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From the COVID front line

Written by Dr Sanjiv Nichani, Consultant Paediatrician

I spent the day on Thursday last week at the Glenfield Hospital in Leicester on the Unit where I normally work i.e. the Children’s Intensive Care Unit which has been handed over to my Adult Intensive Care colleagues in order to help them care for the sheer number of adults being overwhelmed by the Coronavirus.

It was a strange experience to see 12 critically ill adults in beds where we normally look after children following cardiac surgery at the East Midlands Congenital Heart Centre. However these are exceptional times.

The COVID disease and process is something I have never witnessed before, the lengths to which all the staff must go to protect themselves from this tiny but deadly microbe which faces an existential threat if it doesn’t come into contact with humans.

Quite an irony given what it is doing to the human race.

As I entered the Intensive Care Unit (ICU) through what is normally the parent’s entrance I noticed that the whole parent’s area had been turned into the command and control centre.

It was a hive of activity

In addition a section of The Command and Control area also functioned as the staff room where staff would come back from the ICU to take a break and would get brief respite from the life and death battle that they were immersed in .

All staff who were working on the ICU entered through this newly configured area whose pivotal function was to don the staff in the protective layers of PPE in the right order to ensure that the virus stays exactly where it should be and that is away from the healthcare worker.

This crucial role is performed by either a healthcare assistant or a nurse who take extreme care to ensure that the virus had no chance of entering the body of their colleagues who they were literally dressing for battle.

The PPE looks exactly like what has been seen on television so many times.

Humour that essential human emotion, necessary to keep spirits up was alive and present, as every time a time a nurse or doctor was kitted out, not only did they have their names and roles scribbled on their protective gowns but very quickly acquired nick names as well.

It really doesn’t take long and everyone in the vicinity breaks out into a smile lightening the mood before each team member now donned enters the fray.

Once donned properly the doctor or nurse enters a holding area called the warm zone through a set of double doors .This warm zone is in turn separated from the ICU by another set of double doors.

The warm zone protects the Command and Control centre from the ITU and only if the door to the Command and Control centre is closed can the door to the ITU be opened.

Once I entered the clinical arena, I felt like I was on a Hollywood film set except that this is no tale of fiction but a deadly serious battle for life and death.

Communication between the ITU and the team outside is maintained with the help of a walkie talkie and there is a runner at the end of each walkie talkie fetching essential pieces of equipment throughout the shift.

Even the passing of this equipment between the control centre and the ICU via the warm zone needs to be coordinated and performed very strategically and safely in order that the deadly COVID stays in the ITU.

The ICU itself consists of a central nursing station positioned in the middle of the Unit which gives the medical and nursing team a view of all the patients on the Unit.

As I entered the ICU, I observed that the atmosphere was serious but calm.

Everyone donned in their PPE were going about their jobs with a quiet efficiency and dignity, infact the functioning of the beehive came to mind.

The nurses perform essential and delicate nursing tasks, making crucial observations on their patients relaying these vital signs to the medical team who literally make life and death decisions based on that information.

Most patients have one nurse by their bedside and that nurse will spend the next 12 hours caring for their allocated patient making life changing alterations and interventions.

The doctors will round on all patients twice a day leading changes in treatment and responding to the varying clinical needs of each patient.

Each patient is in a different stage of their illness, most of them are attached to a breathing machine or ventilator that is supporting their lungs which have been significantly damaged by this deadly virus.

There are numerous pieces of equipment in the ITU, one called a monitor provides live, real time information of each patient’s condition and another machine called a syringe pump infuses or injects precise and exact amounts of medicines loaded onto a syringe into the circulation of each patient.

Each of these medicines supports a vital function of the body of the patient whose own ability to function without such medical help has clearly been compromised by the virus.

Many of the patients are lying on their stomachs or prone as it called in medical parlance as that method of nursing has been shown to be beneficial to the recovery of the lungs from this viral onslaught.

However the task of turning these heavily sedated patients onto their abdomen’s is a tricky and difficult one, albeit one that must be performed atleast once a day due to beneficial effect.

To turn one patient requires between 6-8 members of staff and demonstrates teamwork at its best.

The patient who needs to be turned is heavily sedated due to being on a ventilator which has made them ‘lifeless’ pardon the pun, literally a dead weight as they are not conscious and have very little muscle tone.

Turning the patient prone requires planning and coordination and a doctor standing at the head of the bed is in charge of leading the process as well as ensuring that the crucial breathing tube through which the patient is attached to a ventilator, doesn’t fall out.

If that were to happen that would potentially be catastrophic for the patient.

The patient is turned on the count of 3 from the leader with 3 nurses or doctors on either side of the patient flipping the patient over.

It’s worth remembering that the patient stays prone for between 12 -16 hours per day and then has to be flipped onto his or her back with the same care and diligence.

This is teamwork at its best.

Some patients amongst those admitted to the ITU are in the recovery phase having fought off this deadly virus which means that the ITU is inevitably associated with a whole range of emotions from joy to hope to sorrow to despair.

COVID 19 is a brutal virus and is a type of infection that most of us have never faced before either as treating doctors or indeed as patients.

Yet as the battle lines are drawn and despite significant odds in favour of this invisible enemy, the staff are resolute, good spirited and indefatigable.

They are good humoured despite being trapped in multiple layers of protective clothing which leads to excessive sweating and dehydration with minimal times for breaks.

The staff come out of the unit into the staff room hot and flushed with marks on their faces not just etched by the protective goggles and face masks but etched with worry that many of the patients they are caring for are facing an uphill struggle.

And when the wife and son of a patient are brought into say good bye to their loved one who has tragically lost his battle for life the fatigue vanishes and one of the team leap up to comfort this family in their darkest hour, their fatigue and discomfort suddenly forgotten.

After the short half hour when they are at break, allowed to breath easily without their protective ensemble on, during which time they also rehydrate themselves whilst quickly scoffing down a sandwich or some kindly donated food they take a deep breath, don their protective gear again and rejoin the battle.

This is human spirit, kindness and endeavour at its best against this invisible killer and like the rest of the country I salute my colleagues in the NHS and other essential services.


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