Doctor on trauma of life in critical care:
INTENSIVE CARE DOCTOR OPENS UP ON THE CHALLENGES FACED BY STAFF ON THE FRONTLINE OF THE COVID CRISIS
“IT’S just utterly demoralising,” says Dr Shondipon Laha of the commute to a shift caring for critically ill Covid patients.
“You drive to work and watch the people walking around and think: what’s going on?’ It’s like two different worlds.”
Dr Laha, honorary secretary of the Intensive Care Society and a critical care consultant practising in the north west, fears the truth of what is playing out on wards here may not have hit home to some on the outside. But for those who work in them, the reality of the virus is impossible to escape.
Sweating in PPE, doctors and nurses are combating not only Covid-19 itself, but the heat, exhaustion and claustrophobia that make their jobs immeasurably harder.
Theirs are also the last faces many patients see before they die. Nurses take the place of loved ones, hold hands, fulfil last requests. It could be to play their favourite song, or something as simple as a final pint.
Staff here are not on their second wave, but their third, the same people going in to battle each time.
For a profession that sees burnout as an occupational hazard, the effect is devastating. Sickness rates have doubled.
“We are seeing reports of posttraumatic stress disorder. Most ICUs now have counselling systems set up,” says Dr Laha of the impact on critical care staff.
“It’s wearing PPE in an area that was never meant to be an ICU. It’s hot; it’s claustrophobic; no one can hear you properly.
“You can’t hear other people properly. Mistakes happen. Tempers get frayed.
“You have to talk to families via phone, or FaceTime. Increasingly that’s about stopping treatment where you think a patient is going to die – and it’s very hard to have these conversations with families. Nursing staff are having to do that on a daily basis.
“We are frequently seeing patients where you’re holding their hands, playing the music they want to hear. One patient, over the weekend, we went to sort a pint of Guinness for him before he died.
“We think that’s as important as all the other stuff we do. But it’s emotionally draining.”
The third wave of coronavirus has so far seen London in the eye of the storm, but the north west’s hospitals are under intense and growing strain too.
Last week the North West Ambulance Service escalated to its highest alert level on the back of ‘extreme’ pressures – caused both by the situation within hospitals and the impact of having 1,000 staff off sick.
Covid admissions in Greater Manchester have been rising fast, running at up to 140 a day over the past week, according to the latest figures released by NHS England. Two thirds of the patients in our intensive units now have the virus and the system’s political lead has warned it will do well not to ‘fall over.’
Hospitals have been standing up ‘surge’ capacity: extra critical care beds that can be opened in times of acute pressure. But those beds do not materialise out of thin air – they do so in wards that would normally be used for other care, or two are fitted into a space designed for one.
And they all still have to be staffed.
Extra beds will ‘get shoved into a corner somewhere,’ says Dr Laha, ‘or or are on wards where it’s much harder to make it physically work.’
“We are into those spaces at the moment,” he adds.
“In some places they are putting an extra bed in the same space and the risk is infection spreading. In other places they are using other wards – maybe wards that were planned for surgery. The biggest concern is how you staff those beds.
“The biggest risk is stretching our intensive care nurses and bolstering them with redeployed nurses who are not trained.”
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If Greater Manchester’s system does become overwhelmed, he says, hospitals will move patients out to other areas and cancel priority operations.
However, while there is cautious optimism in the system – shared by Dr Laha – that the region’s hospitals will not reach the kind of crisis seen in London, health leaders here have already begun cancelling cancer surgery.
Figures seen by the M.E.N. show how stretched other areas of the North West already are, with parts of Cheshire and Merseyside already recording twice the Covid patients they were seeing at April’s peak.
Meanwhile, analysis by the Health Service Journal this week showed Wirral University Teaching Hospitals NHS Trust recording the highest daily increases in admissions nationally.
So the north west system is struggling by any measure. And the more critical care beds that are opened, the more pressure that places on doctors and nurses.
“You can keep creating beds and keep stretching nursing staff,” adds Dr Laha.
Dr Laha is also warning of the effets of long Covid to patients who survive.
He said the system must gear up for a widescale rehabilitation effort, he believes – although he doesn’t think that is so far in place.
He said: “It’s going to be a massive problem and we are not seeing any sensible plan as to how this is going to be dealt with in the long term.
“We are seeing problems we didn’t anticipate.
“Proning people means risk of nerve damage to their arms. Where they’ve had tubes in their throats, it can damage their vocal chords. A lot of people won’t go back to the level of independence they had originally.”
In the meantime, hospitals here are yet to reach their peak, with Greater Manchester still seven days or more away from the most intense pressures that will inevitably result from weeks of soaring infection rates.
Staff will continue to go into battle, treating and caring for ever-rising numbers of patients, says Dr Laha. “Nobody gets turned away.” But that is taking its toll on those pulling on their PPE at the start of each grinding shift.
“It’s a bit like beating a dog – eventually you get used to it,” he admits. “You start to lose track of what’s normal and what isn’t.
“Right now, we are more accustomed to this. So we are just getting on with it.” The Intensive Care Society is raising money to provide emotional support to intensive care staff during and after the pandemic.
One patient we went to sort out a pint of Guinness for him before he died
Dr Shondipon Laha