Critical Care with Covid-19: Just Keep Swimming
I’ve been putting off writing this one again. I feel like there’s pressure (I do know it’s only in my head) to be upbeat and put on a brave face and ideally not disgrace critical care nurses and my profession as a whole. I’m gonna stick with the not disgracing my profession, but for the rest, I’m just going to shoot for honesty. I closed the doors of the Covid ITU on the anniversary of the first lockdown. But for us it isn’t over. We got precisely no respite. The non-covid ITU was filling up and is now overflowing, and our agency nurses, who were being paid for by the emergency funds for Covid, have all been cancelled. We have been short almost every shift this week.
We are beyond tired. I cannot tell you how tired. If you take out the few months last summer when the covid numbers dropped, we basically worked at 300% for 8 months. And the summer months were full (for me at any rate) of waiting for the other shoe to drop. It was not exactly restful. Then the second/third (whatever you want to call it) peak hit and it was so much worse than the first. It was like a warzone. Prioritise the most critical jobs, crisis manage, keep them alive. I don’t think we could have done more. But not being certain about that haunts me.
There’s a condition called Acute Respiratory Distress Syndrome (ARDS). In simple terms it is a type of serious respiratory failure that affects both lungs, that can’t be explained by fluid in the lungs associated with heart failure. It can be very severe. People with Covid-19 can go on to develop ARDS, it is generally what brings them into ITU. The mortality rates of ICU patients with Covid associated ARDS are high, around 40%. Even with the best care we can give, a lot of people die. I don’t know if that sounds a lot? I’ve lost perspective now. To make it clearer: If we had 120 patients (and I’m pretty sure it was more than that) over the five month period of the second wave (end of Oct to end of March) and 40% died that means we lost 2.4 patients per week. That’s one patient every two to three days. For five months. Despite everything we did for them. It takes a toll. I’m going to carry this for the rest of my career. I was never a fluffy-bunny person, but I think I maybe a little closer to dead inside now. Certainly the sense of humour is darker now.
Now we’re back to non-covid patients and we’re seeing what I suspect are the late presentations again. Lots of out of hospital cardiac arrests (people who die in the community, that the ambulance crew manages to resuscitate) and septic patients and a few suicide attempts. Some of the cases are difficult but I think it’s just that there’s no rest. We just keep on going. And we’re tired. Did I mention that part? My brain has gone squidgy. I think I have been running on adrenaline for so long now it’s receded a little, I’ve forgotten how to function without it.
And on the tail end of this huge effort of all of us working our arses off, the government has decided that we deserve a whole 1% pay rise. 1%! I feel so valued. Let us not forget that we have just quite conclusively demonstrated that the country literally cannot cope without us. Nurses as a whole and critical care nurses specifically, the whole world cannot cope without us. You cannot magic one of us out of nowhere, you cannot replace us with any other nurse and you cannot manage without us. But 1%! Thanks for that.
I don’t know if it’s hugely cynical or just an accepted negotiating tactic…but I can’t shake the feeling that this is the government’s low-ball offer, so that when the pay review body recommends 5% they can say ‘Aha! You’re right — it should be more! Let’s meet in the middle at 3%!’ and then they get through a 3% rise when the Royal College of Nursing is asking for 12.5% to correct for the long-standing cuts to nurses pay over years of funding squeezes.
Or maybe they just genuinely believe 1% is all we’re worth.