On my nine-mile drive to work at Cardiff. It’s already an odd morning. I packed my car with a sleeping bag, roll-matt, food, toothpaste and clothes, because I’m not sure when I’m going to be coming home again. The COVID-19 outbreak has changed everything.
My wife Alison is very upset. Last night, I sent her an email entitled: ‘things you should know in case I die.’ I left my passwords and the location of important documents, but I also wrote the following; ‘I have had a bloody wonderful life, travelled, partied, had two amazing children, spent time with friends, family, and done things I never dreamed of. I love my job even though it can be hard and dangerous. Touching the lives of others is the best feeling in the world.’
I’m not scared – the word I would use is ‘uncertain’. There are so many unknown unknowns with this virus. Full-to-the-brim of the news, I switch off Radio 4, and put on Mellow Magic FM.
The start of my standard 13-hour shift. The first challenge is where to go, physically. For the last week there have been changes in the localities of the beds in ICU, and a special, large ward has opened for those suffering from COVID-19, or about to be tested.
At Cardiff, we are on fire making plans. As far as infections go, we are about a week behind London, but we are the biggest ICU in Wales, so expect a big rise in patients. As we do everyday, the staff have a meeting to talk about all the patients on the ward, but all people want to talk about is COVID. I have a coffee, put on my protective clothing, and get to work.
We have one patient being treated in ICU for Coronavirus. I go and check him to make sure his ventilator is helping him as best it can. It’s also important to check he is lying on his front for ‘Prone Ventilation’. Evidence suggests that this position is the best for helping the lungs extract oxygen. Sixteen hours out of 24 on the front, but no more – or the patient will get pressure sores.
When I leave his room, I remove my sweaty, uncomfortable protective clothing – gown, gloves, and a specific mask which filters viruses. If I do things in the wrong order, or touch my face with my hands, the greatest mask in the world will not save me. I take my mask off at the back, throw in in the bin with one smooth motion, and wash my hands. We developed this method during the Ebola scare, and use in now during seasonal flu outbreaks. It takes practice, and staff need training.
I speak to the patient’s family on the phone: it isn’t safe for them to come to the hospital. Communication is the hardest and most important thing in my job. It’s difficult enough talking to the relatives of a critically ill person, even when you are able to look in their eyes. The only way to handle this is to be honest. “Your relative is sick enough to die,” I say. “But our passion in life is getting your loved one better, and back to you.” I like to call it ‘honest hope.’
The ICU community is small and close – not just doctors, but nurses and therapists, too. I receive an email from a colleague in Italy. Right now, the international community talk to each other all the time via WhatsApp and email. Doctors from China and Italy share advice on equipment, such as the fact you can use one ventilator for multiple patients. They also help on the human level, with counsel that this is a marathon, not a sprint, and tips on how to speak to families.
My Canadian friend shows me a photo of where hand-sanitiser has been ripped off the wall at his hospital. This hasn’t happened here yet, but who knows what the future holds?
My lunch: a cookie.
2pm to 5pm
I look after the other residents on my ward. In Cardiff ICU, we see over 1,500 patients a year. Their illnesses are not optional. They can range from people with bleeds on the brain, cardiac arrests infections, or sepsis. My vital work with these patients goes on. With a suspected sepsis sufferer, for example, I organise scans, put plastic tubes into veins or arteries, set up machines to help deal with kidney failure. Plus I have to communicate with their family and the wilder health-care team.
People are asking ever more- anxious questions, from relatives to colleagues and followers on social media. While this is energising scientifically, it can get emotionally tiring. I have a strange, self-selecting group of patients. My colleagues and I normally only see the tiny percentage who are critically ill – and this goes for COVID sufferers, too.
Exhausted, I leave for home. I stop at McDonalds for a McFlurry – this is my dinner. I’m lucky in that I haven’t seen shortages or scrapping at the supermarkets. You would have thought that greed and bullshit would have disappeared during a global health crisis. As an NHS worker, I stand to benefit from an hour in the morning’s dedicated shopping at Marks and Spencer. I’m more worried about petrol running out.
It can be tricky coming home after a day treating the sickest of people, and I have been incredibly busy since the start of the COVID outbreak. My wife, a teacher, calls me ‘a body with a phone attached.’ Most nights, I try to do bath and bed for my children, but my mind is elsewhere.
Tonight, I am going to sleep in the spare room because I’ve been surrounded by viruses all day.
A thought to finish on: Intensive Care started as a speciality in 1952 in response to a polio epidemic in Copenhagen. Sixty-eight years on, that knowledge will help us get through this. To those who are worried, I would say the following: listen to the science. It doesn’t have all the answers, but it’s the best thing we have. In ICU we are here, standing strong, to help.
As told to Miranda Levy