Day 6 An Admission is made

Sunday 15th November, I don’t sleep. I can’t. I walk more briskly, I try 50, then 60 paces it’s no good, my sats drop to 92 and occasionally 91. It’s no good, I have to admit it, I just have to face reality, I need to be in hospital, I have to call 999, it’s just….well….I don’t want to.

A life-long career in nursing has given me a healthy aversion to hospitals, people die in hospital and I don’t want to be one of them! I think of the awful food, the noise at night the plastic duvets, the hot stuffy, smelly wards, I will never sleep, I do NOT want to go!

This is no good, I have to face facts. I have a very real fear of dying from this illness, I need a strategy for survival. First, I must face my fear. What exactly am I afraid of? I remember a patient I nursed on ITU she had Swine flu. Her condition caused the tissue of her lungs to swell, pneumonitis, she became very difficult to ventilate and provide oxygen for her brain. The team tried everything, I had every faith in them, Intensivists are certainly some of the cleverest doctors there are and we had some of the very best on our team. They intubated and ventilated each lung separately, a superbly skilful intervention, they mixed Nitric acid into her oxygen to increase its uptake, they used every drug we had. Despite all this, she died on the tenth day, 32 years old, a mother of five.

From flu. I could hardly believe it. The unit was deeply affected. It was a fight we did not think we would lose.

So, fear of dying then, definitely at the top of the list. Fear of the intubation, certainly, with my lungs I would never survive. Survive I must, therefore I need a strategy for survival. What are my strengths? My sense of humour! It has been getting me into trouble since I was old enough to speak. Right! Check weapons grade sense of humour packed and ready to use

My stubbornness, inherited from both parents and evident in every Peters that ever was. Right that will have to do. I will deal with this with humour, I will relate to my family and friends with humour and when the illness really gets bad, I will dig my stubborn heels in and never give up, never surrender. Thanks Galaxy Quest for that quote, that will be my motto

I don’t feel like laughing right now though, I want to cry. I make a decision; I will purge all the negative feelings. I sit and I think about all the awful stuff that might happen, I visualise myself in ITU, intubated, I imagine the vent getting switched off, the tube being cut, keeping the cuff up to retain fluids, I see myself being laid out and wrapped in the final NHS printed gown and regulation sheet like I have done for others so many times before.

I see my beautiful Brum devastated, I can picture her, not sobbing but numbed to a catatonic state, my lovely children weeping, my sisters in bits. I think of my dear musical friends and the songs we will never sing. I imagine the lonely cremation a far cry from the joyful party I have always imagined my funeral to be. My imagination makes it rain.

I remember sitting through the long lonely night with my father when he died, if I had known what it would cost me, I don’t think I would have had the courage to do it, I weep for that night too and the hurt that I took from it.

I weep, I sob, I grieve for my dead self and the pain it will cause to those who I hold most dear. I purge every negative feeling; I completely fall apart for a good 30 minutes or so and then I sit bolt upright. “Right” I say to myself “NO more of that, from now on I am going to put on my cheerful face and deal with this positively”

I go into the garden and look at the moon, I stretch my arms above my head into a full Julie Andrews and take a deep breath. I bring my hands down to my umbilicus and exhale, just like my friend Ash taught me.

I have always been blessed with a cheerful nature. My mum once told me “You are like fishing float Michael, no matter how deep the water or how fast it runs, you will always float to the top!”

Mind you, mum also used to say, quite cheerfully “It’s not the cough that carries you off, it’s the coffin they carry you off in”

At quarter to four in the morning I post on Facebook

Chilli still burns when you have no taste or smell. I know cos I got some on my nob-don’t ask!

I didn’t really get chili on my nob, I just had to reinforce the decision to use humour as a weapon!

I am going to use Facebook as a weapon too, I am not going in alone, I am going to take everyone along with me.

I pack a bag, wash kit, couple of books, some tee’s and at about eight o’clock I wake Brumanji and tell, her I am going to call an ambulance, I ask her to come and have a cup of tea with me before I call. Bless her she’s clearly not well. I make check her sats and take her temperature.

We sit quietly, I just want one nice cup of tea, I tell Brum about my strategy, she finds an email I have sent her with a link to my life insurance, it’s an awkward moment, but we deal with it. “I don’t want to go” I tell her. I don’t want to leave her.

Reluctantly I dial 999. Ten minutes and I see the big white bus pulling up outside the house. The crew are as always efficient, friendly, professional. We meet Matt, smiley student paramedic under the wings of a very capable looking qualified colleague mentor, Helena, I think.

They start some oxygen, I take a few deep breaths and begin to feel better, I am aware of a previously unrecognised pain around my heart easing. An ECG shows S-T elevation in leads V1 and V2, not I think a myocardial infarction, a heart attack, more likely just the effect of prolonged mild hypoxia. I say good bye to Brummagem, I don’t want to let go of her hand

As we walk out to the ambulance, I make a pretence of walking around it and checking the tyres. I am such a dick!

We arrive at the hospital. I am feeling a bit awkward about this. I was in the Emergency Department (ED) for twenty years before it moved from dear old lovable Frenchay to this new, huge, airport terminal-like hospital. Will any of the old crew be on duty? Will they remember me?

There are ambulances queuing but we go straight through to ED, right in to the middle, no drafty, cold wait in a doorway like the old days.

As we enter the unit a familiar smiling bearded brown face pops out from behind a pillar and does a silly wave

“Joydeep! Now all my worries are gone!” I say. Joydeep is an old friend, ED Consultant, an excellent doctor, we share a similar sense of humour and are equally cynical about politics. Now I know I will be safe.

I meet Helen, registrar and an old friend Louise, nurse colleague, and they very quickly cannulate me in two places, take blood, organise a chest x-ray. My blood pressure is high,190/116, my sats were low on air 89% and I have a blood glucose level of 22mmol/L which is high

Various masked people come and wave at me through the glass panel of the door, I guess they are old friends but my blurry vision and their masks mean I can’t be sure. I recognise Fiona, another old friend, we wave, it’s lovely to see her smiling face.

From the suitably a safe distance of the door Joy and I reminisce. I meet James the medic. They think I may have had a Pulmonary Embolism (PE), a blood clot in the lung or a Myocardial Infarction (MI), a heart attack. A CT scan is arranged and then cancelled as a blood result, D-Dimer positive shows that I cannot have a clot. Check ECG shows that I have not had a heart attack, later, bloods for cardio enzymes confirm this. The chest x-ray shows “some infection”. This my friends, is pure Covid.

They start IV Dexamethasone, a powerful steroid, intravenous antibiotics, Co-Amoxiclav (my friend Domestos), IV Paracetamol, an infusion of Hartman’s solution, as I am dehydrated and a cheese sandwich. I have an injection of Clexane (blood thinner) in my belly an injection of insulin also in my belly to lower my blood glucose.

On Face book I post

Hospital food has not improved

If the virus don't get me I will starve to death

This draws a lot of comments,112, many very witty from colleagues, friends and family. So far, my survival strategy is working I am bringing them all with me and they are making me smile

Joy pops in to say goodbye, his shift has ended “Don’t worry my friend” he says ”I am almost certain you will survive!”

The evening draws on. I dim the lights and try to sleep, at staff handover, the door opens and stood there is a slim nurse, with blond hair, I can’t make out her features and she is wearing a mask.

“Remember me Mike” she says “Natalie!”

Of course, I remember her! When I was a senior nurse in ED she worked there as an HCA, she wanted to train to become a paramedic and I convinced her she should try nursing and here she is now as the sister in charge of the night shift!

She tells me she still remembers some of the advice I gave her back in the day. I couldn’t be prouder if she was my own daughter!

On Face book I post

So many kind messages I have the best friends

Don't be offended if I don't always answer, there are so many

And I am very tired Thank you all I am really feeling the love xxx

and

1802 It's kind of nice to touch base with my old ED buddies again. Although there are better ways to keep in contact.

and

1930 Oxygen! There's a thing! Don't take it for granted You certainly miss it when it's not there

And then I am out of ED and up to ward 31B AMU where I meet tall, funny, satirical nurse Pat who equips me with a long extension tube to my oxygen so I can wander about my room. “It’s a bit long” she says. “That’s ok “I say “I can nip to the pub and I won’t even have to disconnect it!”

And I meet petite Dora Petrova, a care assistant, associate practitioner? I can’t keep up with the changing titles that the low paid providers of care are given these days. To me they are all nurses. They are always paid peanuts and they do all the heavy lifting and the really horrible dirty jobs and invariably they are kind, caring and compassionate. They are the backbone of the NHS. Dora is certainly all these things. We sit in the dark and talk. She is from Bulgaria; she would like to train as a qualified nurse. She is not afraid of Covid, she thinks it’s an opportunity to learn about a new disease and is glad to be able to help at a time of National Emergency. We swap stories, she is fascinated by my long career, we talk about food and she tells me her favourite recipe, one that her mother has shown her. It’s a spicy chicken marinade and I would share it here but ...

My feet keep touching the end of the bed, I guess I am too long for it. It’s a clever electronic bed with a smart mattress that undulates under me like a great serpent. I hop out and take the end of the bed off and push it under the bed. It has a hand set that lets you adjust the angle the bed is at, you can sit right up or go flat, there’s another control that raises or lowers the foot of bed. This reminds me of a Simpsons episode where Homer is in hospital in a similar bed and he happily plays with the handset “bed-go-up-bed-go-down, bed-go-up-bed-go-down, bed-go-up-bed-go-down”

This proves irresistible.I nkow the kids will get the joke! With my mobile I make a little video to send to the family, showing me pressing the hand set and saying “bed-go-up-bed-go-down, bed-go-up-bed-go-down, bed-go-up-bed-go-down”

Unfortunately on the third repetition the bed stops working. The bed is now stuck at an angle just too shallow to sit up but equally too steep to comfortably sleep. No amount of pressing the buttons makes any difference. I don’t want to bother the very busy staff so I investigate the controls. There’s a separate bed-go-up-bed-go-down pad on the bed end which of course is now under the bed.

I get out of the bed and get down on the floor to investigate, I wonder if the connecting lead has come loose, I unplug it plug it back in, try the controls. Nothing I try makes any difference

“What are you doing down there? Have you fallen over? Have you fallen out of bed?” says a voice from behind me. A very capable looking nurse with a stern “we will have no nonsense here” look on her face has come into my room. I explain the bed has broken and sheepishly climb back in to bed.

She looks at the back of the bed, the power cable has caught on the end of the bed behind me and when I made it go up and down it pulled the plug from the wall. As she plugs it back in, she gives a look that only a veteran nurse can pull off. A stare as straight as a laser, as unblinking as the sun, burns into my head. It says “you unthinkable idiot” as clearly as if she had leant over and whispered it in my ear and goes on to say “any more from you mister, and you will be sleeping on the floor”

I thank her in a tiny meek voice that I probably haven’t used since I was four years old.

My room is on the ground floor. One wall is all window of frosted glass. Outside there is a bright orange street lamp, so the room isn’t quite dark. there are some small trees or saplings outside as I can see the branches silhouetted on the glass. They are swaying in a stiff breeze. There must be a road out there as passing car headlights occasionally light my room.

I am sweating profusely. The dexy kicks in and I am wired! It’s like a dirty amphetamine or maybe some bad ecstasy. In the darkened room the monitor is flashing and beeping as is the infusion pump, flashing green lights, irregular beep, blart, beep, beep, blart, a phone ringing constantly, a call button sending its persistent, insistent call a sullen, mournful boop, boop, boop.

An ambulance shoots by its bright, blue lights illuminating the walls, reflecting from every shiny surface, the window erupts into a mosaic of dancing, gyrating tree shadows and I am at the world’s worst rave and in my sodden, sweaty bed I silently start throwing shapes and dancing to the imagined, hidden beat of pure Drum ‘n’ Bass.

Covid Isolation

I think it is safe to say that any stay in hospital is unpleasant for the majority of people. There are none of the comforts of home, it’s a strange, noisy, brightly lit environment, there is anxiety about health and the treatments that might be used, not to mention the uncomfortable, invasive procedures performed by strangers.

Usually, in non-Covid times, this is ameliorated by the visits of relatives and friends, bearing perhaps chocolate treats or the traditional bunch of grapes, but cruel Covid has put a stop to that!

Relatives make life easier for everyone (usually) they provide emotional support to patients; they are a great source of information for the clinical team and can improve communication with patients who have limited understanding or have problems with hearing or vision. Family members can help the patient understand what is happening, they can help to interpret findings and explain symptoms and therapies.

For elderly patients, especially those who are can not use a Mobile phone, this isolation from family must be particularly hard to bear. Many elderly patients have reduced hearing, often the gradual reduction of hearing is just accepted as part of the aging process and they rely on lip reading or raised voices. There can be no lip reading where masks are worn.

There is minimal physical contact and only what is necessary for the provision of care, there are no hugs, no one to hold your hand.

There are no opportunities to meet your religious and spiritual needs either. No visits from whatever representative on Earth your particular deity uses.

With Covid, you are alone.