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Johnny

Brief Outline:

Johnny contracted Covid early on in the pandemic while at work as a nurse and wearing minimal PPE. He was in hospital for 2 months, which include 2 weeks on the mechanical ventilator in Intensive care. Interviewed for the study August 2021.

Background:

Johnny is married and has two adult children who both have their own families. He works as a nurse in the NHS. Ethnicity: British Asian (Filipino).

More about me...

Onset:

In April 2020 Johnny was working as a nurse in an in-patient ward with Covid patients. At that time, the only protection he had was a standard mask. After two days of working on the ward with Covid patients, he felt unwell. Previously he had rarely called in sick. With the public health messages around Covid in his mind, he called his work to say he would not be coming in, and isolated at home, where his wife looked after him. When he deteriorated rapidly, he asked her to call the hospital. He was advised to stay at home. His wife called 999 regardless, and an ambulance came to the house. The paramedics took Johnny’s temperature (above 39 degrees Celsius) and decided to take him to hospital. His wife also tested positive, but she remained asymptomatic, and stayed at home.

In Hospital

Johnny does not remember much from the initial time in hospital. He was sedated and intubated. At this point in the pandemic no treatments for Covid had proven effective, so he was merely given oxygen and antibiotics and steroids for the pneumonia. He had dreams that felt very real to him, but they were not terrifying.

Johnny later learned that his doctors had been very concerned about his condition. They had told his wife that he was seriously ill, and that he had a mere 20-30% chance of recovery. Johnny’s wife was in touch with the extended family in the USA and the Philippines, who all prayed for his recovery. Although his wife was very anxious at the time, she was also hopeful for his recovery. She showed the consultants a picture of a friend in Ireland who had survived intensive care and Covid, saying that her husband could do the same. There are some photos of the time when Johnny was in medically induced coma. He has looked at these and found them disturbing.

Awaking from coma

Johnny has no recollection of being weaned off the ventilator. He remembers that the ventilator was “just gone”, although he could not speak due to his tracheotomy. He felt hopeless and unable to do anything. Not knowing to what extent, he would improve, he wondered if this was the life he would want to be living, a feeling he described as “worry, helplessness and depression”. Had the doctors asked him whether they should resuscitate him at the time, he thinks he would have said no.

Johnny had worked in the hospital where he was admitted, so staff knew him there. They visited him in ICU and on the ward. In contrast, Johnny’s wife was not allowed to visit due to the visitor restrictions. The hospital Johnny was at had introduced videoconferencing to allow family members and patients to “see” each other and to talk where possible. Whilst Johnny was unable to speak, he communicated with his wife via video by writing and waving. Later in the week the nurses added something onto his tracheostomy tube which allowed him to speak. However, as people around him could not understand what he was saying, he returned to writing messages on sheets of paper.

Recovery

Physiotherapists, all wearing PPE, attended to Johnny in ICU. Within a week, Johnny was well enough to be transferred to a chair next to his bed, and he could shuffle around the area around his bed. When the nurses cleared his tracheostomy pipe it felt very uncomfortable: as if they were “sucking the air from [his] lungs”. After two weeks Johnny was more frequently up and out of bed. He could sit but not stand or walk. He frequently wondered how this had happened to him, as he had previously been physically strong. At the same time, he was regaining this strength slowly but surely.

The general ward

Two weeks after his admission, a doctor came by Johnny’s bed to say that he was Covid-free, and that he could be transferred to a general ward. On ICU the nurse-patient ratios are very small, and the patient is monitored continuously, but on the ward this is different. Johnny felt very ill and that he had no control, so just hoped that staff “do what they have to do”. Johnny’s wife brought him a rosary, which allowed him to pray.

A physiotherapist helped Johnny to stand and walk with the help of a Zimmer frame. Johnny was still unable to slowly lower himself onto a toilet, he had to “let [himself] drop down onto it”. His lungs were still not what they used to be: Johnny was surprised he could not take a full breath. Johnny continued to do his exercises: walking with the Zimmer frame, and later without it whilst holding onto the rails in the halls. After exertion he had to sit in the chair for 5 minutes and catch his breath, and he had stand-by oxygen by his chair just in case.

Before Johnny was discharged, the physiotherapist tested his strength and ability to walk up steps. Although he still needed some time to recover afterwards, he was judged to be fit enough to go home.

After leaving hospital

Johnny continued his rehabilitation at home. He was particularly happy to be at home because he disliked the hospital food. At home he could eat the Philippine food he was used to and that he appreciated. Johnny’s main concern was to learn to walk without a Zimmer frame. He eventually managed this by doing physical and breathing exercises. The physiotherapist came to his house to assist him with his exercises; they provided Johnny with exercise instructions drawn on paper as well.

After a month at home, Johnny could go outside and use the aerial gym near his home. At one time he fell outside the house, which was scary as it was on a step near a busy road. After that, Johnny did not go outside unaccompanied anymore.

Slowly but surely, Johnny gained the weight back that he had lost in hospital. He likes going to the market and buying food that he likes there. When the community physiotherapists felt that Johnny was strong enough, they discharged him from their service and urged him to continue doing exercises at home.

Remaining symptoms

Johnny’s breathing remains a problem for him: he cannot run lest he fall, and after exertion his oxygen saturation remains low for at least five minutes. He now experiences erectile dysfunction (ED), for which he has sought information on the internet. He does not feel like he needs any more information. If he does have questions, he can call the hospital ICU team and ask, or his physiotherapist, or his GP.

Johnny has been back to the hospital two or three times after his discharge: the doctors there have tested his strength and breathing and concluded that he has recovered well. He has also received support from neurorehabilitation, who tested his mind and provided “preparation for normal life”.

When prompted to reflect on what was most useful for him in his recovery, Johnny states the help from physiotherapist and himself in regaining mobility, breathe and his weight.

When asked about other patients, Johnny tells me that he has lost a colleague to Covid. Beyond his colleague, he has not been in touch with other patients who had Covid outside work.

Looking back, Johnny feels that he has aged 20 years due to Covid and ICU. Where he felt 30-40 before, he now feels 60, his current age, which he feels has to accept.

Return to work

When Johnny wanted to go back to work in December 2020, he was told that he should shield due to the new (Beta) variant, and his sick leave was extended. The same happened again in February 2021. Eventually he was phased back into work slowly, doing four hour shifts at first, until in June 2021 (14 months after his admission to hospital) he worked full 12 hour shifts again. Where he used to work many bank shifts before, he no longer does this to allow his body time to recover. His experience as a patient has not particularly changed the way he interacts or relates to patients, although he does encourage them to do their exercises and to develop strength early on, as they cannot go home with oxygen. In four years, he hopes to retire.

Messages

When asked about messages for others, he emphasises that doctors and nurses are doing their best to save patients, and that it is best patients remember that.

 

Johnny’s wife was told that he had a 20-30% chance to survive.

Johnny’s wife was told that he had a 20-30% chance to survive.

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My wife only told me that the doctors are very concerned and everything. I think they put me on forced coma, something like that, so they can do the things they want to do, because they need to save me. So, my wife told me the doctor called her and she’s very nervous because she thought the doctor will tell her I’m sorry, just like that. But the doctor said my condition is very serious, I got the severe form of Covid, and my chance of recovery is around 20 to 30 per cent. So, my wife is crying all the time, and she told my brothers and my sisters in the Philippines, and then they call my other brothers in the US and everything. So, they said they’d pray for me. And when the doctor told my wife that my chance of recovery is very slim my wife showed them a picture of her friend’s husband who has the same condition as me. Even the condition of hospital, he cannot speak and everything.

But she said this man has the same condition as my husband, but he recovered, now he is already at home. That is in Ireland. My wife said probably the doctors were challenged because they are better than the Irish. So, they tried to do the same thing, and eventually I recovered. So, when my wife showed me my picture, I saw myself lying motionless, like a dead person, I was scared. I don’t look good when I’m dead, I should not be dead, because I don’t want to lOKook at it. Even when my colleague, when I saw her, she came and looked at it, I’m like a dead person. I don’t look nice.

 

After waking up from ventilation, Johnny could initially not speak. He communicated through writing.

After waking up from ventilation, Johnny could initially not speak. He communicated through writing.

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So, when they brought me to the hospital, I think they put me to sleep and that’s all I can remember. And then when I woke up, I can’t speak, but I can still communicate. I write something on a paper and then give it to the nurses looking after me of what I would like to say, and that’s the way it is.

Anyway, when I’m fully back to life I can only see and move my eyes and some parts of my body, but I cannot do anything. I’m so helpless. So, when the hospital show me my wife speaking on the video, I can only nod my head. Then within a week I was able to move around. They transfer me to the chair to improve my breathing because during that time I am on oxygen. And then when I have a trachea in my neck, and when they do the suctioning, I feel like they are taking away all the air from my lungs and I don’t feel comfortable about that kind of thing because I’m so weak. And then maybe after a week or two I’m already out of bed, I’m already in the chair, so I can see my wife waving on the video, and then I am also waving, but that’s all I can do at the moment.

Then they said I can talk already; they have to put something on my trache and then I was able to talk a little bit. And then after that, after the video, they remove it again so I cannot talk anymore. I want to communicate and to tell everybody what I would like. They cannot understand me. So, I’m back to writing everything what I want on a piece of paper, and that’s the way, how I communicate

 

Johnny had online support from the neuro rehabilitation specialist.

Johnny had online support from the neuro rehabilitation specialist.

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You mentioned some support that you received since you came home, so the physiotherapist… Have you had any other support from the NHS?

Well, it’s only the official policy include also the neuro rehab in preparation for my going back to normal life, like more working back, and yeah, they tested me whether I’m ready to go back to work. They gave me some tests, my mind and everything, my thinking. I don’t know what’s the result, but they thought maybe I could do it fast because they ask me some questions and then do these things, like puzzles, they are testing whether I know how to solve these things. That’s it. I was able to do it. They even ask me can you give some words that begin with this letter, as much as you can? Well, I give more than they ask for me, I think. For example, give me as much as you can in one-minute words that begin with D. Okay, driver, dog, department, everything like that.

So, the neuro rehab and the physiotherapist.

Yes.

And the neuro rehab, was that online?

Yeah, it’s online, but they also ask me to go in person because I have to sit just like an exam. They did some figures, okay, do this and what does this need to be done, and then they show me some pictures and how much you can remember, what have I shown you, and can you repeat this, like that.

 

Recovery for Johnny meant eating well and doing light exercises, supported by his wife, a zimmer frame and sometimes a physiotherapist. Eventually he could walk alone.

Recovery for Johnny meant eating well and doing light exercises, supported by his wife, a zimmer frame and sometimes a physiotherapist. Eventually he could walk alone.

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So, when the doctors finally said I can go home and continue my rehab at home I’m glad because I’m like a very thin person because my nutrition is very poor. I don’t like the hospital food. Only a small amount I can eat. So, when I get home, I eat as much as I can in my own food, with my own food, native food. So, I gain… When they discharged me, my wife said I’m like paper, I’m like a puppet, they had to carry me. Two people carrying me to my flat.

And then from there there is a zimmer frame, but I just cling to the wall because I don’t like using the zimmer frame. So, when I’m finally at home I can breathe well. Then day by day I am trying to gain my strength and I’m trying to inhale as much as I can and do some light exercise, and my wife is always with me because she also got the Covid but she’s asymptomatic, and she also ask her employer if she can take the off sick because she’s positive. So, she look after me for over a month, and attending to all my needs, and eventually I am gaining strength. I can now stand, and I can move around, but I don’t use the wheelchair…the zimmer frame.

And then a little bit into that, maybe around a month, I can go outside. My wife, she stood me in the gym. We had the aerial gym outside. And then walk around and then inhale fresh air from the park. Then the physio who is also coming to the communal area she assisted me in all those exercises. And then when she’s done, she just gave me some papers with drawings so I can do some exercise on my own, and I was able to do all of them anyway. But my main concern is how to walk independently without the frame. I eventually managed to do that, but I thought I’m very confident that I can walk already.

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