Critical Care with Covid-19: The Worst is Yet to Come
I haven’t checked in for a while and I feel like I should. But I don’t know what to say. The worst is happening. Everything I feared is coming to pass.
Right now my 12 bedded ITU is currently caring for 31 people. We have transferred around 10 others out to other ITU’s just to give us more space. We are sending them all over the country. Anywhere there is a free bed.
We are cramming people in to our existing areas like sardines. Because we don’t have enough nurses to open a new area. A new area means you need 2 nurses minimum because you need to be able to cover each other for breaks, go fetch things, support each other, get help…The more nurses there are in one area, the easier this is. We don’t have 2 more nurses.
I took four intubated patients (patients with a breathing tube) on a shift this week. With excellent help, but it’s still hard. There have been shifts this week where there have been 6 intubated patients to 1 ITU nurse. Staffing has taken a hit lately because of the numbers of people either self-isolating or suffering with Covid. The worst thing is that although the daily number of cases has started to drop, it generally takes a week or two for people to become very unwell so for us, the worst is yet to come.
I’m really tired now. We’ve been doing the Covid thing properly again since October and I’m really tired. Covid patients aren’t like regular ITU patients. They’re all really sick. Like, falling through the floor, trying to die on you every ten minutes, sick. It’s exhausting. They hate being stimulated, so touch them, suction them, talk too loudly near them, look at them wrong and they desaturate (drop their oxygen levels) on you. They’re so sick they need tonnes of support, proning (lying on their belly), complex ventilatory management, filters (kidney support), multiple BP (blood pressure) meds, research trial drugs, extra scans…the list goes on. So we’re tired. Even the most chirpy of us are starting to lose it a little now.
To top it all, PHE has decided that all areas that have aerosol generating procedures (procedures that create small airborne droplets) must be in full PPE at all times (Or at least, that is the way my trust has interpreted it). The long and the short of it is that the whole ITU, including the Covid negative area now has to be in full PPE. I understand this is to protect everyone, staff and patients included. But it feels like losing the last opportunity for respite. I have worked 1 and ½ shifts in the negative area since October, so not exactly a lot, but it was a little bit of hope.
I know there are people out there, particularly in the bits of the country that haven’t been as hard hit, that haven’t directly felt the impact of Covid on themselves or their loved ones. The people who’s lives have been hit far harder by the lockdowns and restrictions than by the disease itself. You will feel it soon, if you haven’t already. If no-one you know ever gets Covid (and I hope not) you will feel it when you cannot get a hospital appointment. When what would normally be considered routine care is put on hold indefinitely. Because every time we have to accommodate a Covid patient, it leaves a little less space for everyone else. If you doubt how serious this is…just take my word for it. Just stay apart. Stay away from people. Because I’m really tired. We’re all really tired. And we want to still be able to keep going, because if we can’t, then there will be no one left to help you.
