A chill wind

It’s turned decidedly autumnal; leaves changing from Barbour jacket green to satsuma yellow – and staying golden on the branches for just half a week before falling, crisp and brown, onto skateboard ramps and chewing-gum mottled pavement. And so we have reached the time of year when respiratory syncytial, parainfluenzae 1 through 4, and of course influenza A emerge from the antipodes (I’m only guessing) to infect the naive (in the immunological sense, of course) and unlucky.
With the result, as put by one of the local cardiothoracic surgeons, of “focusing the mind on which cases really need to be operated on”.
The intensive care unit, which over the summer has been occupied largely by post-open heart surgery patients, is slowly filling (and overflowing into the High Dependency area) with patients with respiratory tract infections of one form or other. The ‘flu of the season, as everyone knows, is A/H1N1, and I have seen at least 6 patients on PICU and looked after 3, including one who died.
I suppose it’s only a theoretical question at the moment, but it is not inconceivable that all the available ventilators could be in use. At the end of the week we were at 18 – there are officially only 15 ventilated beds, but there are a few older ventilators and even an old iron lung lying about that could be pressed into service. There are only a few isolation cubicles, and last week we were already ‘cohorting’ infectious patients rather than isolating them, because it has already become physically impossible.
The cardiac surgery patients can mostly have their operations delayed, but some conditions require an operation within a few days after birth for the baby to survive. It’s not just medical vs surgical either. A large proportion (perhaps more than half) of the patients have an incurable underlying condition – such as severe cerebral palsy, relapsed cancer, previous heart transplant, and various genetic or metabolic disorders. So there’s also ‘previously healthy’ vs ‘will never be healthy’.
Perhaps we won’t be able to skirt the issue of who ‘deserves’ (or, in practical terms, receives) care for much longer.

It’s turned decidedly autumnal; leaves changing from Barbour jacket green to satsuma yellow – and staying golden on the branches for just half a week before falling, crisp and brown, onto skateboard ramps and chewing-gum mottled pavement. And so we have reached the time of year when respiratory syncytial, parainfluenzae 1 through 4, and of course influenza A emerge from the antipodes (I’m only guessing) to infect the naive (in the immunological sense, of course) and unlucky.

With the result, as put by one of the local cardiothoracic surgeons, of “focusing the mind on which cases really need to be operated on”.

I suppose it’s only a theoretical question at the moment, but it is not inconceivable that all the available ventilators could be in use. At the end of the week we were at 18 – there are officially only 15 ventilated beds, but there are a few older ventilators and even an old iron lung lying about that could be pressed into service. There are only a few isolation cubicles, and last week we were already ‘cohorting’ infectious patients rather than isolating them, because it has already become physically impossible.

The cardiac surgery patients can mostly have their operations delayed, but some conditions require an operation within a few days after birth for the baby to survive. It’s not just medical vs surgical either. A large proportion (perhaps more than half) of the patients have an incurable underlying condition – such as severe cerebral palsy, relapsed cancer, previous heart transplant, and various genetic or metabolic disorders. So there’s also ‘previously healthy’ vs ‘will never be healthy’.

Perhaps we won’t be able to skirt the issue of who ‘deserves’ (or, in practical terms, receives) care for much longer.

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