Hospital staff, tell us the reality

[Ihateme]

I’m am so fed up of seeing people comment on here that schools should be going back, that people should not be reporting mass gatherings in tier 4, how dare people begrudge a child their birthday party etc...

The hospitals are in a worse state now than they were during the first peak. Would any doctors or nurses care to confirm this? Maybe then these Mumsnetters will get the message.

@LostInMoab

Coincidentally I was reading this earlier www.theguardian.com/society/2020/dec/29/know-you-are-loved-hope-and-tragedy-in-nhs-hospital-as-covid-vaccine-launched What I found quite scary is how young the patients look (from what you can see of limbs etc), and that’s backed up by one of the comments in the article.

People in their 60’s as an average 😨 definitely premature.

@Covidnurse2020

How can your average person be more vocal & show more support?

I'd still be clapping on Thursdays, but we were essentially told it had become meaningless & that we should stop.

I'd very much in awe of anyone working in 'care' or in a hospital, no matter what they do.

Teachers, police & retail deserve medals too

When I was younger & before I had diabetes I'd have been right in the middle of helping any way I could. But now I'm over 50, not very well, diabetic & scared of getting it.

Other than doing everything I can to stay out of hospital I'm at a loss as to what I can do, to make people feel appreciated & supported??

@Cam77

You could go much harsher and weld people’s doors shut like they did in Wuhan

Tired of people constantly dragging this out as though it's in any way symbolic of China's strategy. That happened in about a dozen cases out of a billion when the authorities panicked cos they didn't know what was going on.

Instead I'll give an example of what is symbolic do China's response: there are probably still more Chinese people wearing masks in crowded outdoor spaces than there are British people doing the same. And that's despite China having zero daily deaths for more than half a year and the UK currently having 500+ every day. Different Outlook. They are questioning our concepts of human rights every bit as much as we are questioning theirs.

Are they fuck! 😂

@8obbingabout

My Fiancé is a nurse in a busy London hospital and tells me its worse than the first wave. Both in terms of cases and ICU beds. They are almost at capacity and are desperately understaffed as many people are off with covid or isolating/shielding. They have canceled all elective operations and just operating two emergency theatres and redeployed staff to ICU wards.

The stories she tells me from the ICU wards are really horrific. I honestly do know how they cope. I feel so sorry for them all. They are trained to save lives but this really is something else.

Everyday seeing people die and often unexpectedly. People saying their last good byes via zoom calls on an i pad. People crying and screaming for their families. patients seeing people die and knowing its coming for them next. There's still a shortage of ventilators a vital piece of equipment.

In the last 4 weeks they have almost doubled in cases each week and the hospital have predicted it will peak in 2 weeks time.

: (

Ventilators? Not for Covid surely. I thought it was well established that doesn’t work well.

@Feministicon ventilation is still a very valid treatment for when non-invasive ventilation or CPAP fails.

Ventilators? Not for Covid surely. I thought it was well established that doesn’t work well.

Ventilation is never an easy choice (even in non Covid times) because it comes with lots of risk, nonetheless but lots of Covid patients still need it, having gone past the point where less invasive treatments are enough.

ICNARC publishes the figures for ventilated and other sorts of breathing support used in critical care weekly. Documents are viewable to non professionals.

www.icnarc.org/Our-Audit/Audits/Cmp/Reports

Ventilators? Not for Covid surely. I thought it was well established that doesn’t work well

See, this is the kind of comment that is a little frustrating, although I’m sure that wasn’t the intention.

It’s really not well established at all. Some people with covid definitely need invasive mechanical ventilation.

Some people manage with non-invasive ventilation ie CPAP.

There is an ongoing concern that for the sickest people, delaying intubation and ventilation by prolonged use of CPAP worsens the lung injury and leads to poor outcomes.

As yet we don’t have a hugely reliable way to predict which people fall into the “getting away with CPAP” group and which fall into the “need intubation ASAP” group.

We are probably ventilating fewer in this round than previously, for a variety of reasons, but that may change in due course.

One of the reasons is that sometimes mechanical ventilation is needed to facilitate other organ support eg cardiovascular and renal. Non invasive ventilation does not have the same benefits. We are seeing fewer patients with acute kidney injury than in wave 1.

We also have a large number of people on incredibly long VV ECMO runs.

It’s really a lot more complicated than it sounds on any given news story etc, and it just feels a little like people are coming out with “Dur those moron doctors thought it was all about the ventilators when EVERYONE knows ventilators are bad”. It just sounds so simplistic, when the reality is that it’s actually quite a complicated balance of risk / benefit.

(For anyone interested in the respiratory physiology, the likelihood is that covid has at least 2 phenotypes, one dominated by VQ mismatching and the other by “typical” ARDS. Optimal management is almost certainly different depending on time course and phenotype.

There is a video available on YouTube by Luigi Camporata one of the severe respiratory failure consultants at St Thomas’ which describes this nicely - not sure it is that accessible to lay people but nicely done. It was made for ESICM so you can use that as a search term.)

@RandomMess I think I remember you from other local to me threads - are you NW based?

I was in A&E for 9 hours at Lancaster a couple of days ago and ambulances were queuing all day to hand over patients. There were people lying on beds in the corridors and sat in wheelchairs.

I listened to many a fraught phone call trying to find beds for patients - they were also struggling to discharge elderly patients via patient transport back to care homes due to a huge pile up on the M6. Crazy.

I have Bell's palsy but for a while there they were worried about a stroke. I'd have needed a bed and it was a worry they might not manage it

(I mean anyone can watch the video but it is a little technical at points

m.youtube.com/watch?v=x6l-f3-IK-o

)

Ventilators? Not for Covid surely. I thought it was well established that doesn’t work well.

Ventilation is the last resort, if the steroids and CPAP don't work and you believe someone has a chance with ventilation, why wouldn't you give them that chance ? , it buys them more time, for their body to respond and be supported whilst it fights the virus, people recover from being ventilated otherwise it would never be an option for anyone.

@parallax80 how and when do you make that call ? Person A will be fine on CPAP and person B will need ventilating ?

However many years at medical school presumably frumpety 🙄

@tigerbread20

I'm a 2nd year student nurse on placement on a covid ward. I'm broken, emotionally and physically. My face is bruised and peeling skin from the masks, my hands are bleeding from washing them 100+ times a day. Sometimes I get home from work and sit in the car on my drive and cry for an hour before I can face going home to my 'normal' life, husband, children. If I actually finish my training I will be beyond amazed, when I started this placement I'd had 5 weeks previous hands on experience, now I'm taking sole charge of bays of 6 patients at a time. There's no empty beds, there wasn't been for 2 weeks, when a bed becomes free it's filled again within minutes of being turned around. I truly believe many members of staff will suffer ptsd from this, there aren't words for how awful it is. I'm in my early twenties and have held the hands of dying patients more times than I can count.

I'm so sorry you're going through this. You're so young and having to cope with so much awfulness, and still cope with fools banging on about scandemics and how it's a normal winter. Please know so very many of us care, and we can't thank you enough. My own DD is a second year vet nurse student and I actually have tears in my eyes thinking about you, similar age to her, in this awful situation. I wish I could send you some flowers or something but here are some cyber ones and some very unmumsnetty hugs. 🤗🤗

I certainly didn’t say or think ‘dur’ 😱 I said ‘I thought’ not I know.

Thanks @Kizziebel and @PlantMam

@parallax80 how and when do you make that call ? Person A will be fine on CPAP and person B will need ventilating ?

It depends on a lot of different things - for example:

Some people it’s very clear cut that they will need ventilation for example because they are so hypoxic at presentation that they are not conscious enough for CPAP. Or they have very high respiratory rates and drawing huge breaths on CPAP which puts them at high risk for self induced lung injury and worse fibrosis / difficult ventilating / outcomes further down the line.

People with significant multi-system inflammation typically have a more aggressive disease course that needs multi-organ support and probably ventilation as part of that there are some markers to indicate whether that is present (CRP, ferritin, AST, renal function).

Some depends on time course - for people who eventually recover, covid seems to be worst at about day 10-14 after symptom onset. So if someone comes to hospital on day 10, goes on CPAP on day 12 and is borderline I would be more likely to sit tight and hope they are turning the corner and will be in the “get away without intubating” group. Whereas someone who is failing on CPAP and only on day 5, is almost certainly going to end up ventilated and you gain little by delaying it (and may even cause harm).

Sometimes it also depends on the patient’s and relatives wishes and their baseline medical condition and functional status - invasive ventilation carries more risk than CPAP so there may be patients for whom the burden of intervention that goes along with that - sedation, central line, pressors etc - is not appropriate for the very slim chance of benefit. That is an individual discussion in itself.

There are some pre-existing scoring systems that aim to try and predict who will need invasive ventilation (eg ROX score for high flow nasal oxygen) but none are fully validated or reliable at all, and definitely not specifically in covid. The largest multi centre study pre-covid (LUNGSAFE trial) found that use of NIV in Type 1 respiratory failure delayed intubation and was associated with poorer outcomes, so by using it extensively in covid we are kind of going against the grain of the evidence base which feels a little uncomfortable.

In short, there are very few hard and fast “rules” and the reality is that in covid like everything probably we make the wrong decisions for individual people with hindsight. The problem is that everyone has 20:20 hindsight and no one has perfect foresight. So you can only do the best that you can using both the evidence, evolving guidelines and expert consensus and where decisions are difficult, discussing with colleagues. You can’t be a critical care consultant unless you come to terms with the fact that you are not perfect (I don’t mean that as an excuse for recklessness or complacency - you should strive for excellence, but have the humility to recognise that there is a lot that remains unknown.

Probably some of these questions will be answered to an extent as the pandemic evolves in the same way that lots of elements of medical practice have changed over the years.

@unsure111

I've honestly stopped watching and reading the news. I don't want to talk about it in work or out of work. Because quite frankly I'm sick of all the misinformation and lies. My colleague went to a&e the weekend before Xmas and it was dead only her there. I then read a article in our local paper that the numbers are the lowest they have been since the first lockdown in our town. 2 days later their saying it's uncontrollable and higher than the first lockdown. Which is it? Whatever meets their agenda and scaremongering that day they will go with it.

Then you need to read this thread and reliable news sources

Thank you @parallax80 that answered my very clunky question perfectly

In terms of experience, yes some of it is that - typically critical care consultants do 6 years of medical school and on average 12 years of postgraduate training.

But experience also comes with all sorts of cognitive biases too which you have to watch out for - for example everyone has the patient that they wished they had managed differently and you have to figure out how to let that influence future decisions only in an appropriate way.

ps Femisticon I appreciate that you didn’t say that, I’m just expressing how it felt reading that. As I said, I’m sure that wasn’t your intention, but sometimes the way it’s read isn’t always how we intend. 😂like right now, I probably come across as a massive nerd / pompous idiot, even though I only put stuff like trial names in so people can go and look them up for themselves if they are interedted

Everyday seeing people die and often unexpectedly. People saying their last good byes via zoom calls on an i pad. People crying and screaming for their families. patients seeing people die and knowing its coming for them next. There's still a shortage of ventilators a vital piece of equipment.

It is breaking my heart for so many of you, reading this thread, and making me even angrier that still the deniers pile on with their tedious script about normal winters and false positives. Still they don't listen. I fear the only thing that will make them listen is if they themselves or a relative are caught up in all of this in a hospital. I feel sick with fury that people are being so obnoxiously ignorant in the face of the cold hard facts. I have tried to be kind and tried to understand their position. Now I am done with it.

💐💐 To all of you working out there on the front line.

My friend is an ICU doctor and tonight has written this:

"So fed up by lack of clear and consistent messaging about Covid-19 from this government because they would prefer to play Brexit (the so called deal giving no tangible advantages but plenty of barriers to trade), whilst hospitals are running out of space and at times oxygen.

Fed up by people saying 'the hospitals are coping so why the restrictions'. Pretty much every hospital is under strain but each one in different ways. If your local hospital is coping then rejoice because the restrictions are just right and there is space for you if you get taken ill.

Fed up with people including my local MP playing down the impact of this disease. It has killed scores of thousands in the UK and will take thousands more before it is all over. Over 60s mostly but plenty younger than that too. If anybody calls it 'bad flu' or any likening to influenza to my face, they may get a punch.

The NHS cannot continue business as usual on top of looking after covid and vaccinating the masses all at once. If your appointment or operation gets postponed, perhaps not for the first time, there is not a lot we can do. I would also advise against non urgent inpatient surgery at this time of you are in a higher risk group, catching Covid-19 in hospital is a very real risk, even if you are supposedly in a covid free area.

Ignorance and indifference continue to be contributing to this third peak (the second one never really came down and a week post lockdown we were pretty much back to square one). Complacency is probably a big factor too.... 'I will just pop round for half an hour', 'meeting for one cup of coffee will not hurt', 'I know my test was positive but.....'

Vaccine gives us real hope but this will take time...if Astra Zenica gets the green light this week, then there will be more supply, more easily sent out to GP surgeries etc. Your GP may have to put some other things on hold whilst these vaccines are given.

There are no other easy solutions as many suggest: short lockdowns do not work, sticter and enforced mask rules alone do not work, closing schools on its own will not work. Sit tight, stick to your tier restrictions (and even then see less people from less households, less often) and we will get through this.

I don’t believe in ‘nerd’ as a concept anyway, you know what you are talking about and it’s interesting to read but I didnt make any assertions and I stand corrected ☺️

Femisticon pleasure to chat, I hope at least some of my wanging on was useful. Enjoy your evening.

Hats off to all the amazing staff working in the healthcare system. What we, as the general public can do:
Stick to the rules in our tiers
Accept that COVID exists (for the COVID deniers)
Wash hand regularly
Keep your distance
Accept that our social lives may be much more limited
Fwiw I live alone, have poor mental health and work full time in education. I have managed to follow the rules.

@parallax80

Femisticon pleasure to chat, I hope at least some of my wanging on was useful. Enjoy your evening.

Yes definitely, very much so ☺️ Thanks, you too.