Now that I’ve said that I could give some insight into working on a covid ward, it’s hard to work out what to say. My hospital seems to have been pretty on the ball in preparing for coronavirus - certainly compared to what we’ve seen from Italy, London and New York.
Even before the lockdown we were aggressively clearing out beds and cancelling elective procedures in order to make space for what could have been a huge wave of admissions. Since then we had a couple of weeks where we were busy and seeing quite a few very unwell patients, but after that initial burst activity has significantly tapered off.
This is a good thing.
However, it has meant that our staffing levels are almost excessive. Not infrequently do we have more staff than patients in what is not far off standard ward level care. There are no immediate plans to reduce staffing levels for two reasons: we can’t predict surges and we need to be prepared for them, and since we’re salaried we’re getting paid anyway. May as well have us in if we’re being paid. My team has been converted from another specialty into a covid unit.
Work is not actually that unusual for us; the patient population is about the same - mostly elderly with pre-existing health conditions. The main difference in how we perform our jobs is in the heightened infection control measures. We’re always wearing some PPE on the ward (to varying levels of compliance); we wear even more protection whilst in patient areas, and nothing comes out of patient areas without going straight into the waste or being drenched in chlorine. This makes everything take noticeably longer, and it becomes even more frustrating when we have patients who are “buzzer happy,” i.e. will call for a nurse for incredibly minor things such as moving a cup which is within reach even closer. Normally this is absolutely a minor inconvenience, but every time we have to don and doff our PPE we are producing non-degradable waste, exposing ourselves to the risk of infection, and destroying our skin with soap and alcohol.
All of our patients do need more assistance than usual. It’s scary how debilitating covid-19 is. Although the majority of our population already have co-morbidities, we can still infer from their admission notes the effect that this is having on them. People who were previously able to walk independently - perhaps with a stick or a frame - are struggling to get out of bed. People who needed a hand to get about but were still able are now struggling to move around their bed. Anyone with even less ability prior to admission is now completely dependent. Everyone comes in on high-percentage inspired oxygen, and it often takes at least a week or two to come off. Blood-oxygen levels that used to be an immediate cause for alarm are now background noise.
Pressure area care used to be something we’d consider for perhaps the top 10-25% most vulnerable of our patients, i.e. active treatment to prevent bed sores. Now it’s pretty much 100%. The combination of fatigue, breathlessness, loss of appetite, and reduced oxygen perfusion of tissues means that everybody is at a high risk of tissue damage. This is one of the other reasons it’s so useful to have such high staffing levels; it does take a lot of time to look after these patients.
Our mortality rate is high. It was only relatively recently that we were informed our ward’s discharge rate had finally exceeded our deaths. When our patients deteriorate there is precious little we can do for them save whacking their inspired oxygen up full and hoping for the best. There is no point in trying to ventilate our patients because if that was going to have been an option it would have been used much sooner. Because their lungs are fucked, the patients feel like they’re drowning/suffocating and often instinctively try to remove their oxygen mask. The only way to prevent this sensation of oxygen starvation is with opiates and benzos, and these risk causing respiratory depression. If the patient is lucky (and it feels as much like luck as anything else) then they survive.
Despite the high mortality, team morale is good. We’ve been working more closely since this began, and even beforehand generally got on pretty well. Because we have our patients for longer than usual, we also get to know them better and this makes discharges even happier. We’ve been with them through the worst, and know how much they miss their families. We haven’t suffered from any shortages of PPE - I don’t know what NHS Scotland is doing differently, but all the boards source their PPE from a single procurement body and we have never been told that we should ration our usage. We’ve been working with covid patients for over a month now and haven’t had anyone go off sick. This is what we’re using:
It’s doing us well so far.
Management has been actively supportive by providing many different options for therapy, stress-relief, etc. I haven’t felt the need to seek any out so far. More than anything else I simply miss seeing my friends and family, and I think that goes for most people.
Since it’s a hot topic, I’ll end by trying to summarise how people feel about “The Clap.” I think most of us have at least faintly appreciated it at some point, and no-one I’ve talked to has outright stated that they hate it. However, it may not surprise any of you that this feeling is accompanied with wondering if the public would also support a pay rise (which comes out of taxes), and praying that people will continue to abide by the lockdown. Some of us have neighbours who know that we’re healthcare workers and are actually a bit embarrassed by being applauded on the way to work. We’re lucky to have jobs that still pay us, and that let us see other people in person. Many others are far less fortunate.
If anyone has any questions that I can answer then feel free to ask. Otherwise, please continue to abide by the spirit of the lockdown.