthetic Consultant colleagues, Jeff, had arrived to help and both patients had already received their trauma CT scans. Both patients had head injuries and fractures but neither required imminent surgery. They had already been placed in protective, ventilated comas in order to limit any subsequent neurological damage and their conditions were fairly stable. They needed arterial and central line insertion and various other procedures but this could all be done down in the Resus Room until such time as an ICU bed would be available. The A&E staff worked around us like a well-oiled machine ensuring that everything was done in a slick and timely fashion.
Whilst we were doing all this, another young patient was brought into Resus, having arrived by ambulance. They had been found unconscious at home and were showing signs of liver failure and septicaemia. By this time, our numbers had been bolstered by the arrival of Dave, one of the anaesthetic registrars and Shaun, another of my anaesthetic consultant colleagues who helped to look after the existing patients whilst I intubated and ventilated the new one.
Whilst I was doing this, a fourth patient arrived. It was yet another trauma patient who, apparently had fallen downstairs and was now unconscious. However, they too, also looked like they had septicaemia and were barely conscious as a result. What role any fall had played was doubtful. Once again, the patient needed intubating and ventilating before undergoing a CT scan and I left Emma, Dave and Shaun whilst I headed to the Command Room in order to try to find beds. The Resus Room was now completely full, meaning we could no longer admit trauma patients to the hospital. This was a pretty serious situation and needed resolving quickly.
Fortunately, the Great North Air Ambulance Service had already diverted another two trauma patients to Newcastle instead. It would appear that the Newcastle hospitals are the only ones in the Northern Region that have any regular ICU beds left. This bought us a bit of time, allowing us to keep our heads above water and attempt to clear the Resus Room.
Visiting the ICU Command Room in person turned out to be a cunning plan. They had been hard at work trying to identify beds for the ‘resus four’. My colleagues looking after the ICUs had been able to discharge some recovering patients to the wards and a couple of other patients had sadly died, but this did mean that we would soon have beds.
However, as good as this news was, it wasn’t as good as discovering that I had stumbled onto Annie’s retirement ‘party’. I use the term ‘party’ loosely as it was a handful of staff trying to say their goodbyes in the middle of a Critical Care meltdown. Still, there was cake, which was exactly what I needed at that moment.
Annie is one of our Sisters and has been working in ICU at South Tees since 1988. Her retirement has been planned long before the pandemic started and there are reasons why she is unable to continue working. The last few shifts she has worked have been the busiest of her life and she is relieved to be going. Over the next few months she intends to spend some of her time vaccinating the people of Teesside. Needless to say, she will be greatly missed.
The pandemic has redefined what we mean by the word ‘busy’ but even by these new standards, it had been a pretty hectic day. At least by the time I left the hospital, the situation had moved from ‘totally out of control’ toward ‘marginally out of control’. Success! I headed home and opened a much-needed beer. Dry January? Pah!