Mastering Intensive Care

Mastering Intensive Care is returning from being offline for a full 12 months. In this episode, I ask you to ponder, “how are you going?” after the lengthy pandemic, which has lulled after the worst of the storm but has not yet settled into a state of calm. Whilst few intensive care clinicians have actively diminished what we’ve been through over the last few years, the relentless world of Intensive Care continues unabated. There have been many learnings from the pandemic, but we mustn’t sweep the emotions we’ve witnessed under the carpet. As you listen to this shorter episode than usual, I hope you’ll ponder questions about how you have managed yourself during the pandemic, both individually and in your local ICU community. I share what I’ve witnessed in myself and my colleagues before offering a few thoughts on where we might focus our actions in recovering from what we’ve been through. Thank you for listening as I use this opportunity to reinvigorate this podcast after 12 months of languishing.   Andrew Da

This episode focuses on learnings from the COVID-19 pandemic. Important lessons our global Intensive Care community, your local ICU and you personally might take away from what the novel coronavirus has caused - at least so far. Previous episodes of this series (a series best listened to in episode order) have allowed you to hear the experiences of busy ICU clinicians, the work of an ICU clinical psychologist, and some supportive strategies different institutions have used during the pandemic. Here you’ll listen to the valuable thoughts and considerations about topics including personal wellbeing, awareness of mindset, effects on healthcare workers as a group and even some possible gains from the pandemic hardship. In this sixth episode of the “Persevering Through A Pandemic” series, the guests (in order of appearance) are Dr Rana Awdish, Dr Hayley Gershengorn, Dr Laura Rock, Dr Wes Ely, CCRN Simone Hannah-Clark, Dr Peter Brindley, Dr Matt Morgan, Dr Hugh Montgomery, Dr Georg Auzinger and Dr Julie Highfield.

Intensive Care clinicians are used to being busy. Critically ill patients constantly arrive in the ICU with no awareness of staff workload at that moment. So being busy has not been the major problem of the COVID-19 pandemic. The difficult emotional responses to physical exhaustion, mental strain, heart-breaking human loss and the unpredictability of SARS-CoV-2 have been significant, and the commonly held attitude of “just power through” has not been sustainable. Instead, the most critical influence on the overall wellbeing of Intensive Care practitioners has been the degree to which they have felt supported socially. Maintaining social support and cohesion is hard. Intensive Care professionals have often depended on social support through camaraderie and workplace culture yet have been crying out during this healthcare crisis to hospital administrators, often in vain, for direct and valuable supportive measures for staff wellbeing. The pandemic has therefore required a more healing and individual-focused typ

The physical, mental and emotional burden of the COVID-19 pandemic on Intensive Care clinicians has been colossal. Many ICU staff, of all types and at all levels, have suffered significant psychological effects. After hearing the pandemic experiences and perspectives of bedside clinicians in recent episodes, the focus of today’s episode is a clinical psychologist who’s been working inside several busy ICUs and supported hundreds of people across the United Kingdom during the pandemic. In this fourth episode of the “Persevering Through A Pandemic” series, you’ll hear the thoughts of Dr Julie Highfield who has led a national UK-based wellbeing program in response to COVID-19. Dr Highfield works as a consultant clinical psychologist in several ICUs in Wales and has an additional role as the National Wellbeing Director for the Intensive Care Society in the UK. In this episode Julie talks about: The first year of the pandemic feeling like the best and worst year of her life Her witnessing of ICU staff “just getti

Whilst some people choose to run long distances, caring for patients in the ICU is not supposed to feel like an ultramarathon. If you work in the complex, high stress, emotion-generating environment of an ICU, it might sometimes feel like you are the logistics organiser of an ultimate endurance event, but you should hardly feel like you are a competitor. Yet when COVID-19 arrived, the initial sprint became a marathon and that’s now turned into a seemingly never-ending ultramarathon. In this third episode of the “Persevering Through A Pandemic” series, you’ll hear about this pandemic ultramarathon and the effects it’s had on the people working in ICUs in the UK. A period which has been physically and emotionally difficult yet has provided glimpses of career satisfaction along the journey. Amongst other topics, UK intensivists Drs Matt Morgan, Hugh Montgomery & Georg Auzinger talk honestly about their worst pandemic days, the discomfort that they and their colleagues felt, how their teams kept afloat in suc

Just like a surf beach shore, waves of COVID-19 keep crashing over the world’s Intensive Care Units. The waves have been unpredictable and pattern less, ravaging the ICUs and the people that work in them, often inconceivably. In this second episode of the “Persevering Through A Pandemic” series, you’ll hear from Intensive Care professionals about the COVID-19 pandemic which continues to affect ICUs across the globe. Amongst other topics, US intensivists Drs Rana Awdish & Dr Hayley Gershengorn, and Critical Care nurse Simone Hannah-Clark talk honestly about their worst pandemic days, the feelings of guilt, fear, anxiety and overall depletion, the effects on their family, what they witnessed in their struggling colleagues and how they dealt with the strain. You’ll also hear valuable thoughts on the nursing perspective, the difficult experience of being a patient in a pandemic, and the tension between the support from the community and the flagrant COVID-19 deniers. There have been many emotional and heart-b

Are you sick of COVID? How have you coped in this pandemic? And what’s it actually felt like to live and work throughout this last two years?   Concerned for the wellbeing of healthcare professionals in the hardest hit ICUs during the COVID-19 pandemic I interviewed a group of clinicians previously featured on the podcast. With an emphasis on personal wellbeing, I aimed to uncover their feelings, their struggles, their perspectives and their take-aways from this prolonged global healthcare crisis. My hope is to help you to reflect on and to process your pandemic experience, and to hear lessons you might take away to your Intensive Care community. In this first of a series of 6 episodes you’ll hear the voices of Dr Laura Rock, Dr Peter Brindley and Dr Wes Ely, which were recorded in April/May 2021. Thank you for listening to these wise and thoughtful Intensive Care clinicians tell you how they’ve been “Persevering Through A Pandemic”.   Andrew Davies

I’m trying something different on Mastering Intensive Care. Welcome to a special series named “Persevering Through A Pandemic”. Aghast at the stories I’d heard from Intensive Care colleagues amid large COVID-19 surges I approached several previous podcast guests in countries that had been harder hit than Australia. Concerned for their wellbeing I asked if they’d talk to me about what they’d been going through to help me understand how the health professionals in the busiest ICUs had been coping. They willingly shared their stories and reflections on many aspects of their experience. Their feelings, their struggles, their teammates, their learnings, their take-aways. The COVID-19 pandemic is far from over. Please listen in over the next 6 weekly episodes as a group of wise and thoughtful Intensive Care clinicians tell you how they have been Persevering Through A Pandemic.

Mastering Intensive Care is back after a lengthy break with an episode featuring senior ICU dietitian Dr Emma Ridley. Emma is a Senior Research Fellow and a NHMRC Emerging Leadership Fellow at the Australian and New Zealand Intensive Care Research Centre (ANZIC-RC) at Monash University in Melbourne, where she leads the Nutrition Program. Emma has 16 years of clinical dietetic experience, including as a senior dietitian in the ICU at The Alfred Hospital in Melbourne, and over 13 years of research experience, including the awarding of her PhD. Her research interests include energy requirements across the hospitalisation period, the clinical application of indirect calorimetry and the effect of optimal nutrition delivery on short and long-term outcomes in ICU patients. Emma is a long-time colleague of mine, someone I have huge respect for, and a woman that seems to fit a lot into a busy life and career. I was keen to talk to Emma for the podcast so I could ask about topics such as how she sees dietitians best fi

This episode features Professor David Tuxen, a pioneer of Intensive Care in Australia, who recently retired after 38 years at the Alfred Hospital in Melbourne. David trained in both respiratory and intensive care medicine, and became the Alfred’s ICU Director at a young age. He led the development of one of Australia’s first mega-ICUs before standing down after over 20 years as Director to re-energise his passion for teaching and research. David is a Professor at Monash University, still works as an intensivist at Albury Hospital and previously served in leadership roles including President of ANZICS and Chairman of the Australian and New Zealand Intensive Care Foundation. He is globally renowned for his teaching and research on many aspects of mechanical ventilation. David was my first ICU Director, and he rapidly became, and remains, a wise, enthusiastic and long-standing mentor to me. I have particularly admired his excellent clinical skills and specifically his attention to detail so I am thrilled he agre

In this episode the focus is on our Intensive Care friends in the UK and what they are going through right now with COVID-19. My guest is Rupert Pearse, a Professor and Consultant in Intensive Care Medicine at Barts Health NHS Trust and Queen Mary University of London. He works at the Royal London Hospital, which was at the epicentre of the first wave and now the second COVID wave in East London. Rupert's recent work on Twitter through public health messaging has been outstanding and you can follow him @Rupert_Pearse. Despite being terribly busy in London, Rupert willingly gave his time to talk about: How the cases of COVID-19 are tracking right now How the logistical challenge is being gradually replaced by important reflection What the Royal London Hospital ICU did to deal with the surge The ongoing research they’ve been doing during the pandemic Why the Nightingale hospitals of the first wave seemed to struggle The stress and strain associated with diluting the nurse to patient ratio The difficulty with b

This wide-ranging episode, covering many angles of how we should consider doing less interventions to our patients and more transparent communication to their families, features US intensivist Todd Rice. Dr Todd Rice, is an Associate Professor of Medicine in the Division of Allergy, Pulmonary, and Critical Care Medicine at Vanderbilt University Medical Center (VUMC) in Nashville, Tennessee. Todd is a clinical intensivist, the Director of the Medical ICU (MICU) and the Medical ECMO Program, and leads VUMC’s MICU strategy for the care of COVID-19 patients. In addition, Todd leads a substantial research program as a clinician scientist, and is co-chair of the Learning Healthcare System at Vanderbilt where the motto is "Learn What We Do and Do What We Learn." Professionally, he is proud of the evidence he has generated to improve the care of critically ill patients and the mentorship he has provided to other physician scientists. He loves ice hockey (watching, not playing) and is completely into enjoying life wit

This first podcast episode of 2021 is my attempt to put into perspective at least some of what has happened over the whirlwind of the last 12 months. We can’t control what happens to us, yet we can control our actions in response to our circumstances and we can learn from our experience. I feel like the whole experience of COVID has delivered a few important lessons for us as an Intensive Care community, so in this episode you’ll hear 5 valuable lessons I have been reflecting on. In line with the theme of the podcast, I’ll concentrate on what Intensive Care has learnt, rather than humanity in general. And although 2020 involved much discussion about various drugs, ventilator settings and other interventions, my curiosity is the human side of things. I’ll therefore concentrate on how the novel coronavirus has affected us - as individual healthcare practitioners, as distinct ICUs, and as a greater intensive care community. I am aware many of you are still struggling with overwhelming situations where you work a

Two inspiring and innovative educationalists, Dr Roger Harris and Dr Oliver Flower, are featured in this episode. Both of these Sydney intensivists are the force behind the recently created educational initiative named Coda, having previously been two members of the successful triumvirate who set up SMACC (Social Media and Critical Care). To my mind Oliver (or Oli) and Roger have led an educational revolution by utilising speakers with high level presentation skills and encouraging community engagement, through a blend of real life events, internet technology and social media, to bring us the type of innovative and entertaining educational platform we haven’t previously seen in intensive or critical care. Dr Roger Harris is a senior staff specialist in the ICU at the Royal North Shore hospital and the Sydney Adventist hospital. He is dual qualified in Emergency Medicine and Intensive Care. He is passionate about education, his five children and especially his wife Georgie. He’s on Twitter @RogerRdharris where

The guest on this episode is Nurse Practitioner Naomi Pratt who describes the lingering and harrowing effects of long COVID. Naomi is a Nurse Practitioner who jointly manages and leads the Critical Care Liaison Nurse service at Peninsula Health. In this role she provides clinical leadership and the Intensive Care response to Medical Emergency Team calls. She has completed post graduate qualifications in Intensive Care and has over 20 years of ICU experience. She completed her Masters in Nursing (Nurse Practitioner) at LaTrobe University and has been an endorsed Nurse Practitioner since 2015. Naomi has a keen interest in providing critical care outreach and supporting clinicians caring for deteriorating patients in ward areas outside of ICU. She is a clinical mentor for advanced practice nurses at Peninsula Health and has undertaken research to understand the factors associated with the care of deteriorating patients. This has resulted in several conference presentations and journal publications. Naomi tries t

This episode is a departure from recent conversations about COVID-19 material to cover some very important topics on the human side of what we do in the ICU. My hope is you will glean valuable insights from an intensivist I admire greatly as both an expert practitioner and an esteemed educator of high-level intensive care communication - amongst other things, of course. Dr Steve Philpot is an Intensive Care Specialist at Cabrini Hospital in Melbourne with a special interest in end of life care, organ and tissue donation, communication skills training and empathy in the workplace. He is the National Lead Trainer for the DonateLife Family Donation Conversation Workshops, the Convenor of the College of Intensive Care Medicine communication training program, convenor of the Cabrini Health “Shared Decision Making” and “Advance Care Planning Conversations” workshops and chair of the Cabrini Health End of Life Care Committee. Steve is an Adjunct Senior Lecturer at Monash University and is involved in undergraduate c

2020 has been a roller coaster year and I wish to acknowledge my friends of the Intensive Care world for your outstanding and awe-inspiring efforts as clinicians, researchers, educators, digital content creators, and mostly as human beings, compassionately caring for others in a truly unprecedented global crisis. COVID-19 is far from over yet. Massive numbers of cases are still being reported each day and many countries are re-instituting public health-focused social and business restrictions. So whilst the pandemic continues, unabated, it feels like the right time to reinvigorate the Mastering Intensive Care podcast, after a 6 month break, with an episode where I express my gratitude to each of you individually, thanking you for what you have done so far, and for what you will likely need to continue to do. This isn’t a thank you to one discipline of people who work in the ICU. It’s to every single person, in every role, who has supported either the people admitted to or those who work in any ICU in the worl

In many parts of the world the COVID-19 pandemic is overburdening Intensive Care Units with huge numbers of critically unwell patients, many of whom are dying. Whilst China, Italy, Spain, France, Germany and the UK have been crisis-ridden over the last few months, one of the most inundated parts of the world right now is the USA and especially the state of New York. In this episode you will hear the firsthand experience of a New York City ICU nurse where things are extremely intense and overwhelming. Simone Hannah-Clark is a critical care nurse in the Medical ICU at the Mount Sinai hospital in Manhattan. Originally a New Zealander, she worked in both New Zealand and Australia before moving to the USA 15 years ago. Simone recently penned an engrossing New York Times opinion piece entitled “An ICU Nurse’s Coronavirus Diary”. In this podcast she delves deeper into her recent reality as a nurse caring for ICU patients with COVID-19. She recounts stories of the hard work, the sense of duty, the intricacies of pers

In the midst of the global COVID-19 pandemic, this episode focuses on the pandemic planning all ICUs should be doing - if they haven’t already been overwhelmed. This week a Working Group of 30 colleagues released the Australian and New Zealand Intensive Care Society (ANZICS) COVID-19 Guidelines. This episode features the Chair of that Working Group, A/Prof Steve McGloughlin. Steve is an intensivist, an infectious diseases physician, and the Director of the ICU at the Alfred Hospital in Melbourne, one of the largest Australian ICUs. In this conversation, Steve talks about: How he is “hoping for the best and preparing for the worst” His confidence in the Australian Intensive Care system How and why the ANZICS COVID-19 Guidelines were developed Measures for increasing ICU capacity His belief that intensive care can be offered to all who might benefit in the pandemic The need to communicate more in a crisis to ease anxiety The value of asking “Are you confident we know what we are doing as a team”? PPE being saf

Our need to bring our best selves to work has become more important in the face of this COVID-19 pandemic sweeping the globe. Many intensive care clinicians are presently overwhelmed by escalating numbers of critically ill COVID-19 patients whilst many others are carefully preparing for seemingly inevitable local outbreaks. There is an eerie feeling where I live and work in Melbourne especially with the online reports and accounts from our heroic colleagues in harder hit places like China, Italy and even parts of the USA. My wife, Claire Davies, and I thought it would be useful to record a conversation about what’s going through our minds, right now in mid-March 2020, as public health officials and healthcare organisations around the world are either managing or preparing for the onslaught of individuals infected with the virus whilst also enacting public health measures such as social distancing and airline travel restrictions. Claire, who was a previous interview guest on episode 29, spent almost 2 decades