Sarah Hughes, Consultant Hepatologist

What does your role normally involve?

I have been a consultant at St George’s for five years. In my usual role, I look after inpatients with acute and chronic liver disease, and those with pancreatobiliary diseases. I do outpatient clinics at both St George’s and King’s College Hospitals.

I run a cirrhosis and portal hypertension clinic here, where we look after patients with both stable cirrhosis, and those who are very poorly with complications of chronic liver failure, who may require consideration for liver transplantation. I have an interest in diagnostic and therapeutic endoscopy for portal hypertension, and I am involved in clinical trials of treatments for patients with this condition. I am also the clinical lead for the Alcohol Liaison Team.

How has your role changed as a result of Covid-19?

During my training, whilst I was a Clinical Research Fellow, I spent four years working in a liver intensive care unit. When we started to recognise how significant the Covid-19 crisis was going to be, I knew I had to make use of this experience, so I volunteered to help our colleagues in intensive care at St George’s.

As things escalated, it became clear that the demand for ICU capacity was rising, and that activity in certain specialties would be reduced. As a result, I was asked to join the ICU consultant rota. I am very lucky to work in a fantastic gastro-hepatology department with incredible colleagues, who have supported me in doing this.

I now find myself for the past three months working as an ICU consultant on Covid-19 wards. If you had told me this time last year that I would be doing this, I wouldn’t have believed you!

What is the most interesting thing about your change in role?

The best part has been the opportunity to meet new colleagues in a different directorate.

We work in such a big organisation, and are all so busy working to build better services for our patients in our individual departments, that we often have little idea of what is happening in other areas of the hospital.

I have witnessed some truly inspiring team working and strong clinical leadership, and feel very grateful to work in an organisation where people have reacted and adapted so quickly to achieve the sweeping changes that have been needed to deal with the pandemic at a local and regional level.

What has most impressed you about the response of staff/colleagues?

The response of the junior doctors redeployed to ICU has been phenomenal, and the units have benefited from truly multi-disciplinary input, with trainees bringing their skills from neurology, renal medicine, radiology and so many other specialties to the care of Covid-19 patients with multi-system disease.

From orthopaedic colleagues working their way round all the ICUs to ‘prone’ or turn over ventilated patients, to vascular and interventional radiology colleagues coming to change central lines, the whole Covid-19 ICU response has been like a well-oiled machine – it has been staggering to witness what we can achieve when we pull together.

Also, the dedicated, uncomplaining resilience of the nursing staff, donned in PPE for long stretches, caring for patients at the bedside in an often emotionally as well as physically challenging ICU environment has made me appreciate our nursing colleagues all the more.

What is the hardest thing about the current circumstances?

There is no doubt that looking after some of our very sickest patients with Covid-19 has been very challenging. We have looked after many young, otherwise fit and well men and women, and it has been devastating that many have not survived.

Another hard aspect of these current circumstances is how difficult it has been to have families forced to be apart from their loved ones when they are critically ill and unable to communicate with them. This initially put a huge pressure on ICU nursing and medical staff, who felt the conflict between needing to devote time to the clinical care of patients, balanced with taking time to contact and update relatives.

A seven day Covid-19 family liaison service was quickly set up, run mainly by our fantastic breast care CNSs – and they are doing an amazing job.

On a personal level, taking on the responsibility of being an intensivist, and having been out of this environment for so long has been a challenge at times. However, I have been made to feel so welcome and have been so well supported that I am left with a real sense of satisfaction.

I’m glad to have been part of this huge team effort – this is most definitely a period in my career I will never forget.