Joining the ICU Workforce | The Association of Anaesthetists
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Joining the ICU Workforce

Joining the ICU Workforce


The last four weeks have been a whirlwind for many of us, professionally and personally, as situations change on a daily basis. We are balancing concerns for our own ability to thrive in an unprecedented pandemic against those for our loved ones and colleagues. I am an enthusiast for the concept of work-life integration: sometimes one has to give more to life, and other times more to work. However, COVID-19 challenges one’s own adaptability, flexibility and responsiveness to change.

Our roles as anaesthetists are changing, and increasingly we are asked to join the ICU workforce. Having not practiced intensive care in a few years, I have to admit that I was feeling a little nervous. Conversely, I realised that many anaesthetists will be called to cover ICU as the ‘surge’ continues, and rationalised that it was better to put my best foot forward early. Clearly this is critical care under extraordinary circumstances. We face a disease that no one yet fully understands, the difficulties of communicating with patients, families and each other whilst wearing PPE, and daily concerns regarding our own personal risk and that of our families and colleagues. And all the while, relearning the art of intensive care.

First, I think that we should acknowledge that this is a unique and complex time. Secondly, it is okay to take time to acclimatise, despite it being a rapidly progressing situation. Finally, we should be reassured that there is help on offer.

What I have found is that the process of delivering critical care – systems review, FLATCHUGs[1], active problem lists - comes back fairly easily. However the challenges of delivering care in patients with COVID-19 definitely tests one’s clinical acumen and organisation, for example repeat entries into the hot zones need to be effective and efficient. As anaesthetists, we are pedants for attention to detail – as we rightly should be – and it is about striking a balance. We should be mindful about nursing colleagues who spend many more hours in PPE, are likely to be unfamiliar with the new environment, and dealing with their own anxieties.

In the normal ICU environment, these issues are usually addressed through regular face-to-face interactions. The COVID-19 era has forced us to think differently, test our soft skills, and stop relying on the usual unconscious cues. The bottom line is that it is okay to acknowledge that there are many areas of uncertainty and unfamiliarity, whether one is a consultant, medical trainee or nurse. Colleagues may appear calm on the surface, but many are functioning outside their comfort zones. A brave face and stiff upper lip is definitely not for the COVID-19 era - be kind to yourself and be kind to others. The camaraderie that we have experienced over the past few weeks is a testimony to our directorate. No one is in this alone – reach out and you will find overwhelming support.

In my experience, this pandemic has bought out the very best in people. Over the past few weeks I have witnessed immense compassion and selflessness – each doing what they can to help with no thought of what they might receive in return. Goodwill, and facilitating one another, seems the overarching spirit. As a consequence, I have never felt closer to my colleagues – a true ‘work family’. It is also a time of unprecedented challenges and changeability. Previously well-hidden personality traits and insecurities will now bubble to the surface. We should be quick to forgive and forget the very occasional sharp exchange, and remember everyone is doing their best.

The last point that I want to make is that it is vital to remember self-care: in the hectic nature of integrating work and life at pace, one can lose focus that this is a marathon not a sprint. Whatever this looks like to you – remember to look after yourself! For me, it’s ensuring I get 30 minutes exercise outdoors, that I take time for yoga and meditation (both core parts of my cultural background), alongside ensuring good nutrition and sleep. Good coffee and the occasional episode of The Crown helps too!

As some of you know, I am a writer at heart and I find the rare moments to work on a (non-academic) piece immensely relaxing. Core to wellbeing are family and friends, who should be forgiven for being anxious on your behalf. They are uplifting reminders that it is a privilege to have the skillset to face this pandemic proactively – they think we are all amazing and courageous! I think it is an honour to be a small cog in the anaesthesia and critical care team at Guy’s and St Thomas’ NHS Foundation Trust, and would like to thank those who make playing my part as placid as it can be.

Ramai Santhirapala
Consultant Anaesthetist and Perioperative Care Lead
Guy’s and St Thomas’ NHS Foundation Trust, London


1. Feed / Lines / Aperients-Analgesia / Thromboprophylaxis / Communication (with patient/ family) / Hydration / Ulcer prophylaxis / Glycaemic control

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