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From cardiology to critical care

Cardiology to Critical CareI was one of the inaugural European Rhodes Scholars in 1992, from Ireland, and attended Univ from 1992 to 1995 where I did a DPhil in Physiological Sciences.

I am a consultant cardiologist at St. Thomas’ Hospital in London and in addition to my full time clinical role, I lead a research team in cardiac electrophysiology. Of course, my role has changed dramatically in the last two months. The Escalation phase of our COVID response began in earnest the week of  9 March, when it became very clear to those of us in hospital medicine that a huge challenge was facing us. It is fair to say that the subsequent six weeks was the most difficult of my working life. The intensity and speed at which we had to work to restructure an entire hospital to be prepared for a surge of illness was relentless. I am part of our tactical response team for the cardiovascular division, one of the largest at St. Thomas’, and Chief of our Cardiac Rhythm Management service. Suddenly, we had to somehow safely discharge many of our inpatients, convert all face to face patient interactions to remote (for an indeterminate length of time), continue to ensure emergency cardiac care and prepare our staff to cope with something, the magnitude of which was still unclear. The prospect of the hospital being overwhelmed was itself overwhelming. To put this into perspective, a winter surge of ‘flu admissions will demand up to 95 critical care beds in our hospital. We were at one point looking at a target of creating 300 critical care beds. Thankfully, 150 has been enough. For now.

Added to this was the need for me literally to drop my “day job” as a cardiologist, and be trained for redeployment to critical care, along with all my colleagues. Crash courses followed on Zoom on ventilator management, critical care work patterns, management of severe respiratory failure – very quickly, we all became informed, but definitely not experts, which brought with it a high level of uncertainty and anxiety. The fortunately short time I have spent redeployed to our critical care units has been truly humbling. The courage, good humour, camaraderie and sheer professionalism of the nurses, doctors and support staff, looking after all of our critically ill patients, young and old, in very challenging mental and physical circumstances, has cemented for me the indispensable value of a national health service in striving to deliver the fundamental right to health of all humans.

Through all of this, in addition to managing the escalation response is my responsibility as a parent and a husband, to two wonderful children who have dealt with the switch to the virtual classroom in true millennial fashion. New skills are being acquired in painting, cooking, baking, debating, arguing, scrapping and mediating! My amazing wife (no surprise there, a Rhodes scholar from Pakistan and Univ) is leading a parallel existence in the world of finance, dealing with the equally devastating economic consequences for millions of healthy but now unemployed and struggling people from all walks of society.

Perhaps the darkest moment for me was when the Prime Minister was being treated in our own hospital, by my own friends and colleagues, knowing that the wrong outcome could plunge the country into a state of despair that would be difficult to stem. Thankfully that story ended well but it has served as a stark reminder if one were needed that this disease deserves to be treated with the utmost of caution by leaders everywhere with an informed, intelligent and controlled approach to manage its many consequences, now and in the future.

One of the most positive moments was getting a WhatsApp from two of my Univ medical colleagues, two fantastic women who are consultants in Neonatal Critical Care (Dr Claire Barker) and Colorectal surgery (Ms Sarah Mills, also redeployed to adult critical care), sending me Sir Ivor Crewe’s letter of hope and encouragement to all Univ medics. As a DPhil student, I wasn’t “officially” a medic, but tutored the medics, may have contributed a little to them getting their FHS dissertations submitted on time and with coherent statistics, and joined them on Chalet trips, dinners and social gatherings as an honorary medic. This expression of support at a time of crisis from a formative institution in my life has been very welcome.

As we start week eight of the UK lockdown, it is both saddening and sobering to see the death toll rising, the numbers of NHS coworkers, careworkers and essential workers around the country who have died, and the ongoing struggle to provide a safe working environment for them. However, we are more positive now than ever that we will see this through. The 75th Anniversary of VE day forces me to acknowledge and admire the resilience of the human spirit in the darkest of times and to believe truthfully that better times are not too far ahead.

The global challenge is at a tipping point and, while in Europe, we are seeing a gradual and fragile change for the better, we also recognise that the worst is yet to come in other geographies. It is said that history is written by the victors. The future of our existence is not what we had envisaged four months ago. Our destiny will be written by the victors, and I am optimistic that the script will be a human one.

I send my thoughts to all in the Rhodes and Univ communities and far beyond who I know are doing all they can to fight the world’s fight at a time when that duty has never been clearer.

Dr Mark O’Neill (1992, DPhil Physiological Sciences)

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