Matthew Dolling: The difficulties ICU wards have faced due to COVID-19

— Matthew Dolling is an intensive care consultant at Lincoln County Hospital. This column is part of a series marking a year since the start of the COVID pandemic.

I think the intensive care unit (ICU) community became concerned, as did the rest of us watching the first news items, as the COVID outbreak evolved in Wuhan – a concern that deepened as it spread into Europe.

It rapidly became apparent we would not escape it, so by the time we took our first COVID patient into ICU, we as a department had spent a lot of time preparing and were as ready as we could be.

Nurses and clinicians of all grades threw themselves into this effort and a program of education evolved to include other departments outside of the critical care as well.

A year has passed and it is a blur. Weekdays and weekends were often indistinguishable and months passed unmarked, with the experience on one day being the same as another.

Before COVID the use of facemasks and the level of personal protective equipment (PPE) we have now become used to was a rare occurrence – now it sadly seems the norm.

The nurses have been the hardest hit by this, spending the longest hours by the bedside in PPE, doing both a physically and mentally demanding job – looking after some of the sickest patients imaginable.

Their morale is now low and they are exhausted, and some have been scarred by the experience.

There have been many hard times in this pandemic but something that I think many staff have found difficult to deal with is the death of COVID patients on ICU.

This has often happened without their families being able to be present. As an ICU consultant giving such bad news by phone is so difficult.

The nurses have at times tried to use phones and iPads to link families with patients in their last moments, in an attempt to give them the opportunity to say their last goodbyes – but this is a poor substitute to physical contact.

It is not the same as holding someone’s hand so it was the bedside nurse who did that. They would be the families’ surrogate so the patient did not die alone.

I do not feel I have had enough time yet to know entirely what I have learnt from all this experience, but I do know that ICU nurses are completely undervalued. They lack the appreciation and recognition they deserve.

Some of my colleagues such as operating department practitioners have also proved to have an incomprehensible but wonderful ability to rapidly integrate themselves into a team and help in the care of very sick patients.

A moment that particularly stands out for me was when I collected a critically-ill COVID patient from a Birmingham hospital as part of a regional care transfer team.

The hospital’s resources had been overwhelmed by the sheer number of patients so myself and the nurse I was working with transferred that patient to Lincoln’s ICU, where at the time there were more resources to cope.

This practice has been repeated over and over again all across the country and has allowed the NHS to survive the worst that the disease could throw at it.

For me it demonstrated that the NHS is truly a national health service, not a local one.

A service that can utilise its expertise to provide the best opportunities for everyone wherever they are in the country. A service that when it’s at its best can make the hardest things seem easy.

I have also learnt that whilst my colleagues and I have struggled through the last year, there are still some who would rather believe in conspiracy theories, do not believe in COVID or who would wilfully put others at risk.

As I am still very close to the rock face I am not well placed to comprehend their views nor may I ever.

I will continue, however, to hope that people will behave responsibly, that the vaccine rollout continues at pace and that it remains effective, such that this is the beginning of a sustained return to normality, even if it isn’t a normality we experienced previously.