COVID-19 Plastic Surgeons on the front line - Sanjib Majumder

I am a plastic surgeon, and as such not directly involved in the care of patients admitted with COVID-19. However, keen to help, I volunteered to go to our ICU as a member of the ‘pronation’ team, to help turn patients who were on ventilators onto their tummies, or back over, to help with their breathing. The following account details my first day in an ICU treating patients with COVID-19.

I have to admit to experiencing some anxiety and trepidation as I approached the ICU. Once inside, I was guided into the “donning” room where I was to put on (“don”) my personal protective equipment (PPE - surgical gown, surgical hat, goggles, FFP mask, visor, and 2 pairs of gloves with the inner gloves taped to gown sleeves). One of the staff, Amy, from the operating theatres whom I knew, was on hand to assist people in donning their PPE carefully and correctly. Amy was a jovial character and ensured the atmosphere in the 'donning area' was light and upbeat as she chatted away to us. The two of us donning joined in with the conversation but our increasing nervousness was thinly veiled.

Once donned and checked for safety, we were motioned to go through a set of closed doors. The large sign in bold letters “RED AREA” certainly agitated the butterflies in my stomach. I felt like one feels when walking to the edge of the platform for their very first bungee jump. I knew that I had on the best protective kit available, but as 55 year old diabetic man, did I really want to do this?

When visiting the ICU in the past, I would see patients at different stages of their illness and recovery; from the gravely ill and ventilated, to those awake, sitting up, waiting to be discharged back to the ward. Now the ICU was unrecognisable, all the staff wore full PPE and were busy and focused on their activity. Everyone seemed very serious and the mood sombre; very little conversation; the light conversation in the donning area seemed miles away.

Every clinical space in the ICU was filled with patients; all ventilated, with tubes/wires to the max. All the patients looked gravely ill, some were being cooled with ice as a result of their high fever. It all appeared very surreal. I had experience of offering medical assistance in Haiti just three weeks after the 2010 earthquake, so I felt prepared. Despite this, the scenario before me remained positively terrifying.

I was used to dealing with emergency situations calmly but I was apprehensive as I approached the first patient who needed to be proned. It dawned on me that I was about to make contact with someone seriously ill with coronavirus; was my PPE going to be enough? Before I had time to dwell, our excellent team leader, a senior ICU nurse, explained exactly what needed to be done and explained in detail how we were to turn a patient onto their tummy, (prone them) to aid their breathing. These patients were connected to many tubes and wires keeping them alive, so we needed to perform the manoeuvre carefully and safely. As I got stuck in, my heart-rate settled and the apprehension melted away. My years of training, to function professionally in adverse conditions, had kicked in. I was here to do a job; I needed to get on with it.

As we prepared to turn the patient onto their tummy, the nurse looking after the patient said she wanted to clean the patient’s face before he was turned. I noticed that the nurse softly spoke to the patient before doing anything. This was standard practice in any ICU, but it seemed somehow different in this setting and I was in awe of their compassion. At that instant the penny dropped. All the stats I had seeing on the news suddenly stopped being just numbers and became human beings. The ones in ICU were seriously ill human beings, being cared for by other human beings. Many of the healthcare workers in front line were very fatigued, both physically and emotionally. But all were doing their jobs, utilising their years of training and professionalism to save the lives of others.

We progressed along nicely, a team of surgeons helping turn patients. When we reached our fourth patient, my proning teammate, an orthopaedic consultant noticed the patient’s name and said:“This is ........! I know him; I’ve worked with him in the operating theatres at …….! He retired about three years ago! I went to his leaving do…” I then saw my teammate’s face droop perceptibly as he noticed the red bordered sheet next to the name over the bed; DNACPR (Do not attempt CPR) in bold letters - The pandemic had just become personal.

I made only a minor contribution to the care of the patients with COVID-19 that day. It was the first time since the pandemic began that I felt as though I had made a direct contribution, however small, to the cause. While I saw first-hand the drastic effects of this pandemic on both the patients and their carers, I also felt privileged to see how my colleagues, doctors, nurses and all healthcare workers directly involved are caring these patients with professionalism and empathy. Yes, I was initially apprehensive, then momentarily terrified, but my experience has only help strengthen my resolve to help in whatever way I can.