Space odyssey in coronaland
Doctor’s Diary
IN my dreams of becoming a neurosurgeon, I used to picture myself performing intricate procedures with intense concentration. Nowhere in that dream did a space helmet figure. It would have ruined the look.
A couple of weeks ago, I stood outside the operating theatre at Beaumont Hospital preparing to gown up, sizing up this futuristic looking headgear straight out of Apollo 13.
The white helmet had a large plastic visor and flaps that covered the shoulders. Most exciting of all was the little motorised tube that purifies the air circulating inside — for this was no ordinary helmet but a powered air purifying respirator system (PARS).
I thought I had grown out of space suits years ago, but, yes, I did experience an unmistakable thrill as I pulled it on. It was a bit muffly inside and it had that new car smell, a whiff of Turtle wax polish and rubber tyres.
How do I look? I asked, posing up for a photo. I couldn’t hear the reply, which is probably for the best.
We were about to go into theatre to remove a tumour on a pituitary gland using a long-standing procedure called transsphenoidal surgery. Best set aside your breakfast eggs before reading on. The pituitary gland is right behind the nose between the eyes. In simple terms, we come in from the front. We insert a camera up the nose, crack open the sinuses like an egg, and drill through the back wall of the sphenoid sinus towards the brain. Usually the tumour is sitting on the pituitary gland and we scoop both out.
The coronavirus is found in large loads in mucus contained in the sinuses that we crack through to get to the pituitary gland. If the virus is present, the drilling into the bone sends viral particles spiralling into the atmosphere breathed by medical team gathered around the patient — the aerosol effect.
Some of the first doctors to die from Covid19 in the UK were ENT surgeons who had been performing sinus surgery without this protective equipment. The awareness of the risks didn’t exist just six short months ago.
Patients are tested for the virus before surgery, but the test is not failsafe. We know that at the earliest stages, it is not always detected. Hence the helmets. For those long hours of surgery, we exist in a bubble of filtered air. It is another illustration of the altered medical landscape.
A second wave has yet to hit the hospital, but the medical load is so heavy as a result of the last one, it’s hard to know how we will cope, if and when it does. The word in the hospital is, for now, Beaumont is pretty much empty of Covid-19 patients. The Covid-19 wards are back to operating as normal and the intensive care units are back to their usual pre-pandemic levels of overcrowding because we still don’t have enough critical-care beds.
To be honest, we are all pretty exhausted. On night shift, after a particularly gruelling week, a few of us slumped around the little coffee room at 1am. We sat heads down, scrolling through our phones, in silence.
We must have looked a grim sight because Dave Wilson, the night porter, burst in, took one look at us and said: “Ah lads, what’s wrong? Are ye fighting again?”
Then he did what Dave always does: he produced a magnificent midnight feast. That night it was chicken wings. Dave loves to work nights and loves to cook. As the generous man he is, he seems to take great pleasure in seeing his grumpy, hungry monosyllabic colleagues devour his delicious food and turn back into normal human beings. Long before Feed the Heroes we had a hero feeding us.
Dave has been a much-needed constant when so much of hospital life has changed.
Over a weekend in July, last year’s doctors leave and hand over to a new group of doctors as they all rotate to different hospitals nationwide. This is a big social event but Covid has put paid to that. The consultant rheumatologist, Laura Durcan, saved the day by hiring an icecream van. Word got around the hospital fast. Mr Whippy turned into Mr Stroppy when it became clear there were far more customers than had been paid for. It all ended happily. But it says a lot about hospital life right now that a chicken wing feast at 1am and ice-cream wars were the best fun I’ve had in weeks.