Critical Care is one of the busiest and most high pressure units in a hospital because every patient needs constant care and attention as they recover from life-threatening conditions, major operations, have been injured in severe accidents or are recovering from acute illnesses such as pneumonia. Therefore being a consultant in such a department involves not only being able to use specialist equipment and deal with a variety of conditions, but also being able to think on your feet and make quick decisions as you’re faced with deteriorated conditions and complications like sudden organ failure.
Steve Mathieu has worked at Portsmouth Hospitals as a Critical Consultant since November 2011 and says the acute element of his role is what makes each day meaningful. “In Critical Care I treat patients, of any age with a wide spectrum of illnesses. Care that I provide or drugs that I administer will have an immediate effect on that patient because of just how poorly they are. I am then involved in important decisions about the management of a patient, act as part of the resuscitation team and work with a number of different specialties, so I am incredibly lucky to have a role as diverse, challenging and rewarding as I do,” says Steve.
I ask Steve to tell me about a typical day and the variety of people he could see. “In one day I could go from caring for a tiny baby, to an elderly person. I will be involved in the care of patients with acute medical problems, patients having planned or emergency high risk surgical procedures and patients that may have had a cardiac arrest. There is a huge variety in the conditions and patients that I will treat. Communication with family members is a hugely important part of my role. Tension is naturally always high with the loved ones so it’s important to keep them continually updated. I find myself acting as a support network to not only the patient but the family too as they come to terms with the patient’s changing condition and hopefully their rehabilitation. I am also involved with breaking bad news. Around 20% of patients admitted to intensive care will sadly die. This is a difficult part of the job but is essential and I take great pride in trying to deliver information with compassion and empathy.
Steve says a highlight of his career is when patients beat the odds and have miraculous recoveries. “I remember one young lady who had a bacterial infection that caused septic shock, which is a condition that happens when your blood pressure drops to a dangerously low level after an infection. The sepsis caused a lack of blood supply around her body and her fingers and toes went black which meant she had a risk of amputation. I spent a long time treating her physical and psychological recovery as she fought the illness and contemplated losing both her hands and feet. Against the odds I was eventually able to discharge the girl with minimal effect to her feet and hands – she’d made a remarkable recovery,” says Steve smiling.
Mr Sam Dutta is a fully trained General Surgeon and Laparoscopic Surgeon who sub-specialises in solid organ transplantation and trained in kidney transplantation in Plymouth, Cambridge, Birmingham and Nottingham.
Sam started his role at Portsmouth in March 2008. He is part of a team of four transplant surgeons at Queen Alexandra Hospital covering a population of two million. Sam performs kidney transplants and dialysis access operations and run a busy general surgery practice carrying out emergency general surgery and keyhole hernia and gallbladder operations.
Sam performed the first laparoscopic (keyhole) kidney donation operation in Portsmouth in September 2009 and is the lead for the Living Donor Kidney Transplantation in the Wessex Renal Transplantation Service, performing over 40 keyhole kidney donation operations to date.
Sam is also the Joint Lead for the Blood Group Incompatible (ABOi) Transplantation service, where in November he performed the first kidney transplant at QA where the donor and recipient had different blood groups.
Sam enjoys promoting transplantation and organ donation where he can and plays an active role in patient education and media publicity on behalf of the Trust.
Surgeon Commander Sarah Stapely is an orthopaedic consultant within the Trust and MDHU Portsmouth’s Deputy Military Clinical Director. In 2011, she received the Barclays Woman of the Year Award for inspiring others through courage, selflessness and dedication.
She has served in Afghanistan, Iraq and as a medical Officer aboard HMS Illustrious and returned to Afghanistan early in 2012 as the Deployed Military Director with responsibility for clinical leadership and management for the UK hospital in Camp Bastion. Surgeon commander Stapely acknowledged the benefits of her dual role within the NHS and on deployments, she said:
"It allows the sharing of good medical practise across all specialities between military and civilian health care professionals; it enables the introduction of new techniques within the trauma setting, to be applied within the NHS for the benefit of all patients."
Is a consultant in stroke medicine at Queen Alexandra Hospital in Cosham, with two years experience treating and rehabilitating patients following a stroke, who better to shadow in light of stroke awareness month….
Let’s start with the basics – ‘what is a stroke?’ I ask Dr Siddegowda as I meet him in his office at Queen Alexandra Hospital on a sunny June morning.
‘A stroke is a disruption in the blood supply to the brain,’ says Prasad. ‘Alarmingly 85% of strokes are caused by a blood clot disrupting the brain’s blood supply and 15% by bleeding into or on the surface of the brain.’
Prasad says in order for the brain to function properly it relies on a supply of blood for oxygen and nutrients, therefore when the supply is disrupted brain cells are starved of the oxygen and nutrients which causes damage to the brain tissue.
My next question - what causes a stroke? ‘Strokes can affect people of any age but are more common in older people,’ says Prasad. ‘There is no sexual preference and risks can include high blood pressure, smoking, Diabetes or high cholesterol.
Prasad goes on to say that nearly 20 per cent of people who experience a mini-stroke (TIA) will be at risk of another within three months of their first attack. ‘We score every patient that has had a mini-stroke and put them in a risk bracket. Those that are categorised as high-risk are offered an urgent TIA clinic appointment to educate, investigate and treat all aspects of their stroke risk.’
Stroke is a medical emergency so as well as carrying out ward-rounds and seeing patients that have already been admitted, Prasad will offer emergency treatment to patients in the accident and emergency department. ‘We are a multi-disciplinary team which is made up of stroke specialist doctors and nurses, research nurses, physiotherapists; occupational therapists, speech and language therapists and dieticians. The team also works closely with other professionals such as pharmacists, social workers, community rehabilitation teams and the neurosurgical team at Southampton General. As a team we manage patients with varying complexity.’
Alarmingly Queen Alexandra Hospital sees 1,400 patients a year that have suffered from a stroke, 75 per cent of which are over 65. ‘The biggest message I would like to promote throughout this awareness month are the symptoms. Time is critical with a stroke and every minute that treatment is delayed 1.9million nerve cells will die,’ says Prasad.
The Department of Health have been running a successful FAST campaign. ‘Most people have seen the TV advert which shows the symptoms we should look for to identify someone suffering from a stroke, this advert is great in raising awareness and making every person a potential stroke saver.’
So what are the common symptoms of a stroke? ‘The DOH campaign abbreviates it to the word FAST: facial weakness - can the person smile? Has their mouth or eye drooped? Arm weakness - can the person raise both arms? And speech problems - can the person speak clearly and understand what you say?
‘Stroke is the leading cause of adult disability in the UK, but over 50% of those who receive thrombolysis treatment are more likely to survive and be independent,’ says Prasad. So what’s the time-frame that a person has to receive treatment? I ask. ‘Time frame?’ asks Prasad, ‘four-and-a-half hours (in most cases) – that’s all, which is why it’s so critical for everyone in society to recognise the symptoms.’
A person suffering from a stroke because of a blood clot, known clinically as ischaemic strokes, can be treated by administering a clot-busting medicine called alteplase. This dissolves blood clots, minimises brain damage and salvages the brain from being deprived of blood. However, alteplase is only effective if started during the first four and a half hours after the onset of the stroke. We occasionally use it up to 6hours. After that time the medicine has not been shown to have beneficial effects.
‘If a major blood vessel to the brain gets blocked and no treatment is administered, the person will age by 30 to 36 years over ten hours, which is the average time to complete their stroke,’ says Prasad. This is a rather alarming fact and underlines the reason to enhance symptom education.
‘It gets more complicated,’ says Prasad. ‘Not all patients are suitable for thrombolysis treatment so it is extremely important that alteplase is not used in strokes when there is bleeding in the brain. For those patients we would try and control and reverse the bleeding and occasionally transfer them to Southampton General for neuro surgery.’
So why work in strokes? I had to ask. ‘Portsmouth Hospitals has one of the busiest stroke departments in the country and it’s extremely satisfying seeing the huge difference you can make to someone and their family’s life, especially the people that recognise the symptoms early, bring their loved ones in within the time-frame and qualify for alteplase treatment.
‘To see that person walk out of hospital with in a few days after suffering from a stroke is very rewarding. The TIA clinic is a constant reminder of prevention and education and I always try and push both things.
‘The future for our department is very bright and exciting, with the prospect of new clot-busting treatments and techniques and more research projects underway, I couldn’t imagine myself doing anything else,’ says Prasad before dashing off to complete a ward round.