It’s hard to know how many patients we’ve lost. On a regular ward, if there’s a death, you know about it. In our intensive care unit, we’re supposed to have around 30 beds, but coronavirus has forced us to increase our capacity to more than 80, so I have no idea what’s going on around me. I can also hear cardiac arrest bells from another unit, but I don’t know what proportion of the patients live or die.
Extra beds are squeezed into existing units, and when they reach capacity we have turned theatres, daycare units and post-operation recovery centres into areas to treat Covid patients. I’m amazed at how safe we’ve managed to make things, but that’s despite the situation, rather than because of it.
Sometimes we come in to find a bed empty, and I don’t know if it’s because we’ve succeeded or we’ve failed. I cared for a man during the first wave for more than 50 days, and I still wonder if he made it home. We had patients whose grandchildren were born while they received ventilation, and I wonder if they ever got to see them.
Working in an intensive therapy unit (ITU) isn’t my day job. I am one of the many NHS staff from other departments drafted as extra support. Specialist nurses, general ward nurses, therapists and teams from paediatric and eye hospitals have been recruited to support ITU nurses. Many in the team are juggling regular jobs Monday to Friday, and then volunteering on Covid wards on the weekend. This is my second stint in intensive care, but still there is a lot to learn. I’m walking a fine line between helping my colleagues and burdening them with too many questions.
Each ITU patient should have one nurse by their side, giving them one-to-one care; but at present one nurse is caring for three or four patients. The lack of staff means that providing adequate care can be challenging. When you’re an ITU nurse, your job is to get patients on a ventilator and support their organs, but the real skills are reserved for gradually weaning them off ventilator support or sedation . If a patient starts to deteriorate on non-invasive ventilation, they’ll need to be sedated and have a breathing tube inserted. When you’re weaning them off the sedation, there’s a risk they will pull out their breathing tube because it’s uncomfortable and blocking their airways. It’s hard to keep one pair of eyes on so many people. Because we’re so stretched, we cannot spend enough time supporting a person who is awake, or with a grieving family.
Watching a small number of family members, with PPE strapped over their everyday clothing, walking into ITU to see a loved one is tough. You know these relatives are experiencing traumatic loss, in a converted operating theatre or hastily repurposed room while chaos ensues around them. My heart bleeds for them. Paediatric doctors have been drafted in as family liaisons, and medical students often carry out the task of FaceTiming families so each member can speak to the patient or see them on video.
For many patients with Covid, it’s not a brief stay in ITU. After they have spent 10 or 14 days being intubated on a ventilator, we usually perform a tracheostomy and insert a breathing tube into the hole in the patient’s neck.It takes a considerable amount of time to rehabilitate someone after that. It’s not uncommon to have someone in intensive care for more than a month.
Many of us NHS staff are experiencing a disconnect from our friends and family because our experience throughout the pandemic has been very different. I don’t always know how much to tell them about what I’m seeing, because in a way we’re trying to protect them from it. You often hear about medics coming in the front door, stripping off their clothes and showering. I think that’s a symbolic act as much as anything: to create distance from work and a separate space at home. It is frustrating to see how many people think coronavirus is a hoax, but most of us are smart enough not to engage with these posts. There’s no time to waste winning over minds when you’re trying to keep brains, hearts and lungs oxygenated.
I’m an EU migrant, like a vast number of people working in intensive care. Many of us were working on New Year’s Eve when the law changed, and we went from being residents of this country to being guests with settled status. When all this is over, I hope there is an acknowledgement that we didn’t leave this country; we didn’t leave our posts, even when it felt like Britain abandoned us. The Brexit vote was about taking back control of our borders, but it turns out they were worried about the wrong kind of foreign invader – it was the virus that was the problem. I hope people will remember that when it came to it, it was those people who chose to make this country home who kept the lights on.