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Working in intensive care: ‘You can make a real difference here’

Many alumni are frontline health workers and are working day and night to treat thousands of corona patients. Intensivist Michael Frank (53) is one of them. As head of intensive care at the Albert Schweitzer Hospital in Dordrecht, he is steering his department through the corona crisis.

How are things at your Intensive Care Unit (ICU)?

‘These are extreme times. What makes Covid-19 so deceptive is its unpredictable progression and how patients can deteriorate rapidly. Until last weekend we had had one death, but on Saturday two patients died here in the space of a few hours. One of them was corona-free even, but the virus had caused too much damage to their lungs. The family was able to say goodbye. That was very intense and sad of course, but as a doctor I have to be professional and keep an emotional distance. Otherwise I can’t do my work properly. As well as this job, I’m chair of Rijnmond Intensive Care Region, a partnership between ten intensive care units in the area. We now mainly discuss the corona crisis and what is needed. I’m in the midst of things from two different sides.’

Michael Frank (right) with two junior doctors. Photo: Jamaica Vink

How do you keep going?

‘I’ve been doing this work for 20 years, so I’m used to quite a lot. But I’ve never experienced the intensity and number of patients of this crisis. We’re caring for the patients who are incredibly ill and at the same time we have to think about our own safety. You get to know yourself even better. Luckily I’m good at switching off. I can have a really busy day with difficult discussions, tricky decisions and intensive treatments, but when I leave the hospital, I leave it all behind me as soon as I get in my car and put on some music. It also helps to have some distraction at home in the form of everyday things like doing the shopping. And I sleep well.’

‘I don’t even dare look two weeks into the future’ 

Has your ICU been able to cope with the pressure in the past few weeks?

‘These have been stressful weeks, but things are more manageable now. We usually have an average-sized ICU: sixteen beds and a very varied group of patients. At the beginning of March we quickly had to scale up to 32 beds. You can’t do that at the drop of a hat. The cardiology and operating theatre beds are now intensive care beds, and the doctors and nurses from those departments were trained quickly and now work under the supervision of the regular ICU staff. For weeks, the number of patient increased rapidly and it filled up, but in the past week the growth has stabilised. The intelligent lockdown seems to be having an effect. But I don’t even dare look two weeks into the future. It’s real guesswork.’

What is your role as head of intensive care?

‘As it’s so busy, I now have several roles. First, I’m a doctor on the unit and put patients on the ventilators, for example. Then I also have a crisis meeting every day with the main players in the hospital to look at how things are going, whether we need to scale up, whether patients can be moved from the ICU to a normal ward… Those kinds of things. My working hours are longer now – up to about 60 hours, with night and weekend shifts too. Besides the ICU we have three wards with patients who are very ill and may need to come to us if they deteriorate. We assess whether that is necessary and worthwhile. It isn’t for, say, a 95-year-old who can no longer function independently and will probably not survive the ICU. Because 20 days on a ventilator has a huge impact on your body.’

Two colleagues with a patient. Photo: Jamaica Vink

Why, at the age of 18, did you choose to study medicine?

‘Both my parents studied medicine in Leiden and they were always very enthusiastic about their studies and student life. That was a positive example. My father was a cardiologist ,and as a child I sometimes went to the hospital with him, if he had to do rounds. All those lights and monitors made an impression on me. I found it a really interesting environment and always listened to my parents’ stories about work.’

Why did you later choose intensive care medicine?

‘During my studies, I worked at a thoracic critical care unit (for patients who have undergone open heart surgery, ed.) at the LUMC. It was then called a Joshua job, after the first student to do that work in the 1950s. A professor had just opened a new heart unit and asked students to work there because there weren’t any specialised nurses in that field. I was a nursing aide and checked patients’ wounds, for instance, and monitored their blood pressure. It was practical work, but you had to think about what you were doing. Student doctors like me were also involved in the specialists’ scientific research. It was a unique experience at the unit, which is why I wanted to carry on working in intensive care. You practise acute medicine and can make a difference. I like solving complex problems and making quick decisions.’

With the knowledge that you have now, do you have any recommendations for the Medicine programme?

‘I think it’s a shame that student doctors no longer work in intensive care because hospitals would rather students didn’t do that work. That work was a real training for my fellow students and me because we got to know the profession at an early stage. It is also important that degree programmes pay enough attention to the psychological side of the job. What I see now is that young doctors are more likely to suffer from stress because a work-life balance is more important to them – understandable obviously. I see some of them having difficulty making choices. Because their boyfriend or girlfriend wants to go on a round-the-world trip or to lots of festivals, for instance. We didn’t such desires. Intensive care medicine is a kind of life choice. But I don’t want to sound like a fuddy-duddy, when I actually really like training young people and passing on knowledge and skills. And the opposite is true: young doctors keep me on my toes.’

How does your family find it now you’re so busy?

‘My family doesn’t know any better than that I’m working intensively at the hospital, so that isn’t any different now in this time of crisis. I’ve got three children, two of whom still live at home: a 16-year-old daughter and a 14-year-old son. It’s a bit strange of course, now that we’re suddenly together much more at home, but it’s lots of fun too.’ 

Text: Linda van Putten
Photos: Jamaica Vink
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‘Alongside my studies, I was in a very active group at Minerva student association, and they’e still my best mates. I also had a great student house, Haarlemmerstraat 35A. It was a real medical house, with students who already worked at the hospital. My former housemates and I are still in touch and they work at hospitals throughout the Netherlands. I also met my wife in Leiden; she’s a lawyer. My student days in Leiden definitely determined the course of my life. For my career, thanks to my studies and the work at the LUMC, but socially too.’

CV Michael Frank (53)

  • 2018-present  Chair of Rijnmond Intensive Care Region
  • 2013-present  Medical manager of intensive care, Albert Schweitzer Hospital 
  • 2009-present Intensivist, Albert Schweitzer Hospital        
  • 2004-2009     Intensivist and medical manager, Haga Hospital
  • 2003-2004     Intensive care fellow, LUMC Leiden
  • 1997-2003     Specialty registrar in anaesthesiology, LUMC Leiden
  • 1996-1997     Specialty registrar in surgery, Groene Hart Hospital Gouda
  • 1990-1994     Student doctor, Thoracic Critical Care Unit LUMC
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