Oxfordshire ICU nurse shares a coronavirus day

I AM an intensive care nurse and mum of three, children aged four, six and eight years.

I work in a large city teaching hospital and over the past 13 years I have experienced many different situations but nursing during the Covid-19 pandemic is like nothing else I’ve encountered.

My day starts with my alarm going off at 5.30am, I move around the house very quietly as I really don’t want anyone else up at this hour, but I’m usually joined by my eldest daughter for a cuddle and chat before a kiss goodbye at 6.30am.

My drive takes 40 mins and although some people baulk at the idea of having to travel this long either side of a 12.5hr shift, I really value this time. It’s my time to listen to whatever I choose, to think without interruptions, ready myself for the day ahead or reflect on the day’s events and prepare for when I walk back through the door and am a mum and wife again.

When I arrive at work I check to see where I will be working today.

There are three Intensive Care Units (ICU’s) here and two are currently being used as Covid-19 positive ICU’s whilst my usual unit is the ‘clean’ one.

I’m off to one of the other Covid-19 ICU’s and to be honest my heart sinks. I don’t know the area, the staff or the patients and I’m not used to wearing the full face mask (think old fashioned gas mask) for hours at a time alongside the strict PPE layers. But this is what life as a nurse is like at the moment, so chin up and off I go.

At busier inner city hospitals I’ve heard the nurses have to do the whole 12.5hr day in the PPE with minimal breaks so I’m so thankful for the structured plan here.

Over the past few weeks we have all learnt and been practising the new skills of ‘donning’ and ‘doffing’ all the PPE so as to keep as clean as possible throughout and prevent as much spray of the virus from it as possible.

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Whilst we are getting ‘donned’ in the hub outside the unit there are non-stop calls and messages from inside the unit asking for stock and drugs they need to be taken in, sorting staff for the next few shifts, calling relatives and doctors and nurses discussing plans of action, more patients to be admitted...the list goes on.

I’m nervous as we walk through what feels like a maze of corridors to get to the ‘air-lock’ in which we all huddle and wait for one set of doors to close behind us before we can open the others in front and in we go. It’s like looking through a slightly misty glass, and it feels unworldly, like walking into an alien spacecraft.

I’m what’s known as a floater on this shift so anywhere I’m needed I go.

The nurses have three ventilated patients each which is unheard of until now. It’s usually strictly one nurse to one patient if they are on a ventilator.

In fact, on rare occasions it can be two nurses to one patient if they are very unstable and needing multiple things done simultaneously, because we aren’t actually superheroes (don’t tell anyone!) we only have one pair of hands.

A ventilated patient requires the full attention at all times of a trained ICU nurse. They will be on multiple intravenous infusions (the most I have ever looked after is 13 infusions running at once) to keep them sedated, pain free, sometimes paralysed, support blood pressure, top-up electrolytes, insulin and antibiotics.

There are so many different alarms to keep check on, feeds to keep running, the observations of their heart rate, blood pressure, oxygenation, carbon dioxide, respiratory rate amongst other. And then there is the ventilator, the life support, which has been talked about a lot since the pandemic started with it being said that if we could just get more ventilators then we can treat more patients at once. Well, it can take weeks to train to use one effectively and safely, be able to make adjustments, know when the patient needs more or less support and importantly when you’ve reached the end of your competence and need a doctor to advise you.

Today, as a floater I help with turning and cleaning patients, checking medications, emptying bins, stocking up with gloves and aprons, doing dressings, and supporting nurses during those tense, busy moments.

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I’m also trying to reassure delirious patients that they are safe and getting better but I’m well aware they are waking up and looking at people they don’t know, wearing scary masks, in a place they don’t know, days or weeks later than they remember.

What we don’t share much is that as an ICU nurse and having a one-to-one staff to patient ratio it allows you to offer really special, personal and individualised care to your patient.

On a usual shift (pre-Covid) you would have the chance to wash your patient every day, carry out mouth care every few hours, brush teeth twice a day, rub in moisturiser to their flaccid or tight limbs, chat to family at the bedside, brush the hair out of their face or even wash it for them, wipe the tears away, just sit and hold their hands whilst gently chatting to them.

But not now. This virus has stolen all this away.

We are reduced to doing tasks - giving medication, suctioning, turning, cleaning ...it’s relentless. But there are the times that make this all worthwhile. When someone’s breathing tube can be removed and they breath for themselves again.

When they look at you and you can see some small flicker of recognition. When you can tell a relative that yes they are breathing for themselves or opening their eyes and have eventually turned the corner.

The sight of the night staff arriving is such a welcome relief. We are supposed to finish shift at 8pm but we won’t walk out of the Covid positive ICU area until then and the doffing, a shower and debrief will follow. We’ve been supplied with a variety of toiletries from generous individuals and charities so we borrow towels from the hospital supply and all queue for the three showers.

To see your colleagues out of uniform is always a strange moment when you actually ‘see’ them as an individual, with a sense of style and unique personalities that can be lost amidst the swathes of PPE.

As I take in my first breath of cool fresh air outside I’m surprised that tears start to come. I feel emotionally and physically drained, exhausted. I get to the car at 8.45pm. I try to call someone to chat to about it all, I want to talk, but no answer so I set off home.

When I arrive I creep indoors, not knowing who may be on the verge of falling asleep, happily in dreamland or waiting up for me. But before I see anyone and have to sadly side-step a cuddle for fear of passing any of the stray virus on, I need another shower and clean clothes.

I find my eldest daughter and husband sat on the bed colouring ‘Thank You NHS’ pictures and I lie down next to them.

Part of me wants to tell them all about the day as they eagerly ask, but a bigger part can’t talk about it right now. I need a cup of tea and to sleep.