Wales rugby star and qualified doctor Jamie Roberts has started working for the National Health Service to help the fight against coronavirus.
With sport cancelled indefinitely, the 94-cap centre has stepped in as a clinical innovation fellow – a role which will see him working in Cardiff in a motivational and communications capacity.
Today he’s penned an emotional blog, sharing his experience.
Although this is the most difficult blog I’ve written, I’ve tried to give an accurate account of how I understand the Intensive Care unit is operating at UHW.
Intensive care, also critical care, or ITU (intensive treatment unit), is reserved for the most seriously ill patients in any hospital. On these wards, patients with life-threatening conditions, such as serious injury or illness, receive around the clock monitoring and life support from a highly trained team of specialists. For obvious reasons, the Intensive care unit can be a very distressing experience for all; patients, relatives and staff. As these units are used to treat life-threatening conditions, then its reality that often patients succumb to their illness or injury and sadly lose their lives. Others may win the battle with their condition and survive, yet the very words ‘intensive care’ often understandably provoke emotions of shock, sadness and worry. The very best of care is provided on these units, yet as we’re learning during the COVID crisis, even that very best of care, tragically for some, isn’t enough.
A little evening read….— Jamie Roberts (@Jamiehuwroberts) April 15, 2020
A difficult piece to write. Spent some time with a few Intensive Care Consultants today at the unit. A story of meticulous planning and execution, in order to give our most critical patients the best chance. 🏥📝https://t.co/k9oTQ0iru7
I spent an hour or so this afternoon discussing the impact of the COVID crisis on the Intensive Care unit with two of the units top Consultants, Dr Richard Skone and Dr Nick Stallard. It was obvious both felt very proud of how the unit have planned meticulously for this crisis and proud of how the unit is adapting. Here were two men who, like all Doctors, care deeply for their patients and will move heaven and earth to ensure they are managed with the highest possible level of care. As this pandemic started to unfold, it was arguably the Intensive Care unit that had to adapt and expand its scope the most. The nature of COVID-19 necessitates that many patients with severe respiratory symptoms will require mechanical ventilation to survive. Predicted epidemiological modeling of the virus across the world, specifically in Wales, kickstarted the transformation process to rightly prepare for the worst. And some transformation it has been. The whole of the Level 3 at UHW has become one long Intensive Care unit. 35 intensive care beds have become, if and when needed, 180. The unit already has some 50 or 60 ventilators, yet due to elective surgical operations in other specialties being postponed, then ventilators in most other theaters are immediately ready to mobilize too.
This planning, as most of us have come to understand during the COVID crisis, is to be able to manage the ‘peak’ of viral infections. During the peak, the hospital has planned to have enough intensive care beds and ventilators for its most seriously ill patients. Indeed, if this ‘peak’ was to become short and sharp, then the hospital wouldn’t have the intensive care capacity nor the amount of ventilators to provide the necessary care for the number of seriously ill patients. Unfortunately, we’ve seen this happen in other countries such as Italy, where Doctors have had to make life and death decisions around which patients to mechanically ventilate and which to not. The reason for Government measures such as social distancing etc. is to combat exactly this. Each and every hospital across the country has a ceiling of Intensive Care beds and ventilators and it’s a responsibility of each and every one of us to observe these social rules to help ‘spread the peak’ over a longer period of time as to not overwhelm capacity. We ALL have a responsibility to help ‘flatten the curve’. There is hope that these measures are working. The staff here calculated that the ‘Doubling Time’ (the amount of time for ITU admissions to double) over the past few weeks has stood around 4 days. This has been the case up to around 30/40 patients and they hope they are now seeing a slowing in this progression.
The management is extremely challenging. COVID patients spend on average 2-3 weeks on ITU and we must also remember that as the COVID crisis is evolving, this isn’t preventing patients falling critically ill with other conditions, who may also require ITU admission. One may wonder which COVID patients they decide to admit to ITU. This is always a decision taken on the complete clinical picture; oxygen saturation, level of conciousness, respiratory rate, level of acidosis, just a few of the factors experienced clinicians will use to make their decision on patient care. Don’t think this is all about beds and ventilators either. As Dr Stallard, with 24 years experience, aptly put it, ‘Hardware’ is no good without its ‘Software’. It’s imperative the unit maintains enough adequately skilled doctors, nurses, Physiotherapists and other staff to care for each patient 24 hours a day and also operate the specialist equipment. You can only being to imagine the complexity of the recruitment process and re-allocation of staff if indeed numbers are to hit those originally predicted.
It was also interesting to see the one-way system that has been adopted for staff to move through the intensive care unit and how they undertake ‘donning’ and ‘doffing’ procedures. Staff enter down the ‘clean’ corridor, don and doff their PPE equipment in order and enter the unit. After their 10 hour shift, they doff their gear and exit through the ‘dirty’ corridor, also the only corridor where patients enter and exit the unit. Doffing your gear. Gloves off. Wash hands. Gown off. Wash hands. Visor and head cap off. Wash hands. Sit down. Wash shoes in foot bath. Exit ward. Mask off. Wash hands one last time. Extremely strict procedures are required in order to protect staff from virus exposure. No risks are taken whatsoever.
It goes without saying that the most difficult aspect of this crisis is patient death. This is for obvious reasons, as families are left devastated by the loss of their loved ones. However, the nature of the circumstances have meant an even more painful experience. There are strictly no visitors allowed on the COVID wards due to infection risk and therefore patients are dying alone. There are no flowers, cards or cuddly toys on the unit. There is no ability for our best and most compassionate Doctors to gauge family reaction and deliver bad news to the best of their ability as the most difficult of conversations are having to be made over the telephone. On speaking with both Consultants, this is the most difficult and challenging part of their job, especially under current conditions. It’s an awful situation that makes it desperately sad for anyone who is losing a loved one under these circumstances. To see and feel the level of energy of our staff, even outside the ward, during the current climate, was inspiring. Here we have a team of healthcare professionals who are right on the coal face of this crisis and making the big decisions that are saving lives. Dr Skone & Dr Stallard just a few examples. Heroes.
To those that have lost loved ones, may they Rest In Peace.
LIST | Jamie Roberts and five other rugby stars working in hospitals right now
Here are five rugby players who are doing their bit on the frontline of the fight against the Coronavirus.
1. Jamie Roberts (Doctor)
The Wales international, who is a qualified Doctor, has volunteered his services and is now working for the Cardiff and Vale Health board after flying home from South Africa. He will operate as a clinical innovation fellow – a role which will see him working in Cardiff in a motivational and communications capacity.