Laurence

Brief Outline:

Laurence spent 29 days in an induced coma on ICU, and a further 6 days in hospital on a general ward. His recovery has included physiotherapy and speech therapy. Laurence’s ICU stay has changed his outlook on life, and he is now looking to raise awareness about lifestyle effects on health. Interviewed for the study in February 2021.

Background:

Laurence fell ill with Covid in March 2020. He is married and has two children in their early twenties. Following his discharge, he quit his job that required a lot of travel and started a new company which allows him to work from home.

More about me...

Onset

Laurence first developed symptoms of Covid in March 2020, in the very early days of the pandemic in the UK, after a meeting at work. He developed flu-like symptoms and delirium soon after. When he began struggling to breathe, his wife called an ambulance.

Laurence moved through Accident & Emergency, the High Dependency Unit (HDU) and to the Intensive Care Unit (ICU) within two days but has few memories of this period. His wife kept up to date on his condition by doctors and nurses daily and there was contact between clinical staff and his wife about various drug trials, about proning and about interventions that the team wanted to try. Laurence was put on a ventilator on the 1st of April and remembers regaining consciousness towards the end of the month – 29 days later. In the weeks that he was in hospital, 120 people did not make it in his hospital.

Laurence had dreams in ICU that felt very real (“They make up a reality to me”). Some of the voices and visuals of what was going on around him came through in his dreams. He remembers being proned, but only “in a dreamlike sense”. When it does become possible again, he would like to see the ICU as it could help him differentiate what really happened from his dreams.

Laurence brings out the material, visceral, multisensorial nature of being in ICU. He describes the beeping machines, protective gear that staff are wearing (some with smiles drawn on), photos stuck onto monitoring machines. He describes the tubes, and bodily fluids that need to be suctioned, the weight loss and bodily wounds.

When he regained consciousness, the nursing team brought him an iPad. He had lost his voice, but he could see his family and communicate non-verbally. He was still feeling incredibly weak: he found picking up a mobile phone impossible to do, and even when he did, he communicated confused messages.

Laurence went through a rapid recovery in ICU with the support of respiratory physiotherapists, who “work on you all the time”: they stimulated a cough and brought a little ‘vacuum cleaner’ to suction and clear the throat. He had a sense of ‘constantly being cared for’, which he found very humbling. It is out of this feeling that he seeks to raise money for the clinical staff’s wellbeing, which he knows has been gravely impacted during the pandemic.

Laurence was initially moved to a recovery ward with 10 people and then to another ward with 3 other patients. He spent 5-6 days here, whilst his need for oxygen and painkillers decreased steadily. He started exercising his legs as he had lost a lot of muscle mass during his time in ICU. Here too he witnessed the difficulties staff were under to do their job, e.g., through the use of PPE. He noticed the difference between the ICU and the ward; staff at times seemed less confident and competent in caring for him. One time there was a nurse who gave Laurence pills to swallow when he still had difficulty swallowing.

Laurence was eager to get home. The first thing he spelled out on a board with the alphabet was “car keys”. He was discharged at the beginning of May 2020.

He had longed to go home so much that going home was “almost an anti-climax”. The safety of the hospital was swapped for the familiarity of home. Thankfully, it felt “like the hospital was never far away”. Follow-up was intense and involved:

• a district nurse who visited him at home daily for 3 weeks
• physiotherapy to regain the capacity to walk fully again
• respiratory physiotherapy
• circa 12 online sessions with a speech therapist
• contact with a nutritionist, who sent over the fortified drinks to help him regain strength and muscle mass.
• the GP reaching out to him as well as to his wife, getting involved with newly emerging health concern and arranging a flu jab

Laurence’s aftercare from the hospital stopped in December 2020, although he is still part of a trial for which he wears a FitBit which monitors his heartrate during activity.

Without meaning this as an accusation, Laurence notes that “treatment [in itself] can be harmful”. Indeed, Laurence has suffered bodily damage of many kinds: nerve damage in his tongue, damage to his voice, and he has a significant lisp, and drop foot. After his discharge, Laurence has been back in hospital with heart palpitations. Whilst the damage (which, as he notes, does not ensue only from Covid but also from treatment in the ICU itself) was – and, in part, continues – to be extensive, there is also the huge potential of the body to recover: he walks again, cycles, lifts weights, his voice is back, and his lisp is gone after extensive training with a speech therapist. His heart palpations have not returned after the hospital stay, and his heart rhythm now recovers more quickly after exercise than it did in summer. Some things remain: when he hears a beep like the machine that was at the bottom of his bed in ICU, for instance, it still gives him chills up his spine.

In addition to the illness itself, Laurence describes the ways in which his everyday life was impacted: he never was keen on international travel for work, but now he no longer wants to do so. He has resigned from the IT company he was working for as a managing director and set up a company that allows him to work from home. In the longer term, he wants to dedicate his time to a project that makes people aware of lifestyle changes that can improve health. Laurence is physically active to aid his recovery: “starting to do [exercise] is key”. He exercises and pays attention to his diet. Through his experience in ICU, he has come to see things in a different light: it has reinvigorated his appreciation for life in general, renewed his love for being fit, and has led him to focus on the importance of general health and fitness – something he seeks to contribute to through his new work in the future.

Whilst he does not like to use the word “traumatic” for his experience of ICU, he does use it in relation to his family. Laurence and his wife have spoken about the time of his admission several times, at times up to 5 hours. This in itself has been very helpful for both of them. What was difficult for his family at home was ‘not knowing what was happening’; having to work out the language that doctors were using in conversations with a friend; having to give consent for treatments that the team felt would help Laurence, often rapidly; not being rung when the clinical staff said they would call, presumably because an emergency required their attention, but difficult, nonetheless. Laurence’s wife sought out scientific information to inform herself. She was supported by friends and the local community.

Laurence has a message for clinicians. He says -nothing can prepare you for coming out of a coma. It would be fantastic to have access to videoconferencing, which he calls that “digital connection”, straight away as that was so very helpful to him – or perhaps even to have it continuously, “as if you were at home”. Having that connection, or to have an iPad with photos on it even, would help to “know who you are”.

Laurence is training to cycle the South Downs way as a fundraising project: 106 miles to raise money for the NHS.

Laurence fell ill in March 2020 after having a meeting at work with somebody who was coughing.

I think it was the meetings I had with the two individuals who went on to become unwell, but they weren’t as unwell as myself. They just literally went home with what they described as a really bad flu and a terrible cough. They lost their voice, but they recovered, whereas I think I must have received a big viral load of it and, yes, I didn’t have any strong underlying health conditions. So, yes, I think it was probably in those meetings with those guys and unfortunately, we weren’t as careful about it then as we are now. Now you wouldn’t dream of going into a meeting room with someone for half an hour, you know, a small meeting room. Like, you know, we’re talking now, you wouldn’t dream of doing it because you might be coughing and pass a mug to someone or, you know, share a pen or something silly. So, I guess it was in those two meetings, one in particular where the guy was pretty…he looked visibly unwell and had a bit of a sweat and he was sort of coughing. I sent him home, but I stayed in that room, and I worked in that room for most of that day, so I think that’s probably where I got it, but it took a good two weeks.

When Laurence became delirious his wife decided to call 111 to get advice.

Okay, so in early March 2020 I was in a meeting with a couple of individuals who weren’t very well. They worked for me, and I eventually sent them home. At that particular time Covid had kind of just been mentioned. No-one really knew what was going on. Subsequent to that, about two weeks later I started to feel unwell, and I assumed it was just the flu, so I was at home for about eight days feeling unwell. The symptoms, as have been described, the only thing I didn’t have was any loss of taste or sense of smell, but I have to say, I wasn’t particularly aware of that because I was becoming quite delirious, according to my wife. She became very concerned because I kept thinking I was fine, just taking paracetamol and being hot and cold and hot and cold and all that sort of stuff, a horrible cough. Then she took the decision to call 111, had a conversation, passed the phone to me. I remember having a conversation with a doctor and I think before I’d even passed the phone back to my wife, the doctor had already called an ambulance.

Laurence’s doctors and nurses wanted him to come back to ICU to see the ward, but this practice was temporarily suspended.

Like I said, they looked after me and the one thing that they, and when I say they, I’m talking about the respiratory nurses that I’m in contact with and contact me, they would love me to go back or other patients to go back into ITU to see, well, that’s the bed that you were in, you know, so you can get closure on it and I think that’s important. I think that’s important for me, personally, to see where I was and also if I hear a news programme or if I’m watching the news and they’re in hospital and I hear that beeping in the background. There’s a certain kind of beep, I think it must be just the machine that does the…measures the heartbeat, the oxygen, everything. I get a bit of a, oh, urggh, I get a bit of a funny chill up my spine because in a lot of my dreams there was a song with that noise in it or something like that so it can take you straight back there when you hear that noise. So I’d just like to see that machine and look at it in the face and think, okay, that’s what it is. That’s what it was doing. Yes, you never know.

So, were they planning for you to see the ward at all?

Say it again sorry.

Would they show you the ward in normal times or did they talk about wanting to show you the ward?

Yes, they’ve talked about wanting to do that and I think they feel it’s an important part of your journey to have seen it, to know where you were, where you survived and all that sort of stuff. So obviously they can’t do that at the moment because we’re in the second wave and that might go on for a lot more months, but I think it’s certainly in the programme to bring people back. Because it must be good for them to see someone that they cared for who has made a recovery, wants to come back and see where they were but also for them to be thanked or say hello. It would be great to be able to give someone a hug, wouldn’t it, just say thank you and shake their hand maybe but, you know, who knows, we’ll have to wait and see.

Laurence believed that the positive vibes people sent him may have had an effect on his recovery.

I mean, all those sorts of emotions of the dreams were about getting to a kind of destination. I think, for me and that that might have been my own drive to kind of want to get well would be my light at the end of my tunnel that was driving me on. I know I had a lot of people, and whether it’s the right or the wrong thing to say, I’m not a deeply religious person, I don’t believe in a particular God. I mean, I’m lucky enough maybe like you to have travelled around all over the place and been to Asia and other parts of the world and have witnessed different Gods and all that sort of stuff. And the problems it can create but I do have a faith in something or other and there were a lot of people who were sending positive vibes to me. I have some stories of my daughter’s boyfriend has a strong Italian connection and his mother is a Reiki healer and there was an entire congregation of a family in Italy praying for me through him, through my…it’s stuff like that. I’m thinking, well, I don’t know, did that have any effect? Is that worth contemplating? Is that real?

After waking up from being ventilated, Laurence could FaceTime his family, which was a real morale booster for him and his family.

Then when you did speak to your wife for the first time, so you mentioned you didn’t have a voice yet, so it was… So, what did that whole situation look like? So, they brought an iPad, you said.

Yes, they brought an iPad. I couldn’t use my… so incomprehensible for me, I couldn’t use my phone because it was too cumbersome. It’s not a massive phone. It’s the new iPhone 11 so it’s quite chunky but I just wasn’t able to physically operate it; a) I couldn’t’t speak, b) I couldn’t’t hold it up and I couldn’t’t do the numbers. I wasn’t very… I guess I wasn’t very with it, I suppose. So, yes, that first time the nurse would hold it up like that and just there, it’s my wife and she would be talking to me because she knew I couldn’t’t talk. They’d obviously given her a bit of a pre-chat to say, look, you know, he can’t talk but he’s just been doing this, that and the other and he’s awake, he’s kind of with it so talk to him and encourage him, which is what she did. So, she was just sort of saying, you’re doing fantastically well and your daughter’s here with you… me and here's the dog and it’s lovely and sunny. We’re fine. We’re waiting for you, and all that sort of stuff.

So, all conversations, I think, were aimed at giving me hope to just get better and, yes, they were a real morale booster for me, and I think that’s a brilliant idea if, in the entire ward, in a situation where you cannot have your family or friends. I think if I’d been involved in a motorcycle accident or something or, you know, I’m sure that in a normal situation you’d be able to be beside your partner, holding their hand, without being covered in PPE… you know, all that gear and it would help. There's a connection there, isn’t there? So, this is very new for the nurses and the doctors and for the patients and for the husbands and wives and families at home that are not able to come and see you or drop stuff off for you. So that’s where I got that sense that I felt that the nurses might be struggling with that because they can’t… they must feel that they’re not doing their job to the full extent of their ability.

Yes, so that was one of the reasons that we wanted to raise some cash to buy more iPads because I know that the priority for cash must be to go to more equipment for essential things so that’s part of the fundraising that we’re doing is to try and buy iPads but also to make sure that we push up the agenda that mental health aspect.

Laurence pledged to do 100 miles cycling trail to raise money for his local hospital, and many – including healthcare staff – have donated.

So once I started doing it, yes, it was pretty hard the first few times but once you start getting into it and get your appetite back, the hospital and my local NHS had sent a load of these amazing shakes which were so full of nutrients and god knows what, I was drinking two of those a day, just cramming myself full of nutrients and extra protein and stuff like that to try and kickstart my muscle mass coming back. I looked at myself in the mirror and my legs were just like two poles. It’s amazing how quickly your muscle just falls away. So I’d lost all my muscle mass but like I said, after six weeks by mid-July, end July I was feeling pretty good, well enough to go to Cornwall and take in some sun, have a bit of a laugh and, yes, ever since then I’ve renewed my love for being fit, decided that although I still feel, I don’t know what the correct term for it is but I would just say, slightly chesty, you know, there’s always a bit of congestion in my chest and I think that the exercise is good to get rid of that.

So that’s when I decided that I would get a new mountain bike and I would do this challenge. It was something that I always wanted to do but to give myself a target, to make it 31 March which was the day that I was put into an induced coma last year to be actually on the South Downs cycling a hundred miles on 13,000ft of elevation is a good way to say to Covid, you know, stuff you, but also a good way to say to the guys at [hospital], thank you, you know. It’s a credit to you that I’m well enough today to do that. It was the care that was given then, that I’m reaping the benefits of now. It’s a very strange way to look at it but I think it’s a good kick up the arse for me to realise just how precious life is and, yes, not to be squandered.

…since I did that JustGiving site for this cycle ride, believe it or not, I’m raising money for the hospital and some of the people who have donated are nurses that looked after me which has totally blown my mind.

Laurence would frequently see nurses change in and out of PPE, and appreciated how difficult this made their work.

I think it was on the 4th of May [2020] they moved me from ICU into a normal ward, recovery ward where there were three other guys in that ward with me and again, everyone was very, very sort of Covid aware. So, you’d see a nurse come to see you, visit you at your bed and once they’d finished with you, they would then strip off all their PPE gear, all their aprons, chuck it all away and put a whole new set on to go and do the next guy so you could just see the difficulty they’ve got in doing their job. It just seems like they’re wrapped up in new processes to enable them to do their job but, yes, you’ve got nothing much else to do obviously when you’re sat there but observe the nurses and try and talk to them and all that sort of stuff.