Medicine during COVID
I have been asked how medicine is practised differently under the threat of COVID. The intensive care unit is perhaps the most vivid with the department. it is split into three main areas.
The patient area that requires gowning and gloving to enter. The gowns are running out so it’s now what looks like a modified garbage bag with a plastic apron worn back to front to cover the back. The Parisian catwalk look is completed with a headcover slouched beret style over one eye and a full face visor.
The nurses are bearing the brunt. They are splitting shifts to avoid spending all day in stifling heat with waterproof clothes that do not breathe. You can barely hear when we talk masks and visors. Some put their names on the front of their gowns, however, most people are more recognisable by their eyes than you would think.
The intermediate area is a half dirty layer. Staff wear face masks to protect against aerosols generated from the patients leaking out when doors are opened. We also wear scrubs and wash our hands until they are red. You have to imagine that every surface is coated in an invisible layer of viral dust. Staff here are servicing the patient facing nurses – communicating using a walky talky or by writing onto a whiteboard outside each room. Drugs and equipment are left outside the doors which are opened and closed quickly when things are retrieved.
The clean area is furthest from the patients and is ‘sealed’ off by the plastic curtains that we used to see at butchers in the old days. They are cleaned frequently but everyone hates going through them as they psychologically feel dirty because everyone has to touch them. Also, no matter how you try to squeeze through them, they drape all over you like a dead octopus. Once through, we really only have the staff round to unwind.
Each day starts with a handover round where the night team hands over to the day team – each patient is well known by now so only the ‘highlights’ are shared.
The board round follows. Doctors sit with pharmacists, specialist nurses and dieticians going through each patient laboriously. Intensive care is about detail but also trying to join up the picture from multiple perspectives. In trying to help one organ system, it is common to create problems for another organ. Today this leads to yet another debate over how ‘wet’ to run the patients – or in other words how much fluid to give them. Walky talkies are used to relay observations from bedside doctors, and orders from the clean side team who use specialist software and telemetry to build a complete picture of the patient. Because these are civilian radios, we need to use bed numbers to refer to patients. The junior staff have ‘given’ everybody code names. Today these are in the style of top gun. X-Men is another favoured cultural reference.
The unit is full so the ward round finishes at about 14.00. Time for a quick bite of all the donated food – today is a delicious Thai green curry and an unhealthy quantity of Easter egg. The afternoon is soon filled with calls to patient relatives – always difficult although most of the staff have spoken to each family more than a few times. The main topic of conversation today seems to be how to get mobile phones to patients who simply cannot be visited. We aren’t sure whether patients will really be able to respond or if their obvious confusion will simply alarm rather than comfort relatives.
The late afternoon is typically filled with procedures. These can include central lines that feed into the large veins leading into the heart and allow multiple medicines to be given simultaneously; arterial lines that directly measure the blood pressure second on second; and tracheostomies which are breathing tubes that patients can tolerate without needing sedation and hence enable patients to move off ventilators. The afternoon also sees many of the transfers to and from other units to balance capacity – some units ran out of dialysis machines and proper intensive care ventilators early. Almost everybody is ventilating some patients using machines from operating theatres.
We finish off the afternoon by updating our handover sheet and handing back over to the night shift. These meetings are typically filled with humour and there is a comforting family-like atmosphere since there are only two shifts and the people you took over from in the morning are now slept and ready for another night.
The drive home is fantastic. The weather is good. There is NO traffic. Windows down, stereo on.