Getting up at 6:30 this morning was painful. I had tried to go to bed earlier, but my body clock must be off as I found myself lying awake until nearly midnight. I’m not ashamed to admit I was tempted to snooze the alarm and just hope I could make it to the hospital on time.
Luckily I had a little more sense than that, got myself out of bed and to the ECT unit with time to spare for the morning list. Once there, I had to don this rather fetching paper scrubs ensemble (one size fits no one), before I was fit tested for a face mask. For those of you who do not work in healthcare, this involves putting your head in a large plastic bag with and without a mask, while a bitter tasting liquid is sprayed into the bag. If you can taste the liquid without the mask but not when you are wearing it, then the mask fits.
Before the first patient arrived, we had to get into the hallowed PPE. As well as the scrubs, this included a waterproof gown with full length sleeves, a plastic apron, two pairs of gloves, the freshly-fitted mask and a pair of goggles. You might well be able to guess at this point, but I was warm, really, really warm.
We had four patients to treat this morning, and I was able to do all four with nothing but supervision from my colleague. It was a little like riding a bike, and quickly came back to me. I am still planning on going back next week, practice makes perfect, but it was good to find the procedure a familiar one.
It begins before the patient arrives by setting up the machine. Each patient receives a shock which has been determined to cause a seizure, and while most people tend to be similar there are some differences in doses received.
Once the patient arrives, they are settled on the trolley, their blood pressure and oxygen sats are taken, while wires for an ECG (heart tracing) and EEG (brain tracing) are attached. It is then up to the anaesthetist to insert a cannula and give the anaesthetic medications. Once the patient is asleep, the anaesthetist breaths for the patient for a few moments, before a bite guard is inserted and it is my role.
Attached to the ECG machine are two paddles which deliver the shock. As the psychiatrist I have to position the paddles, for everyone today roughly over each temple. A tracing of the brain is taken, and once everyone is happy a nurse presses the button to deliver the shock.
It takes a few moments to deliver the shock, after which the patient will start to have a seizure. This can, be seen best in the feet, as well as the tracing of the brain which shows a characteristic pattern. Usually lasting no more than a minute, once the seizure stops the anaesthetist takes over breathing for the patient again while they come round from the anaesthetic.
By 11 we had finished the list, the patients were in the recovery room, and most importantly (well, maybe not most importantly) I was out of PPE. I had been gowned up for a couple of hours, I have no idea how those amazing people in the acute hospitals are able to wear their gear for 12 hours or more. I know everyone is speaking of their respect for the work they do, but after spending just a couple of hours in their shoes my admiration has increased tenfold.
Back home after the list was finished, I found a dozen or so emails waiting for me, each of seemingly increasing seriousness. I joked earlier with Sarah, but it appears even in lockdown people are storing up their emergencies for a Friday afternoon.
It was nearly five by the time I had sorted everything out, and even then I was still getting phone calls from people wanting to discuss issues for the weekend. Hopefully I will not be needed on ECT too often on a Friday, otherwise I might find myself swamped.
Once I had finished, Sarah and I went for a quick walk in the afternoon sun, before ordering our Friday night Domino’s pizza. I know I said in week 1 we would not make it a regular thing, after which we have ordered a pizza every Friday night, but right now as I lay here on the floor in a pizza coma, I have no regrets. The plan this evening is TV, reading and a semi-early night (I promise). Nothing too exciting for a Friday night.
Roll on the weekend.