Experiences of Covid-19 and Intensive Care
The general ward
When clinical staff judge patients are improving and no longer need such intensive care, they are transferred from the ICU (Intensive Care Unit) to a general ward. Patients are ‘handed over’ to ward staff, with all information on their ICU stay, continuing care needs and a care plan.
This page covers:
- Transfer to the ward
- Differences between the ICU and the ward
- Physical recovery and physiotherapy
- Emotional recovery
Transfer out of the ICU
When clinical staff judge patients are improving and no longer need such intensive care, they are transferred from the ICU to a high dependency ward, or to a general ward. Often there was a wait between being told that they would be moved and actually being transferred. Some of those we spoke to were transferred to the ward briefly and then on to another hospital closer to home, where they stayed for their remainder of their time in hospital.
These were milestone moments on the road to recovery. Some patients we spoke to were clapped out of the ICU by the staff.
Neil was clapped out of the ICU by the staff to the MAU [Medical Assessment Unit] and then to the general unit after a week.
Neil was clapped out of the ICU by the staff to the MAU [Medical Assessment Unit] and then to the general unit after a week.
And when I came out of ICU all the staff were saying, you can’t go yet, we’re not ready. I said, what do you mean, you’re ready? They said, we’ve got to get all the staff ready. And you’re in your bed going to a new ward and they actually applaud you, the whole shift of nurses, healthcare assistants, doctors, specialists, they cheer you out. You turn into a bloody mess. And they also did that for me when I came out of MAU [Medical Assessment Unit], exactly the same thing, in the bed, the whole…every staff applauding me, high fiving me.
Okay, so I’d spent about a week in MAU [Medical Assessment Unit]. And it got emotional when I left because the nurses at the time there were more people dying than were pulling through, and it’s still the same for them and they must be absolutely mentally exhausted. But one nurse said, you’re coming off the ward today, Neil, and I don’t want you to go but you’ve got to go – when do you want to go? I’d better go now because if we stay here, if I keep you for a couple of hours, me and you are going to be in bits, we’re going to be crying all over the place.
In the early months of the pandemic, support from outside the hospital was tangible on the ward, such as drawings from local schools, and gifts for the staff on the ward.
Sometimes, people continued to have dreams and delusions. Carl’s nightmares terrified him so that he tried to ‘escape’.
For many of those we talked to, the move to the ward was an important step towards recovery. But this new environment also brought new challenges. Gerry was very worried that he would not be able to cope and have to go back to ICU.
For Jenny it was a relief to go to the ward, after being on the ICU for a long time.
For Jenny it was a relief to go to the ward, after being on the ICU for a long time.
What was it like for you to go to the [general] ward after that? Sometimes patients find that quite a big difference.
I was quite relieved to know that I was well enough to go back to the ward because I kept thinking…because they kept me in ICU, I kept thinking, am I ever going to get out of here. And when they said I could go back to the ward, I knew that must have been a good improvement to be able to do that. And then when I got to the ward, you’re still in a separate part where you’re monitored more than…in one bay, you’re monitored more carefully. And then when you improve a bit, then you go to another bay where they don’t have to keep such an eye on you all the time.
When he was on the ward, Gerry was worried that he would be re-admitted to the ICU. He was not sure he could cope again. Receiving his vaccination later on was a relief.
When he was on the ward, Gerry was worried that he would be re-admitted to the ICU. He was not sure he could cope again. Receiving his vaccination later on was a relief.
I had the high temperature in the ward. They just took blankets off me, gave me loads of water to drink trying to cool me down. Because obviously Scotland’s not very warm, but it can get quite humid at night. I can remember that, but at that point I was worried in case…and I said to the nurse, you’re not going to put me back into the ICU are you? She said, no, no. I was kind of worried.
I said to my friends yesterday I don’t know how I would cope again if it happened to me, if that makes sense. Was that a one off that I managed to survive what had happened to me, and if it happened again would my body be able to cope with that? I don’t know. So probably to get the vaccination tomorrow, if that stops it going that level into ICU, and that’s the way I look at it, then obviously the sooner I get it the better. So, I’ll get that tomorrow, so that’s going to give me a great piece of mind. Obviously when I get my second one a few weeks later I’ll feel so much better, and I think a lot of people will. That’s why there’s such a high uptake and people taking the vaccination, which is great. I think in Scotland Nicola Sturgeon’s done really well. I think she’s got 99.8 per cent of all care homes, which is fantastic. Absolutely amazing what she’s doing. She’s encouraging people. Everybody just wants to go back to normal. We’d all like to get back to normal. So, I would say that kind of sums it up for me, if that makes sense.
It was often only once patients had left the ICU that they could begin to come to terms with what they had been through and the physical and emotional toll it had taken. This was a long process that continued after leaving hospital (see also ‘Coming to terms with what happened’).
Differences between the ICU and the general ward
General hospital wards differ in important respects from ICU. The most important difference is that there are fewer nurses to look after more patients (see ‘Intensive care: Patients’ experiences/The general ward: care and environment).
Nahied felt less lonely on ICU because a nurse would talk to her. She missed this on the general ward.
Nahied felt less lonely on ICU because a nurse would talk to her. She missed this on the general ward.
And was there any difference in this, in the Intensive Care, and in the general ward?
Yeah, I get few differences, ‘cause in ICU, the nurse was always there sitting next to me, 24/7. The first thing I wake up, I see my nurse there, the last thing before going to sleep, the nurse is there. But that is not in the ward, that was different.
In the ward, you had to call the nurse.
I had to call them, and I felt a bit lonely in the ward. ‘Cause the nurse was always talking to me, and I was listening. And she was talking about her day, and tomorrow’s her day off, and talking to me about her plans about her family. One nurse’s son was getting married, she was talking about that, I remember now. But I don’t get that in the general ward, I missed that.
You felt a bit lonely you say?
Yeah. It was a side room, but lonely, ‘cause no one was always there. When I called the buzzer, a nurse would come straightaway.
And did you have any contact with other patients in your time in hospital?
No. No other patients, no. Because of Covid, you weren’t allowed. Yeah. ‘Cause of Covid I wasn’t allowed, and there was one nurse, she made me porridge. I never ever ate porridge. She goes to me, I’m going to put something here, and you’re going to eat it. So, she made it for me, she put some honey and I ate it. It was nice.
Another important difference is that these wards were often noisy as patients were awake more and aware of fellow patients. Of the people we spoke to some found other patients disruptive to their day or to their sleep; but in some cases, people were a source of support to one another (see also ‘Sources of support’).
Brian helped another patient on the ward and was given encouragement himself by another.
Brian helped another patient on the ward and was given encouragement himself by another.
On the ward there were lots of issues, there was an old man came in, quite with it, he was 94, I remember his name like it was yesterday. Again, I remember getting stressed out with watching him, because in just on evening he broke three CPAP masks, he was kicking over the side table, water going everywhere. He was accusing the nurses of being actors, it was just… I mean, I spent that first night just kept on pushing the buzzer, not for myself but for him, that was quite stressful.
There was a guy next to me that was recovering from Covid, he knew quite a lot, his dad was a professor and that gene pool of information and knowledge had, obviously, been passed down. So, he was pretty much on things, and he was quite an encouragement to me. But all the while, for me, what was happening was while I’m there and they’re trying to figure out, you know. Trying to give me medication, trying to find out what was going to happen to me or where I was going with my illness, bit by bit I was struggling.
Carl found the ward boring, and he “craved normal life”. Other patients were a source of support.
Carl found the ward boring, and he “craved normal life”. Other patients were a source of support.
You’ve got a TV there and if you think you’re just lying-in bed for hours and hours and hours looking at the ceiling and just watching things happen. And that’s what you did, you just laid there watching things happen, and then it’s bedtime, and then you wake up and same thing again. You look forward to breakfast, you look forward to lunch, you look forward to dinner, and then you go to sleep, or you don’t go to sleep, you dream. The last thing I wanted to do was go to sleep. It’s very, very strange because that’s just not me to be like that.
But I felt the ward was okay, just boring. I think on my last day I was there I turned the TV on, and they had a quiz programme or something on. I turned the sound right up, and it was like a funny moment of the guy opposite me who was 90 years old he was shouting out the answers to the questions, he knew everything. And it was lovely, and you could see everybody else in the ward listening. It’s just quite strange.
And the one thing I do remember is hearing the outside from the window, just hearing things going on outside, and how you crave normal life. That was why it was frustrating because I couldn’t see. It sounds really silly, but I had an imagination of what it looked like outside the window. And then when I actually managed to stand up and look outside the window, I saw something different, and it was kind of very strange.
Physical recovery
People who have been critically ill have commonly lost muscle mass due to inactivity whilst sedated or in bed for extended periods. They feel very weak and have little energy. Physiotherapists work with them to help them to regain their strength, giving them exercises to improve their lung function and their ability to stand, transfer between bed and chair, and walk small distances (see also ‘patient experiences of ICU/Physiotherapy on the ward’).
Emma recalled building her strength back up day by day with the help of the physiotherapists.
Emma recalled building her strength back up day by day with the help of the physiotherapists.
Every day was like, I went, can I have a frame, I need to try and walk, so they’d come in and they’d say, right, today we’re going to do this. They gave me a couple of days, but you know, today we’re going to do this, we’re going to do that, and I’d be like, right, okay, so we’d sit at the end of the bed, the physio would show me the exercises. Even though it hurt, it really hurt, it was so hard, every…there wasn’t one part of my body that didn’t hurt, and I couldn’t breathe properly. I felt like someone had tied something round my chest, and I had a pain going down the middle of my chest, which apparently was from the ventilator where it goes…the tubes are so…where they go in, it was just uncomfortable and painful. So, everything on me was hurting, but every exercise they gave me, I was doing everything, everything they would say to me about, if you go down to the end of the bed and just…they gave me a frame, just try and stand up. They showed me how to stand up, sit down, stand up, sit down, I’d try and do that, and then each day I’d build it up to stand up, sit down, to sit on the chair, there was a chair there.
And sitting on that chair, I even took a picture, I look hideous. .It's the most awful photo in the world, but I’ve never been so proud that I managed to move from a bed to a chair. I sat on the chair and sent a picture to my husband, and then it went from, you know, getting up from the bed to the chair, to walking to the end of the bed. So, then once I’d walked to the end of the bed, I wanted to get to the other side of the bed. And then it would be the toilet wasn’t far from my bed, so then it was, I want to get to the toilet. And then I’d always have to have someone with me, and once I got into the toilet, it was the getting back from the toilet. Then it was going to the window and then just each day or throughout the days, you just build up and up, and then having less oxygen on.
If it hadn’t have been from having all the physios there and the nurses with that bit more time, because they seemed to have more time than what they did…what I’d assume they would do normally, to get you up and about and get you moving. I don’t think I’d have probably been anywhere near as far along as I was, because they all…they wanted you to get better, not because they wanted your bed. Not because they wanted you out so that they could get home and go see someone, they wanted you to get better. They were all quite passionate, and you could tell if the ones that weren’t, they were just like there to shove your medicine in or…but you know, and that’s fine, isn’t it? If that’s what you choose to take from a job, that’s…but they all wanted you to get…so you could see that they’d come in, and they’d be like, hi Emma, how is it today? Right, what have you done today?
And it was just like that, it was just nice, and they were all friendly, yeah, and I think they actually…they make it, they make it for you, they make you want to…in a very childish way, they make you want to please them. Because of how they’re coming in, you…like one of the days they were going to me, see how many times you can get up and down, up and down. And I knew these two physios, I knew they were coming back. I think they were physio, I can’t…you have physios and you have something else, and they looked very much in their uniforms the same. I can’t think, but I’m sure these were physios, and they’d be like…I knew they were coming back the following day, so I made sure that I was up and sitting in the chair when they came round. Just because I knew what they…and they were like, she’s up and she’s in the chair. And I was like, oh yeah, yeah, I’m in the chair. But yeah, you just wanted to be able to do stuff to please them as well, because they gave you so much, you wanted to be able to show them that you could do it, yeah.
Ann had several falls on the ward when she had not yet gained enough strength to walk by herself.
Ann had several falls on the ward when she had not yet gained enough strength to walk by herself.
One day I was sitting in the chair, and because I was constantly falling asleep – it was like I just couldn’t keep my eyes open most of the time – and I recall when that lady was alive opposite…oh, I can’t even remember at that point, but I just heard this shouting, nurse, nurse. And what had happened is that I was sitting in the chair, and I’d dozed off. And I went forward and fell out of the chair onto the floor. Probably, thinking about it now, they probably should have strapped me in, but I just went forward and went on the floor. I don’t recall anything until all the nurses were rushed over trying to get me up off the floor. So yes, that was one of the experiences of me having a fall. I had a fall in the shower as well. The nurses didn’t quite hold onto me, so I sort of slithered down the wall on the floor. And yeah, so there was about three incidents of me having fallen. Because it was like I had no control over my body, and when the physiotherapists started coming in, I remember it was…sorry, I forget words…it was…
Take your time. And if you need to catch your breath that’s also fine.
Okay. It was when I had to stand up from the chair, because my legs were like jelly, so of course trying that, and they gave me the frame and everything, and I’ve had to very, very slowly start trying to walk. But it really was like a toddler standing up and trying to take their first steps, because obviously for nine weeks I hadn’t walked, or even stood up, because I was in the bed or the chair for all that time.
When Neil had a secondary infection that was a set-back. He told the physiotherapists and his doctor that he needed a break. His physio supported him until he no longer needed support.
When Neil had a secondary infection that was a set-back. He told the physiotherapists and his doctor that he needed a break. His physio supported him until he no longer needed support.
So, I got moved and then I went up to another ward. I was still obviously very weak, but I was at a stage where I was coming off the oxygen from 24 hours to lower levels, I began to start to walk – and then I got a secondary infection. And I’d been coming on really really well, I was known as the smiler on the ward by the doctor, My Happy’s happy, and one day they told me I’d got a secondary infection, the blood count had gone down again, I just felt really grotty. And the specialist came around and so I turned to her, I’m not in the mood for anything today, I’m sorry I’m just not up for this. I’ve done so well, and I just feel like I’ve been kicked in the belly. The physios came around and said, are you getting up? I said, no, just leave me. I need a day to process what’s actually happened. And they said, no, it’s fine, it’s absolutely fine, we know what’s going on and it’s a bit of a dip for you, but don’t worry, you’ll get through this, we’ll put you on some antibiotics.
And it was a dip, you know, it was, just because I’d such a great curve of recovery, I didn’t want any dips – but I did and it happens, so… So, that was about the only really low point of it. So, they were just treating me; the physios were giving me exercises and trying to get me off the oxygen, just trying to build my strength up really. And that’s pretty much how it went for the next five weeks. So, it was nearly seven weeks I was in the [name hospital] and progressing every day. Towards the end, even though I now look back and see pictures of me, I was still very, very ill. I was very anaemic, I felt like I couldn’t run around but I felt like I needed to get home – but it was all due to the fantastic care of all the staff in the hospital that I actually got there. There we go. [Dog barks].
He’s cheering you on.
Yeah.
Quite the story, yeah.
So yeah, it’s an experience I obviously don’t want to go through again, but the support I’ve had…I had physio for eight months up till November. And it was…I didn’t realise but [name] was doing my physio, she was actually my physio when I was in a coma, so I had her treating me or telling me what to do from April till November. And again, that got…the day she said, I don’t need to see you anymore, got very emotional. Because that was somebody that had seen me at my worst, and for her to tell me that I could go and not be able to…don’t have to come back was such an achievement for me to be able to do for her. And yeah, so it’s been very emotional.
Patients may start eating again while they are still in ICU; others may only start to do so once they get to the ward. Many may still have feeding tubes in place until they can eat sufficient calories. After the transfer from ICU to the ward, most of those we talked to were still dependent on breathing equipment, particularly at night and after exertion (such as getting up from the bed, or, later, walking to the toilet). Paul and Chris described their difficulties eating solid food for the first time again after being on the CPAP (Continuous Positive Air Pressure) mask or mechanical ventilation.
Chris remembered that eating when breathless was difficult. He enjoyed the company of other patients on the ward, as well as a view of the outside world.
Chris remembered that eating when breathless was difficult. He enjoyed the company of other patients on the ward, as well as a view of the outside world.
When I was in hospital, eating, I found when I was eating, my oxygen was dropping straight after, which said in your head you maybe think maybe I shouldn’t eat as much; or because you’re chewing and you’re not focusing on the breathing properly. I’d then end up thinking, oh, I won’t eat that much because I don’t want it to affect my breathing for the next hour after.
So, I think that played on my mind a little bit, that when I was eating it was then affecting my breathing so that I shouldn’t eat as much. But I was never really, really hungry at any point throughout the whole thing probably, although I did when I was on the ward eat the full meals that they let me choose. I just never really had a proper hunger again, probably till I came home and had a proper, like, cooked meal at home. But yeah, at no point was I hungry, but I was able to eat when they stopped feeding me through the drip.
And what kind of ward was the general ward? So, you’ve described there were four other beds? Is that right?
Yeah. So, when I got in, I was put in a corner by a window, which is nice, because they’d open a window, fresh air, and also being a butcher, I’m used to being cold. As stupid as it sounds, but when you handle cold meat or…like, the nurses always mentioned how cold my hands were. And the thing is, when you’re a butcher you’re handling meat that’s kept at one degree all the time, you’re in and out of fridges that are at one, or a freezer that’s minus-20, so you’re used to the cold. So, the fact that they were able to open a small window next to me and allow cold fresh air in, that was nice.
Yeah, and there was four beds. The nurses’ station was right outside the door as well, which was nice that they literally could see us at all times. And yeah, that it’s…it was nice to be by the window, I could look out the window, although there was not much there except for a couple of birds and a squirrel that were running up and down the tree every day. Just being able to see that was better than when you’re in intensive care there’s not much to see except for intensive care ward. But when I was in…put onto the general respiratory ward, to have a big window, to be able to see trees, even though it was January and it was grey and horrible most days, but it was nice to see light and see outside again.
And yeah, there was four beds in there. They weren’t too far apart as in we could still talk even with our masks on, we could all communicate, we all had a chat. The person in the bed next to me I think changed four times in five days. The first guy got sent home because he was better. The second guy came in and was getting better, so they moved him to a bay a couple of bays down, which when I was doing my second walk test. I then bumped into him because he was sat on a bay, right at the edge of the bay, so when I was walking in the corridor, I met him again, so that was nice. And yeah, it was just nice to have people there to talk to. And yeah, there was only four of us, so we were all laughing and joking and stayed together.
Emotional recovery
Once on the ward, many of those we interviewed continue to struggle with the emotional impact of their time in the ICU (see also ‘Coming to terms with what happened’). Some felt anxious and depressed, and these feelings could stay with them for a long time.
Ann felt very anxious when lying down in bed on the ward and at home, because she associated it with death. For a while, she slept only in a chair.
Ann felt very anxious when lying down in bed on the ward and at home, because she associated it with death. For a while, she slept only in a chair.
And I realised when I came home, I think the reason why I had such anxiety on the bed, and there were many times during my stay I wouldn’t get into bed, I slept in the chair. And I think my fear was that if I get into bed I’m going to die, like the other people did. At the time I didn’t know, but I did have a very, very big issue with lying down, in all the time when I was able to speak to the nurses, they had to put my bed up straightaway because I couldn’t lie flat, because that’s when I started to really panic. So yes, for most of the duration when I was compos mentis I slept sitting up or slept sitting in the chair. And when they had to help me with bathing, they put me on the bed and they said, we’re going to lower you down. And I remember saying, no, no, no, no, up, up; and I kept saying, up, up, up, up. And they said hold on, we’re being as quick as we can.
These experiences may be associated with Post-Intensive Care Syndrome (PICS). PICS includes cognitive symptoms, such as poor concentration, forgetfulness and decreased memory; emotional symptoms such as depression, anxiety and decreased motivation; and physical symptoms such as fatigue and decreased mobility. Treatment is possible. Family members may also experience chronic psychological effects of the admission of somebody close to them. This is known as PICS-F.*
Read more experiences of ‘Discharge from hospital’
* Rawal,G.,Yadav,S. & Kumar,R.(2017).Post-intensive care syndrome: An overview. Journal of Translational Internal Medicine,5(2) 90-92.
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