Roger

Brief Outline:

Roger and his family fell ill with Covid in October 2020. Whilst his partner and sons recovered relatively quickly, Roger became so fatigued that they called an ambulance. Roger spent 23 days in hospital, 11 of which were in the ICU, and was then discharged home. Interviewed for the study July 2021.

Background:

Roger lives with his partner and their twin sons (aged 26). White British.

More about me...

Onset

Roger lives with his partner and their twin sons in a house in which they have lived over the past 30 years. At the beginning of the pandemic, Roger did not feel particularly vulnerable to Covid. He had successfully controlled his diabetes with diet for years, and he felt relatively fit. The general uncertainty as to what the new virus was and what it did, his COPD (Chronic Obstructive Pulmonary Disease) and his age were reasons to be careful, but he was not too worried. The family did not go many places in those initial months. His sons did regular tests on the way home from work.

One day in late October 2020, one of Roger’s sons came home saying he needed to get tested as a colleague he had been working with had tested positive. The test result came back positive. A few days after this, Roger found himself very fatigued: it took him half an hour to shave. His partner and kids were concerned and called for an ambulance. The paramedics decided to take Roger in to do further tests. Roger now feels he may have ‘gotten it worse’ than his other family members because of his underlying health conditions and his age.

Admission to hospital and ICU

Roger walked down the stairs and to the ambulance. He was admitted to the ward where a doctor told Roger that he was very ill. He was transferred to ICU that evening, where he was put on a CPAP (Continuous Positive Airway Pressure) mask, that felt very claustrophobic. Roger says it took him a while to realise that “you cannot fight it; you have to let it do the work for you”. He was given a plaster to prevent abrasions on his nose from the mask. Roger does not remember much from this time, except trying to touch the end of the bed with his toes, possibly to cool his feet on the metal.

Roger was eventually moved to a side room. He took this to mean that it was serious, whilst at the same time he started to feel a bit better. He could sit in a chair during the daytime, albeit still with the mask on. He exercised his feet – until the doctor told him to take it slower. Looking back, Roger feels he should have continued these exercises. When he was hot, he received a fan, which helped to make him feel more comfortable. Roger remembers being turned on his stomach every now and then.

Around bonfire night, Roger was moved back to a six-bed ward. There were two other patients in the ward, one of which was very chatty. He and the other patients could hear fireworks outside. There was a view from the window. Although Roger had never been a good sleeper, he now frequently woke up at night.

The recovery ward

Two days later Roger was moved to the recovery ward, and onto a nasal flow mask. Every hour a nurse would come to measure Roger’s blood pressure and pulse. They measured his oxygen levels as well saying that he could not leave until his values were in the high 90s. At the time they were in the mid-80s.

The chatty patient who had been in ICU with him was also in the recovery ward. Roger says there was a sense of camaraderie between them: they did self-proning together and chatted to each other. Whilst Roger was in the recovery ward, four patients around him passed away; this had a big impact on him. Roger practiced yoga some decades ago, and now remembered this to do deep breathing. Another thing that helped with the breathing was what his fellow patient had called the “Christmas present”, a spirometer that both men had been given to exercise their breathing (a spirometer is a device that measures the volume of inhaled and exhaled air from the lungs).

Roger unfortunately developed a lung infection, for which he needed to get an X-ray and an MRI. He was put back on the CPAP mask, although it was a smaller one, for a week, and then back onto nasal oxygen. The lung infection improved after Roger was given antibiotics.

Roger keeps a list of words he learnt during his hospital stay (indicating how he learned to communicate and make sense of his situation in clinical terms). Roger is appreciative of the hospital food, especially the soups “because you could actually taste them”.

A painful memory is when numerous nurses tried to put in an arterial line. Each attempt took them at least 20 minutes, and none of them could get the line in. Roger remembers that he was in absolute agony. Eventually it was suggested that he would be given a local anaesthetic whilst it was put in, but then this did not happen as the reason why he needed a line in the first place sorted itself. He does still have a bump on his arm, which has only started appearing recently, which worries him.

Communication with staff

Roger felt that communication with staff was good. He felt well informed by nurses and learned that he could ask consultants anything. He made sure to always express gratitude for their work as he observed the time constraints they were working under. Of course, Roger was not allowed visitors due to the public health restrictions.

Communication between Roger’s family and the hospital staff was initially quite difficult. Whilst Roger is not sure what their exact experiences were, he knows that they did not find it easy to get updates from the hospital. It took them a while to talk to the right people. This was easier once Roger had his mobile phone and was able to communicate with his partner and sons directly. They tended to call him around 7pm to have a little chat. He was also in touch with an old friend of his who had been in hospital for a four-month period after a car crash years ago. This all made Roger feel that he was keeping in touch with the real world.

Leaving hospital

While in hospital Roger had unlearned how to walk. He had lost 1 ½ stones in weight. The nurses took his nasal oxygen off and when he passed the test for walking (stair test) with oxygen saturation 92, which he calls “the magic figure”, he could go home. Roger was discharged 22 days after his admission. He received a discharge letter and medications. He was picked up by his sister-in-law. He describes how in the initial days after his discharge he was “having to do everything in slow-motion”. He expected to “be right” at Christmas, but things did not happen exactly that way.

Recovery

Initially walking small distances was difficult. Roger followed self-devised “walking regime”: starting with small distances, for which he and his partner occasionally drive to flat places, because he struggled with hills. Roger slowly increased his strength and ability to walk longer distances. He kept a chart documenting how much he had walked (e.g., 150 yards + bin out) to keep track of progress and milestones. This, alongside some support of a physiotherapist who visited him at home and gave him leg exercises to do, and some gardening activities (which were mostly “therapeutic, not very physical”; he loves the smell of sweet peas), Roger now feels “85% right”. He is still short of breath. Roger finds it difficult to determine what part of this 15% is a loss of function associated with ageing (requiring at least some degree of acceptance), and what is a consequence of having suffered Covid and having received intensive care treatment (and so may be expected to improve further going forward). Roger keeps active to hopefully influence both as much as possible (“Use it or lose it” his partner says).

From the hospital, Roger has – in addition to the physiotherapist sessions at home – (digitally) seen his ICU team for two medical consultations. Since coming home, Roger has had two lung infections, for whom he has been in touch with his COPD department in the hospital. The antibiotics he has received have helped, and rapidly improved his breathing. This support has been “invaluable”. Whilst he says it was “not a good time to require clinical support”, he tells me that he “didn’t miss clinical support”.

Informally, support came from his partner and children, who both live at home. The house has space for all of them, and the garden is a good place to be active and spend time outside. More support came from his close circle of friends with whom over lockdown Roger and his partner met for online quizzes “just to see faces”, and distanced walks, and more walks now that restrictions have lifted. Roger has been in touch with his five siblings, some of whom he intends to visit again soon. Cautiously, Roger and his partner have made holiday plans again for the year to come.

Messages to others

Reflecting on what others may learn from his experience, Roger mentions breathing: he recommends spending 15 minutes on breathing exercises. He furthermore recommends staying optimistic. He has no further recommendations for the improvement of health care services.

Roger kept a list of his steps, mapping out his progress.

So, I was wondering if you could tell me how have you been getting on, since you got home from hospital?

Okay. I have a list here, that I didn’t…I started on the 28th December. I don’t think I was particularly well when I got home and I was having to do everything in slow motion, just to accomplish simple tasks. I do remember though, it took me…I had to stop six times, walking up the stairs, just to catch my breath. That wasn’t… a great time. And I do remember thinking, oh, I’ll be right for Christmas. Not really. Still not right yet.

So, towards the end of December, I started to keep a…a bit of a list about my walking. Now, from the…my kitchen to the front door, is 15 metres. And I thought, well, I’ll do that, and then at least I’m building up my muscles again. And well, the first few days, I was doing about 600 metres, dropped down to 300, and…which I’d been feeling it’s too much. Dropped down 150. So I did 150 for about three weeks. And then I decide to go out of the front door, duh, der. And at the end of my walk, which is only about 50 yards or so, there’s a little lane [name]. Right, so that’s my aim. And it’s uphill, slight gradient. So, yes, I do that, have a little rest and walk back down the hill to the house again. That’s fine. And according to my list, I did that for a month without going any further. And then I gradually increased it, increased it, until mid-April, I’m actually walking two miles, a mile, and then a mile back.

Roger does not know to what extent he can expect to recover, or even retain his abilities in the face of his advancing age.

So, you said you are unlikely to feel again, like you did when you were 40. How do you make sense of…what of your process is recovery from intensive care, what is recovery from Covid, what is ageing? How do you make sense of it, also in terms of what you might be able to change?

I think the best thing to do about recovering from Covid, is not think about it, because it’s kind of depressing. So yeah, I think, maybe the getting older bit, not a lot you can do about that. You just keep active. [Wife] and I used to go out on long walks in the [place] and things. But as I’ve slowed down, I can’t do that. [Wife] is a furious walker. She speed walks everywhere. So she was out on a…she went for a walk at eight o’clock this morning, before it got too hot. So she’ll walk every day and…two or three miles. That’s strenuous as well, there’s some steep hills in [place], which I don’t even…I think twice, before I drive up them sometimes. But I…

It strikes me as such a difficult thing to determine, whether it’s just age and, you know, we all get older, and that’s not something we’re going to change. But recovery is a process that we hope to reverse to some extent, so…

Sure. Yeah, absolutely. I think, basically, I’ve done a lot of that in my walking regime. So a lot…I think, well, I had a lot of muscle wastage. I’ve lost a stone and a half in weight. I’ve no idea what that is in kilos. And just gradually improved. But yeah, well, I think it’s something I have to keep up. Because as [wife] says, use it or lose it, you know. But I don’t fancy going out walking in this weather. So, I’m quite happy pottering in the garden and sitting under the umbrella. Yeah, I don’t know how…yeah, my recovery, I feel as though I’ve…I’m a lot better than I was, which is why I’m saying about 80 per cent. I reckon I was about 30 per cent when I came home.

So that’s been kind of improving. But how much better I’ll get, I don’t know.