Experiences of Covid-19 and Intensive Care

I wasn’t feeling very well on 17th…18th December and my daughter had already had Covid a couple of weeks before, so it was suggested that I went and got a test done. So, I went down to our local town and got that done and that came back as positive. And I didn’t feel too bad initially and then within 24 hours I started to feel very poorly.

And then by the Monday I had to go to hospital because I couldn’t…I had to get an ambulance out because I couldn’t breathe. I have an underlying health problem which is an interstitial lung disease so I knew that they would be affected. So, the ambulance came out and they did all the checks and they said, no, you’ve got to go in. So, I went in, and I was in for three…four days and I came home Christmas Eve. And I felt…I thought it was over because I felt much better. I’d been given various drugs while I was in hospital, but I didn’t go to ICU at that stage.

Then Christmas Day, by the end of Christmas Day, I felt absolutely so ill. So, I went to bed and then the next thing I knew it was…so that was the 25th, the next thing I knew it was 27th December and I woke up not being able to breathe. I kept on having this, like, very heavy feeling on my chest. And again, it was four o’clock in the morning and I got my husband to phone the ambulance and they came out and I was blue-lighted in that time. And my sats were very low, my breathing was horrendous so… and when I got to A&E it was like a scene from Casualty, there were all these nurses and doctors waiting, a bed with all tubes and everything, so [non verbal speech].

So, I was taken straight to resus, and I don’t really remember a huge amount about it. The things I remember are the funny things like the doctor apologised for having to take my nail varnish off, which I’d painstakingly done Christmas Eve so that I’d look nice for Christmas Day. And we had a discussion about…and I said it was vanity, and then we had a discussion about, no, it’s standards. But he was so kind just by doing that, and it was an icebreaker and it made me feel more confident for where I was. A lot of people have said, were you frightened, and at no stage was I frightened because I just felt everybody made me feel so at home, if you see what I mean, and so safe.

There's probably two main reasons why different patients become so unwell. I think the first point to remember is that huge numbers of people have been infected with this virus, and whilst only a small proportion of them become very, very seriously ill with life threatening disease, the massive number who are infected means that we still have a very, very large number of people who need intensive care.

I think that the first main reason why people become very ill with Covid-19 is because they're either of an older age group or they've got other medical problems. That means that when they get sick, they get more sick than a younger, healthy person, but it's also true that the genetics differences between different people have put some people at more at risk of serious disease than others, and we definitely have seen young, healthy people who've developed Covid-19 who've needed intensive care, including some of our own staff.

My stay in that particular ward, what I noticed was, and I think I was in there for about…I must have been in there for five days, is that slowly but surely trying to keep my pride and dignity so I could go to the toilet. Every time I stood, one minute I would be talking to two blokes, two men opposite me, just chatting away, and soon as I got the nurse to pull the curtain around and pee in the bottle…and all I had to do is put the bottle back on the side of the table and get back into bed. I was absolutely wiped out, I was exhausted, straight back on oxygen.

And, I remember the two guys, because one of them I still talk to now, we still phone each other. He said it was just unbelievable, one minute you’re talking, have a pee, screen comes across, screen comes back and it’s just like a different person, I was exhausted. So, I think what was happening is, I became so exhausted with that, that’s when, I suppose, they’re looking at all of my stats over, I don’t know, however many days, and they’re just watching things slowly, slowly get worse.

So, the intervention came when they took me up to intensive care and I was put in a side room, which was a relief for me because, you know. I’d listened to so much nonsense and stress with this old boy downstairs I thought, at least I’m in a room and I haven't got to listen to the nonsense. And also, when you’re on these wards, you know, there is everybody else’s machines going, they’re bleeping, and so I was just, sort of, relieved at that point to be on my own.

Most doctors have a relationship directly with their patient and the patient is the person they get to know and the patient is the human being that they are trying to help in whatever way they can. In intensive care when your patient is unconscious, you for many weeks sometimes don't ever get to properly meet them and understand who they are and their personality, their character. You know, whether they're fun or whether they're serious or whatever it might be. And so, the way in which we get to understand the patient is through getting to understand their loved ones, their friends, their family and so on. So, we are very used in intensive care before the pandemic to communicating an awful lot with family, whether it be when we're going around on our ward around and it's maybe in the evening and the family are in visiting patients and we say hello at that point and often answer questions. Or maybe it's arranging a particular meeting to discuss the challenges we've got with a particular patient and how best we solve them, how we understand what that patient's wishes might be. Really so few patients write down what their wishes are before they become ill that we’re critically dependent on family to explain all of that to us. And obviously those very difficult conversations are much better had in person, and we've always done it that way, and we spend a huge amount of time with our patients’ families. To have that taken away from us was actually really difficult. Because it was almost like having the patient's personality taken away from us. That human being in the bed. We didn't really know them like we used to know them and all of that is very hard. And certainly, you know, I mean, I can remember a particular case of having to stand by someone's bed and phone their wife to tell them they were dying. It's not easy. It's not easy because they can't see them, they can't understand, they can't visualise or picture - if that's somebody who's never visited an intensive care unit before, they're not going to be able to truly picture their loved one and understand why they're so ill and they're just dependent on our word and our professionalism. And, you know, so those two things together, the lack of support as a doctor or a nurse from the family and the extra burden of them relying on us together is very, very hard, and I'd say that was the hardest thing. Certainly, for me the hardest thing in the pandemic.

And how has that changed over time if it has?  

Well, very early on, I mean obviously, so many parts of society would shut completely shut and hospitals were completely shut and hospitals aren't designed to be closed places. They're designed to be places for people to come and visit and come and go. And you know that that's the normal for hospitals and so closing them and making them such closed spaces in the first wave was big shock to us, was very difficult. We didn't really have any technological response to that. It may seem absurd, but a lot of hospitals weren't even equipped with Wi-Fi, so, you know, using tablet computers to make Zoom calls or Teams calls or whatever it might be was not something that we ever did before, and actually probably most of society wasn't that used to online video calls either. We're all completely up to speed with it now. Pretty much everybody, but before the pandemic, nobody really did that, and we certainly didn't do that with patients. And it took us quite a while to set up those systems so that we could have in many cases we have medical students coming around with tablet computers and giving them to patients so that they could speak to their family or their family could see them if they weren't able to speak, so that we could say hello so that the family could see the doctors and the nurses looking after their relatives, their loved ones. And more and more over time actually using that as a medium to communicate directly with the family ourselves. But there were so many things to do. There were so many systems to set up and scale up, and that was one of the slower ones. And I'd say that was the one of the ones that we perhaps underestimated at the beginning. The impact it would have and the need and the importance of that need. I think by the second wave most hospitals were super-efficient: We had communication hubs. We put special messages in the notes in in the Covid ICU that are all closed, so people working on computers outside the intensive care unit could pass those messages to family and those teams would feed back to us if there were particular problems or if we needed a particular phone call. We had to schedule phone calls to make sure that everybody had had an equal opportunity to speak with doctors and nurses if those things were needed. And like so many things in life it's often the better-off people who have the communication skills to get what they need from doctors and nurses and so on, and it's the underserved who don't have those skills and who are often the most neglected. And making sure that didn't happen was a very difficult thing for us.

From what I’ve been told I was in a chair, but I thought I was on the bed, but I was in the chair, and I just flopped. And then I was rushed to ICU. I can’t remember much in the beginning other than the doctors had put me on a hundred per cent of oxygen, and I was sort of drifting in and out. And I recall the doctor coming to the bed and saying, you’re on a hundred per cent oxygen, there isn’t anywhere else we can go with this. He said they didn’t want to sedate me, you know, when you’re sort of put into an unconscious state, because of my other underlying health issues [blood clotting], and they said I wouldn’t survive it.

And when they admitted you to Intensive Care, what thoughts did you have about how sick you were? Did you have an idea of how ill you were?

Yeah. I just kept telling them to tell my family that I loved them because I didn’t know if I was going to wake up. And they were putting me to sleep but I don’t think I was fully aware that they were going to put me right out. And my friend, who works for the Outreach team, told the consultant that they’d got to tell me that they were going to put me to sleep, so they did tell me then, that they were going to put me to sleep. And it was frightening. It was terrifying. Because I may never have woken up again. But I wouldn’t have known anything, and I know that now, I wouldn’t have known anything about it.

He was all masked up, he had…he was on oxygen, so that was on the Sunday he went in, on the Monday, they phoned me and said that they would possibly be taking him up to ICU. So, they would always pre-warn you about things that they were going to do, that was very good. And then on Tuesday, they said ICU are looking at him, they think that he will have to go, so they were warning me that they may have to put him into a coma, but they would phone me first.

Wednesday morning, they phoned me, and they said they didn’t have time, they couldn’t phone me, they didn’t have time, they had to get him into a coma, there and then. So he went, we just didn’t speak to him at all and so that was a little bit like, oh wow, when are we next going to talk to them. And up at [name local hospital], obviously they hadn’t got a training school there. So, the doctors would phone you, it could be late in the evening, I was like, hanging on every phone call.

I’ve a vague recollection of making a phone call to my wife from the hospital. They let me make a phone call. Now, I didn’t know at the time, but my wife and I spoke later. That was a bit strange, because it could have been my last ever phone call, and I don’t know if the nurses or doctors knew that and they were saying, we’re going to give this guy the use of a phone to phone his wife. But I think the doctors maybe spoke to my wife and said we’re going to have to put him in an induced coma to recover, because my organs were failing. So, I don’t know if they suspected that I was in a bad way, and this could be a last phone call. So, I’ve a very vague recollection of making that phone call and that was it.

Oh, just after I came off the phone to my wife, I had a vague recollection of asking the consultant if I was going to die, and he paused and he suggested to me that they were going to do everything they can to keep me alive. That’s all I can remember really. It was very vague. At some points I can’t remember if I even dreamt that. It might have been a dream. I’m just unsure. And then 30 days later I came out of a coma. But maybe in the middle…I’ve just remembered something. The middle of April, maybe 20 days later or so, they thought there was blood clots, because the kidney dialysis machine was clotting up, so they had to give me a blood thinning medication.

And I was told that somebody would get hold of me at some point. By then it was the fourth day where I still hadn’t heard…nobody from the hospital had called me in those four days. That evening, at around six o’clock, I did get a call from the consultant who had ventilated my husband and he explained that they had tried to do the non-invasive ventilation but that my husband hadn’t tolerated it. And that they had ventilated him at around two in the morning and that they were hoping that everything would settle down and it would just be a few days and that hopefully he would show improvement. And that I guess began the process of spending every day waiting for that call. That was on…he was ventilated on the 30th of March 29/30th of March and, yeah, he remained on a ventilator and in intensive care for 56 days following that.