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  • Richard Cree

The Little Mermaid

Updated: Apr 9

Monday 30th March 2020 COVID Figures for 29 March UK Deaths 209 / Total 1228

James Cook Hospital cases - 70 James Cook Hospital Critical Care cases - 18 (3 suspected) / 11 ventilated Overslept so no time to cycle into work today. I’m back looking after the High Dependency Unit (HDU) again today and am surprised to find out that we have not admitted too many patients overnight although we are ‘keeping an eye’ on 4 patients via our Outreach team. Outreach is a team of enthusiastic, dedicated nurses who monitor sick patients on the wards throughout the hospital. They provide valuable advice to the ward staff and will let us know if any patient deteriorates such that they require our attention. They are being kept busy with a large group of patients who are not quite sick enough for Critical Care. The youngest of these is a gentleman in his 20’s, who is the youngest COVID patient we have seen to date. He has existing medical problems but the severity of his illness is still surprising given his age. He is holding his own for now and good medical care on the ward may yet save the day. My colleague Mark and I are called to the Cardiothoracic ICU where they are currently keeping the ‘regular’ non-COVID patients. One of the patients there is in their 40’s but has smoking-related vascular disease and has required major surgery. He developed a fever yesterday (which is not unusual in an ICU patient) and has subsequently tested COVID positive. Now he is infectious, a thorn between roses as it were, and needs to move. The transfer is of course, like everything else we do, a right pain in the arse as a result of having to don all the necessary PPE gear. We have to be especially careful not to liberate virus into the air from the breathing circuit whilst we disconnect from the ICU ventilator and transfer over to the transport ventilator. Hospital Security are deployed to clear the way as we travel between units. Their job is to ensure that any unsuspecting members of staff or public do not come anywhere near our infected patient. A modern-day leper bell if you like. We have no sooner have arrived in the COVID ICU before I am called to A&E in a hurry. There is a likely COVID patient who is being brought in by ambulance and we have been ‘pre-alerted’ they are in danger of suffering a cardio-respiratory arrest. We prepare ourselves quickly for their arrival and within a couple of minutes the whole team is poised at the front of the hospital, ready for action. The ambulance pulls up and out comes an unexpectedly chipper man in his 50’s who, it turns out, is nowhere near death’s door. He looks bemused at what appears to be the whole cast of the movie Contagion in costume before him. Sigh. After another couple of admissions we are now nearing capacity in our two COVID ICUs and need to implement the next step of our surge plan. We are taking over part of the paediatric ICU. Now I hate paediatric ICU. It has been a good many years since I have had to look after ventilated children. This is a good thing for two reasons: 1. I really don’t like it when children die. 2. I cannot stand the endless paintings and stickers of the Little Mermaid, those sodding Minions and that tedious snowman from Frozen which are to be found emblazoned on every wall and piece of equipment. There is something strangely unsettling having Buzz Lightyear winking at you whilst you are programming an infusion pump… The only good thing about paediatric wards in general is that there seems to be an endless supply of chocolates and you can usually find an X-box to play on (even if it is covered in My Little Pony stickers). Our next patient has fallen from a height and suffered a subdural haematoma (a brain haemorrhage). He needs to go to theatre and will need an HDU bed afterwards. He would normally go to the Neurosurgical HDU but because we are now treating every patient as potentially COVID positive until they are tested, he needs to come to us. This serves to swell our numbers more and we have an emergency planning meeting in the late afternoon to discuss where we expand next. By this stage we have admitted another COVID patient in his 60’s to the ICU and make the decision to transfer all the regular patients out of the HDU and turn it into COVID ICU number 4. By the time we seal off the HDU to allow for viral containment, we will have 37 COVID ICU beds in total. We are now at nearly 2.5x normal capacity and we are only getting started. I manage to get away a little earlier tonight and seeing as I’m driving, pick-up pizza from the good folk at Dominos. I have promised to cook more (a simple goal given how little I actually do cook) so I’m starting as I mean to go on.

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