The following is a heartfelt response from a frontline worker in the NHS. We would like to add that some of the comments in the article wouldn’t be shared by all of us in HSG. Nevertheless it is a compelling read which highlights the incompetence and pure disregard of those in power.

 

 

I am a deputy sister (nurse) in intensive care (ICU) in a major London hospital, and I am angry. 

(Please read until the end, the second part is an insider’s view of ICU right now. My use of I/me/us/we/our can apply to all healthcare workers and ICUs worldwide. And these views are my own and not that of my employer.)

22nd April 2020
 I am a deputy sister in intensive care in a major London hospital, and I am angry. 
I am angry at the UK government for their COVID 19 response, or lack-of. 
I am angry at the Chinese government for their cover up of COVID 19, amongst many other things they have done. 
I am angry at the members of the public in the UK that are flouting lockdown rules and continuing to spread the virus. 
I am angry for my patients and their families. 
I am angry for myself and my colleagues in healthcare all over the world. 
I am angry for everyone affected by COVID 19, so everyone.

There are also lots of things I am grateful for and amazed by too, but sometimes it’s hard to remember or appreciate them. Last night on my way home from 13 hours in ICU was one of them.
I am aware of how lucky I am to have a job at the moment, I do not take this for granted. And I am also aware of how lucky I am to live and work in the UK, before and during this pandemic. I can’t even imagine what it’s like in Italy and Spain, and ‘less-fortunate’ (I hate that phrase) countries than them and the UK at the moment and always. 
And I am relieved I’m not in the USA, what we’re seeing on the news from their ‘leader’, the lockdown protestors and the way hospital staff are being forced to reuse PPE is truly scary and bewildering. 

Why am I angry at the UK government’s response?
Where to start…
• The non-evidence based ‘herd immunity’ approach at the start of the UK response that was a complete farce
• The delay in starting the UK lockdown and not actually enforcing the lockdown (I live in south London and I can promise you many are not in lockdown mode)
• They ‘missed out’ on the EU scheme to provide ventilators and other equipment (which now sounds like it could’ve been a political move rather than just a ridiculous show of ineptitude)
• The PPE shortages across the NHS and care sector (not the NHS’ fault, it’s nationally at government planning level). 
• The changing of PPE guidelines based on what is or is not available, not WHO guidance, thereby covering their incompetent backs
• The fact that healthcare staff are dying due to these PPE shortages and it’s not being spoken about enough, or being addressed anywhere near quickly enough

 

Some of these things have allowed the virus to spread faster and more widely than it should’ve and meant that more people have died and will die because of it. More hospital and intensive care admissions, more patients requiring ventilators (which we still don’t have enough of) more people dying and more families and friends bereaved. 

What it’s like in ICU in a London hospital with over 100 patients on ventilators at any one time during this pandemic:

In our ICUs at the moment it is semi-organised chaos (as opposed to the mostly-organised semi-chaos that we’re used to). The sheer number of patients, and how sick and complex they are is overwhelming. Not having enough specially trained ICU nurses/other healthcare professionals and equipment to treat these people means their care is suboptimal. We are doing what we can with what we have, but it still is not enough, or at least not enough to meet our usually very high standards of care. Around the country healthcare staff that left ICU a while ago, or have never worked there, are being redeployed to ICUs to help; they are working so hard and it must be so frightening. 

I have worked in intensive care for six years, and for three of those I have also worked in our post ICU clinic where we see people once they’ve been discharged from ICU and gone home. And I can assuredly tell you not one person would ever choose to need ICU treatment and be admitted there if they didn’t absolutely have to. I have met people that have survived their illness and ICU stay that wish they had died rather than go through it and their very difficult recovery. The treatments, procedures, and measures we sometimes have to go to treat and save people can be brutal, dehumanising, and cause negative affects to patients’ health (we have to use a risk/benefit approach for these things when their lives are on the line). These measures lead to post-ICU syndrome (including PTSD) in our patients, their families, and many of our staff in ‘normal’ times, let alone a pandemic. ICU is not somewhere you should want to end up. 

In ‘normal’ times, 1 in 5 people that are sick enough to be admitted to ICU die there. This is usually due to just how unwell and unstable they are, or because we have tried everything that modern medicine can do for people. All of those people would have died had they not been admitted to ICU. The other 4 in 5 people that survive ICU almost always would have also died had they not been admitted there. If it is the right thing for the patient, then we try absolutely everything we can. 

Right now, during the pandemic in the UK, the number of people dying in ICU is 1 in every 2 or 3. Between one-third to half of people that become sick enough to need ICU treatment for COVID 19 and its complications are dying. And the number of people in ICU are far higher than ever before. This means we are busier and are dealing with far more deaths than ever before. To say this is distressing would be a gross understatement. I know that what we feel as staff pales in comparison to the loved ones of our patients that die. But the cumulative weight of seeing so many deaths, talking to so many relatives of those that are dying, withdrawing so many life sustaining therapies (ventilators, blood pressure sustaining medications, dialysis, ECMO) when all treatment is futile and carrying on is cruel and inhumane, adds up. And it adds up to an individual burden in me and our staff that I can’t even comprehend at this moment in time. Probably as a coping mechanism I am trying not to think about it. Many patients in ICU around the country, and many that have died, are healthcare workers; I am also trying not to think about that, it’s overwhelmingly sad and scary. 

When we can’t save someone in ICU, we aspire to provide a dignified and peaceful death, with loved ones, religious representatives, sometimes even their pets by their side. Sometimes we can even discharge them home for end of life care there. We can’t do that at the moment. The units are chaos, there is no moment of quiet, no chance for reflection. Barely any visitors are allowed (we allow a visitor if someone is at the end of their life and the visitor is not self-isolating). This means that a lot of the time the staff are the only ones able to be there in a patient’s final moments. We are holding their hands (while wearing 3 pairs of gloves) talking to them to let them know they’re loved and not alone (through our muffling masks and full-face visors) and just trying to make it as dignified as we can. We really do care.
At the moment, when one patient dies there is always another needing their nurse, bed, ventilator, drug infusion pumps, dialysis machine, ECMO pump etc. We have to do a quick turnaround and be ready for the next patient that needs these things. This feels so wrong when someone has just died; we usually would have a little bit of downtime in between which feels far more respectful.

I wish I could wear a go pro camera on my head at work and show the footage to the government and all the people disregarding lockdown measures. 
I wish they could see how our ICUs are completely overwhelming and overwhelmed right now; a complete barrage of noise, machine alarms, people, equipment and patients. In a lot of our units we have two patients where we would usually put one. Rows and rows of patients all critically ill, many dying, crammed in together with healthcare professionals doing all that they can with not enough resources, time and literal space to do so. 
I wish they could feel, for a minute, what the families of our patients are feeling; those that are still with us and those that have sadly died. 
I wish people would stop thinking this is something that only kills older people or people with ‘pre-existing health conditions’ - IT IS NOT. I have seen people younger than me die (I am in my 20s). Children have died. Usually ‘fit and healthy’ people have died. This virus does not discriminate.

Meanwhile me and my colleagues (worldwide) are scared for ourselves, our families and loved ones. Scared of going to work and contracting COVID, scared of bringing it home to our families, scared of catching or spreading it to others when just trying to get to and from work. I wish I could work from home. 

My initial feelings of fear when I’m at work have passed somewhat. Yesterday I was mostly angry, frustrated and exhausted. The people all over the world that are working to treat and save those with COVID 19, and those who do not have the virus (people still get sick from other things, don’t forget that), are feeling angry, frustrated and exhausted too. And many, many other things. 

Please stay at home. We can’t take much more of this. 

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And when your next chance to vote in the UK comes, please remember what has been done to the NHS and country over the last ten years. Austerity, disastrous universal credit, increasing poverty, Brexit and its effect on the NHS, NHS dismantling, privatising, closing of hospitals and beds, 40,000 nurse shortages, removal of nursing bursary so that student nurses have to literally pay to work. Many other things that I can’t even remember right now. We would be saving more people in this pandemic if these had not happened. Don’t forget that.