As coronavirus cases continue to rise across the UK, hospitals are dealing with an ever-increasing demand on their resources.
Dr Jenny Abthorpe is an intensive care unit registrar who works in a large teaching hospital in London.
She has written a diary for Sky News about what is happening on the front line.
Today I went to work, cycling down the country lanes to the train station and stopping briefly to appreciate the dawn chorus.
The station is deserted. I feel like a lone warrior as I step on to the train.
It has been a difficult week on our intensive care unit.
We had a number of patients die – I can’t remember ever losing this many in a week.
I can’t stop thinking about the relative of one of the patients who died – an 81-year old mother, phoning each day to enquire about her son.
She had this tremulous frail voice and she had sounded relieved when I updated her that her son was doing okay.
But now I feel physical pain as I think of the phone call made to her the day before – that her son had died.
And the fact that she wasn’t able to get to the hospital in time.
As I near the hospital, I join the army of NHS workers starting their day and feel a sense of pride and belonging.
I walk past the warning signs at the hospital entrance and then those on the doors to the ICU. I’m used to them now.
The ICU is incredibly busy, and the number of COVID-19 patients requiring critical care is rising swiftly.
Our unit is full again with 30 patients, having received six new admissions overnight.
I change into my scrubs, don my mask and receive an update on each patient.
The handover is quick and efficient. The night team of two doctors look exhausted.
We give them a round of applause to send them on their way home. Heroes.
COVID-19 patients have now filled a second ICU on site, and a new unit, created in a former high-dependency unit area, is also full.
There are now a significant number of beds in theatre recovery which are slowly being filled.
Paediatric intensive care units are taking non-COVID adult patients.
Two other ICUs are increasing their bed capacity in preparation for the surge.
Staff are being redeployed from around the hospital to join the ranks of critical care staff. And we are so grateful to them.
The morale of the department is high with support coming from every department and staff level.
We’re beginning to know this silent enemy – the virus.
Patterns are emerging, but it’s frustrating and slow.
And those patients that are doing less well, we feel at a loss to know how to halt their decline.
The day goes by in a blur.
Some patients are early on in their illness and need stabilising, life-saving care.
Last week, a new patient had arrived in ICU at 6pm, after deteriorating on the ward. He needed intubation, but the critical care outreach team were too busy to perform it there so he was brought to us.
He sat there trembling with fear, wide-eyed as he stared around him.
I had donned my PPE and went to reassure him. He was exhausted.
I managed to drift him off to sleep, reassuring him that I would see him soon, that he would be fine, we would take good care of him and that he would never be alone, with a nurse always watching over him.
He held my hand and said: See you in the morning… thank you doctor.
My heart broke a little.
Half an hour later he was stable and settled. I placed my hand on his forehead and whispered Please do well.
A quiet plea.
Others are static in their progress and we analyse their numbers and clinical picture, trying to move them forward.
Some are getting better and are nearing discharge. We have had some great successes.
A colleague and I perform a tracheostomy in a patient who has recovered, but is weak and needs slow weaning from the ventilator. But we are delighted that he has got this far.
End of shift.
An hour’s train ride and then cycle home. Two hours later I am home and showered.
Just in time to cuddle my little one and read her favourite bedtime story Spot Says Goodnight. Precious moments.
It is getting harder to switch off from work. Sleep is slow to come and nights are restless as COVID-19 fills my thoughts.
But a bit of mindless TV and debrief with my husband puts those thoughts to rest for now.
Bedtime. Ready for my on-call night shift tomorrow.