Coronavirus in Scotland: A ‘troublesome day’ on the Covid frontline
The BBC has been granted unique entry to College Hospital Monklands in Airdrie, North Lanarkshire, together with the intensive care unit which has been on the centre of the battle to save lots of lives within the coronavirus pandemic.
Day and night time in intensive care the lights blaze, the screens beep and the machines buzz.
It’s vivid and it’s noisy however for the sufferers that is the twilight world, a spot the place the darkness deepens.
No-one needs to be right here, far much less to return, however nor have they got a alternative.
Trying gaunt and ashen, John Houston is being wheeled again in to the unit he left 4 days in the past.
His kidneys are struggling to deal with Covid-19 and he wants filtration remedy.
“Cannot breathe,” he mumbles as a nurse hooks him as much as a jumble of clear plastic tubes and crimson, yellow and inexperienced cables.
A couple of minutes later John manages a couple of phrases, telling us how he was admitted to the hospital three weeks in the past and had hoped to be again dwelling along with his beloved border collie, Cody, by now.
The treatment John has been given makes him hallucinate, he says, a standard expertise for sufferers in intensive care and one he describes as “a bit scary”.
Medical doctors right here at Monklands say the ever-present public well being recommendation – to remain dwelling, shield the NHS and save lives – has labored however additionally they warn that the primary wave of an infection to hit Scotland continues to be washing ashore.
The variety of coronavirus sufferers right here has fallen sharply previously couple of weeks however the common size of a keep in intensive care has risen through the pandemic.
A lot of those that stay are extraordinarily sick and circumstances like John’s, the place sufferers have to be readmitted to the intensive care unit, are frequent.
On the day we filmed in Monklands – Friday 1 Could – seven coronavirus sufferers died, the best quantity the hospital had seen in any 24-hour interval for the reason that outbreak started.
In intensive care, we met senior nurse Abigail McSherry as she was placing collectively a pack of reminiscences for the household of 1 affected person who had simply died.
Among the many objects had been a diary of the affected person’s time within the unit, a drawing of a tree based mostly on his handprint and a pair of knitted hearts – one to go together with the physique, the opposite to be despatched out to the person’s household.
Companions of sufferers are solely allowed within the hospital below very restricted circumstances, primarily for births and deaths. Even then, to enter a Covid ward, guests need to don the identical private protecting gear (PPE) as employees – gloves, aprons, masks and visors.
“His spouse was right here,” says Ms McSherry of the person who had simply died. “It was crucial as a result of they’d spent their complete life collectively, from major college proper by means of. So, it was crucial that we let her in.”
“I bought his spouse to provide his wee coronary heart a kiss,” she provides.
Medical employees are used to coping with dying however that does not imply they do not really feel its sting.
“The employees have had a troublesome day at present,” says senior cost nurse Donna Marie McGroarty.
“We had a dying this morning after which one other dying there, and that gentleman specifically has bought no household,” she says. “In order that’s arduous for them.”
As a gesture of compassion for a deceased affected person who has no-one to mourn for them, she says, employees stand in respectful silence whereas the physique is taken from the ward. “That is simply one thing that helps the employees get by means of this,” she tells us.
“We’re exhausted,” provides Ms McGroarty, “we have been at this from perhaps the second week, the third week of January.”
The coronavirus referred to as SARS-CoV-2 and the illness it causes, Covid-19, got here early to Monklands as a result of the hospital homes one in all Scotland’s 4 regional infectious ailments models, with a number of the first suspected circumstances within the nation arriving in particular ambulance transfers in early February, in line with Dr Nick Kennedy, a advisor within the unit.
The hospital’s first constructive case was confirmed early the next month.
“It is a unusual sickness, the likes of which we have by no means seen earlier than,” he says.
The weird virus prompted an unprecedented response, a wholesale transformation of this ageing district normal hospital with one goal above all – growing vital care capability.
In simply three weeks in February and March, says chief nurse Karen Goudie, Monklands was basically redesigned and restructured to deal with Covid-19.
Ms Goudie factors out new partitions, new limitations and new rooms as she explains how the whole constructing was divided into two separate pathways in an try to cease the coronavirus spreading – crimson for Covid sufferers and the employees coping with them; inexperienced for non-Covid.
“Monklands is 40 years previous,” says chief of medical companies Dr Rory Mackenzie. “We have now superior plans for a brand new hospital. The shortage of single rooms is an actual problem for us when it comes to managing a few of these points. So having a brand new hospital would have made this a lot simpler to take care of.”
As a substitute, Dr Mackenzie and his staff needed to be artistic. As one of many few areas with a plentiful provide of high-pressure oxygen, the infectious ailments unit was chosen to turn out to be a excessive dependency unit (HDU) whereas the unique HDU turned an intensive care facility. Working theatres had been transformed to deal with intensive care beds.
Earlier than the pandemic Monklands had the flexibility to ventilate 5 sufferers at anybody time. On the peak, a couple of weeks in the past, 15 sufferers had been on ventilators and Dr Mackenzie says the hospital may now present 20 ventilated beds if mandatory.
For some time the hospital was operating three separate intensive care models as a substitute of 1. It’s now down to 2: one crimson, one inexperienced.
“This isn’t the well being service we had two months in the past. It is a totally different well being service,” says lead intensive care advisor Dr Sanjiv Chohan.
Sustaining such a excessive stage of vital care capability is placing monumental calls for on employees and sources.
“I do not assume it is sustainable,” cautions Monklands’ head of emergency drugs Dr Fiona Hunter.
Today Dr Hunter oversees, in impact, two accident and emergency departments – once more, one crimson for Covid sufferers, one inexperienced for non-Covid – a scenario she believes should persist whereas the virus stays prevalent within the inhabitants.
For now meaning two senior consultants on web site always, quite than one. It means double the variety of reception employees. It means costlier gear and the cancellation of go away.
For Dr Hunter it even meant suspending her personal wedding ceremony, which ought to have taken place on 28 March, when she and her fiance realised the very best man wouldn’t be capable to fly into Scotland from France due to the pandemic. It was a troublesome resolution, she says, however “the correct factor to do”.
“It allowed me to be freed as much as actually assist with the struggle on this division in opposition to Covid,” she says.
It isn’t simply the emergency division which is feeling the pressure. Elsewhere within the hospital, physiotherapists and nurses who often work in day surgical procedure, working theatres and the endoscopy unit have been seconded to intensive care.
On the identical time the demand for a few of these companies has risen. Many Covid-19 sufferers have intense fatigue and proceed to require a substantial amount of assist with rehabilitation, says Kirstin Cleary, a specialist physiotherapist who has been working in intensive care.
“Though we’re previous the height there’s going to be an enormous impression on physiotherapy companies, social care companies and companies in the neighborhood as a result of these sufferers are going to wish loads of rehab to assist them recuperate from this,” she says.
Proper now the dilemma for Monklands is that it merely can’t deal with its regular affected person visitors whereas it’s configured for a pandemic and but if there may be “recrudescence” – one other outbreak – intensive care could also be overwhelmed once more.
“I feel we’re over the worst of this present outbreak, and undoubtedly we have seen that when it comes to the figures that come by means of the hospital,” says Dr Kennedy within the infectious ailments unit.
“The difficulty is, after all, we do not have an efficient remedy. We do not have a vaccine. And so there may be each danger that we may have a second wave,” he provides.
It isn’t simply right here. Managers throughout the NHS at the moment are grappling with the problem of the best way to preserve vital care at a protected stage whereas additionally getting ready for an anticipated rise in emergency admissions because the lockdown eases, and the return of sufferers with different severe sicknesses, whose absence through the previous couple of months has apparently led to an increase in preventable deaths from coronary heart assaults, strokes and different causes.
“The general occupancy of the hospital has been down,” explains Dr Mackenzie, and whereas “that has made it simpler to deal with the Covid sufferers, the principle concern we have is there are sufferers who want well being care [who] have not been attending the hospital.”
Matthew Weir from Coatbridge is one in all them. He’s being handled within the infectious ailments unit for a lung an infection. It is a destiny that Matthew, 34, may most likely have averted had he not postpone searching for medical assist due to his fears about catching the coronavirus.
“If I am trustworthy I most likely left it slightly bit too lengthy, which is why I ended up staying right here quite than it simply being handled with antibiotics within the first place,” he says.
Dr Hunter, within the emergency division, says the pandemic is forcing a fast reassessment of the steadiness between offering companies in hospital and in the neighborhood.
She says the hospital has arrange a line for paramedics to hunt “recommendation and maybe a little bit of back-up” from consultants on when a affected person can safely be cared for in the neighborhood, maybe in a clinic, quite than in hospital.
“That is one thing that they did not have entry to earlier than Covid however a lesson I might be eager to proceed on after Covid,” she says, including, “I feel it is made a giant distinction for affected person care, by lowering pointless admissions to hospital”.
On the subject of circumstances that do require hospital remedy although, Dr Hunter is eager to emphasize that “we’re open for enterprise”.
That is the message in intensive care too the place coach driver John Johnston is combating the results of Covid-19.
John has underlying kidney points and has developed a lung an infection. He’s acutely aware however on a ventilator which helps him to breathe however leaves him unable to speak.
As a substitute he communicates, with nice effort, by writing on a small plastic board.
I ask him if he can sum up his message to the employees right here.
“There are too many phrases to say to them,” he manages to put in writing earlier than stopping to wipe away tears.
This pandemic has clearly introduced immense and painful challenges for sufferers and employees alike.
Hope, although, springs everlasting.
Irene Norwood, a 51-year-old housewife from Cumbernauld, is again within the intensive care unit — however solely to say thanks. After a brush with dying she is on the mend.
She tells us she solely has fragments of reminiscence about her time being handled in right here for Covid-19.
“I keep in mind mendacity in mattress at night time considering the machines had been speaking to one another. I feel I will need to have been hallucinating,” she says.
Irene additionally remembers a health care provider telling her that she was being placed on a ventilator and that she ought to phone her family members as a result of she may not survive.
“I keep in mind all the things was occurring actually rapidly they usually stated, ‘we have to get her to name her household’.
“I spoke to my husband and my sons. You’ll be able to solely say what’s in your coronary heart,” she remembers. “If you happen to do not say it you may by no means have gotten the prospect.”
Irene is hoping to go away hospital at present and has a easy message for the general public.
“I do not assume folks perceive the severity of this sickness and that is what folks have to study. They don’t say ‘keep at dwelling’ for no motive.”
Coronavirus: Scotland’s Response is on BBC One Scotland at 20:30 on Wednesday 6 Could and on the iplayer.
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