Friday XXth March 2020
The whole critical care unit is now a Covid-19 zone. We’re almost full. There’s some confusion about PPE requirements, particularly which mask and visor we are supposed to be wearing – the government guidance keeps changing. We start the shift in the meeting room with a short briefing then make our way to a donning area. We check each other over to make sure that our PPE is fitted correctly. We deposit any non-essential items outside the room then go through the doors ominously marked ‘warning – danger of infection’. A few helpers from recovery and theatres are present and you can see that they are nervous about going onto the unit. We talk them through the PPE and thank them for volunteering to come and help.
Today I cared for one of the first patients in the trust to be confirmed Covid-19 positive. He was originally an inpatient being treated for possible pneumonia who eventually ended up in the critical care area. He wasn’t identified as a Covid-19 positive patient until early March and so some of us had cared for him previously without full PPE before we knew about his Covid-19 status. He’s making steady progress, breathing for himself on a low level of support from the ventilator. He’s been on the ventilator for 21 days and seems to be recovering from the worst of the illness. The plan today is possible extubation but at lunchtime a decision is made to hold-off and rest him overnight on the ventilator to optimise his chance of success tomorrow. I contact his partner twice during the day and enable her to speak to him using the mobile phone. I also make arrangements for other members of his family to talk to him. He’s very lightly sedated for ‘tube tolerance’ so he’s able to hear them and I can see from his facial expression that he can recognise their voices. He’s crying.
Saturday XXth March 2020
It’s my second day caring for this patient. He’s been ‘rested’ overnight on a mode of ventilation that helps to reduce the work of breathing in readiness for possible extubation. Once the hand-over and safety checks were complete I made it a priority to ring his partner and explain the plan for today. An uneventful morning that involved stopping the sedation drugs and assessing the patient’s neurology. A colleague from another ward has come to help but she is a bit overwhelmed, upset and frightened. She’s worried that her FFP2 mask doesn’t fit properly and is crying. I take some time out to go and find a colleague who can support her.
At lunchtime the decision is made to extubate the patient – a trial extubation. He’s breathing spontaneously for himself, on just 21% oxygen and is obeying simple commands like wiggling his toe and sticking his tongue out – the sedation drugs are off. Working with the consultant in full PPE I pre-oxygenate the patient and the endotracheal tube is then removed. I’m conscious of the patient coughing and the associated infection risk but I have to be close in order to support him and remove the tube. The patient is placed onto a face mask with some supplementary oxygen. I reassure him and ring his partner – placing the phone near his ear so that he can hear her voice.
Later that afternoon the physiotherapy team assist me with sitting the patient out in a chair for a couple of hours. He looks well and I am able to reduce his oxygen requirement to 2L then eventually to room air. His son speaks to him over the phone and the patient is able to summon the energy to attempt a few words but they are inaudible because he is so weak. Everyone is pleased with his progress – people are surprised to see him sat out. The mood lifts as people come past and see him off the ventilator breathing room air – the patient seems a bit overwhelmed. His observations are good, he’s not struggling and I’m hopeful that it continues. At 7pm I hand over to the new nurse but I want to stay and see how things progress. It’s hard being so deeply involved with someone’s care to then walk away at the end of the shift. There’s an emotional investment that’s taken place. Today was a good day – my second Covid-19 patient extubated. I have had the privilege of extubating the first two ventilated patients on our unit. I’m off tomorrow for two days but I have to home-school my daughter which is a struggle. I’m tired, dehydrated and my face hurts from wearing the mask and goggles. At home I’m not having any physical contact with my wife and daughter. I’m sleeping in a separate room and using the spare bathroom.