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Matt Morgan on Intensive Care in the Time of Coronavirus

Posted on 29th April 2020 by Mark Skinner

In Critical, his intensely powerful account of working as an intensive care doctor, Matt Morgan provides a riveting account of the processes and functions of ICU pre-corononavirus. In this essay, he talks frankly about how the current global pandemic has changed his job and the mechanisms that he employs to cope with such an unprecedented and alarming situation.   

The Tools Every Intensive Care Doctor Needs - Words and Deeds

I wrote Critical to show the public the amazing yet little known medical speciality of intensive care. The book was originally titled “How a little girl helped to save the world” because it starts with the story of a 12-year-old girl called Vivi who loved to dance. During the 1952 Copenhagen polio epidemic she became the world’s first intensive care patient after a brave doctor decided to insert a plastic tube into her neck. Teams of medical students kept squeezing an inflatable bag for weeks at a time attached to this tube. Amazingly, Vivi survived. She eventually left the hospital, fell in love, got married and spent long, warm days at her summerhouse with her husband and dog Bobby. Yet Vivi never danced again and needed a battery powered ventilator for the rest of her life. The world now stands at the feet of another viral pandemic, nearly 70 years after Vivi lived. And the intensive care unit remains as important as it was then.

Although I had done all of the deeds required of an intensive care doctor for a decade before Critical, writing that first page was the first time I instead took time to care for the words needed in intensive care. We now find ourselves in the middle of a global pandemic, where the words used -by politicians, by doctors and families - are often more powerful than the deeds that can be done against the virus.

© Matt Morgan
Donald Trump bathed in UV light holding bleach in one hand and COVID in the other. Thanks to Dr Jess Notzing for her drawing.

Family and friends have recently been asking me “What does it feel like in intensive care right now?”. This is a tough one. Tough because it firstly forces me to confront the fact that it does actually feel like ‘something’. Although I’m a doctor, I’m also a husband, a dad, a son and ultimately just a human. I worry, I get cross, I cry and I laugh. Normally walking through the automatic doors into my hospital, I leave many of these parts of me at home. Yet over the last few weeks, more and more of me is coming to work.

Unsurprisingly, the number of appropriate analogies for working in an intensive care unit during a deadly global viral pandemic is slim. The best I can do is as follows. In those early days it felt a bit like being a first time parent, living in a one bedroom flat, when your baby comes a month early, and that baby is one of triplets. You start parenthood feeling knackered after weeks of sleepless nights. Your good intentions to paint the nursery and have your bags packed ready have slipped by. You worry about your ability to care for more children that your hands can even carry. You also worry how you are going to get through this unscathed. Even if you have enough cots and nappies, the physical infrastructure of your flat is not fit for purpose.

Yet you do get through it. Adrenaline, love and hope are your fuel. The early days are hard, the later days even harder. After the fanfare has settled down and people stop offering help, that is when the really tough times begin. But your children do survive, you change your flat to better care for them, you get systems in place, you find others you can reply on and trust. You cry but you also laugh out loud. Will you come through unscathed? No. But most of the scars are ones that will heal and remind you of what you have achieved. Life will never be the same again. Some parts worse, many parts eventually better. Every time I leave the COVID area of the ICU, I see a glimpse of this hope for the future in the drawings on the wall. Where colour and life has returned.

 

© Matt Morgan
The view after leaving the COVID area of my intensive care unit.  

Many of the things that will stay with me are not the creases on my face from the PPE, but the words written to me and my colleagues by grateful patients and thankful families. When I wrote my own “Letter from ICU” to the frail and elderly about to face COVID, I never expected the words in return to bring so much hope. Yet they do, because words are as powerful as deeds.

© Matt Morgan
Handwritten letters of thanks in response to my own letter that I wrote. 

To those who are elderly, frail, vulnerable, or with serious underlying health conditions,

We have not forgotten about you.

It must be so hard listening to endless news reports that end with “don’t worry, this illness mainly affects the elderly, frail, vulnerable, or those with serious underlying health conditions.” What if that is you?

Our passion as an intensive care community is fixing problems that can be fixed. Yet we often meet patients like you who have problems that cannot simply be fixed. As this virus continues to impact on the world, we will meet many more of you. Although we have fancy machines, powerful drugs, and talented staff, none of these things cure every disease. All they do is give us time – time to work out what is wrong, time to hopefully treat it, and time for people to get better. But sometimes we already know what is wrong, we already know that there is no effective treatment. And so sometimes the machines offer little, intensive care offers no fix. But hope is not lost. We have not forgotten about you.

As difficult as this is, we will be honest. We will continue to use all of the treatments that may work and may get you back to being you again. We will use oxygen, fluid into your veins, antibiotics, all of the things that may work. But we won’t use the things that won’t work. We won’t use machines that can cause harm. We won’t press on your chest should your heart stop beating. Because these things won’t work. They won’t get you back to being you.

And If these things are still not enough, we will sit with you and with your family. We will be honest, we will hold your hand, we will be there. We will change our focus from cure but most importantly we will continue to care. We have not forgotten about you.

Signed,

The Intensive Care Unit

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