Kate – Experiences of intensive care with COVID-19

Kate and her husband both contracted Covid in April 2020, but whilst she recovered, he had to be admitted to hospital. He spent 12 days in hospital and then recovered at home; he went back to work after 2 and a half months. The episode has had a big impact on Kate. Interviewed for the study in April 2021.

Onset/Initial symptoms: In April 2020 both Kate and her husband started feeling unwell. She developed a high temperature, loss of taste and smell, and a cough. As it was not a persistent cough, to the main symptom to look out for in the public health information at the time, they did not think it was Covid. She wrote it off as hay fever. Her husband’s symptoms were nondescrip. They stopped on the Thursday; hers on Saturday. Looking back, she is quite surprised that it manifested so very differently in both of them. By Saturday he had started to be unwell again. On Sunday he woke Kate up saying he could not breathe.

Initial contact with health services

Kate contacted 111, who asked about her husband’s symptoms and said to call an ambulance. Kate remembered they came in masks and aprons only. Initially, they did not believe the oxygen saturation meter, which indicated Kate’s husband’s saturation levels to be mid-80s, as he did not look so poorly.

Hospital admission

The paramedics took Kate’s husband to hospital. Initially neither he himself nor Kate believed that he would be staying in hospital for a long time. She could not go with him due to the visitor restrictions and her own isolation, but also could not have gone for somebody had to stay with the children. In A&E, Kate’s husband was swabbed for Covid twice (the first swab got lost, meaning it took a long time to confirm that he did indeed have Covid.) He was moved to holding ward and then to a respiratory ward.

Communication

At first, Kate and her husband communicated via their mobile phones. Drawing on her clinical training, she helped her husband interpret what he saw staff do. Kate is unsure whether things were not explained to him, or whether he did not understand as his oxygen levels were low. Meanwhile, there had not been any contact between her and the clinical staff and was anxious because she did not know what his clinical picture was. Contact between Kate and the ward staff was extremely limited: on the ward, staff would say they;d ring and then would not; and they did not let Kate know when her husband deteriorated. When Kate called in and reached a nurse, they were surprised that she had not been called, because her husband had been taken to ICU. Kate’s trust in the service calling if something happened was lost. She felt this incident may have led her to call more frequently.

Kate described the ICU communication as much better organised: Kate would receive regular updates from clinical staff who would say at which time they would ring – mostly doctors but also, and significantly, from nurses – who, when she asked for honest accounts of how her husband was doing, gave her information almost as if it was a handover. Particularly important to Kate was the call from a nurse who, although Kate had spoken to the consultant already, called to tell her how the day had gone from a nursing perspective. He told her, for instance, how he had washed him. Kate was eager to speak to this particular nurse to let him know how much this call meant to her.

Kate spent time reading up on the medical research on Covid, which at this point was coming out of China alone. She describes this as her coping strategy which helped on the one hand but made it worse on the other (a double-edged swor).

Kate’s experience as a relative in the NHS has influenced her own clinical teaching – she now, even more than before, encourages students to take family members and their concerns seriously.

ICU: The ICU where Kate’s husband was admitted, was working on increased capacity. Her husband was on high flow oxygen and had been given some morphine which allowed him to rest and improved his breathing. Staff had considered intubation/ventilation, but Kate asked them not to if they did not absolutely have to. To everybody’s relief he did eventually manage on CPAP (Continuous Positive Airway Pressure). That evening, he was stable, and started to get better. Later Kate learned that her husband had also not wanted to be intubated, possibly because of seeing five people around him die, all of whom were intubated.

What Kate found particularly distressing is that a film crew was allowed on the ward, whilst she was not. She understands that there was a value in showcasing what was happening in the ward, and the work the staff was doing, but she felt resentful about it as she herself could not be with her husband when his life was fragile and precarious.

Support

During her husband’s time in ICU, Kate was isolating at home following her own Covid infection. Kate felt very supported by a friend who would listen to her on the phone. When Kate cried a lot, her friend suggested that this was anticipatory grief;, which helped Kate make sense of her emotions. Support also came from relative strangers: When the postman found out that Kate’s husband had been admitted, he brought round some shopping for the family. The neighbours gave her their phone number in case she needed something.

Transfer to ward

One day when Kate called the ICU, they said he was no longer there; he had been transferred to the high dependency ward (HDU). From then onwards she was able to talk to her husband directly again. The ward never called Kate, but she called them. One time her husband called Kate ask her to please ring the ward to make them aware that he needed the loo; she did, and he was given a call bell.

Discharge/recovery

On the 11th day staff were not quite happy to discharge him yet. The next day, Kate’s husband convinced them that Kate would be well enough equipped and trained to take care of him. He was discharged home.

Kate felt that whilst people may think that after discharge everything is well, that was not the case at all: a long road still lay ahead. Kate’s husband was breathless, struggled to get up the stairs, and continued to have nightmares. She cooked for him and cared for him. Kate felt there was very little follow-up care for him as well as for herself. The GP had not contacted him at the time of the interview. His GP nurse, who contacted him for his asthma review, had no idea he had been in ICU. His mental health care was never discussed, aside from a few questions around discharge and follow-up. Kate described feeling just dismissed by them and that was that Kate then helped her husband to self-refer to support services, but felt strongly that she should not have been the one to do it, as it involved having to disclose details he may not have otherwise have chosen to share with her. He eventually received a diagnosis of post-traumatic stress disorder (PTSD), for which he received for which he received cognitive behavioural therapy (CBT).

At the time of the interview, she felt that her husband was back to norma again. He had gone back to work after 2 ½ months instead of after the 3 he was signed off for. He has a more positive outlook on life now. For Kate, however, things have not returned to the way they were. She particularly remembers being at home when her husband was in hospital – and nobody could be with her in the house because they were self-isolating.

All in all, she felt that there had not been any support for her. Kate talked about her health anxieties; she struggles in crowded places; she gets angry when people do not wear masks; she worries that she has Long Covid. The anniversar of his admission had been a distressing time for her. She had reached out to her GP for support, but eventually self-referred to talking therapy.

Reflecting back/Messages to others

The experience has been traumatic for Kate. She found herself trying to rationalise what had happened. The most important thing to Kate is the knowledge that she can pick up the phone to call somebody (e.g., the friend who has been very important in listening to her, but also staff) – and the recognition that it has been traumatic, and the anxieties that result from it. Her message to others is to stay away from social media and to keep talking with others, because that will help you to figure out what you need going forward.

Kate advised family members to stay away from the news and find somebody to talk to.

Gender Female

Kate was relieved when her husband was home but felt that there was very little acknowledgement for what family members go through when their loved one comes home from hospital.

Gender Female

Kate felt a lot of anxiety around reinfection but also does not want Covid to be what defines her and her family.

Gender Female

Kate long searched for what would help her when she experienced anxiety and panic attacks long after her husband had gone back to feeling that things were normal again.

Gender Female

Kate felt that the liaison team could not provide what the ICU doctors could.

Gender Female

It would be helpful for family members to have someone to talk to about their experiences, Kate suggested.

Gender Female

Receiving a call from a nurse about the care he had provided for her husband on the ward was really important to Kate.

Gender Female

Kate lost trust in the ward when they did not update her on her husband’s deterioration.

Gender Female

Kate found it incredibly difficult when a film crew was allowed into ICU when she was not.

Gender Female

Kate felt ‘anticipatory grief’ when she learned that her husband may need to be intubated.

Gender Female

Kate’s husband decided against mechanical ventilation, after which his condition improved whilst he was on CPAP.

Gender Female

Kate, who works as a midwife in the NHS, felt powerless when the UK government did not lock down.

Gender Female

Kate and her husband did not recognise their symptoms as signs of a Covid infection.

Gender Female