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

(Antfer) #1
The Times Magazine 11

sat down with my wife, Tish. I wasn’t much
company. We talked about the kids, about
lockdown and eventually about Adam. I often
come home worried or upset about a patient,
and invariably Tish makes me feel better. She
listens, she asks questions, she sympathises,
and we move on, but that night I couldn’t.
If Covid could kill Adam, it could kill
any of us.


APRIL 2
Another ICU consultants meeting. I’d been
chairing two of these a week for the past three
weeks. I’m not the leader, not even a leader,
but I can chair a meeting. I have a talent for
it. I was told so on a leadership course in



  1. It’s not the talent I’d have chosen – I’d
    have taken Peter Cook’s or Roger Federer’s



  • but I have what I have, and back then there
    were a lot of meetings to be chaired.
    By now 600 people a day were dying with
    Covid in the UK.
    Every staff group had a different set
    of pressures, and within each group there
    were as many opinions as there were people.
    Everyone was willing, but also stressed, scared
    and out of their depth, and with more than
    40 consultants working on ICU now (up from
    our usual 18), consensus was often impossible.
    By solving one person’s problem you inevitably
    upset someone else. It was whack-a-mole.
    There wasn’t a simple solution, as far as
    I could see, much as I’d have loved there to
    have been. This was a feature of Covid that we
    hadn’t appreciated until we saw it up close and
    personal. It wasn’t just the number of Covid
    patients that were coming to ICU, it was also
    how complex and gruelling so many of them
    were to manage. As Adam had demonstrated,
    it was affecting not just the lungs, but also
    the brain, the heart, the kidneys, the guts,


everything. Just when you thought you’d got
a plan and were winning, they’d do something
totally unexpected and make you rethink
everything. I could barely imagine what it
was like for their families trying to make sense
of it all back at home.
“So,” Rik began, “I want to talk about
Haydar, who’s just moved into recovery. Do
you both know him?”
“Give us a quick recap.”
“One of our first admissions, 68-year-old
man, background of diabetes, hypertension,
but living independently, day 26 of symptoms,
admitted to us 19 days ago. Two days of CPAP
[continuous positive airway pressure] but
struggled, so intubated 17 days ago. Was proned
for a week, very hypoxic but easy to ventilate,
and had a nasty pressure area on his face from
his endotracheal tube holder. For a while he
seemed to improve, but when we started to
lighten him up and get him breathing, he
deteriorated dramatically. He is now up to
90 per cent inspired oxygen, and his lungs have
become very stiff. We’ve started antibiotics for
a possible secondary infection, he’s needing
high-dose noradrenaline and steroids for
shock and he’s gone back into kidney failure.
The questions for today are: should we
continue? If so, should we support his kidneys
again with the filter? Should we set other
ceilings? CPR? And should I get the family in?”
Haydar was in established severe three-
organ failure – four if you included the fact
that his guts had stopped absorbing the food
he was receiving via a tube, and he was getting
worse. It didn’t look good. Should we go on
putting him through this? He was sedated
at the moment, but at best he’d need months
recuperating, retraining his respiratory
muscles, sleepless nights, delirium, pain,
paranoia – torture. For what? What were
the chances of him recovering at all, let alone
to a meaningful quality of life? Slim, we all
thought, but we didn’t know.
From another perspective, was he a good
use of resource? Not just equipment but
people – nurses, physiotherapists and
pharmacists. Would they be better deployed
looking after a younger, less sick patient
with a better chance of survival? We were
not rationing officially, of course. We could
accommodate more patients, we had space,
but every time our numbers expanded the
care was thinned, the staffing ratios stretched.
So the risk of harm increased, for everyone.
“God, I hate this disease.”
Rik was speaking for all of us, the whole
country probably.

The aspiration is to carry on caring without
losing objectivity. We shouldn’t switch off,
be cold and despondent, but neither should
we put people through invasive, painful and
prolonged treatments that are ultimately futile.
“What do the family think?” I asked
“They want us to try everything.”
As I left that evening I bumped into my
colleague Jamie, coming in for a night shift.
“Hey, how’s it going?” “Night shift.”
“Ah, sorry. How have the nights been, for
the emergency ‘family’?” “Mixed.”
“Do you get some sleep?” “On a trolley
in the toilet.”
“What?” “We’re sleeping in the toilet, on
the second floor.”
“Why?” “Because that’s where they’ve
put us.”
“Who’s they?” “The people who hate us.”
“In a toilet?” “Not in... It’s a changing room,
with a toilet in it. People come in though, in
the night, to use the toilet.”
“I’ve got to go, Jamie. I want to catch the
kids. Sleep well.”

APRIL 9
A night shift. The ICU was full (35 beds),
the Pods [a makeshift ICU in the operating
theatre complex] had a further 21 ventilated
patients, and up on the CPAP unit there were
another 18. The patients were getting sicker.
Only two had recovered and been discharged
to the ward since my last day shift two days
previously, and three had died. We’d taken
three in from other hospitals that day, we
were taking roughly five per shift from the
emergency department, and the last non-
Covid patient had been moved out.
At 4.30am I was called to the bed of Tricia,
a head of nursing from Great Ormond Street
Hospital. Having colleagues on the unit was
upsetting and disconcerting for the staff.
These were fellow frontline NHS workers,
people they might have trained with or
worked alongside on a bank shift in another
hospital. They were also clinical staff who
had become critically sick with Covid. Had
they caught it from patients? Had they been
exposed to a particularly high dose because of
the nature of their work? Had they used the
same PPE as us? No one verbalised this, the
nurses continued to work as professionally
and compassionately as ever, but these
questions crossed my mind, so I assume
they crossed theirs too.
Tricia had coped well on CPAP for
four days, but her oxygen requirement was
increasing and she was starting to get tired.
“OK, let’s call the intubation team, and I’ll
join them. Have you spoken to her family?”
“Not overnight.”
“Do you mind giving them a call?”
Tricia was still calm and focused but she

I was called to the bed of a head of nursing. She


gripped my palm as I tried to reassure her

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