Dispatches from the Covid-19 frontline
‘I am an NHS nurse treating coronavirus patients in the ICU. We’re fighting a war and soon we won’t have any bullets’
‘I don’t use the bathroom for hours on end because the cost of time and equipment is too high’: a critical care nurse tells Helen Coffey about her experience of fighting the pandemic
The Independent’s ‘Dispatches from the Covid-19 frontline’ is an interview series detailing the reality behind the headlines as told by the nation’s vital key workers. Samantha Margerison, 57, is a critical care nurse working for the NHS on the south coast of England. She tells Helen Coffey what it’s like to work on the front line right now.
I’d only been an intensive care unit (ICU) nurse for 18 months when the coronavirus pandemic hit. I retrained when I was in my fifties having worked in IT for nearly 30 years. I had a successful career, but I didn’t want to make money for people anymore – I knew I wanted to work in critical care.
Even before Covid-19, ICU nurses had a hell of a lot of responsibility. Doctors will decide on a course of treatment, but moment to moment, how much sedation a patient needs, how much oxygen, all the checking – we’re responsible for all of that, so you have to be on the ball. And doctors listen to us; they ask for our opinions.
When I look at my experienced colleagues during the current crisis, I continue to be amazed at how skilled they are. At the same time, I’m struck by how challenging it is for all of us. It’s such a stressful, surreal time.
Getting ready for work is a time of anxiety now, because you don’t know where you’re going to be placed. There’s the normal ICU, the Covid ICU and the surge capacity satellite wards, set up because of the number of patients we’re seeing. Every shift I could be working in any of those settings.
I have to get into work earlier – to try and find a parking space and so I have time to don all the personal protective equipment (PPE) – before going to the handover, where all the nurses get a five-minute summary from the nurse who was in charge on the previous shift.
There are lots of new faces. Nurses who don’t usually work in ICU are being redeployed; for instance, I had a nurse working with me last week who normally works in the ophthalmology unit, so her specialism is eyes. She was amazing, she stepped up and it was a pleasure to work with her. It’s vitally important to make these folks feel welcome: they’ve got the normal anxieties that any of us have, plus they’re working way outside their comfort zones and experience.
The biggest change is PPE. If you’re working in a Covid zone, before you even enter the outer doors of the unit, you have to put on gloves, a long-sleeved gown, a tight-fitting face mask or some hospitals will provide air hoods – they look like a space suit. If you’re wearing a face respirator mask, you also have to put on a face shield and something that’s essentially a shower cap over your hair. You wear that for the entire time you’re on the unit. When you go to the bedside of a patient, on top of all that you’ll put on an extra set of gloves and an apron.
Wearing all this gear is hot; it’s physically draining. Trying to talk is hard as it’s muffled through the mask, so you shout and your voice gets hoarse. You’re thirsty, too. Before Covid, you might say to a colleague you needed to pop to the loo or get a drink of water and you’d be back in 60 seconds. Now, the simplest self-care activities require stripping all the equipment off in the safe zone and then being re-garbed. The reality is you don’t dare do it for hours on end, because the cost in terms of time and equipment is too high.
It also makes it more difficult to reassure the patients. We talk to them as we examine them – we describe what we’re doing. Now, with the masks, it makes it hard because you’re shouting; the patient can’t see that you’re smiling; and with two pairs of gloves on, there’s no touch either. My heart bleeds for them – it’s like they’re surrounded by space aliens, on top of being terrified about what’s going to happen. It’s why I launched the COV-ID project, which encourages healthcare workers to wear a photo ID style badge when they’re in PPE. It shows your name, your role and has a smiling photo of you to help reassure patients and meet that basic need we all have for human connection.
By the end of a 12-and-a-half-hour shift, I’m absolutely exhausted. But it’s still not over: I have to do a full decontamination, remove the PPE and do multiple handwashes. It doesn’t feel safe to head home until I’ve had a shower – particularly after wearing all that hot, heavy, sweaty gear – but there aren’t many showers, so there’s invariably a queue. When I finally get home, I feed the cats, I feed me, and I fall into bed. It’s eat, sleep, nurse, repeat at the moment.
In the ICU we’re invariably treating very sick people, and they sometimes don’t make it. That’s always a horrible experience for everyone involved – but the frequency of that is increasing right now. And then there’s the added stress of knowing that, if I make the slightest mistake and get infected, I might pass it on to my colleagues, or other patients, or friends and family.
I’m part of a small project where we’re ensuring the healthcare workers in the UK who have died from the virus are remembered – as of a few hours ago [at the time of writing] it was 110. That’s not what work is normally like for us. I know a lot of people don’t like the war metaphor – but we’ve been drafted into a war against an unseen enemy, which is taking our patients, taking our colleagues, taking us. There are big concerns about stocks of PPE too; we’re in this war and soon we won’t have bullets.
I wish I could believe that nurses and all frontline workers will be more appreciated after this. A couple of weeks ago, Matt Hancock was interviewed on TV and was asked how many nurses had died of Covid-19. He didn’t know. We were already short 43,000 nurses before the pandemic; when all this is done and dusted, a lot of nursing staff will have been taken away by the virus and a lot of nurses will experience burnout.
For a decade and a half, the salaries of NHS workers have been eroded. I have an MSc, two bachelor’s degrees and I literally provide life-saving care to people – and I earn £24,000. I love being a nurse, but I don’t think it’s fair that a workforce that’s so essential is not valued. But at the moment my priority is looking after very sick patients.
That’s why my biggest message to people is this: it is vitally important we maintain social distancing. It literally is a matter of life and death. I saw a good analogy the other day that said if you jump out of a plane and you’re plummeting towards the ground, you deploy your parachute to slow the descent. You don’t think, “Oh, the parachute’s working – I’ll cut the strings”. It’s the same with the lockdown.
Please know, coronavirus is not “a little bit worse than the flu”. It’s a death-load worse than the flu. And it’s not just people with complications who are affected either. Young people who are fit and well are dying while cut off from their families. Please stay at home because this is serious, deadly stuff.
Details of the #CoveEyeDee project can be found on Twitter or at whatwouldflorecedo.com/cov-id
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