A Pandemic Diary of an Intensive Care Consultant 

Siobhan Harris

Disclosures

May 20, 2020

Intensive care doctor Richard Cree is sharing his experiences of working on the NHS front line throughout the COVID-19 pandemic.

The 50-year-old is a consultant at James Cook University Hospital in Middlesbrough.

He started his blog 'There Are No More Surgeons' on March 23rd and has been updating it regularly, giving an insight into the situation he and his colleagues are dealing with.

Medscape UK caught up with him.

Q&A

What prompted you to start your blog, and why the name 'There Are No More Surgeons'?

It was a fairly spontaneous decision. The lockdown measures had been announced earlier that day and my youngest daughter had been telling me that one of her school assignments was to keep a diary during what her teacher described as ‘a historic time’. It prompted me to consider whether I should do the same.

The following morning, after my first shift treating COVID-19 patients I started writing and I’ve been doing so every day since. I imagined that it would be read only by family and friends, but to my surprise, it’s developing quite a following.

The blog’s name comes from a quote from Dr Daniele Macchini, of Bergamo, Italy. Most of your readers will be aware of it and more than anything else I’d read, it summed up what was happening in Italy at the time and what we were fearful would happen here.

It has been an unprecedented time. We are used to being busy but we have had to throw our all into ensuring that we continued to provide a high standard of care. We are so grateful that we were not completely overwhelmed like some ICUs in Italy and Spain.

We are seeing some very ill patients, and we are seeing lots of them at the same time. We have been dealing with what has turned out to be a much more complicated disease than we had initially anticipated. We are now more experienced than we were 2 months ago and are able to apply what we learned to ensure we save as many people as we can.

Throughout it all, morale has remained high and I am fiercely proud of my department.

What do you think of the Stay Alert message? Are you expecting a second wave of infection?

I understand what the Government are trying to achieve but they have muddied the message. It feels to me like the policies have been built around the slogan. Having said that, when it comes to social distancing, it’s obvious that whilst some people have been given an inch, they are taking a mile. Middlesbrough has one of the highest infection rates in the country and I do fear that we will see a second peak.

If the public does become too lax in social distancing, when do you think hospitals will feel the impact?

Clearly, there is a lag between an individual contracting the virus, incubating, showing symptoms and then deteriorating to the point that they require admission to hospital. Applying a bit of 'pub maths' I reckon there would be a delay of 10-12 days before hospital admissions started to rise and another 2 days or so before we might see these patients needing ICU. We are all hopeful that things will not be as bad as some have forecast.

How is the pandemic impacting mentally on intensive care teams?

It has been difficult for everybody but it is the nursing staff who have had the toughest time. I have written in the blog about how hard it is for them to care for dying patients when no family members are able to visit or be there at the end.

Some of the hospital’s clinical psychology team have been embedded in our unit and they have been a very welcome addition. It is a Faculty of Intensive Care recommendation that psychologists offer support for ICU staff. I suspect that when this is all over we will want them to stay.

We have had to deal with many more of our patients dying than we are used to. We have all learnt to celebrate our successes in order to remain positive. There is a reason that healthcare staff have taken to applauding patients as they leave the ICU.

You can read all of Dr Cree's blog posts here.

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