Hear our Infectious Diseases consultants talk about Covid-19 at our AGM

Communications TeamNews

The first confirmed cases of Coronavirus in the UK were confirmed at Castle Hill Hospital on 29th January, 2020. Ever since then our staff have been on the frontline in the fight against this terrible illness. Tragically, over 200 patients, including two of our colleagues, have lost their lives.

At our Annual General Meeting (AGM) on Monday 13 July, 12pm-2pm, you can hear our Infectious Diseases team tell their story, via video conference. Describing the first moment Coronavirus arrived in the UK all the way to our current position in the hospitals, this will be a first-hand account of how NHS staff have worked together to keep us safe.

With introductions from our Chairman, Terry Moran, we will pay tribute to our staff and remember everyone who has lost their lives  this year.

The AGM also includes a review of the year from Chief Executive, Chris Long, as well as a look at our financial position with Chief Finance Officer, Lee Bond.

If you wish to join us from 12pm on the 13th July, please let us know by emailing us at hyp-tr.comms@nhs.net and we will send dial in details to you.

Please note that we will be recording this meeting  held in public in order to make it available to staff and if possible, the public, afterwards. If you join via video link your image may be captured as part of the meeting.  If you do not wish your image to be recorded, please do not turn on your camera

Due to bandwith restrictions numbers are limited but we will seek to accommodate as many people as possible.

“If you’re coming to Hull’s Emergency Department, please come alone”

Communications TeamNews

People coming to Hull Royal Infirmary’s Emergency Department must not bring anyone with them as hospital staff attempt to protect the public from Covid-19.

Hull University Teaching Hospitals NHS Trust is appealing to the public to come alone if they need to attend Hull Royal Infirmary’s Emergency Department.

More than 300 people a day have been attending ED recently, many of them bringing friends or family members which has made social distancing in the department extremely difficult.

In a direct appeal to people, Chief Operating Officer Teresa Cope said: “If you are coming to our Emergency Department, please come alone.

“We’ve changed our department so we can isolate people with signs of Covid-19 but that means we have less space for those with less serious illnesses and injuries.

“We understand people want someone with them when they are unwell or hurt but we cannot follow social distancing if too many people come into our department.

“People accept they have to travel alone in ambulances when they are brought to hospital for emergency treatment and we are now extending that to our department.”

The patients-only rule is being introduced as the trust experiences a surge in attendances, with around 330 people attending each day compared to fewer than 200 at the height of the lockdown.

Almost four in ten have minor or less serious illnesses and injuries who could have gone to Urgent Treatment Centres, pharmacies, GP surgeries or the walk-in GP surgery at Wilberforce Health Centre.

Some have been attending with minor skin complaints or verrucas or long-standing complaints like coughs which should be treated by a GP in the first instance. Others have been attending with minor injuries like small cuts or sprains which could be treated by fully trained emergency staff at Urgent Treatment Centres at Bransholme, Beverley, Bridlington or Goole.

Teresa Cope said special provision would be made for children, those with additional needs or those with carers who required additional support while attending the department during Covid-19.

She said: “We accept some people will require support when they come to us for help, from those with learning difficulties, children or those with carers, but we need everyone else to help us by coming alone.

“If you need someone to bring you to hospital, make arrangements to call them when it’s time to collect you. Do not ask them to come into the department with you.

“Although the lockdown might be easing for the public, Hull Royal infirmary remains on the frontline and we must do all we can to keep everyone safe, including our staff.

“We can no longer have people in our department who does not need to be there.”

500 patients well enough to go home after Covid-19

Communications TeamNews

Five hundred patients have been well enough to go home from Hull’s hospitals after contracting Covid-19.

Hull University Teaching Hospitals NHS Trust discharged its 500th patient this week after confirming the first two cases of the virus in Britain in January.

Father of two Glynn Cooney, 44, was one of the 500 well enough to go home to Sproatley with wife Dianne, daughter Ellie-Jean, 15, and son Samuel, 16, after he was rushed to Hull Royal’s Emergency Department on March 30.

Doctors feared he might not pull through as he was transferred to Intensive Care and put in a coma while critical care staff worked round the clock to save his life.

Now, after learning to walk again with the support of staff on Ward 9, the Complex Rehabilitation Unit at Castle Hill Hospital, Glynn has been presented with a bell engraved with “I survived Covid 19” by Ward 9 Sister Lisa Cunningham as he left hospital last week to join the family he hasn’t been able to see for almost three months.

Lisa said: “We are so pleased Glynn can go home to his family again. He’s been through so much and it’s fantastic to see him back on his feet.

“I bought him the bell and had it engraved so he could ring it as he left the ward. He’s been through so much and has done so well.”

Chief Operating Officer Teresa Cope also paid tribute to the trust’s workforce who had contributed to the recovery of hundreds of people.

She said: “Thanks to the hard work, care and compassion of our staff, we have been able to discharge almost 500 patients diagnosed with Covid-19 from our hospitals and we wish those people well as they continue their recovery.

 

 

“We would also like to use this opportunity to appeal to the public to continue the social distancing measures which have enabled our organisation to care for those people who need us most.

“Only by following the guidelines, with every one of us playing our part, will we stand a chance of reducing the spread of the virus and saving further lives.”

Glynn was seriously ill when he was brought to the Emergency Department on March 30. Tests confirmed he had the virus.

He was admitted to the area of Hull Royal designated to care for patients with the virus but had to be moved to the Infectious Diseases Unit at Castle Hill Hospital three days later when his condition deteriorated further.

His condition continued to worsen and he was transferred to the Intensive Care Unit at Castle Hill and was placed in an induced coma.

But he pulled through and,  five weeks later, he was well enough to be moved back to the Infectious Diseases Unit.

However, after so much time in hospital, his muscles were severely weakened so he was moved to Ward 9 to work with the rehabilitation team including nursing staff, physiotherapists and occupational therapists, to rebuild his strength and learn to walk again.

Lisa said: “We’d like to wish Glynn and his family all the best for the future and we wish him well in his continued recovery.

“Covid-19 is a dreadful disease but Glynn shows there can be a happy ending.”

Tragic milestone reached as 200 COVID-19 hospital deaths are recorded

Communications TeamNews

Teresa Cope, Chief Operating Officer for Hull University Teaching Hospitals NHS Trust says:

“We have now reached the terrible point of recording the deaths of 200 patients from Covid-19 in our hospitals.

“This is not just a headline figure to anyone at Hull University Teaching Hospitals NHS Trust (HUTH). Each and every one of those deaths represents a family devastated by the loss of their loved one, people whose lives will never be the same again.

“We extend our heartfelt sympathies to those suffering the consequences of this dreadful disease. To those families, we say you and your loved ones remain in our thoughts.

“At this point, I would also like to pay tribute to our own staff who have worked so hard since we received the UK’s first confirmed cases of Covid-19 in January. We are so grateful to each and every member of our team who continue to work night and day to provide the best possible care for our patients throughout the pandemic.”

Trust response to CQC rating – 24th June 2020

Communications TeamNews

Although the Care Quality Commission (CQC) inspection at our Trust was underway in March 2020, it was never completed as all inspections were suspended due to the Covid-19 pandemic. Therefore our overall rating and those of the five key domains has remained the same as in 2017.

This means that 39 of the 47 areas inspected at Hull Royal Infirmary were rated as Good, and 8 were Requires Improvement, while 27 out of the 29 areas inspected at Castle Hill Hospital were rated as Good and two were Requires Improvement. Furthermore, at Castle Hill Hospital all five key domains were rated as Good.

We were very pleased to note that inspectors found the compassion and care provided in neurosurgery to be outstanding, particularly with regard to minimising distress for patients, families and carers. In addition end of life care at Hull Royal Infirmary and Castle Hill hospital was also identified as outstanding by the inspection team with special reference to the support offered to patients, families and carers by the organ donation specialist nurses.

We have responded to the CQC regarding areas for improvement and we are confident that we have addressed most of the issues that our inspectors highlighted. We have robust plans in place to deliver the remaining improvements identified in the report, and we hope that we can have a full and thorough inspection when the CQC are able to return.

Help for cancer patients throughout COVID and beyond

Communications TeamNews

Over recent months, the COVID19 pandemic has led to difficulty, heartache and worry for millions of people across the UK. But imagine being diagnosed with cancer at the same time, or undergoing cancer treatment knowing you are much more susceptible should you catch this potentially fatal disease.

Thankfully, the staff and patients at the Queen’s Centre, Castle Hill Hospital, have a team of supporters looking out for them before, during and after the pandemic.

DanKitching35 Foundation chairperson, Kimberley Kitching, brings another delivery to Castle Hill

The DanKitching35 Foundation has been providing local cancer patients with activities, days out, equipment and more for almost three years now.

The charity was set up in 2017 in memory of dad-of-three, Danny Kitching, who died from an aggressive form of bowel cancer aged just 35.

In recent months, the charity and its supporters have served as a lifeline for patients spending time on oncology wards during the COVID19 pandemic. Having previously supplied TVs and personal computers for patient use, these items really came into their own as visiting restrictions tightened and keeping in touch with loved ones became increasingly important.

But a good cuppa can also be worth its weight in gold, so the charity has continued to supply wards 30, 31, 32 and 33, plus the outpatients and radiotherapy departments, with tea, coffee and biscuits throughout the pandemic too.

More refreshments for patients and staff at the Queen’s Centre

And not wishing to forget the hospital’s hardworking staff, the foundation has also provided refreshments, treats and essentials for those putting themselves at risk to deliver life-saving care and treatment in the trust’s specialist oncology centre.

Bryan Birch, Danny’s father-in-law and Trustee of the DanKitching35 Foundation says:

“Chemotherapy treatment in particular can be gruelling, leaving people feeling really low, tired and unwell. While Danny was receiving his treatment, we saw just how important it was for him to have things to look forward to between cycles of treatment, and to keep himself occupied when he had to spend time on a ward.

“Since Danny tragically passed away, thanks to the support and generosity of our sponsors and fundraisers, we’ve been able to provide items and experiences great and small to improve the lives of cancer patients and those caring for them.

“We’ve paid for short breaks for cancer patients and their families, events, days out, and personal computers which patients can use on the wards to stay in touch with loved ones.

“We’ve provided hundreds of dressing gowns and personal care packs for patients admitted in an emergency or without provisions, and then we’ve also supplied the more routine or daily comforts such as refreshments, tea and biscuits for staff and patients across the wards, outpatients and radiotherapy departments.

Portable laptops, courtesy of the DanKitching35 Foundation

“Supporting cancer patients, their families and staff is our way of acknowledging the outstanding care shown to Danny and of keeping our memories of this wonderful and deeply caring man alive.”

Angie Barstow, Junior Sister on Ward 32 at the Queen’s Centre says:

“The DanKitching35 Foundation has been a great support to the Queen’s Centre in recent years, and we’ve seen first-hand the positive impact their donations have had and the benefits they’ve brought to our patients and their families.

“The past few months have been particularly difficult for us all; coronavirus has placed a significant additional strain on our hospitals and for cancer patients in particular, who are more vulnerable to the disease, it’s been a time of great concern.

“But the DanKitching35 Foundation has been a shining light for us throughout, and thanks to carefully managed and safe deliveries, coronavirus hasn’t stopped the group from ensuring our hospital patients can still access the comforts and refreshments they’ve come to appreciate.

“On behalf of all the oncology centre staff and patients, we’d like to thank the DanKitching35 Foundation for their ongoing support.”

For more details about the work of the DanKitching35 Foundation, visit www.dankitching35foundation.org.uk  or email dankitching35foundation@gmail.com

 

Top photo: Ward 32 staff (L-R) Caroline Kennedy, Kayleigh Bartle, Angie Barstow, Lucy Rudd and Cathy Sharp with some of the personal care packs given out.

Pharmacy plays a key role in COVID-19 treatment and research

Communications TeamNews

The role of the hospital pharmacist can often be misunderstood, but the recent coronavirus pandemic has really given Hull University Teaching Hospitals’ pharmacy team the chance to shine.

Comprising more than 180 staff working across Hull Royal Infirmary and Castle Hill Hospital, the team has carried out many essential ‘behind-the-scenes’ duties which have allowed doctors and nurses to continue their life-saving work.

As well as ensuring a consistent on-going supply of medications for both COVID and non-COVID patients in recent weeks, the team has also played a key role in research and development to better understand and tackle the disease, whilst also supporting front-line care.

Paul O’Brien, Deputy Chief Pharmacist at the trust explains:

Members of the Pharmacy Procurement Team

“As the coronavirus situation began to escalate, one of the main concerns we had as a trust was obtaining essential medications which would be needed to treat coronavirus, especially in intensive care, such as sedatives and muscle relaxants. Demand for these types of drugs was high, particularly in parts of the UK such as London and Birmingham which were seeing significantly higher numbers of cases than we were in Hull at the start.

“Our pharmacy procurement team worked alongside other NHS trusts, as part of a national network, to ensure supply and demand was managed. In some cases, because of supply issues, the drugs that we would normally use had to be changed for alternatives, so this would mean working with our clinicians to approve the change, developing a new protocol for their use, and arranging refrigeration if the new drugs required temperature control.  We’d then need to follow up with staff, making sure they were aware of the substitutions and felt fully supported in their use. It wasn’t unusual, therefore, for our clinical pharmacy teams to be donning full PPE and spending time on wards and intensive care units alongside staff and COVID positive patients to oversee their medicines management.

“Managing the daily checklist of critical medications was no mean feat. Some of the drugs we needed had to be sourced from Europe and the United States, which meant the names and strengths could all be different to the UK versions. Our procurement team worked with our IM&T colleagues to develop an algorithm which ensured, no matter how the drug came in, we were confident and secure in our supply.

“I’m really proud of the fact that, with their hard work and a lot of careful planning, working together across the country, we haven’t run out of supplies of any of our critical medications at any point during the pandemic.

Paul continues:

“At times like this, when a new virus is emerging, there is always a strong focus on research and development to better understand it and to try and find ways of treating patients or protecting society against the virus itself.

Members of the Pharmacy Trials Team

“In an average month, the pharmacy team would normally get involved in around four new different clinical trials; reviewing and approving the medication, and working with the research and development team to ensure that staff are well supported and the drugs can be delivered safely to our patients.

“Because coronavirus was taking such a strong hold so quickly, there was a huge drive to discover ways of reducing the severity of the virus, lessening the duration of patients’ illness, and finding a vaccine.

“In one month alone, we almost doubled that figure with seven new clinical trials, all centred on COVID-19, starting within the Trust. The most widely known trial we took part in was an international study for Remdesivir, for which we recruited around 20 patients. This trial has now concluded and the collated evidence does indeed suggest that appropriate use of this drug can lessen the time for which a patient is ill with coronavirus, so this was something really worthwhile to have been involved in and something we know will make a difference going forward. We’d really like to thank those patients who took part the trial locally and contributed to our learning.

“The latest trial to begin locally is that for a coronavirus vaccine. Working with colleagues in infectious diseases and research and development, both locally and Oxford-based, the team has screened more than 350 members of NHS staff for the trial which is now underway.

“Working on trials has seen pharmacy staff working late into the evenings to ensure that patients involved in complex trials, who might need their medication at night, could still access this safely.”

Paul says pharmacy staff have also stepped into the breach left by doctors redeployed to the COVID front line:

Members of the Clinical Pharmacy Team

“Thousands of hospital appointments were being cancelled during March, April and May, and as many as 20 per cent of our medics were redeployed from their existing roles to support the COVID effort.

“Pharmacists and our pharmacy technicians, who were fast learning and quick to adapt to working in different ways, were able to step up and help to support patients, such as those being treated for cancer, by ensuring their medications could still be prescribed safely and without interruption.

“The focus for many people and indeed for our hospitals became very much COVID-19, but of course the demand for drugs and for medications advice for other conditions didn’t go away. Emergency surgery was still going ahead, patients on our wards still needed pain relief, and treatments for cardiac issues, stroke and cancer didn’t stop. Patients were still being discharged from hospital, either to continue their recovery at home or for end-of-life care, and in the latter case we worked closely with our colleagues in community pharmacy and GP practices, to ensure people could die with dignity, and as symptom free as possible, in their own homes.

“Pharmacy staff, including those working on our aseptic unit, made sure that what would be considered our day-to-day work of preparing chemotherapy doses, making up nutritional packs for patients who can’t eat, preparing patients’ discharge medication and keeping our wards and departments supplied and supported, still went ahead.

“Pharmacy may not be the first team of health workers that people think of when it comes to coronavirus, but their round-the-clock input, both behind the scenes and on the front line, has been invaluable throughout our hospitals. They’ve helped to treat our COVID patients, helped to innovate, and helped to keep the routine work going at an unprecedented time; I’m really proud of the team and hugely grateful for all their support.”

Continue showing your support for our NHS heroes

Communications TeamNews

COVID has not gone away. Here’s how you can show continued support for the NHS at the same time as protecting yourself and your loved ones

We’ve loved seeing your NHS rainbows and all the doorstep clapping. We are so grateful for all your donations and words of support. We now have an important message we need to share back with you, and it’s to make sure everyone stays safe.

As national lockdown restrictions related to COVID19 have eased, we’ve seen a sharp rise in the number of people seeking treatment in our emergency department again.

At the height of the coronavirus pandemic, Hull Royal Infirmary’s A&E department was seeing fewer than 200 patients each day, but that figure is now at 325 and rising.

Many patients who come to us for treatment could have been seen elsewhere, the pharmacy or a local urgent treatment centre, for example, or even practiced self care at home with rest and paracetamol.

Our A&E department is getting busier, even with COVID-19 still around

Emergency care is exactly what it says it is. It’s care for the unexpected; the critical injuries and life-threatening illnesses. All of us would expect doctors and nurses to be there in a flash if someone we loved was having a stroke or involved in a serious road traffic accident. Use of emergency care for anything other than serious problems potentially takes our highly trained experts away from someone who really needs them, or whose life could even depend on them.

A&E should not be used because it’s the nearest, or because it’s open late. Nor should it be used because you “actually don’t mind waiting”, or because you don’t’ know what the other options are.

Hull Royal Infirmary’s A&E department belongs to all of us. It will be there for us in our darkest hours, and we all have a responsibility to use it only in genuine times of need.

This is even more important right now, as staff continue to deal with the impact of coronavirus on top of delivering their amazing, life-saving care.

Let’s be really clear. Coronavirus has not gone away. Nationally, we continue to see people dying and scores of people contracting COVID19 every day.

Coming to A&E when you don’t need to:

  • puts you at increased risk of exposure to coronavirus, and by default, those you live with
  • puts others who could be more vulnerable to infection at higher risk of catching COVID-19 too
  • makes two metre social distancing in a small department very difficult, and at times, almost impossible
  • results in longer waiting times for everyone, as staff must take additional precautions – masks, aprons, cleaning and extra handwashing – between each and every patient.

How you can help

Public support for the NHS throughout the pandemic has been overwhelming. The love and support shown for staff treating patients with coronavirus and keeping the hospital wheels turning elsewhere has been nothing short of amazing.

Call 111 or visit NHS.uk for advice and to find out where to get treatment

Let’s continue that by showing our A&E staff the same amount of understanding and respect as life slowly begins to return to a ‘new normal’.

We need everyone, including you, to look for services other than A&E if the problem is not a serious injury or critical illness. Call 111 or visit www.nhs.uk  for online advice, to find out where you could be treated closer to home, and don’t assume your GP surgery is closed. All parts of the NHS are still working to protect patients from COVID-19, but they are still working.

Let’s harness all of the goodwill that you have shown for NHS staff and offer our thanks in a different way. Think carefully, look for alternatives, and if you’re ever unsure, call 111. If it’s a real emergency, they’ll be sure to tell you, and we’ll be here for you.

Sources of help and information:

Find out more about the different NHS services and what they do at NHS.uk

Find sources of medical help near to you:

Find out what to do if you think you have COVID-19 symptoms

Get advice or read more about different health problems at www.nhs.uk

COVID-19: “We now need a different type of public support”

Communications TeamNews

Hospital staff in Hull say they still desperately need the huge level of public support shown for the NHS in recent weeks, but this time in a different way.

As national lockdown restrictions ease and the country looks to resume some kind of normality, staff at Hull University Teaching Hospitals NHS Trust are also working to resume more routine activity such as hospital appointments and planned surgery.

One area which seems to be returning to normal faster than most, however, is emergency care.

At the height of the coronavirus pandemic, Hull Royal Infirmary’s A&E department – which provides care for the most seriously injured and critically ill patients – was seeing fewer than 200 patients each day. Just a month or two earlier, A&E attendances had regularly been exceeding 400.

Now, as the nation seems to be breathing a virtual sigh of relief as far as COVID is concerned, hospital bosses are already seeing huge rises in the numbers of patients returning to A&E and are worried this could put both patients and staff at greater risk again.

Teresa Cope (pictured) is the trust’s Chief Operating Officer and has led the hospitals’ response throughout the COVID-19 pandemic. She says:

Teresa Cope, Chief Operating Officer

“The number of patients being treated in A&E during the course of the pandemic more than halved, and most of those we did treat were patients who were in urgent or critical need.

“To do this in a way which was safe for both staff and patients, we had to split our A&E department into a ‘hot’ area, to care for COVID positive or symptomatic patients, and a ‘cold’ area for those who had no symptoms or were known not to have the virus. Operating what was essentially two smaller departments in one placed quite a strain on the team but they were able to manage this safely and in line with all the necessary guidance because of the lower number of attendances.

“As public restrictions have begun to ease, what we have seen over the last two to three weeks is quite a significant rise in the number of people walking in to the emergency department again. In the last few days, we’ve seen around 330 people per day, and a much larger proportion of those are now coming in with minor illnesses, such as verrucas or minor skin complaints, for which advice or treatment could have been sought elsewhere.

“To be clear, COVID is still here; we continue to protect our patients and our staff, we continue to care for patients with this potentially deadly virus, and we are planning for it to be around for many months yet.

“A&E is often seen as the ‘open door’ to the hospital, but patients who come to A&E when they don’t need to are placing themselves, other patients who can be much more seriously ill, and our hard-working staff who have battled so hard to try and beat this virus in recent months at much greater risk.

“Some of the lockdown restrictions may have eased, but trying to enforce two metre social distancing round-the-clock in a department which has hundreds of people through the doors every single day is almost impossible. Caring for each individual patient also takes that little bit longer as staff need to wash hands and change PPE much more often, make sure their patients are suitably screened and protected, and ensure areas are safe to provide care in.

“We now desperately need the public to show the same level of understanding and support for us as we’ve seen during the height of the COVID-19 pandemic.

“We will be bringing our hot and cold areas safely back into one this week, but we need people to understand that things can’t just return to normal.

“Before we see a return to pre-COVID levels of activity in the department, which even at that time were difficult to manage, we’re asking for the public to really help their NHS once again. This time, we need people to look for services other than A&E if their problem is anything other than a serious injury or critical illness.”

Dr Ben Rayner, consultant in emergency medicine

Dr Ben Rayner, emergency care consultant who will be a familiar face to many after appearing in Monday’s Channel 5 documentary, A&E After Dark, says:

“A&E After Dark provides just a snapshot of the cases we deal with, but in doing so shows just how labour intensive some of our work can be and just how seriously ill some of our patients are.

“With the easing of lockdown on 1st June, the emergency department has experienced an increase in patient attendances, and this increase has been most noticeable over the last four days.

“The number of patients attending, along with the measures the trust has put in place to maintain the safety of both staff and patients have led to longer waits to see a practitioner and, at times, a more crowded department, and we are sorry for this.

“The support which has been shown to the NHS over the last couple of months, however, has been fantastic, and I would ask that this support continues with people not attending the emergency department unless it’s truly needed.

“For the emergency department to function as intended, to see patients arriving with acute severe illness or injuries, and to meet the challenges COVID-19 has presented, more than ever we need patients to use alternative services such as pharmacists, urgent treatment centres, GP surgeries, and NHS 111.”

Statement from Chief Executive Chris Long regarding the death of a member of staff

Communications TeamNews

“On behalf of his family, it is with a heavy heart that I announce that our staff member Richzeal Albufera died on June 9 at Hull Royal Infirmary.

“Richzeal was a Biomedical Scientist at Castle Hill Hospital. He joined Hull University Teaching Hospitals NHS Trust in April 2005.

“Tests confirmed the presence of COVID-19 and, despite the best efforts of our Critical Care team, we were unable to save Richzeal and he died of severe complications associated with this terrible disease.

“We extend our deepest sympathies to Richzeal’s family, friends and all who loved him. We share their grief at the loss of such a wonderful life. Richzeal had already given so much to the NHS and had so much more to give.

“Staff who worked with Richzeal will lead our entire organisation in a minute’s silence on Monday and we are opening a Book of Condolence for those who worked with Richzeal throughout his career to share their thoughts and memories.

“It is not possible to say where he contracted the disease, given the nature of the virus, and speculation would only intensify the grief of his family.

“We ask the media to respect the privacy of Richzeal’s family and our staff who both worked with him and cared for him as we come to terms with the enormity of our loss.”