Dispatches from the Covid-19 frontline
‘Every single aspect of our care has to be rethought’: What it’s really like to be an ICU doctor fighting the coronavirus pandemic
Intensive care doctor Sarah Hart speaks on The Independent‘s Coronavirus Podcast about working tirelessly to save Covid-19 patients and what’s really going on with PPE, writes Olivia Petter
The Independent’s ‘Dispatches from the Covid-19 frontline’ is an interview series detailing the reality behind the headlines as told by the nation’s vital key workers. Sarah Hart is an intensive care doctor working for the NHS in a south London hospital. She reveals what it’s like to work on the front line right now.
Even in times of crisis, frontline medics must never lose compassion for each individual patient, says intensive care doctor Sarah Hart.
“I had a patient recently who asked me if she was going to die,” Hart tells The Independent’s Coronavirus Podcast. “She said she didn’t want to die but she died a few days after we had that conversation. I think if you forget it or it doesn’t affect you, you probably shouldn’t be doing the job anymore.”
Hart is just one of the thousands of medical workers putting their own health at risk by working on the frontline of the coronavirus outbreak. As we are all too aware, the NHS has been put under massive strain trying to cope with the many thousands of people needing life-saving treatment for Covid-19. And as the pandemic continues, concerns are mounting regarding the health and wellbeing of NHS staff. In recent weeks, we have seen the government face increasing pressure to explain why they have not hit targets for testing for NHS staff and why, weeks after it was promised, some hospitals are still reporting shortages of personal protective equipment (PPE), which is crucial to ensuring healthcare workers do not catch the virus from their patients.
Hart, who is also an anaesthetist, explains that the south London hospital where she is currently working has tripled its intensive care unit (ICU) capacity due to coronavirus. This meant tripling staff numbers and the amount of equipment in ICU. “It did that by taking all of the doctors that had any intensive care experience in the hospital, putting them onto the rota and then going and getting more from everywhere else in the hospital,” she explains. Typically, Hart only deals with patients who are severely unwell. “The general reason patients get admitted to intensive care is because one aspect of their body is failing and requires a certain level of intervention,” she says.
With Covid-19 patients, the most common form of treatment needed is respiratory support but, Hart explains that support for the heart and kidneys requiring drug infusions and a dialysis-type treatment are common. “There’s also evidence that they’re getting neurological impairment as well, so confusion and delirium, which comes a little later,” she says.
Management for these patients usually involves tracheal intubation, ventilation and a medically-induced coma. This means healthcare workers need to wash and care for patients as well as fine-tune their treatment based on blood results and vital signs and administer any necessary medications.
Not knowing exactly how the virus operates is one of the hardest parts for healthcare workers. “It’s actually a really complex process for a disease that we have very little understanding of because it’s entirely novel,” Hart says. “Every time you take two or three days off, you come back and there’s been a new change or a new development.”
Given how little is known about the illness and how it affects people has been difficult, Hart admits. “There’s been a couple of times where I’ve had a feeling of hopelessness that what we were doing was futile. That we were keeping people alive for weeks and they seemed entirely static, and by static I mean statically looking like they are going to die every day but not quite dying and then eventually somehow turning the corner. However, we are still seeing people coming in and dying very quickly, and that’s heartbreaking.”
Patients with Covid-19 are taking far longer to recover than those with more traditional respiratory problems, Hart says. “Every single aspect of our care for a disease has to be rethought. And then on top of that, we’ve got the sheer numbers [of cases].”
The shortage of PPE for doctors and nurses treating Covid-19 patients has been one of the most contentious issues to emerge from the pandemic, with one doctors’ leader saying that the failure to provide adequate supplies was a “shocking indictment” of the government’s response to the coronavirus outbreak. The circumstances are such that there is now growing support for a minute’s silence to honour the health and care workers who have died during the pandemic.
Hart explains that she has never had to enter a Covid-19 unit without adequate PPE. “However, that PPE has been a whole range of different things,” she adds. “I’ve probably worn about five to six different types of gowns and visors and masks, depending on the stock and the flow and the amount of different stuff available at different sites.”
It’s been a challenge to adapt to working in PPE, Hart says, explaining that it can be hard to check a patient’s pulse when you’re wearing three pairs of gloves. It can also feel “really hot and sweaty” wearing the equipment for hours at a time, and Hart says she has to be careful not to drink too much prior to putting it on so as not to waste it by needing the toilet and therefore having to take it off and then use a new set.
PPE also makes it difficult to communicate with patients and other doctors because your mouth and ears are covered. “It’s really difficult to hear,” says Hart. “For the first few weeks I’d regularly come home with a sore throat and I kept thinking, ‘Oh God, is this it?’, and then I realised it was just because I was shouting at work all day. Then you feel rude because you’re shouting to people.”
In spite of the obvious difficulties, Hart says she has felt fully supported at work. She works on a three days on, three days off rota, which also allows for a seven-day gap every so often that Hart applauds for helping NHS staff to reset. “Not that there’s much we can do in the seven days off, but at least there’s that option where we can decompress.”
Hart also says she receives daily emails from friends and colleagues checking to see if she is okay, with many providing support helplines. The way that members of the public have united to support NHS staff has also been invaluable, Hart explains. Despite her initial scepticism about Clap for Carers, she now enjoys joining in every Thursday that she isn’t at work. “I love it because I get to meet my neighbours,” she says.
With the UK entering its fifth week in lockdown, it’s impossible to know what the wider long term consequences of this pandemic will be for the health service. There have already been some major missteps that could have crippling long-term implications, says Hart. “One of the things I was getting very frustrated about was that we weren’t cancelling all elective surgeries and front loading that theatre time that we had with cancer patients,” she says. “If we had done that for even two weeks, we would have saved across the country several thousands more lives for those surgeries that are now not happening.”
Hart also believes that given the strain the NHS is under, we will see a knock-on effect of people avoiding going to A&E for necessary medical help. She is also wary of how the resilience of NHS staff will be impacted. “I think that it will eventually be affected, and whether or not this makes people want to leave the NHS… I don’t know. I can’t really speak for other people,” she says. “I think for me, it just reinforces that I feel lucky I’m in a situation where I can do something that can help.”
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