I’m an NHS consultant anaesthetist. I see the terror in my Covid patients’ eyes

I’m not prepared,” the affected person implores me by means of her CPAP [continuous positive airway pressure] hood. She’s respiration at greater than triple her regular fee and I’ve been requested to intubate her as she’s deteriorating, regardless of three days in intensive care. She is 42 years outdated.

There’s terror in her eyes. A tear runs down her cheek. She’s taking a look at the affected person reverse who’s in an induced coma, intubated and ventilated, and isn’t doing properly.

The noise of 30-litres-a-minute of oxygen in her CPAP hood makes communication virtually not possible. She repeats, “I’m not ready”, and raises trembling palms.

But her oxygen saturation is just at 84%, when it must be near 100%, and he or she’s changing into exhausted and agitated. She tries to tear off her hood. “I need to phone my family,” she gasps. I nod and say OK, virtually shouting to be heard over the noise of the alarms.

I’m sporting clawingly claustrophobic PPE for this aerosol-generating process: an FFP3 respirator face masks, face visor, robe and double gloves. I’m beginning to sweat, and realise that, resulting from her weight problems, it’s prone to be a troublesome intubation.

The affected person tries to speak to her household on FaceTime. She is extraordinarily breathless and appears like she is dry drowning in skinny air. Tears pour down her face. I hear somebody on the telephone crying and saying “I love you”.

I take off the masks and pre-oxygenate her with 100% oxygen by tightly making use of a Waters respiration circuit to her face. I gently put my hand on her shoulder. “We’re all here to help you. Everything is going to be OK. We’re now giving you some medicine to help you relax. Let us look after you.”

The anaesthetic trainee injects 100mg of ketamine, 100mcg of fentanyl and 100mg of rocuronium intravenously in fast succession “Everything will be OK,” I repeat. Almost instantly her oxygen saturations begin falling. The tone of the oximeter turns into sickeningly low.

We want to permit 60 seconds for full paralysis. “Sats are 60%,” says the working division practitioner [ODP]. Forty-five seconds, and I can’t wait any longer. I take a giant breath. I thrust the video laryngoscope blade into her mouth and over the again of her tongue and instantly see a swollen and haemorrhagic oropharynx. I go deeper, till I can lastly see the larynx and the vocal cords. There is Covid pus effervescent by means of the larynx.

I instantly insert the endotracheal tube [ETT]) with a metallic stylet. The ODP removes the stylet and I insert the tube by means of the vocal cords and additional down the trachea. I clamp the ETT tube, and we join it to the ventilator and ensure we see an end-tidal carbon dioxide hint on the monitor. The oxygen saturations are unrecordable, the affected person’s lips are darkish blue.

The pulse oximeter tone lastly rises and the oxygen saturation ever so slowly rises from the abyss. I lookup at the staff and meet their large dilated eyes by means of our visors. I breathe a deep sigh of reduction. All the monitoring alarms are screaming however I don’t hear them. I look throughout the bay and see one other terrified affected person, on CPAP, staring straight again at me.

Three hours later, we’re requested to intubate this affected person. She bursts into tears, saying: “I’ve got children at home. I can’t go on a ventilator. I’m not ready. I can’t die.” She is 35 years outdated. I kneel down and maintain her hand. I clarify once more that we’re right here to assist her together with her respiration. As she FaceTimes her kids, we urgently get our tools and medicines prepared. Her younger kids are crying. I should look actually scary to them. I can see them however can’t talk with them in any respect, whilst their mum is changing into more and more hypoxic and agitated. “I love you, I love you, I love you… ” she says, till she lastly presses “end” on the display screen together with her shaking fingers.

She is struggling and can turn into extra acidotic and distressed if we don’t take over her air flow quickly.

While we’re pre-oxygenating her, I take off her CPAP hood and lean nearer. “We’re here to look after you. Everything will be OK.” I cease speaking as a result of I suppose I may cry. I fear she is dying. I maintain her hand. She squeezes it and I squeeze hers again.

I look throughout the bay at the affected person from earlier. I take into consideration her household at house. I take into consideration this affected person’s household at house. I take into consideration my household at house. “Sats are 75%… ” Thirty seconds. “Sats are 60%… ” Forty seconds. My consideration snaps again to the airway, which I must quickly safe first time. No time to suppose. No second probabilities. We are prepared.

After many subsequent emergency intensive care Covid intubations, I suppose again to my first two sufferers virtually each day. I can nonetheless see the terror in their eyes.

Almost 50% of Covid sufferers intubated after failed CPAP haven’t survived, regardless of the most intensive of care. I determined to not discover out what occurred to my first two sufferers. I can nonetheless really feel a hand holding mine tightly with determined hope. Was I the final individual ever to talk to them? The thought is just too painful.