Learning Critical Care at the Source

My Life-Changing Time in Cambridge

Every year, the European Society for Anaesthesiology and Intensive Care (ESAIC) offers residents and young specialists the opportunity to participate in selected European hospitals. This programme allows participants to be chosen by a committee based on a voting mechanism. I have followed this programme for several years and decided to apply in 2023. I chose Royal Papworth Hospital in Cambridge, UK, because of my strong interest in intensive care, particularly in ECMO.

Papworth is renowned for its historically extensive ECMO programme, and its affiliation with the prestigious University of Cambridge made it an obvious first choice for me. I submitted all the required documents to the ESAIC secretariat, and after a designated period, I was informed that I had been accepted into the programme. To experience the UK system as a fellow, I started to arrange my membership in the General Medical Council (GMC) ahead of time. This involved a considerable amount of documentation, including a language test. However, seeing this as a great opportunity, I considered these challenges relatively minor. Once I gained GMC registration, I was excited to prepare for my full hands-on fellowship at Papworth. I began reviewing anaesthesia and critical care textbooks, focusing on cardiac topics. I discovered that several of the authors were individuals I would soon meet.

Royal Papworth Hospital in Cambridge is one of the world’s leading cardiac centres, providing comprehensive cardiac surgery services, including heart and lung transplantation, an ECMO programme, robotic thoracic surgery, and a complete interventional cardiology programme. It is also the world’s second-largest centre for pulmonary thromboendarterectomy. The hospital is situated within a beautiful biomedical campus, adjacent to Cambridge University Hospital (CUH) and another specialized hospital for mothers and children, the Rosie Hospital. Although Papworth is a relatively small hospital with “only” 300 beds compared to CUH’s capacity of 1,400 beds, the quality of care is extraordinary. The intensive care concept in this “small hospital” is based on 48 intensive care beds with a patient-nurse ratio 1:1.

After the initial orientation day, I joined the team as a senior fellow. A junior doctor typically undergoes a mandatory internship within their speciality. At the same time, a senior fellow is an experienced doctor in intensive care medicine, often a certified specialist who may also serve as a consultant in another hospital. Due to the high specialization at Papworth, consultants have several years of experience specific to this institution. They have in-depth knowledge of the system, enabling them to provide the best possible care for patients.

As a senior fellow, I worked alongside another colleague and the consultant, managing one department that could care for as many as 18 patients. Although the ICU days were demanding, the consultants made time to teach us and share their knowledge and experience, primarily during rounds. This resembled the classic historical rounds introduced by William Osler in the 19th century. I learned to operate within a different competence framework, where nursing staff also managed basic ventilatory setups, a practice I had not encountered before.

The Papworth Critical Care Area is structured as an open ICU, meaning that patients are cared for by various highly skilled and specialized teams concurrently with our rounds. At first glance, this may seem chaotic; however, it is a well-established care method. Daily, patients are reviewed during multidisciplinary team meetings, which include intensivists, microbiologists, radiologists, and other specialists. Amidst these organized daily events, there is time for imaging examinations, pulmonary catheter insertions, central venous catheter insertions, new patient admissions, and discharges. From 6 p.m., we have further classes—often in an online format, including M&M meetings to discuss patients admitted to our Critical Care Area in recent days. I found it fascinating to participate in these activities as a team member. I observed how the nursing and rehabilitation team supported patients with tracheostomy tubes by taking them to the local hospital store, helping them walk around, and providing new stimuli and motivation. Surprisingly, despite using older equipment compared to some of our hospitals, their communication skills and abilities were consciously and purposefully refined daily.

During my three-month fellowship, I had the opportunity to meet numerous patients and engage with their stories. I witnessed patients waiting for lung or heart transplants on all possible types of mechanical heart & lung support, who exercised to get strength even with the help of family members. I listened to the conversations of consultants of various disciplines with the patients and their relatives about the termination of the treatment, which they considered futile. I saw the professionals talking to each other. Although strict and medically precise, always with respect for the opinion of the other. Despite everything we experience in everyday practice behind the walls of hospitals in Slovakia, I understood that attitude is the most important. The pathway of modern evidence-based medicine is not only shaped by technological advancements and medical tools but, more importantly, by listening and being sensitive to the needs of the patient and their loved ones. With this principle, together, we can create an inspiring and motivating environment even beyond the borders of our workplaces.

Author

• Robert Nagypal, Anaesthesia & Intensive Care Specialist, F. D. Roosevelt University Hospital, Banska Bystrica, Slovakia