Day 3 Knock Knock

My father’s birthday, I always feel a little sad, how I miss my dad! However, I tend to remember him fondly, with a smile, he was such a good man, such a funny man, as time goes by, I recognise more and more of his traits in myself, no bad thing given he was such lovely human being. Is this deliberate emulation or genetics?

I have bit of a cold, an irritating little dry cough, I choose to ignore it. I have a lovely morning at work. John comes in and his leg is looking better, the heat has dissipated, the skin is less taut and not so red, I am pleased, I redress his leg and arrange another appointment for him.

Having made the decision to retire, I find that am really enjoying my job, I want to finish my career working to the best of my ability and go out on a high. I have been working for the NHS for forty years , I started as a porter and then got a job as a plaster technician (left) before choosing a career in Nursing

The morning flies by, the cough is a nuisance, I try my inhaler but it has no effect. We have a CPR training session in the afternoon with an old friend of mine, later on Facebook I write

It was great to see my old mate Tim Hart today with some excellent risk adverse CPR tips, Tim is an excellent teacher and has some really innovative problem-solving ideas. We have known each other for nearly forty years I think it can be safely said "we ain't no spring chickens!"

I cough through the whole session. As we were finishing up and I am giving Tim a hand down the stairs with his gear several people come running up the stairs “Where’s Mike? We need him, quickly!”

“Ok" I say “I am coming!” I remind them not to run, never arrive at a scene out of breath!

A young woman has self-harmed, lacerated her arm with a blade of some kind, she is stood in the doorway of the practice bleeding. Our reception lead, Lisa, a very capable woman is talking to her.

“Bring her down to my room” I say. We all go to the room. The cuts are all fairly superficial, I stop the bleeding and close the wounds that I can with paper strips and dress and bandage her arm. I get a good history from her and reassure her, calm her down. She is a little manic. She has a marked nystagmus in both eyes. Nystagmus is a rhythmical, repetitive and involuntary movement of the eyes. It appears as if the eyes are vibrating -sidewards! She tells me that her voices are talking about her, not to her. She maintains eye contact. She is obviously hallucinating. She tells me there is a distressed child under my desk. She expresses that she wants to kill herself. It’s fascinating to watch her listening to voices that I cannot hear. I am concerned that she may have taken an overdose of one of her many medications, which might explain the nystagmus.

Clearly, she is at risk, probably section-able and needs to be in the Emergency Department (ED) because of the potential overdose. I discuss with Harry one of the GP’s and call an ambulance. Lisa sits with her while we wait for the ambulance. She shows considerable skill in the way she calms the patient; I am not surprised though she has done time in ED just like me. Time and again throughout my career, I have seen amazing caring skills from reception staff, HCA’s, porters, they are the low paid true heroes, always stepping up to the mark, bless ‘em all, I could not do my job without them.

After the ambulance has taken her off to hospital, I have to work like demon to catch up with all my appointments. This is what I love! Bit of CPR training, sort an acute situation, then work like a crazy thing to get everything done! Day flies by, the cough has got more constant but I ignore it. However, towards the end of the day I start flagging, I feel irritated by small problems, grouchy, nothing seems easy, I am making errors in my typing of my notes.

There has been one patient, a young man, who I tried to call several times through the afternoon but he hasn’t answered the phone, I have left messages. Unanswered calls account for about 20-25% of my day. Each time it happens, I leave a voice message and send a text, I do this twice for each unanswered call, I waste so much time trying to contact people who supposedly want my help.

I walk down to reception to say goodbye, my shift has come to an end. I am feeling uncharacteristically grumpy. Carla, one of the receptionists, tells me the patient who didn’t answer the phone is on the phone now. She is holding the handset in her hand I take it from her, he wants to know about the result of his MRI scan he had eight months before for a chronic shoulder pain “Is it an emergency?” I ask he says not “Is it Urgent for today?” he says not “Well then” I say “You have got the wrong man” and end the call. I hand the hand set to Carla. This is not like me.

My head is throbbing, I can’t stop coughing, I feel rather unwell. When I get home La Brumiola is also feeling rough. We are in bed by nine thirty and fall directly to sleep.

Harry, Carla and Lisa all become unwell over the next few days. Harry and Carla test positive for Covid. Tim thankfully is alright. John also falls ill the following week and tests positive. Covid Guilt.

Covid Nouveau

Covid is a novel virus, a virus that has not previously been seen, it is of the same kind as other coronaviruses but has distinctly different aspects never seen before. Unlike most illnesses it has variable symptoms and presentations. Initially it seemed almost any symptom could be associated with Covid, now it is recognised as having three major symptoms, a high temperature, a continuous dry cough and a loss of smell and taste.

This I think this variety of presentations is why so many “alternative theories” have sprung up about it and why initially it was so hard to treat.

Covid causes the tissue of the lungs to swell, a condition known as pneumonitis, which results in difficulty breathing and reduces the uptake of oxygen. The simplest way to measure this is with a device that fits on your finger, a pulse oximeter, usually referred to as a “sats probe”, which can measure oxygen saturation, referred to universally as sats. This is a measurement of the percentage of your blood that is carrying oxygen. Most healthy non-smokers have sats 97-98%, 95% and higher is ok, 94% is when you should start giving supplementary oxygen to the majority of patients, lower than this and first the heart and then the brain begin to take damage

Covid has a fourth symptom and that is fear. Covid is a scary disease. You can see it coming and when it gets you, you know it’s going to get worse but you don’t know how bad it’s going to get; however, you do know that people of all ages can die from it.

And then there is the fear of isolation, of dying alone and then the fear of giving a potentially life-threatening illness to someone else.

It is thought to have originated in bats although it is probable that another animal is the link to human contagion. This means that unlike viruses that originate in humans, it has animal characteristics that our immune system doesn’t recognise and cannot fight.

Unlike many viruses, Covid can mutate. It has mutated at least three times since it was first discovered. A new study published in Science confirms that SARS-CoV-2 has mutated in a way that's enabled it to spread quickly around the world. The new strain of coronavirus, called D614G, emerged in Europe and has become the most common in the world. (Science Nov 14 2020)

What we have witnessed this year is science in action, exploring, experimenting and finally finding a vaccination. It’s incredible how quickly we have discovered a vaccine and it’s now just a case of finding a way of delivering it to millions.