An intensive care doctor has shone a light on hospital life as exhausted medics battle to save lives – and warns of a “psychological reckoning” still to come as staff face up to the ‘sheer horror’ of all they have seen.
Nitin Arora, a member of the Intensive Care Society, kept a video diary for one night that gives a startling insight into what is happening behind the closed doors of a city hospital, describing “a flood’ of patients that shows no sign of stopping yet.
In a series of short selfie videos, he describes in detail aspects of the work underway to care for hundreds of those most at risk of dying from coronavirus.
He talks of the:
* ‘heartbreak’ of making calls to families desperately waiting on news of their loved ones
* ‘moral hazard’ for nurses and doctors who know that staffing ratios are compromising the quality of care they can give
* ‘astonishing’ collaborative work by health colleagues to pull together to support the critical care efforts
* problems ahead for those who survive weeks in ITU and face ‘significant’ longterm psychological and rehab issues
And he expresses concern about the psychological impact on nurses and doctors in frontline care, who have endured months of caring for the sickest.
“The pressure of looking after so many patients, the moral hazard where you know you cannot deliver the quality of care you would ideally like to give, even if you are keeping people safe and delivering a good standard of care, and just the sheer horror of the number of sick people we see every day.
“I think we will need to have a lot of support in place when this ends. There will be a psychological reckoning here.”
He also talks of one patient he sees during his shift who he discovers has a spouse on a neighbouring ward and three other family members in hospital. “This is affecting whole families,” he says.
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And he implores people to take the vaccine when offered to help bring the case rates down permanently.
The diary – captured in four videos – comes as local hospital trusts report a slight dip in admissions of newly affected patients in the past three days, giving hope that the post-Christmas surge is easing.
But with infections in the community still high, and the pressure on critical care beds exceptionally high, the impact of the new, more transmissible variant and Christmas mixing is still posing challenges and will do for some weeks yet.
There are currently 958 confirmed Covid patients in University Hospitals Birmingham settings – most in the Queen Elizabeth Hospital, but also in Heartlands, Good Hope and Solihull, slightly down from a high last week of more than 1,000.
The numbers who are critically ill remain very high, with 199 people in ITU beds including 139 with coronavirus.
In neighbouring Sandwell and West Birmingham Hospitals, there were some 409 inpatients with Covid, including around 40 in intensive care, at the end of last week.
In his four-part video diary, recorded over a single night last week, Mr Arora highlights the intensity of the workload facing critical care doctors.
It echoes the comments of fellow medics working at Birmingham’s City Hospital, who shared their own testimony with BirminghamLive last week to help illustrate how vital it was for people to heed rules, stay home and get vaccinated.
He says: “We have more patients now in my intensive care unit than at the peak of the first wave. And the flood is showing no sign of stopping.”
Recorded in the car park outside a local hospital, then in a corridor and an office, and ending back outside, he shares information about his shift.
The video diary includes observations about the cases he supports during an overnight shift.
In his second video, he says: “Normally I expect to see two, three or four referrals (patients being considered for intensive care) – today I have reviewed 11 patients already and admitted two to ICU and have lots more to review.”
The hospital’s normal wards also contain patients who would normally be treated in intensive care, he says – including patients on pressurised oxygen therapy delivered via tight-fitting masks, and by tube.
“If you count the number of patients on CPAP and high flow (oxygen therapies) we have probably trebled the capacity of looking after seriously ill patients,” he says.
“But it has come at high cost.
“The biggest problem is staffing and the dilution of nursing ratios, which reduces the amount of time nurses and doctors can spend with every single patient, which means you will lose some attention to detail and stress for the medical professionals,” he warns.
In a third video Dr Arora is sitting down “for the first time, five hours into the shift” – and he reflects on the families he has spoken to and the heartbreaking discussions he often has to have.
“Worse are the phone calls where we have to phone the families saying their loved ones are dying, or dead. We have never had to do this before Covid,” he says – normally ITU has open visiting, and families are prepared for such terrible news.
“A lot of next of kin are themselves sick or self isolating or shielding and cannot visit (at end of life). It is heartbreaking to make these phone calls.”
He gives examples of the collaborative work taking place between medical, nursing and support staff.
He describes how phsyios and medics worked together for 40 minutes to clear fluid off the chest of a patient struggling to breathe, and of the constant exertions of ‘proning’ patients (flipping them onto their fronts to aid oxygen take up).
But not everyone can make it into intensive care, he adds, talking of instances where “the patient was so sick and frail they would not have a realistic chance of survival even in ICU.”
Critical care is not a risk-free intervention, he says – and there is a need to ensure effective rehabilitation is in place to support those who survive.
In the final clip he describes his “bruising” shift, paying tribute to colleagues but also urging people to take the Covid vaccines when offered.
“What I am hoping and all my colleagues are hoping, is that with the vaccination the numbers (into hospital) will start coming down,” adding his hope of then ‘never seeing another Covid patient.’