Round Two

Tuesday 24th March 2020

Briefly saw Nicky, my wife, for a few minutes at handover before heading home after my first night shift. Nicky is also an Intensive Care Consultant working in the same department as I do. This creates some unique problems as we try to plan for the next few hectic months.

At home, I found the kids all at the kitchen table doing the 'homework' that the school has set them. Rather impressed with them and tell them so. They look pleased!

We have three children: Millie is 13, Jamie is 12 and Sophie is 10. We are trying to avoid sending them to school, despite the fact that we are both 'key-workers'. There appear to be so many children that are authorised to remain in school that one begins to doubt the efficacy of the 'social distancing' policy that caused them to close. We would rather they don't mix with other children in order to avoid infecting us. Nicky and I are resigned to being infected at work at some point but would rather it happens later rather than sooner. We want to try to stay well so we can cope with the peak surge in COVID cases that we should see over the next 3-4 weeks. This will sometimes involve leaving the children at home for 15 hours at a time but so be it.

I return to work in the evening again. I am enjoying the lack of traffic in town and use the opportunity to set a few personal records on Strava. Upon arrival I head for the hospital restaurant. It is now closed to visitors but is open late for staff. There is no longer any charge for food and drink and I sit eating chilli and rice whilst we handover cases.

Mercifully, things appear much quieter than last night. I have told one of my colleagues that we don't need him for the time being and send Tim home after a couple of hours. That leaves Matt and I minding the shop. We have an interesting case down in A&E Resus: A man in his early thirties appears to have had a severe stroke. He has abnormal blood vessels at the base of his brain (probably congenital) and some of the other vessels have taken up the slack in delivering blood to his brainstem. Something has gone wrong with this compensatory blood flow and he is now profoundly comatose. Given that this is Middlesbrough I assume its because he has taken cocaine, although there is no evidence for this. Matt chides me for my cynicism and points out that the patient‘s partner is COVID-positive. Perhaps Coronavirus can cause vasopspasm and is indirectly responsible for the stroke?

He has already been intubated and ventilated and so is taken up to an isolation room in ICU. The prognosis is guarded. There is nothing we can do for him except give him aspirin to prevent further strokes and see what degree of brain damage he has suffered.

I wander around reviewing patients, drinking tea and snacking before getting bored and retreating to my office. There is a ridiculous amount of COVID correspondance in my inbox and I spend a few hours sorting the wheat from the chaff.

It is still surprisingly quiet by 0100hrs so I leave Matt to it and head to bed. Overnight Matt rings to discuss a couple of cases that need our attention. Both are COVID patients. The first is a gentleman in his 60s who has been in hospital for a couple of days. He has now developed worsening respiratory failure and is no longer safe on the ward. His initial COVID test was negative but we are finding out that they are unreliable and that as many as 20-25% of tests will not detect the virus despite the patient being positive.

We admit him to an isolation room until we get the results of another test. He certainly looks like a COVID patient so will be very surprised if he doesn't ultimately test positive. We start him on CPAP (Continous Positive Airway Pressure) delivered by an oxygen hood that the patient wears. There is a pressure valve on the expiratory port so that pressure remains within the alveoli (lung air sacs) at the end of each breath. This means the alveoli don't close completely so it's less work to re-expand them when breathing in. He seems to be doing OK for now.

The second patient is an 81 year old chap who is in good health but has come in a few hours ago. He is hanging on in there but his breathing is deteriorating fast. Again, we are certain that he is COVID positive based on his history and chest X-ray but are still waiting for the test results. We move him to the other isolation room and stick him on CPAP as well. We are worried that he will soon need intubating and ventilating.

The hospital is starting to fill with these patients and at handover the next morning we decide to empty the second ICU and turn that into a COVID unit in preparation for the patients that are coming soon. We decant the non-COVID patients to the Cardiothoracic ICU which has scaled back its elective workload to allow for this. We are now in a situation where all the intensive care units will soon be full. We are ventilating on our High Dependency Unit but once we fill that we will have to move elsewhere...

Time to head home. A surprisingly quiet shift and I'm now not back in the hospital for a few days unless the situation really gets out of hand.