An orthopaedic surgeon’s diary at the Nightingale Critical Care Unit

by Niall Eames
Clinical Director & Consultant Spinal Surgeon Belfast Health and Social Care Trust

Published 20 April 2020

Monday 6th April 2020

The first Nightingale critical care unit opens in Belfast during the corona virus outbreak. Ortho surgeons volunteer to join nurses and medical colleagues there in the fight against corona virus. 19 colleagues form the 'nightingale platoon'.

Over the weekend prior to opening we all visit the unit and receive briefings on how it works and what to do etc.

Monday 6th 2000hrs

My first shift. It’s 12 hrs. I haven’t done a 12 hour night shift for an awfully long time - I worry I can get through it without falling asleep.

Completely irrationally I cover my car insides in old sheets - maybe it will stop the virus getting onto the seats etc. Crazy notion. I haven’t worked in BCH since I was a surgical trainee in the early 1990s.

A senior nurse, also being redeployed there, has given me a tip to bring my scrubs in a pillow case. It was a great tip. It can simply go straight in washing machine when I get home.

Arrive and met as planned by John at entrance foyer of hospital. The hospital is deserted. Car parks empty, except for staff arriving for night shift. I meet Pooler and Wu in car park - it’s reassuring to see familiar faces. We all carry our pillow cases. She must have told everyone this tip!

John takes us to the changing rooms. We meet another anaesthetist who is wearing the oldest long green farming boots I have seen. What on earth are those for I ask?! They will protect your ankles and feet he says - you will see.

We gather in what is called the anaesthetic control room. The welcome is huge. We could not be made more welcome. They seem genuinely glad to have us along - we work together in theatres obviously, so there is an immediate bond. I have left my glasses in the changing room. A schoolboy error. Nerves I guess...

John is an intensivist and our boss for the night. We are going to work in pods - mine has a consultant anaesthetist - an ENT trainee, an orthopaedic trainee, an anaesthetic trainee and me. Everyone is very friendly. It seems like first day at school - but clearly different.

We receive a briefing from the day team now going home - a handover round. John comes across as so caring and professional. He obviously is completely on top of his game and immediately reassures us all. Each patient is carefully discussed. It is very real now. This is a very impressive group of clinicians running the unit. I wonder how on earth I can help them.

Then it’s time to go to the unit. Pooler tells us he has heard that showers are dangerous because they vaporise the virus and it’s where people catch the disease. This is frightening. I had a plan to shower before I went home. I don’t know what to do about this, but there isn’t time to worry about it now.

We move towards the room to get kitted up. It’s called the donning room. It is really strange - it’s the same room I worked in as a surgical trainee 27yrs ago - now it’s a security locked door into the new critical care unit.

Four of us are taken in together at a time to get all the PPE on. This is a bit scary. It’s clearly critical - the door is opened and we go in. Everything is laid out carefully in order - big large laminated sheets demanding how we will put each layer on. Everyone looks after each other. Our first job as a new team might be the most important one we do tonite! We check each other. The masks don’t feel that tight on my face. I wish it felt tighter. But it is the way it was fitted the day before by the technician and the testing machines said it was ok - have to trust it’s ok. The plastic gowns are flimsy - I wonder if they make a difference. I’m a big man. Everything feels tight, but it’s ok. There are boxes of PPE - that’s good. We write our names on stickers and put them on our visors or chest.

My feet and ankles are uncovered except for my scrubs. They feel vulnerable. I see why some people wears boots. I will buy some. For the moment, I just must remember not to touch them. It is really strange being in all these gear, to protect me. I am used to being in scrubs to protect patients - we usually can’t touch anything in operating theatres that isn’t sterile - this is now the exact opposite. Where do I put my hands? I feel like a medical student again.

The inner locked door is opened, and we go into critical care. I see patients in critical care as part of my normal job frequently. So I am used to it. But this is nothing like I have seen before. It is the same as TV. Everyone is dressed like me. You can only see their eyes. The stickers without names are vital now. It seems as if everyone is looking at the four people entering this space shuttle. It feels awkward. But that passes quickly.

John and Brenda take us on a ward round. There are a lot of patients. It’s hard to hear in the gear, but there is a dull noise of calmness about the place. In my normal job, scans and pictures tell me what I need to know about patients - here it’s numbers. There are numbers everywhere.

We have all spent the last few days relearning these figures and what they all mean. Looking at the monitors and sheets - I take a deep breath and work my way slowly through what they all mean. Hopefully soon they will speak to me the way scans do! But not yet...

Gillian, the ENT trainee and I try and calculate some of the ratios we have learnt. It takes a few minutes, but we get there. The excitement of getting the result is very quickly overtaken by the realisation of what it means for the patient we are standing beside. These are very sick patients. As if we didn’t know.

Brenda is brilliant with us. She explains all. I’m sure she is fed up already. A patient needs turned. We all help do that. The numbers are slowly beginning to make sense, but I know how to lift someone.

After 2 hours, John tells us to leave. We have been in for long enough and he wants us to limit our viral load. So we are led out to the area where all the kit is taken off - the doffing area. This is where the virus really can get you. Everyone is ultra careful. Layer by layer we take it off. My glasses get caught. I recover. I need to be more careful.

Now in the control centre again we all sit awkwardly. What can you touch, what can’t u touch? Don’t touch my ankles. I wish I had boots. Food has been supplied by shops. We try and relax. I feel dirty. But I’ve washed my hands 7 times in the last 15 minutes.

John sends us back in again in shifts. Some of my colleagues are on Level 2 of the tower, moving beds and ventilators about to prepare for the next surge of patients - if it comes. I wonder when it will come.

Brenda tells us it’s on Twitter Boris is being taken to ICU in London. That’s not good. We joke about middle aged men being at risk. I look around. Wu says I’m not that old. I’m roughly same age as Boris.

Again we go back in, following the same procedure of doffing. It feels easier the second time. When the doors open, it doesn’t feel so strange. We do another round of all the patients.

The nurses are very stretched. Many are new to ICU as well. Some only got phoned two hours before we started. John tells us to support them as much as possible. There are some tears around the place. People are stressed. He says to lighten the mood.

Brenda and Tim are really good. They take time to explain all the stuff to us. Gillian understands it better than me, but it’s beginning to make sense. The next patients nurse I know - one of ur mph nurses. We punch each other in the chest, glad to recognise a familiar face. He’s such a positive guy. His patient is stable.

Then I see two more nurses I know - again more punches and high fives. Brenda wonders what on earth she has let herself in for.

At the next patient Brenda leaves Gillian and me for a moment to check something. As we stare at the charts and decipher the numbers, the nurse comes over to us. I don’t know her. She asks if all is ok - clearly worried we are finding a problem with her work. She doesn’t know who we are other than two new faces scrutinising her work. Her work is fantastic. I look at her and say - we are doing a handwriting check. Do you have your report card? She looks bemused. Were u not given a card? Well your writing is excellent. The three of us laugh. She is doing a fabulous job. We tell her that.

The round continues. We move between areas. Bizarrely, an outside door opens rapidly directly beside us. Three cardboard boxes are slid across the floor at us, and the doors slam shut again! We look at each other. Must be the PPE arriving!! Nothing else to do but pick them up and carry them to the centre station. How do u pick up a box in full PPE gear?!?

The clock on the wall hasn’t been changed to summer time. It’s an hour slow, but my heart drops a bit looking at it. I thought I was doing well until I saw it.

John says it’s time for us to get out again. We duff our gear again - it’s easier this time. We head to the beds layed out in a nearby ward to grab some sleep. As I lie down I worry about my collar and ankles - they were exposed. I can’t sleep really. I worry I might touch them when I doze off. Boris is now 'receiving oxygen'. I wonder what the truth really is...

Morning arrives. I go and shower - but I worry now again. I trust Pooler and what if he is right. I drive home and strip off at the washing machine - everything goes in. I shower again. Back of my neck gets a special clean. It’s hard to cover up.  Then go into my isolation room away from family. I sleep better now. The night had been ok. I hope my friends are all ok. I wonder how Boris is?

Night 2.

It’s a beautiful day when I wake up. Had been sleeping well, until Amazon delivered a parcel.

Go for a walk with Rosey and kids - beautiful day. Nature is alive and happy.

Time to go back in again. I change into tracksuit again. It has shrunk in wash. Now sits some way up my shins. I look a fool. Who cares.

The same cycle starts again. Handover. Doning, doffing.