PERSPECTIVES: NEW ROLES
Redeployment to intensive care: A viewpoint from an Obstetrics and Gynaecology trainee Kate McCallin is an Obstetrics and Gynaecology trainee (ST1) working in the South Yorkshire area.
COVID-19 may well provoke permanent changes to healthcare delivery in the UK. From video consultations with patients and online multi-disciplinary team meetings, to extensive phone based triaging systems – we have had to adapt national practice significantly to reduce face-to-face contact and help prevent virus spread. As for my personal role, seven months into my speciality training programme of Obstetrics and Gynaecology, I was redeployed to the unfamiliar territory of Intensive Care. To say the workload was different is somewhat of an understatement. No longer was I helping to deliver new-born babies by caesarean section, the new focus was to prevent death in critically unwell patients. Daily life now consisted of a prompt eight o’clock morning handover led by the night senior registrar and attended by the full cohort of doctors working that day. Each patient was discussed in minute detail, ordered logically by organ system and cardiovascular status, blood pressure support medication requirement, respiratory system and ventilator settings and so forth. Initially, I felt as though I was listening to a different medical language. The vast majority of the patients on the unit were COVID positive, sedated and requiring a ventilator to breathe. Most had been on the unit for days and some up to four weeks. It was difficult not to blur patients all into one. Following morning handover, it was time for the daily patient reviews. We donned our stiflingly hot personal protective equipment (PPE) including surgical gown, sterile gloves, non-sterile gloves, surgical hat, FFP3 mask and visor and entered the unit. After being assigned a patient, the in-depth analysis began. Each system was closely evaluated using detailed charts meticulously kept up-to-date by the nurse looking after that patient. Ventilator settings were monitored. The three or four drug infusions that the patient was on were carefully assessed. When was the patient last proned? When did they open their bowels? What were their most recent blood oxygen levels? Proning was new to me. I had never before come across this in my ten years of being at medical school or a doctor. It involves turning the patient, complete with central line, endotracheal tube, and arterial line onto their front in order to improve oxygen levels. Patients remained prone for approximately sixteen hours per day.
14 Medical Woman | Autumn/Winter 2020
Coming from a specialty where patient communication is of upmost importance – breaking bad news of a second trimester miscarriage or metastatic ovarian cancer diagnosis – not being able to talk to patients was one thing, but not even being able to see their faces? Proning was not the only barrier to effective communication. Wearing a voice muffling FFP3 mask which covers half your face also effectively conceals the majority of muscles used for facial expressions. Dressing all staff in identical outfits also provides issues. Each worker had a sticker placed on his or her surgical gown detailing that person’s name and job role. These small additions to enable cohesive team working in a new, stressful environment should not be underestimated. There were tough days. And this was despite the amazing support of the intensive care consultants, anaesthetic trainees and experienced nursing staff. To watch a previously fit and well man in his fifties die despite the consultant giving him every last drop of available treatment possible is hard. To watch the grieving relative in full personal protective equipment (one family member allowed only) say goodbye after not seeing her husband for three weeks was harrowing. Towards the end of my time there, I saw a patient that I had become familiar with over the past few weeks, walk unaided out of the unit with staff providing a poignant round of applause. He no longer had to communicate via miming nor breathe through a tracheostomy. During his stay he told me of the mental struggle he had struggled to overcome. He felt imprisoned in his single room with no daylight and much to his annoyance, a clock that showed the wrong time and could not be fixed. His mental and physical recovery provided the much-needed moral boost that the wearied staff needed. For many specialties within the NHS, particularly surgical based, work may be currently less busy than usual, with many elective surgical lists cancelled. However, at a time like this, spare a thought for intensivists and anaesthetists, working tirelessly for each critically unwell patient. My contribution was miniscule but it has taught me the importance of adaptability, resilience and teamwork in the face of the unknown. I hope that the lessons we learn during the COVID crisis will continue to benefit the National Health Service (NHS) for many years to come.
