A nurse in Manchester has spoken out on the realities of nursing the coronavirus pandemic and the huge strain that it has had on her and her colleagues.
Lucie Brown, 31, from Yorkshire, is a cardiothoracic critical care unit nurse at Wythenshawe Hospital, Manchester.
She has been caring for COVID-19 patients for the duration of the pandemic and, like all hospital staff, has had to adjust to a ‘new normal’ as she has found her working day changed beyond recognition, the Manchester Evening News reports.
One of those changes has been the daily ritual of putting on and taking off her vital PPE, which Lucie and her colleagues have managed to get down to something of a fine art.
But, as many heartbreaking photographs that have appeared online in previous weeks show, pressure sores from wearing a tight facial mask in the springtime heat have become part and parcel of Lucie’s uniform.
And another thing that she and her colleagues have had to adjust to is the necessity to shout at each other, just so that they can be heard through their visors.
These are the shocking new realities that critical care nurses across the country have had to get used to, since the beginning of this devastating pandemic.
Lucie said: “At first it did feel like the calm before the storm.
“Obviously we were aware that this virus in China was on its way to us.
“When it reached Italy it definitely felt surreal watching how quickly it escalated there.”
The additional ICU at Wythenshawe, as well as the existing two units, filled up quickly as patient numbers went up and up.
NHS staff were redeployed and given crash courses in intensive care to ensure that hospitals like Wythenshawe could meet the increased demand of ventilated patients.
And people who had had never worked together now found themselves in new teams, taking on a new specialism and getting used to life on the frontline of a deadly virus.
It wasn’t easy, admits Lucie.
She said: “Obviously we’re incredibly grateful all these people came through but it came with its own challenges.
“Normally you would have one-to-one care for an intubated patient, but as an ICU nurse you might be caring for your own patient while supporting two or three other nurses who had been redeployed.
“It did feel quite strained at times.”
There were also huge changes to the way that ICUs operated, which was yet another adjustment that Lucie and her team had to contend with – at a time when pressure and stress was already running high.
Families were no longer allowed at the bedside, which meant that ICU nurses had limited contact with relatives – posing yet another additional challenge.
“When you have an intubated patient who is sedated, you usually have their relatives around.
“That’s how you find out what the patient likes, and what they dislike”, Lucie said.
“We suddenly lost all of that so it felt like we weren’t able to deliver the same level of holistic care we had before.
“You can have a telephone conversation with a relative but it’s very hard to get the headset near your ear when you have a mask on, and also to be heard.
“Even when someone is sedated, we still use a lot of verbal communication and small things like knowing a person’s favourite radio station can actually make quite a difference.”
Lucie said that it is important to know as much about your patients as possible, so that you can make their time at hospital as comfortable as it can possibly be – an integral part of a nurses role.
“When someone is stable enough to start waking up, knowing that they might not get called by their first name on their birth certificate and that they like to be called by a different name can make a difference.
“Some people have tickly feet, knowing these little things can make help a patient.
“A lot of us have really missed that patient-relative input”, Lucie said.
On top of worrying about herself, her colleagues and her patients, Lucie has also been worrying about her patients’ families, too.
The fact that they have been unable to visit means that it has been harder than usual to update them on progress, though the medical teams have been doing their best to update them every day.
“The fact they can’t visit, it just must be awful. It must be the worst feeling in the world”, Lucie said.
And far from being laborious to put on and take off, wearing PPE has come with it’s own set of unique challenges as well.
Lucie said: “Normally I have quite a loud voice and this is the first time in my life I’ve been difficult to hear.
“A patient has no idea that you’re smiling behind your mask, and you forget how much every day we rely on lip-reading; it’s not until it’s taken away that you realise that.”
As a critical care nurse, Lucie and her team have to cope with death on a regular basis, this was a reality of the role long before the coronavirus pandemic hit.
But Lucie said that it is not “something you ever get used to”.
She said: “Losing any patient, whether it’s to covid or not, is horrendous.”
But, like all those fighting on the frontlines of this pandemic, Lucie has been able to find positives in among the negatives, and uplifting moments as she goes about her day.
“A lot of patients who come in via A&E or another route are usually awake and aware that they are going to be put to sleep to have this extra ventilatory support.
“I remember one of the first patients who was well enough to start waking up. Seeing the relief on her face was just wonderful.
“She gradually got better to the point where we were able to put in a little speaking valve with the tracheotomy that enabled her to have a voice”, Lucie said.
The first time that Lucie and her team heard her speak about how she was feeling was “absolutely incredible”, Lucie said.
“We were fortunate enough to witness the moment she spoke to her family on the phone for the first time and that was really amazing.
“The best bit was when she was discharged from ICU to the ward and just week a later we saw a thank you card saying she was back home.
“That was obviously the best outcome we could have hoped for.”
As the UK enters the next stage of the pandemic, hospitals in England are starting to return to ‘normal’ busines – if such a thing exists.
But, at Wythenshawe Hospital, this means resuming specialist service as a heart and lung transplant centre, as patients who have undergone such major procedures need critical care support.
Running the transplant service alongside the treatment of covid patients is another hurdle to overcome.
Lucie said: “We have excellent infection control measures in place but going forward we are thinking about how we get the two services, the covid patients and our usual patients, running simultaneously.”
Like most people, Lucie has relied on Zoom calls with family and friends during lockdown.
She says their virtual ‘Ready Steady Cook’ sessions have been a weekly highlight during stressful weeks.
Lucie says the support for NHS workers during the pandemic has not gone unnoticed in hospitals and it has been on of the things that has kept her and her colleagues going.
“We’ve had perfusionists from other hospitals, nurses coming out of retirement, people being redeployed.
“I really do think they need to be commended for their bravery, and the general public’s support really has been wonderful.”