Agilan is someone whom I respect a lot, because he has this unassuming personality but has a wealth of knowledge about wide ranging topics. He’s a vivid reader and has the uncanny knack of focusing on the right things which makes him happy. It’s only right to post a picture of him in his full PPE kit while serving in the intensive care unit to treat COVID patients. This blog has a lot of learnings; prioritising tasks, empowering people, handling failures, celebrating successes – Enjoy reading and learning.
Over to Agilan now….
Remember, this is a 3 part blog series, you can find the introduction here
LEADING THE COVID-19 PANDEMIC RESPONSE – A FRONTLINE EXPERIENCE
We are living through a pandemic that has claimed nearly 400,000 lives so far and is continuing to wreak its devastation around the world.This global outbreak has changed our lives profoundly affecting everything from international travel to meeting your next door neighbour for a cup of tea and a chat. It is the worst health, social and economic crisis the world has seen in decades.
I am a Consultant in intensive care medicine working at an NHS hospital just outside London and led my department in preparing for this pandemic and managing the surge of patients affected by COVID19. I would like to share some of my experiences. In any hospital, you will find the sickest patients in its intensive care department. These patients usually have one or more organ system failure and will be treated with life support measures including ventilators and dialysis machines in an effort to keep them alive giving them a chance to recover. It is a small but highly specialised area of the hospital run by a team of ICU staff whose skills take years to acquire.
As the pandemic started moving across the world, it became obvious that the UK was not going to be spared. We were facing an extreme situation where the intensive care facilities were going to be completely overwhelmed. When a healthcare system runs out of intensive care capacity, patients who otherwise would have survived will die because they cannot be provided with the treatment that they need.
Looking at the data from Italy and Spain, it was clear that we were less than 2 weeks from the peak of the pandemic. Intensive care capacity had to be expanded by at least five fold and perhaps even more which was completely unprecedented. The pandemic preparation had multitudinous workstreams. The hospital stopped all the non-emergency work to focus on COVID. Entire wards were cleared to make space and create the foot print for the expanded intensive care. Oxygen supply pipes were upgraded so that they could cope with the huge number of patients requiring large quantities of it. Ventilators and other equipment were ordered and alternatives were procured and commissioned. Huge effort was put into getting hold of Personal Protective Equipment (PPEs) in an extremely crowded marketplace.
Top of the list for me was to create an vastly expanded intensive care team with the right skills and structure so that we could save as many lives as possible. We had to set this up in a matter of days. The oil tanker travelling at speed had to be turned around. And turn around it did. Literally on a sixpence. Due to the coordinated efforts from the whole team, intensive care facilities were created for COVID patients up to five times the usual number in our ICU.
In normal circumstances, the ICU team is a group of close knit individuals who have forged their relationships over many years. The new team is going to be made of disparate individuals from various parts of the hospital, all coming together towards the common goal of saving the lives of the worst affected patients. Understandably, there was a lot of fear and anxiety among staff who are going to be on the coalface treating patients affected by a hitherto unknown, highly contagious and potentially fatal disease.
They had to walk into the battle head on while the rest of the country was being asked to physically take themselves away from society by the imposed lockdown. Many of them were in the older age group or health conditions themselves which made them vulnerable to dying from the virus. They also feared for the safety of their families, worried that they might take the virus home.
Every minute of every day, there were bad news stories in the media reporting the escalating death rates and individual tragedies. As the pandemic progressed and we started admitting people into the intensive care unit at an alarming rate. These were some of the sickest patients we have ever managed. Inevitably, several staff members and their loved ones were also taken ill with COVID and had a terrible time recovering from it. We had to witness the death of one of our beloved colleagues after a long fight.
But the sense of duty and the resolve to fight for our patients was strong throughout. I truly applaud every single member of the team for their devotion to the cause and their selflessness. Such an amazing team has to be supported and protected so that they can do their jobs safely. We trained those who required additional training to work in the ICU. They were provided support, supervision and feedback which made the new staff not only safe but also empowered to deliver care in an environment that could otherwise have been alien and intimidating. Clearly, it is not possible to provide all the intensive care skills and expertise with an ultrashort training. But it was incredible to see how much transferable skills were available within the organisation and with the right support how quickly people can adapt.
If I have to look for a silver lining, it must be that the extraordinary circumstances have shattered a lot of bureaucratic barriers that tend to hold people back and impede progress. I experienced the team spirit and solidarity getting stronger through this crisis.The team had countless instances of heartbreak. After losing several patients to the virus, we discharged our first patient from the ICU only to find out that he died unexpectedly the next day. It was a moment of profound shock. But the team grieved together and supported each other and continued to care for the other patients.
We also celebrated our successes together. Every patient discharged was applauded on their way out by the whole team which were incredibly uplifting moments. The appreciation and support from the public was wonderful. NHS workers suddenly found themselves to be everyone’s heroes and deservedly so. There was a tsunami of messages and cards which decorated the corridors of the hospital reminding you of all the people rooting for you. There were donations of PPE, hand creams and food appreciating all the hard work that the healthcare workers were doing.
Our core value of compassion shines brightly as we work through this terrible virus. We know that there is a lot more that we could and a lot more that we could have done better. But the commitment and compassion from this team has made a difference in a lot of people’s lives and will continue to do so.