This post has popped up a few times on my timeline.

It sounds incredibly stressful for the poster.

It has shown however that a lot of people don't understand the legal framework around Do Not Attempt Cardiopulmonary Resuscitation DNACPR orders. First point, DNACPR orders aren't a do not treat order, or an order to transition into palliative care.

It specifically refers to the act of CPR if a patients heart or breathing stops.

During the pandemic years, particularly pre vaccine, many healthcare staff saw a constant stream of people, often relatively young, and with minimal comorbidity, dying with refractory respiratory failure, despite all efforts. This frequently caused personal suffering in terms of the psychological fallout of seeing so much injury being wrought.

Hospitals had to divert staff and resources away from many others who still needed care and attention to prevent the system from being overwhelmed.

I was on strike today.

Lots of people have posted saying that they did so reluctantly, and found it a hard choice.

For me it wasn't.

I'm sick and tired of talking to patients who haven't been able to access care in a timely manner because we don't have the staff, the time or the resources to help them, and stop their illnesses progressing

I'm sick and tired of patients getting bumped from MDT meeting week upon week because we don't have enough radiologists, CT scanners, MRI scanners, histopathologists, lab technicians, so that their cancers

As a consultant in intensive care medicine, the staff in my father's local ICU were likely very nervous having me watch them tend to his final moments as he was removed from a ventilator and made comfortable.

They gave him peace, respect and dignity as his death came, gentle and pain free.

Whilst still surrounded by machines and in a hospital environment rather than a dedicated hospice, it was expertly done, with grace and sensitivity, with my father and our family cared for and cradled.

Intensive Care is a specialty that, by its nature, can see as

Not linking in the current news story, although my heart goes out to all involved, family and staff, for what be an extraordinarily hard set of circumstances to be navigating.

But it might be a good time to talk about brain stem death and how confusing it can be as a concept. Traditionally there are two ways death can be medically declared.

A complete cessation of cardiorespiratory function, which is sometimes called cardiac death. This is where the heart stops beating irreversibly.

However, there are specific circumstances where death can be

My strongest memory of COVID:

I was sat in a respirator. They are horrible to wear. It made my nose stream and I'd gone deaf in one ear from pressure on my temperomandibular joint from the mask straps.

I was tired. So, utterly, dog tired.

I'd just reviewed a man, in his 50s Very little in the way of comorbidity, he was being ventilated, COVID, face down, oxygen saturations terrible, lungs stiff like wood. The regional ECMO centre felt nothing they could offer that would help. There was nothing left I could try either.

He was obviously dying.

Watching the marches against mandatory vaccination for NHS staff and I'm angry.

A long and rambling thread follows: I wasn't the first ICU Consultant in my hospital to intubate a COVID patient, but I was close to the front of the first wave, some time in March 2020.

Me and @DaveJMelia went in, in tandem, sweating in unfamiliar PPE.

We'd heard stories of doctors and nurses dying already.