Critical Care with Covid-19: What Now?
It’s been quiet lately. (To all of my colleagues: I’ve done it. I’ve said the q-word, sorry in advance) This is both good and bad. It’s good because with fewer people in, life is easier at work and we’re getting a very much needed break. We are also catching up on stuff that was left by the wayside when we were manic. Getting ducks in a row for if it gets bad again.
But where are the patients?! If you ignore Covid for a moment, there is always a steady trickle into ITU. Heart attacks, head injuries, major surgeries, severe infections, there is always an unlucky proportion who are very unwell. I’m hoping the infections are happening less because people’s hygiene is better right now (namely hand hygiene) and we’re avoiding other people, so the usual culprits (flu, chest infections) are not being spread at the moment. Perhaps the people who would normally be throwing clots (strokes, heart attacks, clots in their lungs) or pushing blood through narrowed vessels (angina, more heart attacks) aren’t doing because they’re not exerting themselves as much at the moment? But I can’t shift a nagging worry that people are scared to seek help, because they’re worried hospitals are not a safe place to go right now, so are becoming more unwell or dying at home instead.
Speaking of worries…I am struggling not to be anxious about the future. I’m generally pretty chilled, it takes a fair bit to get me anxious. But I can’t seem to get over… Have we relaxed too fast? Will we have a second peak? If we do will it be worse than before? I’m starting to question if my anxiety is rational or whether I’m over-cautious because of what I’ve seen. I was asked this week: “How bad was it? You don’t seem traumatised? Unless you’ve hidden it?”
I’m pretty sure I’m not traumatised. I don’t feel too bad about what happened, but the longer you look back the more you realise it most definitely wasn’t fun. I keep thinking back to a particular group of patients, all in one of the overflow wards together. There were eight of them. Two lived. The mortality rate from Covid (percentage of people who die) is higher than for our usual, general ITU population. So more people were dying. We can handle that. It’s hard when people die, but it’s something we already deal with. The thing I found the hardest was the uncertainty. Normally, people come through the doors and you have an inkling. Age, pre-existing conditions, what they’ve come in with, how they look — you get reasonably good at judging how well they’ll do. There are always people who buck the trend but…by and large, you have an idea. But Covid patients…they all come through the door looking exactly the same. High oxygen requirements, not maintaining sats (oxygen levels in your blood) and starting to get tired (when I say tired I don’t mean Covid related exhaustion, I mean the effort required to breathe and generally function is becoming too much). You just can’t call it. You have literally no idea who will live and who won’t. I didn’t realise that mattered before Covid. Apparently it does.
So, take the fact you just don’t know what way your patient will go, add to that the guidance changing day by day. You don’t know what rules you’re working to until you get there each day. You’re covered in PPE, you’re hot, slightly sweaty, your face hurts, round the back of your head where the straps go does too. It takes 10 mins to get your kit off just to go pee! You’re busier than ever and supervising other people who expect you to have all the answers. You finish your shift, worry about taking it home to your family, shower and still don’t quite feel clean. We did this every day for months. From the beginning of April to the end of June. Some units are still doing it. So yeh, not fun.
And it might happen again. It might be worse.
I guess it makes sense that I worry. It was a lot to deal with. Physically, the dermatitis on my wrist has cleared up and my nose isn’t sore anymore. But mentally I think it’s going to take a bit longer for a lot of us to reconcile. I’ve heard people mention PTSD and I think it’s a very real concern for the people who cared for covid patients. If another peak were to come, I worry about all those who are a bit wobbly dealing with it a second time around. We know more now, guidance should change less, but the workload and the mortality rates are unlikely to have changed much. And the PPE’s not going anywhere. The adrenaline carries you through when it’s all going on, but looking back after…I think that’s harder sometimes.
For anyone who worked with covid and is struggling — the Laura Hyde Foundation are a wonderful charity who offer mental health support for healthcare workers, they have lots of resources and people to speak to. Find them at: https://laurahydefoundation.org/