I am an Irish nurse working at one of the major hospitals in an intensive care unit in London.
We all know Europe has been named as the global epicentre of the Covid-19 disease, and that means that my hospital and my job are, to say the least, at the very centre of the whole mess.
I am from the eastern part of Ireland. Let’s call me Emma. Without authorisation, I am not allowed to talk to the press.
For me, it was St Patrick’s Day when it all changed. That’s when we got our first very sick patient.
I had been working in critical care for a while.
Some of my colleagues were taken off other wards to train and work in the ICU for the first time in March. We did additional training in putting on and taking off the PPE [personal protective equipment]. There was also training for proning — putting patients on their stomachs.
Surgery has all but stopped, and this big hospital has pretty much been given over to Covid. But nothing could prepare you for what happened over the last eight weeks here. Nothing could prepare you for this at all.
We have been trained for ICU work, but not for this intensity. You are used to very sick people, but not this many.
Because London is an epicentre of the disease, we are seeing waves of people coming through my ICU. And I suspect some people in my ward will not make it. If people are not getting better after eight weeks you run out of things to do to save their life.
The first few days back in March were very surreal, like a film. Looking back now, I was thinking of it in the short term: ‘How are we going to cope?’ Now, my colleagues and I are wondering: ‘When will all this be over?’
After two consecutive nights, eight to eight, over the last two shifts, I have to admit, I’m a bit tired, but overall OK.
Travelling to work in London was scary. Early on, I gave up travelling on the crowded tube and took the bus.
In the hospital, we stopped allowing visitors in mid-March, so arriving is surprisingly straightforward. They have security at the doors who look for ID.
I get my scrubs on the ground floor in a changing room. That bit of the morning or night shift hasn’t changed much.
I go up the stairs to a unit where I get my allocation for the shift. There is the usual security to get into the ICU and, reassuringly, that has not changed. Then, in through the doors to a docking unit, which has changed a lot.
Each ward now has a station where you go in one door and exit by another door so you don’t contaminate yourself or your colleagues.
The docking unit is where you get the PPE. The gear is so incredibly heavy and cumbersome to wear over the regular scrubs for 12 hours. My colleagues help each other to put it on.
You may have seen it on TV, but that gives no idea of the weight of the thing. It is mostly made of plastics and you sweat quite a lot with it on.
You have to don and doff the gear in the right order to avoid contaminating yourself. In the normal course of things, I get quite a few headaches and the visor has to be very tight on the head, which isn’t ideal.
With the mask and the visor, it makes it quite difficult to communicate with colleagues. And you are wearing gloves.
The mask is called FFP3 and, over that, you have a visor. It takes about 10 minutes to get on all the gear. Part of the PPE is like a waterproof gown or sometimes you have a suit above the scrubs.
And there is a cap for the hair. All this has to be discarded and a new set of PPE put on each time you have to leave and return to the unit, every few hours or so. Everything has become a lot more difficult.
And then through another set of doors into the ward. You have side rooms of cubicles for some seriously sick patients but usually, you have a bay of four patients in the single room.
There were around 50 patients in the ICU at the peak of the storm only a few weeks ago.
There is a handover with a colleague to bring you up to speed with what happened over the last 12 hours.
I then do all the checks: See that all the monitors are working; that the alarms are set properly; and check whether all the emergency drugs by the bedside are all there.
I then assess the patient from head to toe, checking whether the tube is in the right position on their mouth. There is a numbering system to help with that. I check pulses and then pull back the covers to check the patient.
You squeeze the hand of the patient. My first name is on the PPE, but they may not be aware of you at all.
You have to understand that most of the patients would be sedated and, with a tube in their mouth there is little to no conversation and, by definition, they are seriously ill. They would barely recognise anyone.
I have rarely seen a patient in the last two months who is fully awake.
I don’t like using the term, but some patients would be in a medically-induced coma, and we give them paralysing agents sometimes if their lungs do not work in time with the ventilator.
When you have been heavily sedated for two weeks you rarely wake up immediately. It’s a long process weaning [a patient] off the ventilation.
After so long in an ICU, a patient’s muscles become so weak that they need rehab and they are removed to another unit. I will never see them again.
With the best intentions, at the start of the shift, you go in with a plan. Then something happens. An alarm may go off: A patient deteriorates; the blood pressure or heartbeat and heart rhythm or oxygenation levels go up or down. And you try to fix it.
There is a line to an artery which tells you the blood pressure in real-time.
Because the patients are all on ventilators, you measure their carbon dioxide levels as they breathe out through the ventilator.
You might adjust the medication. Some may need immediate attention or it could be just that the electrolyte is not quite in the right range and you may give them potassium, magnesium or phosphate.
What may surprise people is that there is a one-to-one patient ratio because the patient is at so much risk of losing their life. You sit down at a sort of workstation beside the patient, which gives you some idea of the intensity of the work over the next 12 hours.
You have the monitors and the machines and a countertop and a press for all the medication you need.
We have a phone in each bay to contact a doctor who is in the room, or a radiographer, or a technician if they are needed to fix one of the machines.
Last night went pretty well.
You take the breaks in the canteen. On a day shift, you get the first break —20 minutes — around 10 o’clock, two hours into the shift.
For each break, you take off the PPE. You can’t eat or drink when you are wearing PPE. It is not always possible to get all your breaks. In a side room where the most seriously ill are, it’s sometimes not possible to get someone to cover for you.
At each break, the PPE is taken off and the visor and mask and gowns and cap are all discarded. About three or four sets of full PPE have to be discarded in each shift for each nurse, and that sort-of gives you an idea of the amount of PPE that is required.
I have dealt with about 25 different people in the last eight weeks.
A lot of the patients have black, asian, and minority ethnic (BAME) backgrounds.
It struck me at an early stage, London is diverse but, even allowing for that and comparing it with a normal ICU, the disease has disproportionately affected people from a BAME background.
We got more and more nurses getting ill before social distancing came in.
That may be because so many BAME people work in hospitals and care homes in England that they have caught the disease through their jobs.
I heard of a case in our hospital early on — a colleague with symptoms was advised to go in to work, but was promptly sent home. Other hospitals have had cases of their own staff falling sick and being treated in the ICUs where they work.
I have noticed underlying conditions in our ICU such as Type 2 diabetes and hypertension and obesity that are disproportionately represented.
Surprisingly, some people pull through. But the longer you are in an ICU, the less reserves you have, and more things can go wrong.
Some of the medications we have for breathing, for instance, can have negative effects on the lungs and affect the kidneys. Every intervention has some sort of risk.
The longer you are there, the more things that can go wrong. There also appears to be the risk of pulmonary embolisms with this disease. The drugs we give to prevent the clot put people at higher risk of bleeding.
You can start to see patterns, but it hasn’t been long enough. The thing is, we just don’t know.
At the end of my shift, it is the reverse procedure. You hand over to a colleague. You take off the PPE. You change out of the scrubs and go and get the bus home. I don’t wear a mask outside. I will probably start wearing one.
But I get very frustrated with people with masks who are touching their face or wearing gloves. The whole idea is not to touch the face. As for gloves!
I have not been tested over the eight weeks. I have a friend who works back home in a hospital and she hasn’t been tested, though she works on an ordinary ward.
Like back home, if you have symptoms you get tested, and you have to get tested to go back to work. Some of my colleagues in the ICU have caught it, but there is no way of telling whether they were infected in the hospital or outside in the community.
In late February, we were fairly knowledgeable compared with most people in Britain about what was going on. I don’t want to think about it too much, because I feel the anger building in me just talking about it.
You know the thing is on its way, and it is like you are seeing a car crash and there is nothing you can do about it.
The people who could have done something to mitigate it weren’t doing the right things. I feel very let down by the government here.
It’s everywhere now and you are dealing with very intense situations.
It feels very abstract to many people.
People locked up at home watching the news are not seeing anyone dying or being very, very sick from it on a daily basis. It is like a disconnect between the policy and what is going on in the hospital.
I wasn’t jaded back in March. I could see what was happening in Italy and Spain, and I could see other countries were nipping it in the bud and locking down early.
I wondered why they weren’t acting. It was already here, there were already cases. We were weeks behind Italy. We knew it was coming, and what was going to happen, and no one was doing enough. I get angrier about it all.
I don’t work in a hospital in Ireland, but it does seem that it was a more serious approach a bit sooner than they were doing here. It was so obvious what was coming.
And I feel it was unfair. I’m the one being asked to clean the mess up, their mistakes.
Why can’t I just sit at home and cocoon myself? Instead, I had to put myself in danger every day on public transport to get to work and then have these very tough shifts.
As an Irishwoman, I feel that the NHS is being kept going by different nationalities. Over here, they say that at least with Covid it has stopped people talking about Brexit.
And everyone is clapping for the NHS. There are a lot of Irish and BAME nurses in London. And — not necessarily in London, but in Britain — there is the anti-Europe mentality, and now we are the ones running their health service.
The clapping for the NHS and the whole ‘NHS heroes’ stuff I feel is not great.
There are young nurses who are losing their lives — I just want the proper equipment and better equipment and to have a living wage. For instance, the PPE gear is made for males. That is still the case.
The clapping for the NHS is ironic also because 8pm is the precise time across the country that most nurses are in shift handover and will most likely never hear it. I don’t want people to clap. I just want people to stay at home.
Our hospital got a congratulations message from the Tory MP.
I looked up how he had voted previously on nurses’ pay, and, of course, he had voted it down. I emailed him to inquire whether in the future we could rely on his support to secure a living wage.
I never heard back from him. It all feels bad.
- As told to