It was meant to be a colleague’s wedding in late March. Her dad had died suddenly of cancer a couple of years ago and her mum had also been diagnosed with cancer. She got engaged in summer 2019 and the wedding was planned for March so that her mother would definitely be there to see her only daughter get married.
The bride-to-be was worried about whether it should go ahead. Her mother was immunocompromised and the majority of the guest list was people who worked in A&E surrounded by lots of germs. It was this awful turmoil; should she potentially expose her mum? She needed to get married because she wanted her mum to see it.
In the end the decision was made for her. Lockdown was announced on 23 March. People were allowed out for essentials like food and medicine, and for exercise close to their home once a day, but that was it. Weddings were definitely not allowed. She decided to have a celebration on the day over Zoom. Everybody posted pictures of themselves in wedding attire, raising a glass to the couple. It was really fun, even if some people only dressed up their top halves that could be seen on screen. Earlier in the day, I had driven round to her house and left a hamper I had put together full of goodies on her doorstep. She later made a new wedding invitation which features a picture of all of us on Zoom for a date in 2021.
As the days and weeks went on, fortieth and ninetieth birthday parties were cancelled, another wedding was postponed. I resisted meeting up with my mum for Mother’s Day, though I was quite upset about it. My sister had made it up to Yorkshire before lockdown was announced to work from home and to be with Mum whose grief was still so raw. Self-isolating would be tough enough for anyone, let alone a grieving seventy-year-old widow. I was incredibly grateful to my sister for moving home and being such a rock for my mum during this unsettling time. We had planned a social-distancing picnic, but Mum didn’t think it a good idea. She was right. How long would it be before I saw her again?
When I arrived on shift, everyone would come together in a room just off-site with the consultant in charge who discussed where everyone would be working: hot (coronavirus) isolation units or resus, or cold (non coronavirus) minors, majors or resus. I liked this. Before, everyone came in at different times so I’d often be the only one starting at a certain hour. I’d sneak in and tell the consultant I had arrived. This way was better for team morale and there was a stronger feeling of camaraderie.
The consultant would make sure you were suitable to work in the hot area, that you didn’t have any risk factors that made you more vulnerable and that you had been fit tested for the masks so that you were safe to work in the area.
Each member of staff underwent a fit test. When I did it, I wore a mask with a hood over my head. A foul-tasting aerosol was sprayed into the hood while I was asked to do various manoeuvres like moving my head up and down, and to the side. I had to talk, and do various breathing techniques. If you can taste the spray, you’ve failed because it shows the mask wasn’t working properly. I passed.
Then there was donning (putting on) and doffing (taking off) the PPE every shift. The first time I wore it, my nose was very sore and bruised. Before you enter an isolation unit, there is a step-by-step process you have to go through. First you wash your hands, then you put on a pair of gloves, a full-sleeved apron which is tied at the back, a respirator and either goggles or a full visor. Lastly you put on a second pair of gloves. Once you’ve got the process down, it takes a few minutes.
I felt safer when I had PPE on. In cold majors the patients were supposedly not meant to have Covid. A handful of times, when I went to see them, I took an in-depth medical history during which they explained that they had symptoms which were in line with having coronavirus. By that time, I had been in there and examined them, potentially exposing myself for around twenty minutes.
In that way, PPE made me feel more secure; all I had to do was remove my top pair of gloves and extra apron after each patient. That didn’t mean it wasn’t so uncomfortable though. Even having a conversation would lead to me getting out of breath, and I like to think I’m quite fit. When giving patients advice, I’d have to stop mid-sentence to catch my breath. I was always hot and everything felt like so much effort. With the mask across my face and a visor coming down over the front, I felt so claustrophobic.
Going to the toilet was a nightmare. You’d have to be so careful about doffing the PPE, making sure you took it off so that you didn’t touch any areas that had been exposed and that you disposed of it correctly. Then, because a one-way system had been introduced to reduce cross-contamination from hot and cold areas, I had to walk a long way round to get to the bathroom. It became a fifteen-minute trip, instead of the two minutes it normally took. I often ended up waiting till my break for periods of time of up to six or seven hours.
Doffing the PPE at the end of a shift was a laborious process. Each time I came out of an isolation unit, I would peel it off and away from me. I washed my hands before I touched anything on my face. Last to come off was the mask. I couldn’t fling it off my face but took the straps off away from my head, held them out in front and then dropped the mask into the bin. Hand washing followed each individual step. Often, by the end of a shift, my hands would be so dry, they’d start to crack.
Inside the isolation unit, I always wrote my name on my apron because much of my face was covered and I couldn’t even recognize my own colleagues. The PPE made conveying empathy and compassion to patients more difficult. This is such a vital part of patient care that was missing and made this new virus all the more cruel and inhumane. The mask goes right up to beneath your eyes so no one could tell if you were smiling or pulling another facial expression. It’s harder to be heard and I had to make sure I enunciated every letter at a louder volume. It was tiring to constantly repeat things over and over again.
If appropriate I’d put my hand near the patient to show a level of comfort, or I’d put my arm on their trolley. It must have been so scary for patients so I made more of an effort when I went in to see them. I told them I was smiling and made a joke about how they couldn’t see it. I hope I went some way to easing their distress and panic.
Before Covid hit, I was used to feeling pretty confident in my surroundings at work. I was often the nurse in charge of certain areas. It’s often said that nurses are the backbone of the NHS; I certainly felt that was the case. If anybody needed anything, I would normally have the answer. I knew all the protocols and where everything was. If I didn’t know the answer I knew someone that did. In the isolation unit, however, everything was new and I felt like I was stepping into the unknown. I realized how junior doctors who constantly do rotations must feel when they have to start over in a new department or hospital. I didn’t know where anything was. I felt stressed because there were new protocols and it was overwhelming. All my previous knowledge was almost useless in this new environment. I think everybody felt like this to some extent.
There was more though. I was only a few months into my new role and wasn’t completely at home yet with the increased responsibility I had. Clinical decision-making was new to me and it was scary. Anxieties around whether I was doing the right thing were ever present. Was the man in front of me constipated or had he got an obstruction with a potential bowel perforation?