Day 7 the calm before the storm

Monday 16th November In the night I am moved to another ward, 26b, it’s a dedicated Covid ward, usually it is a cardiology ward but needs must. I am in the Plague Pit. It’s actually run by an old friend of mine Ali who comes to see me in the wee hours. She’s an excellent nurse and I feel safe here knowing she is in charge.

There’s a big pink clock on the wall. It ticks, loudly! I hate a ticking clock; I hate the way they make me aware of the passage of time. Mentally, they age me, I can feel grey hairs growing, wrinkles forming. I consider my options. It is high on the wall. It looks as if it’s out of reach, sabotage probably not an answer then. It is loud, it forms an undercurrent of sound below the beeping of the various machines and rumbling of the bed motors, constantly shifting the mattress around. But it is still there. A regular beat through the chaos of the various other sounds, loud, steady and ticking away the seconds of my life.

I realise I am going to have to accept it. I try some mind games with myself. I carefully count the beats and work out how often it ticks and then I deliberately try to not hear the tick, to ignore it, to hear past it to other sounds, initially I find that making a little noise to cover it helps. I sit on my bed, sweating, feverish, the dexy running through my veins making little noises every couple of seconds

This doesn’t seem crazy to me. I guess you had to be there.

At 6 am I post on Facebook

Sats 96 on air! Yeh Covid You better run

Cos I got my buddies with me And they are nurses too

I am having a day without oxygen. I actually feel quite a lot better. I think I will suggest that I can go home. Of course, what I am forgetting is that my fingers are pricked twice every hour or two to check blood glucose level and ketones. I am having two hourly jabs of insulin, a jab of Clexane and three lots IV antibiotics as well as my IV dexy!

I meet Joan, nurse, and Kiki, who is very important, she brings the meals and Anton, charge nurse.

Several doctors drop in at various times, I don’t always get their names, my BP is dangerously high, 240/135, I am dehydrated, I must drink more. One doctor, Sean, tells me that I am being considered for a new antiviral drug called Remdevir, he tells me that it might damage my liver, if I choose to have it, I will need daily blood tests to monitor this.

He says that in trials it has increased the chance of survival from 5% to 10 % in cases like mine and that where successful reduces the length of time that pneumonias take to heal.

“Yep!” I say “Yes please, give that and anything else that might help, bung it all in!”

When he leaves, I realise what he has just said 5%! Five!

He returns later I ask him about the 5% he says “give or take a bit!” I get the idea that Sean has seen a lot of patients with Covid, I can tell that it does not always end well, there’s a sense of resignation about Sean, the war weary vet, a bit of the thousand-yard stare

He tells me that days 6-8 are the critical days, that Covid patients often suddenly deteriorate and crash on those days and if we get through those, we will be ok. We!

“Well, that’s good then” I say “Because I am on day 7 and I am feeling much better”

“You are on day 5” he says “we start counting from the day you had definite symptoms, your fever. Listen, if you do suddenly drop your sats things are going to happen very quickly. You will be moved to the High Dependency Unit for supported ventilation and if that doesn’t go well, then we will tube you and take you to ITU. If that happens, it will happen very quickly and you won’t be able to talk so make sure you phone your loved ones today!”

Day 5! I need to reset my clock. I start drinking more. As much as I can. I am not going to die in here.

I ring my lovely Brum at least three times daily. I hope she is ok, home alone and also ill with the virus. She has been getting a lot of support from family and friends she tells me. I love her so much I cannot put it into words. We just fit. We love each other’s company and can sit quietly together for hours and never get bored. There’s not a day that goes past where we don’t spend some time looking into each other’s eyes. I play some of the recordings we have made, she has a fantastic voice and hearing it brings me comfort.

On Facebook I post

1808 I have never seen a nursing team that works as hard as this one. A 32 bedded ward, all Covid patients. If one of them goes down, the others don't get to self-isolate, they carry on. None of them are given a choice about working here. There's no increased pay for the risk they take. They have piss poor level two PPE. The charge nurse came in at 7 finishes at 8 has not yet had a break. Has three nurses instead of five for his section. He's just been told of another sick day tomorrow and that there will be no cover. He is visibly stressed and tired. I wonder if he sleeps. Who would do this? It's like working in a plague pit. Imagine how their families must feel. I'm shit scared I'm going to infect them so I put my mask on when they come in. They have a confused old lady who won't stay in her room. The emergency alarm has gone off three times in the last hour. And I have had every test every drug and every meal bang on time. These guys are awesome. I thought I was a good nurse but I can't touch this. Don't none of you ever dare clap ever again.

EDIT I've had a lot requests to share this post please feel free share away

This post must have struck a chord because it was shared 479 times!

That evening I make the two most difficult calls of my life to my two lovely daughters. I steel myself to stay strong and I relate to them what the doctor has told me. I tell them it is ok to cry but I have to stay strong. I am not going to get emotional. I tell them it might be the last time I get to talk to them and that there are things that need to be said.

I will not embarrass them here by naming them or revealing any details, of our conversations but I can say that I told them how proud I was of them, of their achievements and how they have grown to become, two wonderful, original, unique, socially aware, funny, witty, intelligent, strong women, who are generous of spirit, not frightened to be themselves and a positive force in this world. Of course, I make them cry, but I make them laugh too

I talk for an hour with each of them, both conversations end on a positive note, I hope I have done the right thing and not distressed them needlessly.

Music has always been a huge part of my life, I gain so much inspiration, joy and satisfaction from listening to music and playing guitar and harmonica and from hearing Brumarosa sing. I play some of the recordings and videos we have made, particularly a cover this song Fade.

I play various pieces of music to keep me calm and help pass the long hours. I love this, Yagudky by Dakha Brakha, a Ukrainian folk band, for me this could be backing track for Covid, a lament for mankind, its deeply sad, sombre tone and haunting voices a perfect accompaniment for a world plague, it’s a dirge to purge my blues.

And on Facebook I post

It feels like the world exists in two different universes. The clean one, where ignorance carries on as usual

And the universe of plague. People are dying in both

This is a mournful, beautiful purging lament suitable for the occasion. Lamenting our previous lives perhaps or those that have fallen.

I think am becoming a bit of a favourite patient. Some of the staff stay longer and have chat. My room a has become a bit of an oasis for them, most of the patients are elderly, many of them are confused, none of them are happy, all of them are scared. They are not easy patients to manage.

I write a piece about this and post it on Facebook. I call it Covid Challenges and it is reproduced below.

Covid Challenges

Illustration by Katie Morris (my daughter)

Covid isn’t simply another disease. It presents particular problems which make nursing care even harder.

Nurses are traditionally kind to confused patients. There is always one on a night shift, everyone remembers their name.

Elderly patient, wakes up in a strange place in the dark and gets frightened, often aggressive, inevitably wanders looking for something familiar. When there is a confused patient, all the staff are aware and keep an eye out for them, keep them safe, adapt coping strategies, talk in soft kind voices, often sit with them, sometimes sit them near the nurse base.

The confused patient drains resources, is a constant drain on time and energy, and never, ever wanders out of a door at a convenient time.

This wave of Covid is producing a flux of elderly displaced patients who have no direct contact with their family members. A nurse today told me there are three times as many confused patients as usual. Covid has neurological effects in most people, in its simplest form this presents as “brain fog”

Covid has subverted the traditional caring role of the nurse in the hospital setting.

Nurses are not afraid of disease. They know how to deal with it. Infectious patients are treated in a side ward, a process called barrier nursing commences. Nurses don PPE to enter the room and remove it when they leave. The patient is safely isolated. All staff know the procedure. The patient receives the best care most safely. A great system, that with diligence, stops the spread of disease.

Covid is having none of it. It sneers at barrier nursing.

All the patients on the ward have Covid. Barrier nursing stops at the door. The ward is the infectious patient, and all within carry the disease.

Staff wear a plastic apron, a thin, cheap piece of blow away plastic which barely covers them. A standard surgical mask and a visor. This is laughingly called PPE 2.

The mask is essential but it makes communication difficult and Covid neutralises and muffles the nurse’s best weapons, her smile, her words, her reassuring ways, so calming, the stream of wise, hard earned words that quell fear, remove pain, explain symptoms, seek to reassure and increase understanding.

Nurses are taught about nonverbal communication and they are masters at it. They can make you laugh with a slight change of stance and a twist of the head, but a mask to the eyes is hard to work with. Masks are sinister. Scary. Dehumanising. Covid- damn your masks!

Covid patients are different. They have an insidious illness that they have been hearing about for most of the year. They know it can kill them. Their knowledge has mostly come from mainstream media, they are frightened, terrified in fact. This is human nature. And we nurses know that terrified patients do not hear well. They do not receive or retain information, they become defensive, demanding, aggressive. Their character changes and we don’t always see the best of them. The Covid patient in hospital will never be anyone’s favourite memory.

Traditionally the nurse will sit for a while with anxious patients, reassure them, speak kind words, explain the symptoms.

Covid has changed this too. Not only is there not a moment to spare, every minute is packed with taking and recording observations, delivering drugs, providing hygiene, but something far more subtle is happening.

Covid is a different disease for everyone who gets it. Each patient has a different regime, different needs in a way never encountered before. This variety of presentation is a complication not previously encountered. How do you explain a novel illness to someone who may not be thinking as they normally would? Through a mask.