A day in Wellington Hospital's ICU

BRONWYN TORRIE
Last updated 12:58 19/01/2013
icu
PHIL REID/Fairfax NZ

NERVOUS WAIT: Katie and Bede Bailey with 20-month-son Charlie Tiger Bailey.

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On average, 1600 people are admitted to Wellington Hospital's intensive care unit each year. While the doctors and nurses deal with patients needing life-saving care, about 90 per cent survive and are later moved to a general ward. Bronwyn Torrie discovered it's not all doom and gloom, even though life often hangs in the balance for these patients.

9.35AM There are 16 patients in the 18-bed intensive care unit (ICU). All have had their morning chest X-rays and the consultants and registrar doctors are just finishing their rounds. It is relatively calm and quiet. Most patients are sedated and connected to ventilators - machines that breathe for them. Some are awake, but drowsy. All have a spaghetti junction of cords connected to bags of fluid and beeping machines. Each patient has a dedicated nurse, who can't leave unless another nurse relieves them.

9.40AM A man who has had abdominal surgery is rolled on to his left side by three nurses. Even though he's unconscious, a nurse is still explaining to him what is happening. He's been in the ICU for four days after being flown in from a smaller hospital. Nurse Ruby Kopelov has been at the man's side since she started her 12-hour shift at 7am. Shortly after rolling him she brushes his teeth. This is done four times a day as the ventilator tube in his mouth is a "portal of infection".

10AM A new patient who has deteriorated in a ward arrives. He's wheeled in and taken into a room where seven people transfer him to an ICU bed, which takes about five minutes.

10.11AM It's back to the abdominal surgery patient, where a registrar and consultant discuss the plan for that day with Ms Kopelov. His condition has improved compared with a few days earlier and they deliberate about the right time to start waking him up.

10.25AM Associate charge nurse manager Karyn Hathaway says "it's getting a bit tight" even though they've had five discharges since the day began, including one person who was flown to Auckland by the Life Flight Trust.

10.30AM About 15 people perch in the staff room to do The Dominion Post 5-minute quiz and get nine questions correct - apparently this isn't out of the ordinary. Unfortunately the posh coffee machine is on the blink. It was donated by Sir Peter Jackson as a thank-you to staff after time in the ICU last year after surgery on a perforated ulcer.

10.45AM After a much-needed instant coffee, it's down to a dark room where X-rays are being projected on to a wall. Five doctors rattle off patients' stats and ponder who is fit enough to be moved to a ward - by this stage it's becoming clear that space is at a premium.

11.15AM Porirua mum Gina Solomon is sitting at her son's side waiting for him to be taken away for another operation. Te Pehi, 20, was injured in a car crash nearly a fortnight earlier. It's been touch and go, but he's improving. However, the journey to recovery is going to be long as he suffered a traumatic brain injury as well as several broken bones.

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MID-MORNING A patient dies. About 90 per cent of patients leave the intensive care unit, but there is a small number for whom nothing more can be done, nurse educator Kevin O'Donnell explains. "It's not just about saving people, intensive care is also about people dying . . . it happens quickly and subtly."

12.55PM An unconscious cardiac patient is admitted directly from surgery. Four doctors and a theatre nurse wheel him in with machines connected. They spend about five minutes briefing ICU staff, who transfer the cords and lines and take over care. The patient will spend at least one night in the ICU before being transferred to a ward. About 30 per cent of ICU patients have had elective surgery, such as heart and brain surgery, and their stay is planned.

1.30PM All 18 beds are now full. Since the start of the day five people have been discharged and six people have been admitted. There are now toddlers, teens and adults lying on the beds with various medical conditions. The unit cares for most conditions, except burns and spinal injuries. These patients are transferred to specialist centres in other parts of the country. The ICU also manages most pediatric cases that come through its doors - between 80 and 100 each year - but refer the very young and very sick to Auckland's Starship Hospital.

1.35PM A man in his 70s from Nelson is preparing to go to a ward. He spent the night in the ICU after a triple bypass the day before. He's awake and feeling as well as could be expected. He woke up in the ICU with his wife at his side a few hours after the operation. "The marbles were not rolling in their little tracks," he says. "I didn't quite know what was happening, I knew my wife was there, but what was said I have no idea." He will spend up to seven days in hospital before he can go home.

1.45PM Katie and Bede Bailey are waiting for their little boy, Charlie Tiger, to wake up. He has been unconscious in the ICU after a seven-hour operation the day before to join up his oesophagus. The Upper Hutt toddler was born with tracheo-oesophageal fistula, which means the pipe that enables people to eat didn't form properly in the womb. The Baileys won't know if the operation was a success for about five days.

1.55PM Patient-at-risk (PAR) nurse Sara Imray is in her office writing up notes. She was involved in monitoring and then transferring the man who had deteriorated in a ward earlier in the day. "I was like an extra pair of hands, an extra pair of eyes." PAR nurses are the link between the ICU and the rest of the hospital. They follow up with patients and nurses when someone is transferred from the ICU and they are also part of the medical emergency team.

2.15PM Charlie Bailey wakes up and pulls out the tube that is connected to the ventilator. About 15 people rush to his side to help him while his parents step back and watch. "They just saved his life," his dad says after Charlie is stabilised. During the emergency a nurse stands with the couple and explains what is happening. "We've seen it happen twice - the first time it was devastating," a tearful Mr Bailey says.

2.30PM Karyn Hathaway has sent out a text to off-duty nurses asking who can work the night shift. With just one bed left, and two staff down, she needs to make sure there are enough nurses. "Not every day is like today." The person who died has been taken away and the room is cleaned for the next patient - this takes about 25 minutes.

3PM Four hours to go for this shift before they hand over to the night crew. It's been quite busy with a mixed bag of patients. From toddlers to the elderly, car-crash victims to triple-heart-bypass patients - no day is ever the same.

LIITTLE CHARLIE BACK AT SQUARE ONE

Little Charlie Tiger looks so peaceful. His optimistic but tired parents are at his bedside waiting for him to wake from his sedative-induced sleep.

The 20-month-old is in intensive care recovering from an operation to join his oesophagus together - the pipe that enables you to eat.

He was born with a birth defect called tracheo-oesophageal fistula. One in 5000 babies has this, but most have a short gap that is easily joined.

Charlie's gap is much bigger at six centimetres, says his mother Katie Bailey of Upper Hutt.

"They finally got it to join together. That's a big step really."

In five days they will find out if the operation was successful.

"If things are good we will be able to slowly start teaching him to eat. Because he's never eaten he's never been able to talk."

The seven-hour operation the previous day went well. But as Charlie comes to, he pulls the tube out of his mouth that is connected to a ventilator. Within seconds, more than a dozen nurses and doctors are working on him while his helpless parents look on.

A nurse asks them if they want to watch. They do. The nurse explains what is happening until he is stable.

"We're basically back at square one," his father Bede says once the emergency has passed.

This is Charlie's second stint in ICU and his parents can't say enough about the care he has received.

"His whole journey through the system has been positive and we couldn't have asked for more from his carers - from nurses to surgeons to even one of the orderlies that has taken him to eight out of 11 of his operations who remembers him."

Charlie has spent about a quarter of his life in hospital - his first stint was for three months in the neonatal intensive care unit after he was born.

Charlie was transferred by the Life Flight Trust to Starship children's hospital in Auckland a day after The Dominion Post visited.

He was awake just before Christmas and able to play for short periods, but was still "fragile", Mr Bailey says. After a month at Starship, the family has returned to Wellington Hospital where Charlie is due for more surgery.

BEDSIDE VIGIL WITH SON HURT IN CRASH

Gina Solomon plans to spend every waking moment next to her son Te Pehi.

The 20-year-old apprentice painter from Porirua was in a car crash on the motorway just north of Johnsonville on a Friday night.

"I got a knock on the door from police asking if he was home because they didn't know who he was. We figured out it was him. We got here and if it wasn't for his ta moko [tattoo] we wouldn't have recognised him - it was that bad."

Ms Solomon looks exhausted.

"The first couple of days was touch and go. I was a mess, an absolute mess. We thought we were going to lose him. A lot of his mates came to visit, I wanted them to see what happens. This is what happens, it's not bloody Shortland Street."

Te Pehi is lying in bed hooked up to machines and drips. He has several broken bones but the traumatic brain injury was causing the most concern. Part of his skull was removed to allow his brain to swell - the bone will be replaced when he recovers.

"The doctors were saying that, worse-case scenario, he could be in a vegetative state, but now it looks a lot better," said his mother. "I don't want to get too excited, infection is the biggest risk."

He's now off the ventilator, recognising people and communicating by moving his head or giving the thumbs up.

Ms Solomon has nothing but praise for ICU staff, who asked her to bring in photos of Te Pehi so they could get to know him. They also gave her a patient diary, which family and staff can fill in to document his time in hospital.

"They've been really sweet, kept him clean-shaven - little things like that."

While Te Pehi was unconscious the nurses and doctors would explain what they were doing to him.

"They really, really care. They don't even know him."

Te Pehi has since been discharged from hospital.

The crash has affected a lot of people (he received about 100 visitors while in hospital) - and many have told Ms Solomon they have slowed down on the road.

PLENTY OF CHAT ENCOURAGED FOR RECOVERY

Most patients in intensive care are unconscious while their body recovers from the trauma of surgery or an accident.

Regardless, doctors and nurses speak to them from the moment they arrive.

They tell them what is happening, where they are and who is around them.

It's not known if they can hear what is being said, but intensivist doctor Shawn Sturland believes it makes a difference.

"Relatives want to know if they can still hear. I don't know what people can hear, we don't turn their hearing off with anaesthesia.

"Often patients can be here for several weeks and not remember anything, even though they're awake for some of their stay . . . when the family come in I reckon they can hear at a very basic level."

For this reason, relatives are encouraged to speak directly to their loves ones, who are hooked up to machines and drips.

The brightly lit ward on level one isn't a place where people go to die - 90 per cent of patients survive. This is partly because doctors are selective about which patients are allowed through the doors as they don't want to put people through the experience if there is little chance of them improving, Dr Sturland says.

"That's why we don't have the death rate that many people think we do. Also, we do put a lot of effort here into preventing death."

Unexpected deaths are rare because of the resources - both medical and staff - that are devoted to each patient.

"It's about intensive nursing. There's one nurse per patient. If someone is more critical then we can get four to five nurses per patient. That's what makes the difference."

The work is varied, from car crash victims to heart bypass patients, from toddlers to retirees.

"We see the sickest of all the other medical specialties, but having said that, they all come down to being sick in a way that they are all physiologically sick.

"A 5-year-old or a 95-year-old - on the whole we're dealing with supporting failing organ systems so there are some common elements."

It's this variety that draws staff to the unit that Dr Sturland leads.

He specialised as an anaesthetist before turning his hand to intensive care medicine in 1995.

He began working in Wellington Hospital's ICU in 2006.

A clinical on-call shift lasts 24 hours, compared with nurses who do 12-hour shifts.

"You get into the rhythm of it. The thing is, it doesn't really stop. There is a great sense of team effort over the 24 hours."

Dr Sturland is quick to add that it's the nurses who should be in the spotlight. They are, he says, what makes ICU.

"It can be very demanding.

"You're totally engaged with the patient and their relatives at what may be the worst time with their lives.

"[It's] very satisfying to be allowed to share an emotional period in someone's life."

- The Dominion Post

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