The following are four pieces of writing, three by fellow American nurses and one by a Canadian nurse. We have all had different experiences but the core feelings are the same.

At the start…

by Rachel Cutshall

I very clearly remember the day the pandemic became real for me. In theatre (the main operating room), our days always begin with a multidisciplinary meeting to discuss the cases on our list. After making a plan for the day we talked extensively about coronavirus and what it could mean for us as healthcare workers.

There were only 51 cases in the UK at that point, but the scope and severity of the situation quickly became obvious. For the next few weeks our department was a hive of activity. Our anaesthetists spearheaded efforts to prepare the staff for the pandemic. The hospital was selected as a regional surge centre and as a result the elective caseload reduced to prepare for a massive influx of patients.

Instead of scrubbing and circulating, I worked alongside the anaesthetists and our education department to develop COVID-19 policies. I taught donning and doffing of protective personal equipment (PPE) and fit test staff for FFP3 masks. The department was buzzing for weeks, we took a course to prepare us for critical care nursing, and then we waited. We saw the tide recede and we braced for a tsunami that never came.

The tsunami that never came…till now

Fast forward to a year later and I wish I still had the adrenaline from the first wave. What we expected to happen then is happening now. Resources are stretched. Staff are exhausted. Beds are full. People are saying “it’s all hands to the pumps” and “it feels like trench warfare” and they aren’t wrong.

Instead of working in theatres, I’m now supporting learners across the Trust. A challenging role, but one that I think is extremely important. With pressure building from every side it’s essential that we remember to care for and support one another as best we can.

You can learn more about Rachel at her blog Anywayward which she launched at the start of the pandemic. She wrote an in depth piece at the start of the pandemic worth reading. Read more about her experiences as an American Expat and nurse in the UK.

Track and Trace

by Jamie Davies

I am a COVID-19 Test and Trace nurse for my Trust. We monitor positive COVID-19 employees or family members of the employees. The staff or family will get tested at designated sites outside the hospitals and we monitor the results and follow up. Our goal is to be quick and swift in notifying them, confirming they are not working and isolating at home. We ask them questions to identify what we call “high risk contacts” and “moderate risk contacts.” High risk contacts the people you live with which must also isolate and get tested if they become symptomatic. High risk contacts also include other employees who work with them on the ward and might have sat near them in the break room, both parties not wearing their masks while eating. Or a possible carpooling partner. Moderate risk contacts are if only one person took their mask off. Moderate risk employees or exposure continue to work but must do lateral flow tests (LFT) daily.

What’s a lateral flow test?

Lateral flow test are home COVID-19 test given out to NHS employees.  Employees are asked to do the test twice a week. Yes, we ask the employees to stick the swabs up their nostrils, mix in a solution, drop some drops on a pregnancy test looking device, and tell us if there are indeed two blue lines. Not the positive you hope for. We have captured a high number of asymptomatic positive tests with LFT. But it can also create a false reassurance, as they can be negative at home but a proper swab through the lab may turn up positive. We just always suggest any symptoms at all, even if LFT is negative, to go get a proper swab. I also act as a follow up for these people who are isolated at home. Give advice and offer support until they return to work.

Another plan

I am a pediatric nurse by training with over ten years’ experience. I did not plan on this job, it was not what I set out to do in England. At first I felt bad not being on the front lines, but I have found great purpose in this role. We are vital to helping control and slow the spread at the frontlines. I am part of the group having to make major decisions that affect the whole operation of the wards, including at times closing down a ward.  The speed of this spread and the symptoms even the youngest are experiencing are so eye opening. Major symptoms that stick out are headache, body aches, chills, extreme fatigue & sore throat. Not everyone has a cough, shortness of breath, high fever, nor lose their taste and smell. All I can advise is be vigilant in your hand washing, seeking a proper swab, social distancing/isolating and getting your vaccine. COVID 19 is indeed not a joke, propaganda, conspiracy theory or the government’s way of micro chipping us. This is a pandemic, history in the making. This is science’s time to shine.

You can learn more about Jamie and her family at thedaviespost.blogspot.com

My time with COVID-19

by The Nurse’s Eye

I am about to head in after three days off and I am mentally gearing myself for looks of desperation from patients. As I walk through the hospital doors I often take a deep breath reciting our family mantra, “we can do hard things.“ The last couple of weeks have been physically, emotionally, and mentally exhausting.

We are currently seeing the effects of what was thought to be an innocent holiday family gathering. Or the New Year’s party hosted by youth, who believe to be impermeable to the virus. Due to the mutation the National Health Service (NHS) is seeing 60% more patients versus the previous lockdown. We are seeing young to middle aged patients who are otherwise healthy, disintegrating with oxygen saturations that we wonder how they are even talking (64% on room air, improved to mid-80% with a mask at full oxygen). I think back on a study looking at postmortem lungs in COVID 19 patients. The lungs were necrotic and alveoli congested, drowning. I now see the patients breathless and I picture their lungs slowly getting more and more filled with fluid slowly tissue sloughing off and in need of oxygen. And now our Trust is running low on oxygen.

Our morning report now includes the level of oxygen in our hospitals.  A vague status as in “we are okay right now” or “there is no need to ration out.” But the thought of having to ration oxygen hits raw nerve. The porters bring portable oxygen compressors to use instead of the wall oxygen an attempt to preserve the main storage.

If they are here, they are sick

The NHS created a good system to monitor patients from home. First, if a patient is suspected of COVID-19 somehow (unknown to me) they are able to complete a home test. If confirmed positive, they get added to a Pulse Oximetry Clinic. The clinic remotely monitors oxygen levels with a pulse oximeter and detects early deterioration. If a patient has low oxygen levels or poorly the medical team comes to the patient’s home to evaluate them. A doctor or community nurse decides whether they need to come to the emergency department (ED). Once the patient has arrived to us they have already been evaluated by at least one healthcare provider is not more. We only see the sick.

The treatment plan changes daily. The latest cocktail is vitamin k, Enoxaparin and steroids. Patients come in with low oxygen level and feeling horrible, headaches, body aches no appetite, sometimes with vomiting and diarrhea and of course known COVID-19 positive. We hydrate them via an intravenous cannula. Check that their ambulatory (walking) oxygen level does not drop below 90% on room air and even though they do not feel great, we might send them home. We remind them to stay hydrated and to return if they have difficulty breathing. We send them home because our hospital is at capacity and we only have the space for the patients that require oxygen.

My worry…

The ED itself is saturated with a mix of COVID-19 patients awaiting beds and your usual ED lot of stroke patients, diabetic patients, bronchiolitis kids, or appendicitis. We attempt to keep the COVID-19 patients separate but when you have a query (unknown) abdominal pain with a fever, it is not only appendicitis but possible COVID-19, therefore they might be next to the patient I mention above who is COVID-19 positive.  My heart twists in agony knowing of a possible exposure, another possible transmission and reminding both patients to keep masks on please. Each patient has their own cubicle but they are only separated by a plastic partition.

At the end of the shift I change into my cloths but the surgical masks stays put. As I step into the fresh air I finally am able to rip it off. I breathe the air, standing a bit longer than necessary in the cold night air. Other than the 30 minutes we are given to eat our meal, we keep the mask on the remainder of the 12 hours, along with a face shield and a gown. I feel protected with my gear.  Not invincible, but secure enough to come home and hug Gary and Alvin good night before heading back for more.

At the Center of the Crisis

by Hannah Zywczok

Hannah a Canadian nurse I meet while studying for the OSCE has worked at St Thomas in London since the start of the pandemic she describes her experience below

The New Year’s began with a notification that St Thomas Hospital status was black. Black status reflects no capacity for patients, no beds to put the sick. I work on surgical ward converted again into a COVID ward. And with it I transition from a surgical nurse to a COVID nurse. We were told we would gain additional nurses which have yet to appear.  During my New Year’s Eve shift I was being pulled in so many directions I broke. I locked my locked myself in the medication room and sobbed loudly; a cleansing cry that shook me, lasting 10 minutes.  Afterwards, I washed my face, unlocked the door, and went back to work. 

We are tired too

Nurses are constantly asked to give more: care for more patients, to fill more job rolls, to ‘step up’ you signed up for it right? “We’re all in this together” was the motto during the first lock down. Hospital staff lived in a hotels for months in order to protect their vulnerable loved ones. There was evening claps from the community. There is none of that this time. People are tired of being stuck at home leading to frustration and anger. But we are also tired.

COVID has mutated causing a greater number of staff to be out sick compared to the first wave. The intensive therapy unit was short 39 staff one of the night shifts at the start of the year. The mood in the hospital is heavy and dark. The weight on my shoulders from the patient’s needs I cannot meet. I want to give them my best. I desperately want to ensure I do everything in my power to provide care that will enable them to fight this virus and walk off the ward but patients are coming in are sicker and younger than in the first wave. Short staffing equals higher patient to nurse ratios; more humans putting their faith in me. Someone needs water or medications, another patient needs the bathroom, and another spiked a temperature and needs immediate blood tests. A family member is on the phone wanting an update, a constant chaos.

We are wearing thin

Everyone is important, but as the nurse, you constantly are triaging what needs to happen now versus what can wait. There are days I leave the hospital feeling like I was constantly in motion and I did not do enough, while apologising for things in and out of my control. A daily grind, a daily battle, one in which feels like there’s no end in sight, but we need to be in this together. And as they say, hopefully this too shall pass.

You live through that little piece of time that is yours, but that piece of time is not only your own life, it is the summing-up of all the other lives that are simultaneous with yours. … What you are is an expression of History.

Robert Penn Warren, World Enough and Time