Birmingham news Tears, heartbreak, togetherness - the story of life inside city ICU MetiNews.Com
MetiNews.Com - We were given exclusive access to life inside a city intensive care unit and this is the story of the staff working 'at their limits' every day
Breaking News ! Dr Nick Sherwood breathes in deeply. The grey clouds are rolling over our heads, but for now the threatened rain is holding off. He’s glad for the chance to be outside after the stifling claustrophobia of wearing full PPE, including a tightly fitted mask, as he oversees the care of the most critically ill inside Birmingham's City Hospital. But as we talk in a small garden in the hospital grounds, two trollies pushed by porters roll by towards the mortuary, just out of shot. Their sad cargo is body bags containing patients who have succumbed to coronavirus. It's a horrible, stark reminder of the shocking everyday playing out in hospitals across the region. Dr Sarb Clare, left, and Dr Nick Sherwood appeal for people to take the vaccine and follow rules - as City Hospital's intensive care unit supports the sickest Covid patients Overshadowed in terms of media attention by its bigger neighbours across the city who oversee the Queen Elizabeth, Heartlands and Good Hope hospitals, the story here in west Birmingham is no less profound or heartbreaking and the impact on staff is horrific. "Every day you finish work, you see nurses in their cars in the car park crying before they go home and see them coming into work wiping the tears from their eyes before they turn up to do another 12 and a half hour shift," said Dr Sherwood. "It is incredibly hard. "Even the toughest of us - and I thought I was pretty resilient - but I have had some pretty dark moments this year." BirminghamLive was granted access to speak to frontline medics about the reality of the situation playing out here, supported by images and a short video shot inside ITU by the hospital. Daily these men and women and hundreds of their NHS colleagues are at the sharp end of the pandemic, as they have been for months. In return for putting their health on the line, they ask two things of us - don't 'stretch the rules' and risk someone else ending up here and definitely, absolutely, "take the vaccine when your chance comes." "It's our best hope," they said. Inside City Hospital Pre-pandemic, there were 18 ICU beds in the two hospitals that together come under the umbrella of Sandwell and West Birmingham Hospitals NHS Trust. On the day of my visit earlier this week, there were 36 of the sickest patients needing critical care - 24 at City, 12 at Sandwell. That's more than double normal capacity. Two wards have been commandeered to create the extra ITU beds. All are full. It's the most intense period yet of the 'massive long major incident' that is the pandemic, said Dr Sherwood. Video Loading Video Unavailable Click to play Tap to play The video will auto-play soon8Cancel Play now The youthfulness of his current cohort of patients is a big worry for him - and it's affecting morale enormously. "We have got a mix of patients here (at City), 16 downstairs and eight upstairs. Our youngest patient is in their early 30s, our oldest in their late 70s. The vast majority of the patients are aged just 45-55. "Most of our patients, until this happened, were relatively fit, independent, had jobs, had fairly trivial chronic health conditions that did not cause them problems. "The sad fact is that of those who get to be on a ventilator, half of them unfortunately will not make it. "That is very difficult for their families, who cannot see them and visit them, and it is very hard for our staff. A patient in ICU is monitored by a medic (Image: Sandwell and West Birmingham Hospitals NHS Trust) "We get attached to these patients, particularly those who are not put immediately onto a ventilator, who are on pressurised oxygen therapy for some days, we get to know them. "I have a guy whose birthday is tomorrow – that is going to be really, really difficult for his family because he is relatively young." Read More Related Articles Nearly 200 Covid patients fighting for life in city intensive care beds - average age just 58 Read More Related Articles New lockdown measures for West Midlands 'under discussion' as hospitals full His colleague Dr Sarb Clare, an acute medicine consultant, is also deputy medical director at the hospitals Trust. She is proud of the Trust's exceptional approach and record on staff wellbeing but says the distress being endured is a huge concern. "Some of my colleagues are struggling to sleep, we are not trained to deal with the sheer volume of deaths of young people, the utter pain we see every day," she said. "We know the odds are against some of our patients but we are passionate we want to get them through, we pray for them, we work through the treatments and the proning, and we are destroyed when they don’t make it. "The pressure at the moment is immense and we are feeling that sense of gritting our teeth. "It is definitely much harder, this is our third surge here, and what is getting us down is the volume of young patients we are now seeing. "These are young people, with young families - they are gasping for breath and they are scared." But she said it was infuriating that the graphs and numbers showing daily the impact of the virus were failing to reach some people who "need to take on board this is real and here." She illustrated her point with a stark reminder that those working on the frontline are not only among the most at risk, but also part of families that are affected too. "I did a 13 hour shift this week that included looking after the mum and dad of one of my colleagues," she said. "We have had a grandparent, son and grandson together - these are families together. "In a way it is what we had been predicted with the get togethers over Christmas. "The pressure is huge but as we do, as we always do, is we get on, we are the NHS, we are resilient and we will get through this. I am exhausted, we are all exhausted but we will get through this." (Image: Sandwell and West Birmingham Hospitals NHS Trust) She added: "With any crisis you see the worst and the best of people. It has shown me the true nature of human beings and the compassion I have seen from my nursing teams is incredible. "In the patient's dying phases they are there holding hands, they inspire me every day. "Covid is a condition that is not only affecting our patients but also us - we can get ill, our loved ones can get ill, colleagues get ill and they are treating and looking after patients when their loved ones are going through it, which is really tough. "We are seeing younger and younger patients this time round - the variant is incredibly contagious, but while our older populations are keeping inside and not mixing as much, our younger people are at work, out and about." Video Loading Video Unavailable Click to play Tap to play The video will auto-play soon8Cancel Play now And she made a passionate plea to people to comply with rules and get a vaccine. Speaking straight into the camera, she implored: “Thank you to everyone complying with the rules during lockdown. I know it is really tough but we have to keep going. "Please wear a face mask, wash your hands, and social distance. I would also like to beg and plead to everyone out there, when you are offered a vaccine, please please take it. “It is really important with this surge, the variant is very contagious, we are seeing very young people coming in who are incredibly sick and some of them unfortunately are not making it, they are dying. It is vital we comply with the rules and comply with lockdown." (Image: Darren Quinton/Birmingham Live) It's a theme picked up by Dr Sherwood: "This is one massive long major incident. There is only a finite amount you can do in the middle of it. A lot of that comes down to the strength of your team. "We know when it is really bad, when we lose someone young, or unexpectedly, we make sure particularly that junior staff are supported, tell them that it is okay to feel as if you are out of your depth, because we all feel like that at some time." The hospitals trust has risen to the challenge of supporting staff, drawing on its wealth of well being services including a wellbeing centre, massages, mindfulness, special relaxation pods, a ready supply of food and drink, staff huddles every shift and a wellbeing champion programme.
. "We have got much closer, the nursing team, cleaners, porters, doctors, we are all together and it really has helped us. We have gone through this experience together." But Dr Sherwood said he worried that while the teamwork and togetherness inside the hospitals was a strength, the public were not as fully supportive of the NHS as they had been in the first phase of the pandemic. "The Thursday clap was useful, lots of us drew from that. But there has been a definite tone change in the nation," he said. "Everyone is fed up of it - the unquestionable support there was for the NHS has wavered a bit. "We are working harder now than we have ever worked. So please give the NHS guys a break!" He also implored people to do the right thing and follow rules. Our graph below illustrates how dramatically Covid admissions have gone up at the hospitals since November - with no sign of it stopping yet despite lockdown.
"Central messaging seems to have changed, but let’s be clear – if you stretch the rules, sooner or later as a consequence of that someone will die. It’s as straightforward as that," Dr Sherwood said. "It might not be you, or the person you stretch the rules with, or who they stretch the rules with, but sooner or later someone who is vulnerable, probably someone in their 50s who is reasonably fit and well, will get it and they will come into intensive care and probably die. "This virus does not jump. If you maintain social distance, put a mask on as much as possible but certainly when you have to, and you wash your hands, because it is not just breathing stuff in it’s on surfaces too, you will be safe. You have to get close to people for it to be transmitted." Inside Intensive Care A short video created by the Trust gives an incredible insight into life inside City Hospital's intensive care unit. You can view the video in full below.
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In some ways it should dispel the fears of relatives, unable to visit and desperately worried for their loved ones. There is something pleasantly disarming about the interaction of a medic asking a patient if she wants her sandwich, and of another sitting stroking the hand of a patient. Among those in shot is Vanessa van de BovenKamp, 27, pictured below, who is a a senior rotational physiotherapist at the Trust, where she has worked for five years. Since September she has spent much of her working day in intensive care, helping the sickest patients.
(Image: Sandwell and West Birmingham Hospitals NHS Trust)
She and her physio colleagues work on the poorly patient's chest, helping to loosen any build up, while also moving arms, hands and ankles to try to limit future problems. They also assist medics when they have to 'prone' a patient - involving flipping them onto their front to improve oxygen delivery. It's one of the regular activities designed to prolong someone's chances of recovery. She said: “The role of a physio within intensive care has certainly increased during the pandemic and it has been challenging." But don't be fooled by the air of calm - this is a critical situation, and many of the patients will not survive their ordeal, said Dr Sherwood. He and his colleagues have extra facilities, extra ventilators and extra equipment to help provide care. He is not short of willing colleagues desperate to answer the rallying call that has gone out across the city. But what he doesn't have is extra specialist ITU staff, and it's a constant worry.
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"We have more equipment but what we have not got is more specialist nurses," he said. "It takes years to train an intensive care nurse. Normally if you are on a ventilator you will have one highly trained ITU nurse looking after you. "Currently we have one ICU nurse looking after three or four patients, supported by nurses drawn from other areas of the hospital. Some have been with us so long they are quite experienced, some have literally started today. "We are trying to provide the safest service we can - but you cannot split an ICU nurse into four and expect to provide the same service. We are making it as safe as we can to get through this." More people are expected to be admitted in the days ahead, as still high infection rates persist in Sandwell and Birmingham. What he is confident he will not face is the prospect of rationing covid care - a frightening prospect raised by some medics, in which care will be denied to some with covid in favour of others. "We have never had to deny care for lack of facilities or capacity, and we have always managed to stretch, and sometimes stretch a lot, to get people in.
Inside ICU at City Hospital Birmingham
(Image: Sandwell and West Birmingham Hospitals NHS Trust)
"The awful reality is that if you are over 80 and very frail, it is almost certain ITU will not help you - whatever we do you will not make it, so it is not right to put somebody through treatments that are uncomfortable and painful and degrading in some ways. "But we use absolutely standard decision making protocols. We have been led to believe that if it ever came to triaging – or sorting – that would be a national decision made by a national NHSE medical director, not down to a medic, or trust or area." Will the hospitals cope until the third wave dies down? Says Dr Sherwood: "We think with the expansion plans we have in place we can open up a few more beds and we have enough to get over the peak. "It looks like community numbers are just about levelling off. We would expect a reduction into hospital within a week and into ICU two or three weeks after that. "The problem is our patients are staying two to four weeks, they are that sick, they are staying that long on ventilators. "So even if numbers admitted go down in nine or ten days, we don’t see the benefit from that in reducing intensive care numbers for another month. "We don’t expect to have anything back to normal probably into April the way things are going." He said the backlog of other cases, including a huge number of elective operations building up, will mean for staff there will be no let up.
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"I think we can get our staff through the next three months. But what will be really difficult will be swapping one problem, Covid, for everything else we do. Managing that for the whole country will be really, really tricky. "Lots of specialties have been impacted hard – acute, A&E, respiratory – but certainly I have seen the toll on ICU." And he had this message for those who think the NHS can continue absorbing pressure indefinitely. "A lot of people (in the NHS) are considering their careers - they will get past the pandemic because they feel it is their duty but are not sure they can keep doing this." The next few weeks, for Birmingham and the Black Country, is going to be critical. Stay Home. Protect the NHS. Save Lives.
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