Donna – Experiences of intensive care with COVID-19

Donna’s husband Simon contracted Covid in January 2021 aged 68. When in hospital he struggled with his breathing, he was mechanically ventilated. After 33 days he deteriorated significantly. Donna and Simon’s children were able to see him before he passed away. Donna was interviewed for the study in April 2021.

Donna participated in an interview for the study three months after her husband had died in ICU from Covid. Donna works in healthcare. Simon worked in education. The family had been careful with the risk of contracting Covid: they had worn masks, slept in separate bedrooms and had not gone to many places outside of the home. Simon had some health issues, but neither of them had felt that these put him at significant risk.

Onset

In January 2021 Simon began to struggle with his breathing. Looking back, Donna thinks she would have called for help earlier if public health messages had reflected a wider range of symptoms beyond cough, lethargy and fever. Simon had other symptoms: diarrhoea, collapsing, confusion, some delirium. When Donna called 111, she was advised to get an oximeter. When she did and used this to measure Simon’s oxygen levels, these were very low. When Donna called 111 again, she was advised to call 999. The ambulance, however, was busy and could not take Simon to hospital.

Donna herself had tested positive for Covid, which meant that she was unable to drive her husband to A&E. She called their daughter Sophie, who had herself just recovered from Covid and was back at work and she took him in. At this point the whole family felt that Simon probably needed some oxygen and would then come back home.

In hospital

In hospital Simon was given steroids and oxygen. The family communicated via WhatsApp and text, which meant that Donna and her daughter knew roughly how he was. The phone their lifelin, especially as communication on the ward was somewhat slow at the time.

As Simon continued to struggle with his breathing, he was moved to ICU and put on CPAP. He soon improved and was moved back to the ward. At this time he communicated that he was afraid of going back to ICU. When Donna and Sophie called Simon’s breathing was often laboured, so they kept the calls short to help him manage his breathing.

When communication with Simon suddenly stopped

Then the messages suddenly stopped, and Donna called the hospital to find out how Simon was. She found out that he had been ventilated, and that the decision had to be made so rapidly that the team had not been in contact with Donna and her daughter beforehand. Donna said she understood why this had to be done this way, but this meant there had been no opportunity to say goodbye. She has spoken to the patient liaison service, PALS, to gain a better understanding of how these decisions are reached, and how it may have unfolded in Simon’s case. This had helped her to come to terms with it.

Liaising with ICU staff

When Simon was unconscious, Donna and her daughter liaised with the ICU staff, who were giving the family daily updates. The hardest thing for Donna was waiting by the phone: she sat at the phone for weeks on end, afraid of missing calls and of receiving bad news. Time felt extended, partly due to the fact that Donna herself continued to be in isolation. She was unable to go out of the house – waiting became the main thing to do. Sometimes Donna called the ICU, but knowing how busy they were, she tried not to do so.

Waiting was also very difficult for Simon’s children. Once, Donna and Simon’s daughter went to the hospital to see if they could see him. Whilst Donna knew this was likely not going to be allowed, the chat her daughter had with the doctor in the visitor room was really helpful. After that, the family could FaceTime Simon, which helped them as a family.

The doctors communicated openly and honestly. Whilst Donna was hopeful throughout, she simultaneously realised how critical Simon’s condition was whilst he was in ICU.

Keeping others updated was difficult for Donna, especially as it had to be done over the phone. It was again difficult to communicate well in a way that others were not getting their hopes up unrealistically. Some of her family members are clinically trained, which meant they asked for numbers and figures and oxygen levels. Donna had some knowledge on these, but not always enough – and numbers were changing all the time. Donna kept notes to be able to relay the correct information. Eventually the doctors who Donna spoke to recommended not to focus on numbers too much, but rather on how Simon was doing that day.

Although a doctor on a Friday night had carefully suggested that there might be a little bit of a turnaroun, Simon took a big step backwards the following day. Donna and her daughter received a phone call from a consultant who told them it would be best if they came to the hospital to see him. There was a choice as to when to go in, and Donna felt it would be best to go in the afternoon so that Simon’s other children could join.

Donna, her daughter and her partner at the time, her two step-children, and daughter in law went to hospital. Simon’s older children went into the room first, whilst Donna, her daughter and her partner waited in the visitor room. Then Donna, her daughter and partner went in. It was good for the rest of the family to speak to a consultant, as it had been Donna who had directly been in touch with them until then.

It took a while to put on the PPE. The PPE restricted how they could relate to Simon. They were able to spend some time with him without many others present in the room. The staff were helpful, and one staff member who had taken care of Simon was quite emotional. It was difficult to know when to leave.

After they had left the room, the clinical team turned the machines off. They had said it could take quite a while, but everything went relatively fast. Simon’s older children had gone home, and Donna and her daughter had waited. They were able to see Simon again in the Chapel of Rest. Donna describes this moment as traumatic, as this time all the tubes that had previously been there were now suddenly gone, and whilst they were no longer in the same room, they were still in the hospital environment. Also, having to take his belongings on the day (due to Covid, the hospital preferred that there were fewer moments for which relatives came to hospital) was quite difficult, especially for Donna’s daughter, who did not understand what her mother was signing for.

The family needed to isolate at home for 10 days following the visit to hospital. This meant that they could only communicate via FaceTime and phone, and nobody could comfort and cuddle them in their grief. Funeral arrangements had to be made from the home, although the decision to have the funeral after a month allowed both for some time to prepare, as well as arranging some things in person (e.g. going to the undertaker). The funeral had 30 people and a webcast.

The family received a lot of support from a large network of friends, family and colleagues, who sent cards and flowers and called. Professional support included the option to have bereavement support, but Donna preferred to have this face-to-face, so was still waiting on this at the time of the interview.

Looking back, Donna reflects what may have helped her through her experience: visiting, more awareness of different symptoms of Covid, and more communication between staff and herself, although she understands why this was difficult. Although she anticipated this to be difficult, Donna was about to go back to work shortly after the interview.

Her message to others was to talk to staff and take all the support offered. She furthermore noted that being aware that others around you have also lost somebody in your loved one, can be a form of togetherness in grieving, which she herself found helpful to become aware of.

During the end-of-life visit, Donna “Facetimed” her parents, who were shielding, to enable them to say goodbye to her husband.

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Donna found the end-of-life visit to her husband Simon traumatic, both for her and her daughter.

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To Donna, taking the belongings after her husband’s death felt very final. Her daughter was distressed seeing her mother sign papers for receiving them.

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Donna, her daughter and her partner saw Simon before and after the ventilator was stopped. Wearing PPE made the encounter more difficult.

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Eventually, Donna found it more helpful to focus on how Simon was doing than to know his saturation levels.

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Donna, her daughter and partner, and two stepdaughters went to hospital to say their goodbyes to Simon. They visited in threes.

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Donna sat by the phone for 20 days, afraid to miss a call, and only asked staff to call her daughter when she had to be elsewhere.

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Donna had many messages from friends and family who were wanting to know how her husband was doing.

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Donna was frequently told that her husband was stable but critical.

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Donna phoned the hospital to see why Simon had not texted them to find out he had been ventilated.

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The practice nurse asked Donna to measure her husband’s oxygen levels, which showed that he needed hospital admission.

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Donna felt she may have taken her husband to hospital sooner had she had an oximeter.

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When Simon became increasingly unwell, Donna was in self-isolation so that their daughter had to take him to A&E.

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Donna’s husband Simon had symptoms that were not communicated via public health messages.

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