Covid-19 doctor’s diary details intubated patients’ fear on ICU

An intensive care consultant said an “indelible memory” of treating coronavirus patients will be the fear they showed if they need to be intubated.

Dr Richard Cree, who works at Middlesbrough’s James Cook University Hospital, has been blogging about his experiences on the front line fighting Covid-19.

His nomoresurgeons.com diary notes that cases are falling slightly and the number of patients needing intensive care treatment has stopped increasing.

But as the national figure for coronavirus deaths passed 100,000, Dr Cree said the toll at his hospital continues to increase, with three more patients dying overnight.

He works along side his consultant wife and said: “One of the indelible memories of this pandemic for Nicky and I will be the fear we have witnessed in those patients that we have had to intubate.”

While some are so ill when they arrive there is no time for them to dwell on being sedated and possibly not waking up, some Continuous Positive Airway Pressure (CPAP) patients are transferred to ICU after being on a ward for a few days.

Dr Cree said they “cannot fail to notice” what happens to patients in nearby beds, even though they are shielded by curtains.

He wrote: “They watch others who are also struggling with CPAP and eventually see curtains drawn as their neighbours are sedated, intubated and ventilated.

“They watch as doctors and nurses repeatedly adjust ventilator settings, check X-rays and they see and hear the alarms chiming as oxygen levels fall.

“They witness the proning teams visit twice a day to flip these patients back and forth in a bid to improve the situation.

“Finally, they watch as family members are called into the hospital to sit with their loved one when it is clear that we can do no more.”

Dr Cree said if they then need to be intubated their fear is “palpable”, and staff will try to reassure them.

“Some want a straightforward explanation, gentle reassurance and are calmed by a matter-of-fact approach,” he said.

“Others can be distracted by light-hearted banter and mundane conversation.

“Many need us to promise them that they will recover and offer them a guarantee that they will see their families again.

“Others just want the nurse who has been by their side for the past few days to hold their hand.

“It’s an emotionally-charged moment as you can imagine and not one that any of us like to dwell on.

“There is not much chance of doing so at the time as there is work to be done.

“We quickly move to stabilise the patient on the ventilator and ensure adequate oxygenation.

“Then there is always someone else to attend to and it’s easy to become distracted by another problem.

“However, once some calm returns, these memories tend to stay with you.

“I fear that for many ICU staff, some of the most vivid recollections of the pandemic will be the promises that we made to our patients.

“Sadly, all too often, they were promises that we were unable to keep.”