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Love, grief and hope by the bedside in Intensive Care

ON THE COVID FRONTLINE: In the second part of our series looking at healthcare in Greater Manchester during the pandemic, the Manchester Evening News meets patients, families and staff at Wythenshawe Hospital’s Critical Care Unit.

BySophie Halle-Richards

  • 19:39, 28 FEB 2021
  • UPDATED20:03, 28 FEB 2021

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Ivan Sangster (L), visits his younger brother Greg, who lies intubated in a hospital bed (Image: Joel Goodman)

Clutching the hands of his younger brother through a pair of bright blue surgical gloves, Ivan Sangster leans in to tell his sibling how much his family miss him.

The breathing tubes attached to his body stop him from speaking. But Ivan is conscious and alert. His eyes light up with emotion as he appears to recognise his brother’s masked face.

In the background is the soft hum of the mechanical ventilator which is keeping him alive.

It’s such a sweet, personal moment, it’s possible to forget for an instant, in spite of the machinery, that you’re on a ward surrounded by patients rendered helpless by Covid-19.

Clinicians at work on a Covid-19 ward in Wythenshawe (Image: Joel Goodman)

Greg Sangster was admitted to intensive care at the beginning of the year. The 58-year-old bus driver at Manchester Airport believes he picked up the virus from a colleague at work.

Shortly after spending Christmas with his family, Greg was rushed to Stepping Hill Hospital in Stockport, having phoned the 111 service. He told the call handler he was struggling to breathe.

He is now being cared for by a dedicated team of staff at the Covid-19 Critical Care Unit at Wythenshawe Hospital. Thanks to them, Greg has been weaned off sedation and is beginning to turn a corner.

Ivan is the first familiar face he has seen in nearly two months.

It’s extremely rare for loved ones to witness what happens on a Covid intensive care unit, such is the cruelty of this disease. But doctors have made an exception in this case, as they believe it could be crucial to Greg’s recovery.

PPE-wearing staff on Wythenshawe Hospital’s A1 Respiratory Ward (Image: Joel Goodman)

“Up until 18 months ago he weighed 24 stone, but Greg’s become a guru for the Keto diet and lost nine and a half stone,” says Ivan, 64.

He removes his plastic apron and gloves as he steps outside the ward, having hugged his little brother goodbye. He knows it’s unlikely he’ll see Greg again for some time now.

“Doctors said if he had not lost that weight he might have been in a very different position,” Ivan continues.

“But we think he’s turned a corner now.

“He was definitely trying to join in the conversation just now. It is difficult because he’s intubated and can’t talk, but he did manage to smile a couple of times.”

‘We think he’s turned a corner now,’ Ivan Sangster says of his younger brother, Greg. Visits to Covid patients are significantly restricted (Image: Joel Goodman)

Greg is among seventeen patients who are intubated and hooked up to a ventilator when we visit the intensive care ward.

Normally only staff are allowed behind these doors. Covid-19 can be so lethal that visits are significantly restricted, allowed only in specific circumstances.

But, so we can show the public the reality of the disease – and reveal the commitment and courage of staff, the Manchester Evening News has been allowed to visit our region’s hospitals for a series of stories about the Covid frontline. Each looks at a different aspect of our region’s health service as it comes under unprecedented pressure.

At Wythenshawe, a second Critical Care Unit had to be set up as Covid patients flooded in last year.

Now, both units are full – as Wythenshawe accepts patients from struggling hospitals across the North West and the Midlands.

Despite only being in his late 50s, Greg is by no means the youngest person in intensive care when we visit.

‘Most of the patients are holding their own – but things can change in minutes’: Respiratory specialist nurse Ellie Walker (Image: Joel Goodman)

As we arrive, the atmosphere is calm, peaceful and positive, as staff tend to patients during the lunchtime ward rounds.

Most of the patients are ‘holding their own,’ says respiratory nurse Ellie Walker. But the mood can change in minutes, she warns.

Just a few days ago, the team lost three patients in the space of one morning.

Shortly after we chat to Ivan, two grief-stricken family members are ushered around a patient’s bedside. A curtain is drawn for their privacy.

The family’s pain is reflected on the face of every health professional in the room.

They all work tirelessly, sometimes at a great emotional cost, to ensure their patients recover from this disease.

That means that for every loss, there are stories of hope, like that of Kevin Crampton. The 59-year-old can now breathe on his own, having been discharged from ICU to a Covid respiratory ward.

A member of ward staff holds a phone for patient Kevin Crampton as he takes a video call from his sister (Image: Joel Goodman)

The dad-of-two from south Manchester contracted Covid-19 at the start of January, and has spent a number of weeks in a coma on ventilation.

To give his lungs the best chance of working, doctors used a technique called proning.

The controlled and perfectly timed team movement consists of six or seven people turning a patient on to their stomach, where they will stay for hours at a time.

Kevin no longer requires oxygen, or a breathing tube.

However, due to the amount of time spent in the prone position, he is unable to use his arms and may have suffered permanent nerve damage – profound weakness is common after a prolonged intensive care stay.

He is strong enough to eat and drink again, but doctors predict he will need to remain on the A1 respiratory ward at Wythenshawe Hospital for at least another month to six weeks.

“It was scary,” Kevin says as he recalls the moment he was admitted by ambulance. You can see the torment in his eyes and he looks for the reassurance of nurses stood attentively at his bedside.

“When you’re told that you’re going to be put in a coma you think about what might happen next.

“My head was spinning. I thought, will I come out of this? But I did it. It’s been very emotional. I have definitely done a bit of crying.

“I can tell people you don’t want this virus. You really have to fight it.”

‘You don’t want this virus. You really have to fight it’, Kevin Crampton, 59 (Image: Joel Goodman)

Kevin’s recovery will now consist of rehabiliation. It’s likely to be months before he will return to the man he was before he was struck down by coronavirus.

It could take even longer for him to regain full movement in his arms and legs.

“Patients get very surprised about how weak they are when they wake up,” says Specialist Intensive Care Physiotherapist, Barbara Bonvento.

“Most people can’t even move their fingers or sit unsupported. It can be quite horrible when they wake up because patients are quite confused.”

Barbara says some patients have woken up believing they have been kidnapped, or are trapped on a boat, due to the amount of time they have spent unconcious.

“We have to explain to them they are not going crazy, it’s just the side effects of the drugs,” she says.

“It can take patients weeks for them to come round.”

Physiotherapist Barbara Bonvento (Image: Joel Goodman)

The Italian born mum-of-one hasn’t been able to visit her own elderly parents in Bologna, Italy, for over a year now.

And, like so many of her colleagues, Barbara contracted Coronavirus last April. Her sense of taste and smell has still not returned.

Despite her fears about whether she’ll see her parents face-to-face again, her dedication to the hundreds of patients she’s cared for since March hasn’t wavered.

Much like A1 Covid-19 Respiratory Ward manager, Thomas Kellet, 32, who is responsible for the wellbeing of patients, 43 members of staff, and three young children at home.

From the junior doctors, to nurses and health care assistants, everyone is visibly exhausted during what the hospital now classes as the third wave.

The 28-bed unit has been near full for the entirety of the pandemic, and admissions don’t appear to be letting up just yet, says Thomas.

‘We thought everything was getting better – then it all started again’: Thomas Kellet, respiratory ward manager (Image: Joel Goodman)

“I think this time has been more challenging for staff. We thought we were at the moment where everything was getting better last year and then it all started again,” he says.

“My staff have found it quite hard. It’s just ongoing. People are getting tired.”

The admission of younger patients and groups of families, believed to have some link to Christmas mixing, has taken a heavy psychological toll on Thomas’ team.

“Since October we have seen a lot more younger people. Most of them have pre-existing conditions but there are some who don’t,” he says.

“We are seeing more families too and that can be quite difficult. Recently we had a dad and two sons admitted, and we’ve also had a man with his wife come in at the same time.

“That is emotionally difficult for the staff.”

Without their bravery, expertise and diligence, patients like Kevin simply wouldn’t make it.

Patient Kevin Crampton, being helped to reposition himself in bed (Image: Joel Goodman)

“I just can’t thank them enough. I’m here and that’s the main bit,” Kevin says as he grips the hand of a nurse and smiles warmly at her.

As he speaks, Kevin receives a video call from his sister. He’s desperate to answer but can’t pick up the phone, so ward matron Michele Oldbury carefully holds the device up to his face.

His wife and family haven’t been able to visit him since he was admitted to hospital, and so they call his mobile every day.

Kevin tells his sister: “I’m talking to the Manchester Evening News about Man City.”

He’s an avid supporter and tells us he can’t wait to get home so he can watch them win the league.

He tells his sister that he’s had this final tube removed that morning. You can hear the relief in her voice.

Despite everything he’s been through, Kevin’s spirits remain high. He knows he’s lucky to be alive, and he doesn’t plan on taking a second for granted.

A clinician cares for a patient on the ward (Image: Joel Goodman)

Critical care beds in Wythenshawe have been at a premium throughout the pandemic, but particularly so since Christmas, says Consultant Respiratory Physician, Richard Baraclough.

“We had a mini peak in November but since the end of December the numbers have gone up massively,” adds Richard, who is also clinical director of the North West Lung Centre.

“Unfortunately, despite our best efforts there are still people dying with this disease, young and old.

“It takes its toll on the staff.

“On a respiratory ward we are used to patients dying but normally you have a small number of patients die in a given week. With Covid, the mortality rate can run up anywhere from 20 per cent.”

That rate is considerably higher for those patients who require ventilation, which involves a painstaking decision-making process Richard is occupied by on most days.

“If people are deteriorating we need to make a decision about whether they are likely to benefit from critical care and whether ventilation is going to be in their best interest,” he says.

“The mortality rate on intensive care nationally has been around 40 to 45 per cent.”

A clinician at a workstation, alongside oxygen canisters (Image: Joel Goodman)

The team have often found younger patients most reluctant to be ventilated, as many view it a form of death sentence, Richard says.

“We do get some patients who are too scared and refuse to go. When we feel someone has reached the point they’d be better managed on ICU and they refuse, it is difficult.

“It’s something that bothers me. You worry about what their outcome is going to be. It sticks in your mind. You feel like you’re failing the patient.”

The devastating consequences of Covid-19 mean there are some patients who get so sick, even a ventilator is unlikely to save their life.

Wythenshawe Hospital is one of just five centres in the UK with access to ECMO (Extracorporeal membrane oxygenation) machines – which can replicate the job of the lungs or heart to allow the organs to rest and recover.

The service has come as a lifeline for a select number of Covid patients, including a number of healthcare staff and key workers from across the region.

But, choosing who to put on ECMO isn’t an easy decision.

Dr Julian Barker, Group Clinical Director for Critical Care (Image: Joel Goodman)

Julian Barker is the director of Wythenshawe Hospital’s ECMO service, and has the punishing task of applying clinical guidelines to decide who could benefit from it.

In the first wave, as many as 14 patients at a time were using the service.

“The survival for Covid on ECMO is about 50 to 60 per cent,” he says.

“The things that count against your chance of survival are age, BAME, obesity and social deprivation – Manchester has high scores on all of those things,” says Julian.

“ECMO will keep you alive, but it might not save your life.”

A porter pushes a patient on a trolley along a corridor at Wythenshawe Hospital (Image: Joel Goodman)

Knowing when to inform a patient’s family that everything that could be done, has been done is the hardest part of the job, says Julian. The weight of each decision marks his face as he talks about it.

“After a few weeks, and if there is no improvement on their lungs, we have to ask are we torturing this family – are we keeping them alive when they may not survive?” he says.

“We have had a lot of conversations about whether we are doing the right thing. That has been really hard. It’s been very difficult knowing when enough is enough.”

In a place where lives hang so precariously in the balance, it’s the memory of those patients who beat the odds to survive that staff cling on to.

“There have been some patients that we thought weren’t going to make it and then they did,” says Barbara.

“When you see them go home you remind yourself why you do this job. Sometimes you have to stop yourself crying with joy because there are a few people we really thought wouldn’t get there.”

An ECMO device provides cardiac and respiratory support to a patient as deoxygenated blood is taken from the body, reoxygenated and returned (Image: Joel Goodman)

Kevin is hoping to be home in time for his 60th birthday in May. His family have already made plans to throw a party (rules permitting) and are said to be organising a treat for hospital staff.

“I am looking forward to getting a proper shower and getting my clobber on. I’ve lost a lot of weight so I’ve got my six pack again,” he jokes.

He urges us to use his story as a stark reminder of just how cruel Coronavirus can be.

“People should still be worried about Covid,” he says, putting all jokes aside.

“It’s not a light thing like a cold or the flu. People need to understand how serious this is. If it wasn’t for the staff here I would not be alive.

“I have got a lot to do before I’m back to normal but I am happy. I am just grateful to be here.”

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Published by technofiend1

Kazan- Kazan National Research Technical University Казанский национальный исследовательский технический университет имени А. Н. Туполева he graduated in Economics in 1982

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