The Times Magazine - UK (2021-02-20)

(Antfer) #1
10 The Times Magazine

MARCH 24, 2020
“Jim, they need you in bay 5. The young
guy – Adam – in bed 36 has crashed his
blood pressure.”
“Right, OK. Thanks.” I walked back to
the table of personal protective equipment,
dropped my valuables into the tray and picked
a new mask from the box.
“Has his temp gone up again?”
“Don’t know. I’ll ask.” Taciana, the staff
nurse who’d called me, spoke into her
walkie-talkie.
“Jim’s coming in. What’s his temperature?
In bed 36.”
The walkie-talkie crackled. “What?” she
asked again. “Sorry, can you repeat that?”
“41.8.”
“Shit,” I muttered, adjusting the mask
under my chin. I felt sick. I’d seen Adam that
morning on the ward round and set up a plan,
so why was he so hot again? He was a young
man, still in his twenties; his whole life was
ahead of him. This was meant to be a disease
of the old and frail. His next of kin was his
mum. She was probably my age, but I’d not
met her. Relatives weren’t allowed in during
Covid. He had a six-year-old son too, called
Harry. This was not supposed to be happening.
His temperature should have settled with
the measures we’d put in place. Viruses make
you hot, but not this hot. This was like a drug
reaction to Ecstasy or one of the anaesthetic
gases: malignant hyperthermia. He was life-
threateningly hot again, and now his blood
pressure was crashing.
I took three breaths in and out to check
the mask’s seal. Air blew into my eyes, so
I adjusted the strap and squeezed the metal
band tight around the bridge of my nose.
What next?
I glanced at the laminated PPE donning
guide – hat. As I pushed my arms into the
waterproof gown, I tried to think logically.
Cool him first then go from there. I pulled a
second pair of gloves over the first and taped
them to the gown.
“Taciana, can you tell them to cool him
with whatever they’ve got – wet towels,
bladder irrigation, ice packs, fluids. And if
there’s another consultant around, can you
ask them to join me?”
Next came the plastic apron and finally a
grey visor from the tray. The black ones gave
me a headache within 20 minutes.
My consultant colleague Rik joined me
at the donning table and began the laborious
process. It was three tables in fact, hastily set
up in a row like trestle cake stands at a village
fête. They took up most of the corridor outside
the ICU bays, each piled high with boxes
of masks, aprons, hats, gloves and visors.
Underneath were more boxes, and downstairs

hundreds more. Short strips of tape created
a fringe around the edge of each table, pre-
prepared to stick gloves to gowns. At the
far end a large plastic tray overflowed with
sandwich bags filled with the valuables of staff
currently “donned” within the Covid bays.
I patted my chest, mentally checking off
the items of PPE.
“I’ll tie you up.”
Someone I’d never seen before tied the
back of my gown and apron.
“Thanks,” I mumbled, then raised my
voice. “Can we get the Doppler and echo
machine into bay 5? And the crash trolley.
And... can you keep someone at the door
for communication?”
I checked the tapes on my gloves one final
time. “And can you call his mother?” I shouted
to no one in particular.
“And say?”
“Come in.”
Our voices were muffled through the
masks, so every request or question had to be
half shouted and often repeated. Three pairs
of gloves meant that even a simple task, like
putting in an intravenous line, was cumbersome
and awkward. They were covered with Covid.
Touch my face and I’d catch it.
I was frustrated and I could hear the edge
creeping into my voice. This was my patient,
my responsibility. I’ve dealt with hundreds of
medical emergencies in my career, countless
cardiac arrests and near-arrests. It is always
chaotic and noisy, but this was different.
Over the next 90 minutes we tried
everything we could think of. We gave fluids
and drugs to increase the blood pressure,
other drugs to make the heart pump harder
and others still to slow it down. Each one had
benefits and side-effects – cure one problem
and you almost inevitably made another worse.
We gave sodium bicarbonate to neutralise the
acid in the blood, sugar and insulin to lower
the potassium, calcium to stabilise the heart,
and then we connected him to the filter to try
to maintain the homeostasis. We wrapped him
in wet towels and irrigated his bladder with
cold water to bring down the temperature. All
the while we were keeping a watchful eye to
ensure that he was fully sedated and unaware.
For short periods we were winning. We got
his temperature down, then his heart rate, and
he seemed to improve. At one point a cold,
wet towel was wrapped tight around Adam’s
head, and the heart rate fell by 40 beats per
minute, but it didn’t last. Within minutes
everything had crashed again, and we
were pushing in huge doses of adrenaline
to keep his heart pumping. We verbalised
everything – all our ideas, theories, requests,
anxieties – desperately searching for
something that might turn it around, but
gradually the periods of stability and hope
became shorter. I looked under the sheets

and saw the ominous patchwork of purple
mottling creeping up his thighs and on to his
abdomen. His tissues were dying.
At some point during the process Adam’s
mother arrived in the hospital. The nurses
helped her into full PPE, brought her into the
bay, and she walked tentatively over to the bed
space to look down at her son. She saw his
exposed torso, the breathing tube coming out
of his mouth, the lines carrying his blood to
and from the filter, the drug ampoules, the
crumpled wet sheets, the crash trolley with
drawers open and equipment spilling out,
the fluids, the catheter, the syringes and torn
packaging discarded around the bed, the
machines and monitors and the eight of us
surrounding him in our PPE. We paused for
a second, then carried on, and she watched.
Eventually she backed away to a seat by the
door and listened to our efforts. Half an hour
later, when I assume she couldn’t bear it any
more, she left.
The blood pressure was down to 40 again,
and ominously now the heart was slowing too:
80, 70, 50. The sharp spikes on the ECG had
broadened. “Agonal”, we call it, and it means
only one thing. Every four or five beats there
was a pause, then another weak flick of pulse
on the blood pressure trace. He was dying.
There was nothing more we could do.
“OK,” I said, looking round the eight
shattered faces, “I think we should stop.
Anyone disagree?” A part of me was desperate
for someone to disagree, but no one did. We
watched as his heart twitched for a few more
seconds and then stopped.
“Thank you, everyone. I’ll go and find
his family.”
I threw my mask in the bin, washed my
hands and trudged back down the corridor.
I felt desperate. What had happened? Had
I missed something? Should we have tried
a novel anti-inflammatory sooner? He was
the first patient I’d seen die of Covid and he
was 28 years old.
When I got home, I kissed my children,
Tom and Edie, good night, listened to their
plans for home schooling (scanty at best) and

Everyone was stressed,


scared and out of their


depth. Covid affected


not just the lungs, but


the brain, the heart, the


kidneys, everything


Right: inside a Covid ICU ward, May 2020

GETTY IMAGES

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