I wrote this in May 2020. A bit of cleaning since then, but I wrote it coming out of the first wave of covid in the UK. By the first of June 2020, the UK had seen 34,000 deaths (note: this is within 28 days of a positive test. Tests were not easy to get early on, and there are certainly people who died after that period as well). As things settled down somewhat, I sat down and thought about my experience, my anger, and decided to write something, anything. The order might not make the most sense, despite my cleaning it up, simply because my brain has processed things in the order I’ve written them.
Hi, I’m Henry, I’ll be the nurse looking after you today. The words I would start each shift with usually. For a couple of months of 2020 they fell on deaf ears.
I was a charge nurse in a cardiothoracic HDU; my job was basically taking patients out of the ICU/theatres and then to a ward when able to; a middle ground, single organ support, various types of respiratory support that don’t require us to stick a tube down your throat. Not as many machines as a full ICU, more than a ward. Think of it like that. I’d been doing it for around 4 years when the pandemic hit.
At the beginning, the worst part was the waiting. COVID was all we could talk about for a while. Discussing happenings in the news, talking about predictions. March was so incredibly long. My hospital is a specialist hospital; no A&E so we were winding down surgical admissions before the surge hit us, thankfully; we were slightly behind where other hospitals were in terms of admissions. We kept them in an ICU on a different floor to my unit initially. I shaved my beard, to get a proper mask seal leaving only the important COVIDstache (over a year later my face still didn’t feel right). I of course immediately catch COVID before I even get a mask. Felt fine when I left for work; late morning I’m holding in an annoying cough and feeling like reheated ass; temperature 38.1. No swabs of course, just sent home for a week. The NHS knew people who tested for COVID then, and considered them all cowards apparently. I move into the spare room, and do my best to not give it to my high risk partner. I felt ok for the first day or two, and then would feel short of breath just eating for another few days. I lost all sense of taste as well, which was annoying. Just as I start feeling a little better, my seven days are up, and its time to get back to the floor.
My first or second day back we closed my HDU down, merging with one of our ICUs because we had stopped doing 95% of our elective surgery. We knew what was coming. We change how staff allocation works early on; you go to a central location and go to wherever you’re allocated. So you never know what you’ll be doing each day. You have no idea if the patient you see in the morning is the one you’ve seen the day before. Might it be COVID, might it be surgical? Who knows! I for one love uncertainty at stressful times in my life, who doesn’t? The anticipation starts to turn to fear as the cliff face gets larger.
The first time I went in and got sent upstairs I had no idea what I was doing. My sign in went with the message of “They’re ventilated, is that OK?”. I asked what would happen if it wasn’t, and was met with silence. That was the end of that conversation. I’ve never touched a ventilator before. It’s terrifying. I have no idea what I’m doing with almost anything. Colleagues help when they can, but they are also swamped. The patients are incredibly unwell, all of them; luckily my patient is the exception, and we extubate him, and let him breathe without any tubes for the first time in over a week. It’s the only real win I see for the next two months. During the day I run into people who work on my unit; I was having to show them how to do things I’d learnt just that morning. It’s terrifying; how did we get to this? And so quickly? Why weren’t the staff prepared properly? Heroes aren’t this scared all the time.
My hospital remains a centre for emergency cardiac surgery, one of the two still operating in London. People out there being selfish and having major heart attacks requiring a very urgent bypass, or their aortas deciding to dissect requiring immediate repair. I spend the next two months alternating between the two types of ICU we have. I go in each day with no idea what I’m going to possibly be seeing. Do I have someone on death’s door? Do I see a couple of routine post cardiac surgical patients? COVID or non COVID? Are they improving, or do they remain the hottest of messes? I spend my time off reading how to run/properly care for a ventilated patient properly. I’m still fucking terrified.
My life revolves around work. There is nothing but COVID. My partner moved out once the isolation for my symptoms was over on medical advice; she is in a high risk group, and I work in COVID central. I write this over three months since she first moved back in with her parents, and I miss her often. Are heroes this lonely?
I get to watch the government response be entirely inept at every step. I got to watch poundland Donald Trump get hospitalised with the disease, less than a month after he was bragging about still shaking everyone’s hand. I watch people slowly stop giving a fuck about the disease as the numbers slowly get better; the government felt themselves above the rules, why should they not? Barnard Castle, anecdotally, was a real turning point in how many people you’d see out and about in public. For me, it was noticeable. Oh, and why was there a fucking ice cream truck out at a nearby park just a few weeks after the peak? And how can people not understand that you can’t queue on top of eachother at the moment? I’m angry now. Are heroes this fucking angry?
A few weeks in I’m almost used to the routine of it all now. I’m pretty comfortable with the vents now, which comes in handy during those times when I, someone with no ICU experience before this, ends up being the more senior person around during breaks/emergencies elsewhere on whatever unit I’m on that day. Sometimes that involves just reassuring colleagues with no critical care experience. Things are fine, don’t worry! Sometimes it’s a whole lot more complicated than that; there’s no oversight, no one around to ask. A real crash cause. I’m still scared all the time. Not for my own health, I don’t care about that; but that I’ll do something wrong, and cause someone else harm. That I’ll miss something that someone I’m helping does. The stress headaches continue even when I’m not at work. I keep learning the same things over and over to make sure I understand properly when I’m not at work. It became a ritual. Almost a way to focus the mind. It helped with the panic attacks. Heroes don’t need to learn these things.
The cases I see stick with me throughout. I’ll get back from a break a few minutes early to go check up on other patients I’d looked after. Some of them survive, some don’t. Either way, its emotionally tough. Survival isn’t always a win. I’m glad that generally I did not have to deal with family members much – my trust had set up a central hub for enquiries, and staffed it with nurses from various areas. I don’t know how they did it, day in, day out. Eventually we allowed one family member to visit when we thought a patient would die. That was a bad time. Sometimes they couldn’t come, be it due to distance, their own illness, or whatever valid reason they had. More than once an entire family had been effectively wiped out by covid. So we would sit there with the patient as we let nature take its course, if we could manage it. Sometimes we couldn’t. Death in critical care is rarely a pleasant affair, and in these circumstances, that fact becomes even more amplified.
We do see the good as well. The patients who, after 20 days intubated, ventilated, sedated, on maximum support get extubated and within a few hours and a bit of help get themselves sitting on the edge of their hospital beds, and taking a few steps just a day or two later. The patients who had no right to survive based on their medical history eventually pulling through. There is balance to the bad in these people; I hope they know that their successes and hard rehab work helped us almost as much as it helped them. Are we really the heroes?
The numbers slowly decrease. Our surgeons have been antsy for the entire period because they’re barely operating. It’s like telling a driver you’re going to take their cars away; apart from exceptional circumstances of course. We start doing a few more surgeries, working through a bit of the backlog. Slowly things return towards what I guess will be our new normal; a slightly reduced caseload, combined with full PPE still despite being ostensibly a “green” hospital. We’ve all learnt a lot about different colour designations for the hospital lately.
I get to see people flock to beaches, and the government tell everyone that we’re going to slowly exit lockdown, faster than their scientific advisors suggest as it transpires. Everyones forgotten about the Dominic Cummings insanity by now. The news of potentially corrupt PPE contracts. Rumours of 1% pay “rises” at the next negotiation are starting. Are “heroes” this forgotten about?
I was lucky, we always just about had enough PPE, although I can’t speak to the quality. My (least) favourite was the CSI crime scene style white bodysuits. I sweat so much I had to change scrubs three times that day. Who needs kidneys to get rid of fluid? I evolved past that and just let it all out through my skin apparently. After a lot of hours with the masks on, the headaches start. We all felt a little mentally slower after 4-6 hours at a stretch wearing them. The constant pressure on your face combined with the dehydration. Oh, the dehydration is part intentional, because peeing is just not something that can be done in full PPE. The covidstache became a snot catcher. I never heard Ned Flanders use that as a name for his? I was looking forward to referring to the cookie duster, but no, I get fucking snot catcher? Wearing gloves for 12 hour stretches makes your hands very sweaty, the skin just falls off when I wash my hands when I leave the infected areas.
The teamwork was generally outstanding. The medical staffing seems to have been more responsive than the nursing one, to the point where early on we have doctors doing nursing care alongside us, and helping covering breaks as well as the medical tasks. Everyone just did what was needed, when it was needed. We reduced the amount of paperwork significantly, both to help the staff sent from the wards and other areas, but because we didn’t have time to write our normal essays. Everything got rationalised – do we actually need to do X? Will there be a significant enough benefit to stop us from doing something else? And is this accessible enough to show to the people who’ve come in from non critical care areas?
The media tried to portray us as heroes. Comparisons to soldiers marching to war are trotted out for weeks at the beginning of the pandemic. Why this comparison? Some soldiers die, and so will some of us. I have colleagues who were hospitalised and off for a significant amount of time. Thankfully no one at my hospital I am aware of passed. The trust as a whole was not so lucky, unfortunately. People go outside every Thursday evening, clap, bang on pots and pans for a few minutes (during our shift handover no less – just to make sure as many of us as possible at working) and then go back to normal. They focus on those of us in the hospitals, largely forgetting about those dealing with outbreaks in care homes; the most vulnerable of patients, none of whom would ever even be taken into an ICU. They forget about the people working in supermarkets to make sure we have food. The millions of other low paid jobs that are just as essential, but forgotten about.
Maybe this does make me a hero. The narrative out of the government that we were at war with covid. It has died down somewhat for now, and we are forgotten about. I’m sure some colleagues of mine will have some elements of PTSD after this. I know some really struggled during it. I feel lucky on that front so far; my usually atrocious mental health just about held throughout the entire nightmare so far. Only a few several panic attacks!
The NHS pay deal is due to be renewed at the end of this financial year. That’ll be a fun one. Matt Hancock was out there during the pandemic trying to worm his way out of even thinking about a pay rise for us. I guess this is exactly how we treat ex-military as well. We call them heroes too. Maybe hero doesn’t mean what we think it means anymore. Or maybe it always meant this, and no one cared.