‘You are literally fighting for your breath’: Inside ICU battling deadly second wave
Written by on 12 November 2020
Just behind a screen, shielded from public view, there is a hint of the pain and anguish I am about to witness.
Here a family waits, each member comforting the other, bracing themselves for the news.
This is a quiet, private area set aside for the families of patients being treated in University Hospital Coventry’s intensive care unit.
I was here a few months ago, in September. The ICU was empty of COVID patients then.
The first wave had taken its toll and the hospital was pivoting towards restoring its backlog of non-urgent operations.
But the hospital has had to respond to rising COVID infection rates.
I was not prepared for the change. The once empty beds are now full of very sick patients.
Extra capacity has been created by removing the partition walls of a neighbouring unit. That has made two more bays of critical care beds.
There is an army of staff; nurses and doctors moving quickly between patients, poring over charts and checking notes, discussing treatments.
These are some of the sickest patients in the region. Some are receiving end of life care.
Hunched over one bed there are two physiotherapists. One is pummelling her patient’s chest, pushing up and down, up and down.
She does this while her colleague inserts a tube, a suction catheter, down her patient’s throat. He is an elderly man and totally unaware of their efforts because he is sedated and intubated.
They do this for several minutes. The therapist pumping the patient’s chest must be tired but she keeps going, pausing only to glance at the multiple monitors above the patient’s head.
Fluids, blood and mucous pass through the transparent tubes leading from his mouth into a reservoir.
They have to do this because the patient cannot clear his lungs by himself. This is specialist care for ventilated patients who cannot cough out the fluids that are building up in their chests.
Almost all the patients in this bay are sedated and intubated. There are men and women, old and young, black and white.
They all look very poorly as they lie motionless in their beds attached to machines that are keeping them alive.
If there any doubts about just how deadly this second wave is then the scene inside this unit will blow away those uncertainties.
There are only a few patients who are conscious and able to speak to me. One is Tom Skingle.
He is not what I expect a COVID-19 patient to look like.
He is only 51, he celebrated his birthday in ICU and looks fit. Or at least I expect he was before becoming infected with coronavirus.
Tom is understandably emotional. His eyes well up with tears and his voice breaks as he tells me his story.
“I thought I had a cold, I thought I had tonsillitis,” he says.
“My wife is a nurse. And she checked me and she knew it was more than that. So she spoke to the doctor who said have a COVID test which I did and it came back positive.
“The worse thing is the chest – the lungs. The lungs collapsed and you are literally fighting for your breath.
“It’s the hardest feeling ever not being able to do anything and literally breath. At one point I thought I wasn’t going to make it. That’s how bad it was.”
I am almost the same age as Tom. I struggle to think what it must be like for him.
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He has been confined to this intensive care bed for three weeks watching helplessly as the daily struggle for life and death is played out around him.
“I was terrified,” he says.
“I’m in here away from my family and the people are great. It’s hard work, genuinely hard work to get through it.
“Stay strong, that’s all it is, stay positive and hopefully I will get out of here.
“I’ve seen two people die in this ward whilst I’ve been here. That’s just harsh. It gives you a reality shock of how serious this thing is.”
I have talked to numerous intensive care doctors throughout the pandemic. They all tell me about the steep learning curve, learning about a novel virus on the job, the dedication of their teams and the relentlessness of this health crisis.
Privately many will tell me they are at breaking point, exhausted and drained. Now, without barely a lull, they are having to step up again.
Dr Chris Bassford is leading the ICU teams in Coventry. He tells me about the success of medical interventions and the use of new drugs.
But I want to know how he copes with losing patients.
As a physician, Dr Bassford has devoted his life to treating the sick and saving lives. I ask him to answer “not as a doctor but as a human, a person”.
There is a pause. A sharp intake of breath, his mask hollows as he inhales deeply. This is followed by another pause and then he moves his gaze to the floor.
“It’s never easy,” he says.
“Sometimes it is difficult. What I can say is this is a team that knows what they are doing.
“And if you have a patient that you have cared for to the best of your abilities, and you’ve done everything right, and they still didn’t make it out of the intensive care unit alive, then that sometimes is something you have to accept.
“You have to try and leave at work and not take home with you.”
Dr Bassford pauses again.
He then says: “Some patients are more troubling. So for example, for a lot of the nursing team you have a young woman come in who has kids and that’s exactly the cohort my nursing team are in – that’s really hard.
“The team will struggle with that. Having said that, it’s also hard when you’ve got someone who has got grown-up kids and it could be your mum and dad who is that sick as well.
“There are times that yeah, it can be hard. But that emotional something about that particular patient makes it very hard to leave it at work.”
The hospital is facing a perfect winter storm.
A sharp spike in emergency attendances of non-COVID patients, an ICU filling up with desperately sick patients.
It is already at 99% capacity and is determined to continue with all elective care.
But it accepts there will be a tipping point when this is no longer possible.
It is already struggling with staff shortages; 630 of its 9,000 strong workforce are off sick.
Since October, the hospital has lost six patients. In the few hours I spend here, the total rises to seven.