I work in intensive care. Our beds are full, and more Covid patients are arriving
It’s Christmas morning and it’s 2C outside. My breath rises as I stand at the boot of my car, peeling off my layers. This is my ritual now. I have already changed into clean clothes at work, but with a new, more virulent strain of Sars-CoV-2 I’m not taking any chances.
Tiptoeing through the front door, the house is silent. Everyone is still in bed, even our three-year-old. I step into the shower, turn up the heat as high as it goes, and let the night shift wash off me. I’m grateful for the chance to sneak in a quick coffee; I left for work 16 hours ago and have been awake all night. The past few weeks have been the toughest NHS workers have faced yet in the battle against Covid. The virus has not discriminated as much as we thought it would. Older people, younger people. Those with medical problems, those without. All brought in in their droves.
Ambulance after ambulance would arrive with patients fighting for breath as we desperately tried to shuffle beds around to accommodate them. By November things were looking bad. We had clung to the hope that a second lockdown would slow the relentless march of Covid.
But as we hit December, cases in the south east of England, where I work, continued to rise all around us. The virus worked quickly. Some patients would come in smiling, talking, not realising their oxygen levels were already critically low, and probably had been for days. We term these cases “happy hypoxia”. Our hearts would sink as we pulled up their chest X-rays. Their fate was already sealed. We knew hours later they would be face down, fighting for their lives on a ventilator.A heroic effort was once again under way to enact surge plans. Management cancelled operations to free up staff and equipment. Medics with no experience in critical care were redeployed, turning up on our units looking wide-eyed and shell-shocked. We made a special effort to look after them. We could not afford to lose them while each day another one of our colleagues became sick. Wards became temporary ICUs. Yet as quickly as we could free more beds, they were filled by those sick with the virus. Teams scrambled to move ventilated patients by ambulance out of the south east to hospitals with any capacity left. Those hospitals are now full. By the week before Christmas there was simply no room left at the inn.Are you surprised by this? Maybe you are. The tabloids continued to report we were quieter than this time last year, that we had even more capacity than before. But this simply wasn’t true. What they had failed to realise when reporting on our expanded ICU capacity is what that truly meant: using portable ventilators and anaesthetic machines, the kind of ventilators used for operations and not intended for long-term ventilation of sick patients; putting patients in theatres and wards not set up for critical care; using staff who aren’t trained in looking after ICU patients. When you hear that hospitals are running at capacity, what that means now is that they are running at 100% of 150%. I’m not sure how we can find more space.
For NHS staff, the painting of this inaccurate picture works to sap away at the morale that is left, and erodes the support and understanding from the public and their families that helps get them through. While people worried about Christmas, doctors and nurses were worrying about how they could possibly keep patients safe.
For many, their leave had long been cancelled while others were moved onto emergency rotas and found themselves working over the holidays at the last minute. Some, like me, volunteered.
Aside from being an ICU doctor, I am also the lead for the Doctors’ Association UK. In my role as president I hear from those on the frontline across our platforms catering for more than 45,000 doctors. I can’t tell you how hard we have had to fight to raise morale a second time around. How do you raise spirits knowing that last time we lost more than 650 of our colleagues? I can’t tell you what it’s like having to ventilate a colleague. I lost more than one.
Long gone are the days of claps on doorsteps. Things put in place to support NHS staff during the first wave have been taken away at the time they are needed most. Free parking. Access to tea and coffee during the long nights. Mental health support. Let alone the promised pay rise. And now, even as staff continue to put their lives at risk every day that they turn up for work, they find themselves at the back of the queue for a vaccine. In some hospitals, vaccinations haven’t even been mentioned yet to staff. I have no idea when it’ll be my turn. It was our one light at the end of a very long tunnel.
I dwell on this as I sip my coffee on Christmas morning, watching the sun come up. Our three-year-old wakes up. I couldn’t be happier seeing how excited he is. This is the first year he really understands Christmas. The morning is spent opening stockings, ripping off wrapping paper. A box of chocolates is opened; it is decided that 11am is not too early for bubbly. My heart is so full. Yet my mind wanders back to the previous night. I can’t help thinking of the family who will not be celebrating today. The family of the young man in his 20s who will never come home. I can still feel his ribs cracking under my hands as I tried to push life back into him with CPR. “You’re quiet,” says my husband. It stirs me out of my reverie. He is given a tired smile. A hug that lasts a second too long. “Bad night?” he says. He understands. I say a silent prayer for the family who I know will be mourning today and push it out of my mind. Today is a day for joy. I have so much to be grateful for. And so I celebrate, and enjoy this brief reprieve before what I know will be waiting for us around the corner in January.
Dr Samantha Batt-Rawden is president of the Doctors’ Association UK and a senior registrar in intensive care medicine