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Experiences of Covid-19 and Intensive Care

Support from staff

In ICU (Intensive Care Unit) people are cared for by doctors and nurses who provide highly specialised care 24 hours a day. In UK ICUs, there is normally a one-to-one ratio with each patient having their own ‘named’ nurse (see also ‘Patient ICU experiences/Nursing care in ICU’). During the pandemic, ICUs were expanded to cope with the high numbers of sick patients, and there were not enough ICU trained nurses to maintain this one to one care. During the “peaks” or “surges” of the pandemic, one ICU nurses was looking after two patients, or sometimes even as many as six critically ill patients at a time, with the support of redeployed (not ICU-trained) staff. These ratios affected the patients admitted to the ICU and the nurses and other staff working there.

Below you can listen to people speaking about:

  • nurses mitigating loneliness on the ICU and hospital wards
  • experiences with frequently changing staff
  • memories of particular staff members

Support from nurses

In the absence of family members, it is often nurses who made being in ICU less isolating and cheered patients along; this type of care now became vitally important for patients (see also ‘Sources of support in ICU’).

 

In the absence of anybody to talk to, fleeting chats with nurses was all Carl had to keep him going.

In the absence of anybody to talk to, fleeting chats with nurses was all Carl had to keep him going.

Age at interview: 50
Sex: Male
Age at diagnosis: 50
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Why weren’t you talking to other people? No energy or you couldn’t see them, what was it?

I don’t know. I’m so sociable. I talked to the nurses. The crazy thing is I couldn’t wait, I think it was every hour or something they come and check your blood pressure and temperature and stuff, I would crave that hour for that little two minutes of attention. It was absolutely lovely to chat to the nurse or something.

The thing is I suppose, as well, they don’t want to be really near me very much because you’ve got this deadly disease and the longer they’re with you the more likely they might get it. So, I understood. And they’re all masked up and everything. But most of the patients around me they looked very, very scared, they looked very scared, to the point where to me it didn’t look like they were going to make it. That’s how it looked to me; they looked really, really ill. And every day I was getting better, and they weren’t. It was very sad. You find yourself lying in bed just crying. You weren’t necessarily crying for yourself but other people because it’s quite upsetting to see other people so ill.

There was a time, especially when I was going in and out, they sent me a couple of times down to the CT scan because my lungs had still not healed. They were very infected on the bottom of my lungs, and you look round and I could see everybody else how ill they were and then it sort of dawned on me that maybe I’m not that good after all, and maybe I’m just as bad as them, I just don’t realise it. And then I started asking more questions to the nurses and stuff, and they were like no, no, you'll be okay, you’ll be fine. But that was probably one moment where I really doubted, that I thought actually maybe I’m not good and maybe this is not…you think you’re okay but you’re in a false sense of security here because you’ve actually got a lot of things still wrong with you and looking round at other people.

I think also to talk to other people, because people weren’t going next to each other, I think you felt maybe, even though all of us in the ward we didn’t have masks on or anything, well the others did because they couldn’t breathe, but I didn’t have a mask or anything on my face. But I think it was hard to talk really as well. I didn’t have any power in my voice whatsoever; my voice was just really, really weak. But I was absolutely craving attention, wanted to talk to people.

 

Paul had bouts of depressive feelings after waking up from ventilation when he realised what his family had been through whilst he had been in coma. He hoped to raise some money for the NHS to thank staff for saving his life.

Paul had bouts of depressive feelings after waking up from ventilation when he realised what his family had been through whilst he had been in coma. He hoped to raise some money for the NHS to thank staff for saving his life.

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So, can you remember how you felt in this time in the ICU?

I got a bit depressed with everything, how bad I was, what I’d put my wife and my family through. They were traumatised more than me. I was in a coma; I didn’t know what was happening. I felt annoyed that they had to endure phone calls and me nearly dying. It was as bad as that. I remember thinking after I came out of hospital, when I was home the seriousness of it all. The one night I realised that my wife either had to arrange a welcome home party for me or arrange a funeral. It was as bad as that at one time when I was at my worst. I thought, how would I have been if it was my wife in hospital on life support? I wouldn’t have been able to manage. I don’t handle stress particularly well. I just don’t know how I would have felt. Trying to run the house, the 12 pups and things like that. But my wife managed all that, kept the house running. She cried lots. She painted a fence and the house and the garden, her and the neighbour. The house was spotless when I came home. She was de-sanitising everything, getting it ready for me coming home. I was thinking just crazy things. If I did pass away and I died, how would she have survived the first Christmas?

We were due to celebrate our 25th wedding anniversary last September. We were going to go on a wee cruise or a wee holiday, but with lockdown and things like that we only went for a meal. It was going to be a big anniversary, but we couldn’t have anything really. So, I was very confused when I came too, and I had spells of real depression. But then the nurses were great. In the middle of the night… I never went to sleep. I came out of a coma, I never slept for the next three nights because I was too scared of shutting my eyes and not waking up. But the middle of the night nurses would come in and do their observations and they could see I’d be crying, and they would just hold my hand and talk, speak, reassure me that okay, there’s a long way to go but you’re off the kidney dialysis, you’re off this machine, you’re getting stronger, your pulse is stronger and you’re just doing better, it’s great to see that you’re doing better, so you need to try and stay positive. You’ll soon be going home to your son, and you can play football with him, and you’ll see the pups and there’s lots to look forward to. So, the nurses were great at keeping me positive and reassuring me.

Without family members to visit and with infection control measures in place, patients had no one to hold their hand or soothe them. Touch, the squeeze of a hand or a comforting smile from staff was incredibly important. Nurses played their patients music that family members had suggested, they held their patient’s hands and celebrated important milestones with them, such as birthdays and transfers between wards.

 

Michael’s nurse played him music that his sister had recommended for him.

Michael’s nurse played him music that his sister had recommended for him.

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I remember there was always music playing, and my sister told me that that’s the type of music I like, so she had given them a few ideas. So throughout most of my time there they would be playing music. Not sure if that was to – what’s the word – to keep me motivated or what, but there was always music playing. And it was a little shock by the time I went to the Covid ward, because it was pure silence. Nothing.

So, did you appreciate the music?

I think it did take my mind off the nothingness of the whole environment. Okay, if you can imagine you’re in a bed 24/7 and there’s nothing else there. You take for granted, you know, or I’d look on my tablet or pick up my phone, or what, but when you don’t even have the strength to be able to do that, you’ve got to find other things to kind of keep your mind occupied.

And did you say the music, that was the music that your sister picked out for you?

Yes. It wasn’t necessarily what I would normally listen to, but at least it was… (stops mid-sentence).

Did you recognise it?

I did recognise it. Yeah. Kind of Motown and music from the ‘70s, ’80s. So, it was definitely recognisable.

 

Emma missed human contact. When a nurse touched her, although she was wearing PPE, “it felt human”.

Emma missed human contact. When a nurse touched her, although she was wearing PPE, “it felt human”.

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Then a lady on the other side, she said to me, you alright, and we just started chatting. Not chatting chatting, but she was like, you alright, my love, they won’t be long, they’ll be coming in. And I still couldn’t speak properly, but was like, thank you. She just smiled at me, and she was just really nice, whereas when you’re on ITU, I was literally looking at a door, and like I said to you, I had people around me, but I couldn’t see anyone, I didn’t know who was around me. On this ward, I had four other people around me, one of them absolutely crackers, and the others just a couple, older, and then the lady in front of me, but yeah, just…it was human contact. I hadn’t had any of that apart from nurses that you can just see their eyes, which is horrible, really horrible, because you can’t even see the expressions. You couldn’t…you wouldn’t know who anyone was, you couldn’t…you can’t see a face and all I wanted was somebody to touch me in a…not in a sexual way, please…that’s made that sound really wrong, I don’t mean it…I just wanted someone to…I’d have killed for a cuddle, anyone, I just… I would have killed for a cuddle.

But just someone to put their hand on you and just sort of go, are you alright, darling, like that nurse did. I think it might even have been that night, actually, she just came in, and I cried, and she just held my hand. Oh, it was amazing, because you can’t…you know, they’re too busy putting on all their PPE and just having their visors on with your masks on and your gloves on and your…and even though she had her gloves on, it just felt human. It felt really nice, and that’s something with Covid that you don’t…because normally people touch you, everyone’s so scared of touching, and you’re labelled Covid, so people literally stay away from you a lot more. And you don’t realise how much you need human contact, yeah, yeah.

Patients in the ICU were often aware of how exhausted the staff were. Brian said he felt sorry for the nurses for having to work under such difficult circumstances, having to wear PPE and working long hours for days on end. Laurence explained: “You’d see a nurse come to see you, visit you at your bed and once they’d finished with you, they would then strip off all their PPE gear, all their aprons, chuck it all away and put a whole new set on to go and do the next guy, so you could just see the difficulty they’ve got in doing their job.”

 

Brian tried not to ‘complain’ because he felt sorry for the nurses who were visibly exhausted. He is thankful for the care he received from one nurse in particular.

Brian tried not to ‘complain’ because he felt sorry for the nurses who were visibly exhausted. He is thankful for the care he received from one nurse in particular.

Age at interview: 55
Sex: Male
Age at diagnosis: 55
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And so, you know, yes, I suppose, you’re just watching a lot of people busy, a lot of nurses busy, and they were…I felt sorry for them because they had their masks on for however many hours. I’ve worked with masks and it’s not pleasant so, as much as I was moaning about the CPAP, watching doctors and nurses just continually work these long hours with these P3 masks on, I felt sorry for them. So, you, kind of, don’t want to complain, but there are moments when you want to talk to somebody and you just want somebody to listen, and I felt at times they just weren't listening.

Then, when I…there was that one guy, I think they do, like, three day shifts, there was that one particular nurse, when he came in, he was just... So, we can all tell, you can tell when somebody’s going to come…when somebody has got a long face, you know. When somebody, and I’m not saying that they don’t care, the way people walk, the way they hold themselves, the way they communicate. And then, you can tell when somebody’s got just a different personality, and so the guy that ended up, well, I was blessed to have him look after me, his name was [nurse], just beautiful, a South African guy, [nurse]. He was, he was just a darling, just a great guy.

And, I remember waking up at different times of the night, he was taking bloods all through the night, as well. But, you know, sometimes you get into the early hours of the morning three, three thirty, and you’re looking because it’s dark, all the lights and all the machines are going, and some of these guys were just asleep, some of them were just dropping off asleep.

And, there’s nothing worse than when you really need to rest or sleep, and I’m thinking, I’ve got the luxury of lying down and this guy was just nodding off. I wished I could have swapped or said to him, just budge over, come and have…just come and have a kip with me, just lie next to me, I won’t say anything. Just, you know, out of humanity just reach out, there’s nothing worse than thinking, I just need to go to sleep. But he cared for me really well, he really was, and that meant a lot, an awful lot to be, because you could just feel…I just felt relaxed.

With too few ICU staff for the high numbers of Covid patients needing ICU care, staff from other areas of the hospital, or even other hospitals, came to ICU to take on part of the work (a process called ‘redeployment’). There was a lot of staff turnover and patients were cared for by constantly changing teams. Often redeployed staff were not ICU trained, and they worked under the supervision of an ICU trained nurse. For instance, one person we spoke to recalled being cared for by a heart surgeon. Mark felt some staff members taking care of him lacked ICU experience which affected his care. These were distressing instances for patients as well as staff.

 

Mark recalled a moment in which a staff member did not immediately know what to do.

Mark recalled a moment in which a staff member did not immediately know what to do.

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And yes, you’re in hospital but you don’t really take it on board that you’re actually in ICU, because of the amount of bodies that are just literally moving around. And I’m saying the amount of bodies because you’ve got to remember, at that sort of time, you had members of staff coming in from Liverpool, Scotland, Newcastle. And every day, everyone’s coming in to help but it’s not unfortunate, it’s just the way it is, they’re not specialists in that department. They’ve actually got to be trained for that particular day.

I had a surgeon who was looking after me one particular day. And she does heart surgery. And I’m thinking, hold on, she’s come down from Scotland to do a 12-hour shift in the capital. Excuse me, and this lady’s got to wipe my bottom. But she’s normally doing bigger stuff. And I just thought that’s absolutely amazing. Then her demeanour and her calm approach was totally wonderful.

Then you had less experienced members of staff. And I remember one particular day, I was on the ventilator and because of the trachy, it has to be…there was a build-up of phlegm and it had to be sucked out. And I don’t know how this happens, but you have to find a way to communicate because you can’t speak. So, I used to tap on the side of the rail, like the bedrail’s a bit like a cot. So, I remember like tapping the side to get someone’s attention. Because you do have people moving very quickly in front of you in ICU but they’re not making eye contact with you. They’re moving up and down. And I suppose they’ve got to do it or, you know, they can’t stop. So, I used to tap on the side to get people’s attention.

And you need to have three people looking after a bed. And this particular young chap, the best way to describe him, I was choking. And I tapped on the bed. And he’s about 10 metres away from me. And he’s looking at me. And I don’t know if he’s frozen or not but he’s looking at me and I’m choking. And I’m saying something in my head, obviously I can’t say it on tape. And he’s just standing there and he’s watching me. And I’m thinking, are you really just going to stand there looking at me? And eventually, he comes over to me and then…it’s the trachy, yeah. And then he pulls the thing out and I go [inaudible]. And I’ve just looked at him. And I’m trying to work this out in my head now, did this guy just freeze because he’s young and he’s new and he had to work it out in his head?

Despite these difficult situations, people felt very grateful for clinical staff doing a job they were not necessarily trained for, and the distances that staff travelled to support their colleagues in other trusts.

Despite the rapid turnover of staff, patients did build up a rapport with some doctors and nurses and valued their support. Pete said: “Most of the other nurses were either on a daily basis or maybe two days and then you’d see somebody else. So generally, most of the time, they were always swapping over.” He added: “there was one nurse in particular who was always coming in to check on me and we would have a bit of banter between one another. And those sorts of people, they get you through.”

Remembering particular staff members

In this extraordinary time, special relationships could form between staff and patients, particularly those who had spent a long time on ICU or who had made unexpected recoveries. ICU staff sometimes clapped patients out when they finally left the ICU and went to visit patients on the general ward after they had been transferred out of ICU. Many like Emma, Brian and Ann remembered particular staff members, sometimes in a negative, but frequently in a positive way.

 

Emma remembered particular staff members, and how they made a difference to her, mostly in a positive sense.

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Emma remembered particular staff members, and how they made a difference to her, mostly in a positive sense.

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And another lady who was from theatres, she came down to help because they were so busy, and she just…I couldn’t…I just…obviously I hadn’t been to the toilet for 11 days, I think it was. They obviously give you stuff and you don’t think about things like that until you think, I actually don’t know when the last time I’ve been to the toilet is, but I feel like I need to.

And she was like, oh, do you need to go? And it’s so embarrassing, because all these things you could do, but all of a sudden you can’t do anything, so the littlest thing like getting up and going for a number two to the toilet, to having to sort of say, I think I might need to go to the toilet. But you can’t stand up, you can’t get to it, you can’t wipe yourself, you can’t do anything. It’s humiliating, but they don’t care, but it’s you that cares, so you have to get over that pretty quickly in your head, that they don’t care, you’re the one with the problem here, love. And she just laughed about it. I can’t remember what she said, but I can just remember thinking, I’m so pleased it’s you that’s here. It could have been anyone, and maybe the next person was like that as well, but…and I didn’t need to go to the toilet and I hadn’t been to the toilet or anything, but…and she just said, do you want me to freshen you up? And I was like, yeah.

And she did, and I didn’t feel embarrassed by it, I didn’t feel like a piece of meat, not that a piece of meat, but do you know what I mean. I didn’t feel…and I’m big, so I wasn’t bothered about, oh gosh, you’re looking at my stomach and my saggy boobs are going from one side to the other, I didn’t feel like anything like that at all. She just made me feel like, I’m here to help you and I’ll give you a hand, whatever you want. And then when I went onto the ward, every one of those nurses, there was two in particular, the one that showered me, and the one that sat there with me at night when I’d had a nightmare again, and I couldn’t sleep, and she just came in and she just held my hand, and I just cried and cried.

Yeah, so you know, there is, there was lots, and even a lot of the physios that came round, they were like, you’re doing really good today, Emma. Oh my god, you’ve done this and you’ve done that and not patronising, not patronising, oh, you clever girl, sort of thing, it was just a…you’re doing really well. Alright, let’s see about doing this. And then if I’d go, oh, do you think I’ll be able to get to there today or to do this and they’d be like, no, we’re not even going to try that, that’s just not happening. So yeah, there was, there was so many different nurses, doctors, yeah, you know, a lot of them, I only had one bad experience, but a lot of them were brilliant, really, really good. Yeah.

 

Caroline is most grateful to the staff members who treated her as an individual.

Caroline is most grateful to the staff members who treated her as an individual.

Age at interview: 58
Sex: Female
Age at diagnosis: 57
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There were some nurses and some healthcare assistants who were more dedicated than others. And they’re the ones who really made an impact and they’re the ones who really treated me as an individual, who would come running when my bell went because I haven’t got an emergency bell, I’d only got a buzzer because that was all they could attach. They had to attach a special button that I could press because obviously I couldn’t press a normal call bell. But they would come running to me, even if I wasn’t one of their patients if they heard my bell go. Because they knew a) I’d only call if I needed something and b) it might be an emergency, because I hadn’t got the emergency bell to push.

The nurse or the healthcare assistant who brought me in some chocolate pastries because I wasn’t enjoying breakfasts and I needed to gain weight. And she’d made them herself at home. The nurses who clubbed together to buy me something on my birthday. And the clerk who got a neighbour to make me a cake for my birthday because I was in hospital for my birthday. The healthcare assistant who sat with me and went through my cards when I was feeling particularly low, to cheer me up. The critical care team who would always pop in just for a social visit, just to say hello at the end of their shift.

The junior doctors, one of whom wrote out all my meds for me because I didn’t know what I was taking. And she wrote them all out and explained them all to me. And another junior doctor who’d been to the rehab centre that I was at and talked to me about what it was like, because I had no idea what it would be like. And he talked to me about the buildings.

Those are the people who really made a difference, the ones who saw me as individual. There were some to whom I was just another patient and just a person they were looking after for that day. But, you know, you can see it. The doctor from critical care who admitted me and also saw me off, he was on duty, he was looking after me the day I went up to the ward, who wrote on the notes…instead of writing all the summary of care, wrote, this patient is well-known to me. And he came up to see me and he told me that the reason he and the team had fought for me is because when they were bringing me to critical care, he’d asked me, is there anything you do or don’t want me to do for you. And I said, I trust you to do the right thing for me. And he said, that had pushed them to do everything they could for me. And he saw me as an individual.

There were probably only two. There was a doctor who made me cry and shouted at me because I’d been told to contact critical care outreach if I needed help. And there was a nurse who needed to suction my tracheotomy and this must have been very early on in my stay. And I was really scared because I knew she hadn’t done it before and I asked for someone from critical care to come up, having been told by the previous doctor to call if I needed help. And the doctor who came up shouted at me and told me I shouldn’t have done that. And that really upset me. And he had no understanding of how it felt to be suctioned and some of the nurses had no understanding of how terrifying it was, and they occasionally went too deep one time, that really upset me.

And there were a couple of healthcare assistants who talked negatively about other patients in my hearing. And that upset me because if they were doing it about other patients, were they doing it about me as well. And they were talking about patients who had dementia and saying how horrible it was looking after them and how they came using their call bell.

And a really bad point was on my last day when they transferred me from the single room I’d been in onto a ward with dementia patients, onto a bay with dementia patients, because they needed my bed. And that was horrible because it was my last night, I was already quite uptight and they just…I had to pack up everything and move onto a four-bedded bay with three dementia patients. And that was horrible. That nearly broke me because it was…yeah, it was just awful. And actually, to be fair, the ward manager when she came back, was furious they’d done that. They’d done it on a day she wasn’t there and she was absolutely livid. But apart from that, it’s just a huge thank you because they were amazing and they bent over backwards for me.

 

Ann remembered one particular doctor who made a difference to her time in ICU.

Ann remembered one particular doctor who made a difference to her time in ICU.

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I actually liked her, because she was straight talking, and she didn’t pussyfoot around what she was saying to you. And I like that, I like people to be up front and direct. So yes, so she became my favourite doctor. And I remember when she used to look in on the ward, come in on me, and she would sort of say, hmm, well, you know, your oxygen levels aren’t great, we need to get them at such and such a point; and I used to say to her, but when will we get to that point? She said, you just have to be patient. Well, God, I remember getting frustrated, but I was never frustrated at her, because she was just doing her job.

And I remember the one day when they got me down to a level one on oxygen. And she came in dancing. And she danced around the room and saying that that’s great, that’s brilliant. But of course, you know, things have changed since then. And I remember having to go to the hospital and see her six months after I came out of hospital, I went to the hospital and saw her. And yeah, she was still the same. And she was saying, oh, you know, everyone still talks about you, and you’ve done well, but you know… She didn’t say at the time that I was going to be on oxygen for life. Because I don’t think anybody knew at that point how long, and how much affect…the Covid had on people, and the symptoms of things, that they developed after leaving hospital.

 

Neil was clapped out of the ICU by the staff to the MAU [Medical Assessment Unit] and then to the general unit after a week.

Neil was clapped out of the ICU by the staff to the MAU [Medical Assessment Unit] and then to the general unit after a week.

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And when I came out of ICU all the staff were saying, you can’t go yet, we’re not ready. I said, what do you mean, you’re ready? They said, we’ve got to get all the staff ready. And you’re in your bed going to a new ward and they actually applaud you, the whole shift of nurses, healthcare assistants, doctors, specialists, they cheer you out. You turn into a bloody mess. And they also did that for me when I came out of MAU [Medical Assessment Unit], exactly the same thing, in the bed, the whole…every staff applauding me, high fiving me.

Okay, so I’d spent about a week in MAU [Medical Assessment Unit]. And it got emotional when I left because the nurses at the time there were more people dying than were pulling through, and it’s still the same for them and they must be absolutely mentally exhausted. But one nurse said, you’re coming off the ward today, Neil, and I don’t want you to go but you’ve got to go – when do you want to go? I’d better go now because if we stay here, if I keep you for a couple of hours, me and you are going to be in bits, we’re going to be crying all over the place.

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