Some more thoughts after another 4 long days if I may

1. The majority of people are getting better and going home, which is positive. This can get missed, especially when we in the West Mids are getting hammered 1/n

2. There is loads of #delirium, and this from someone who is always looking - so much so that other specialists are now asking about it. Like all things COVID it is similar, but like nothing seen before. Severe attention deficits, as if they are the only person in the room.. 2/n

...and very agitated - unable to sit still, pacing around room, not keeping O2 on. Lots of 'wool picking'. It is extremely difficult to manage and responds poorly to drugs. Seems an early hypoactive/mixed phenotype, and a late hyperactive phenotype @midlandsneuro

3. In this context, use iPads with care - this sounds a wonderful idea but may worsen the delirium & cause immense distress to relatives. Non-pharm measures seem very February 2020 4/n

4. Dermatologists (yes, I know!), oncologists and GUM doctors know a lot more general medicine than they think - we need to encourage them, and help them see the transferable skills -and end to the joke about the plastic surgeon in ED please 5/n

5. The lovely presents arriving rarely get past ED, AMU & ITU - please ensure a good train 'backwards' to the wards - there is as much COVID and COVID challenges there, just not as visible and they can feel a bit abandoned 6/n

6. Any more than 3-4 hours in 'hot resus' is too much - the speed of difficult decision making is extremely hard work, and it seems to be in a different time zone - you cannot trust your usual gut instincts which is very disorientating

7. The hierarchy of specialities, grades, and professions is being torn down - this is refreshing, affirming, and gives me lots of hope for the future - the idiot specialist who was difficult the other day stood out because this was an isolated incident over the 4 days 8/n

8. so all in all they were tough, but manageable.
Downtime at home feels absolutely priceless, but I am struggling to truly switch off - I'm writing this

My pinned tweet stands, and the imagery of the next few days is going to be reflected on in an entirely new way END