In a special webinar organised by the UK and Ireland Society of Cataract and Refractive Surgeons (UKISCRS), Elizabeth Yang, a trainee ophthalmologist in West London, spoke with Prof David Spalton about her experience working with seriously ill COVID-19 patients
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I was contacted about three weeks ago and asked if I would like to help out at Northwick Park Hospital, one of the epicentres of the COVID-19 epidemic in London. I was asked to come the following day for induction at the ICU unit. It was quite a shock as it came out of the blue, but it reflected how dire the situation was at the time, with the ICU bed capacity expanding rapidly within a week to cope with a high influx of COVID-19 patients.
The senior staff were very helpful from the moment of our arrival. They tried to recruit us as early as possible after the outbreak of the epidemic when they were still in a position to be able to train us and show us the ropes. They have always been on hand when we need advice or direction. They have been really helpful and kind despite the pressure and the awfulness of the circumstances we are facing.
We work a 12-hour shift over four days: two day shifts and two night shifts and then we have four days off.
There are a lot of aerosol-generating procedures in the ICU such as intubation, extubation, cardiopulmonary resuscitation (CPR) etc, so everybody is wearing enhanced personal protective equipment (PPE) within the ICU areas. It can vary slightly from day to day, but we usually wear yellow surgical gloves rolled up high with purple nitrile gloves as well, surgical gown, hat or hood, FF3 mask, goggles and visor. The gear is quite suffocating, but you do get used to it after a while.
It has been very busy and at times we have had more admissions than we had the capacity to deal with. We try to identify patients who are fit for transfer to other hospitals. Triage is performed by a consultant to determine who is admitted to ICU, as it can be the difference between life and death. It really is decided on an individual patient level – there does not seem to be an age cut-off point at which patients are not given access to a ventilator as has happened elsewhere in the world.
Typical patients tend more likely to be male, middle-aged with higher BMI, and are often diabetic, hypertensive or with other co-morbidities. At a rough approximate, by day six or seven of their ICU stay, we can usually identify who is going to do well and who isn’t. We are currently transferring a lot of our stable patients to other hospitals, and the most unwell patients, who are likely not fit for transfer, are kept in Northwick Park.
Our job is really to help wherever we can, learning to troubleshoot ventilators and infusion administration. It is intense work but rewarding. It helps that all the patients have the same condition, so their management is usually fairly similar, although intensivists are still learning about this very new condition and how best to manage in a crisis. I have definitely learnt new skills in my time here and am glad I can contribute to the effort to save as many lives as possible.
