‘I haven’t had a fever, a cough or a sore throat, if that’s what you’re getting at. I definitely don’t have the coronavirus.’
Those symptoms were the warning signs at the time. I asked my specialist ear, nose and throat colleague to come and review her as I knew next to nothing about nose jobs. He shared my anxiety, but I reassured him that she had no Covid symptoms. Little did I know then that so many people would be carriers of the virus while presenting no symptoms.
Face masks were hardly used at the time so it was a surprise to walk into one cubicle and see a woman wearing one with unicorns and rainbows all over it. It seemed like a fashion statement, especially when she took it off when I stepped in to see her. Was I a safe bet? I tried to suppress the 6 a.m. sniffles that I get most night shifts when I’ve been working for hours and am tired.
The first real case of definite Covid-19 I saw was a patient in her forties, at the end of the first week in March. The first person in England died on 5 March after testing positive for coronavirus. Italy, meanwhile, was in crisis. By 6 March, their death toll had grown sixfold in six days; more than 230 Italians were dead and caseloads were growing by more than 1,200 every day. My patient had attended A&E because she was feeling short of breath. None of us was wearing personal protective equipment (PPE) at that time, apart from a cursory apron and pair of gloves. I remember looking at her chest X-ray and a colleague glancing over my shoulder and saying, ‘Well that’s a terrible-looking chest.’ It was odd because she had evidence of a potential infection in both of her lungs. I assumed it was pneumonia, but that usually only presents in one lung, not two. Little did I know at the time that her chest X-ray was what I would come to recognize as an obvious sign that the virus had embedded itself in someone.
She was none the wiser to Covid. She’d recently travelled, but not to one of the areas that were on the news. When I look back, all the clues were there and it was obvious. She was barely conscious, her eyes weren’t open and her breathing was very laboured. When patients aren’t able to talk, I just get on with my job. I don’t start a conversation expecting them to talk back to me because they’re so exhausted and I need them to conserve energy. It was obvious she needed to go to intensive care so I called them and they came straight down. It was the ICU doctor who told me bilateral signs of consolidation on a chest X-ray was a sign of Covid. My heart sank into the pit of my stomach. ‘It’s here,’ I thought.
We weren’t immune anymore and it had come to us. My thoughts went deep down a rabbit hole; this was the start of a long battle. I’d heard what my brother-in-law had been experiencing in China and thought that would be us. We wouldn’t be able to go anywhere. China had built a new hospital in six or seven days. We couldn’t do that, so what the hell were we going to do? I thought about the images I had seen of mass graves. Our mortuary had reached capacity one winter and a makeshift extension was erected to house all the bodies. If that happened in one winter, how were we going to deal with a pandemic?
This was getting dark and I began to feel that I was pre-empting things and being a bit too negative. ‘Chill out, Louise,’ I told myself. We hadn’t even got her swab result back yet so it wasn’t like we knew for sure. I didn’t have any thoughts at the time about me being infected. She hadn’t coughed on me and we’re so used to dealing with infections that it didn’t really cross my mind. Perhaps it was because it was before we knew just how easily it spread. We found out she did test positive; the news went round the department like wildfire. It wasn’t long before coronavirus was our new normal, however, and stopped being newsworthy in our professional lives.
The following night, a disgruntled man in his twenties came in accompanied by an entourage of police officers – six in total. Wasn’t this a bit excessive?
‘What’s brought you to A&E this evening?’ I asked before he threw his shoes across the room, and then looked around to see what else he could launch in my direction. I couldn’t help glancing towards a sharps bin in the corner where the scissors and scalpels had been disposed of, and was so glad of those six officers when they reacted quickly and restrained him.
Violence is part and parcel of working in A&E, unfortunately. I’ve had a long list of insults yelled at me that I won’t bore you with here. Once I heard a drunk patient shouting and ran to find him ripping off his monitoring, throwing thousands of pounds’ worth of equipment across the room.
‘What are you doing?’ I asked in what I thought was a perfectly reasonable manner. He came and stood one centimetre away from my face and said, ‘I’m going to kill you.’ He reached into his pocket, but before I knew it, one of my colleagues had restrained him up against the wall.
I’m lucky; in some cases, the violence can be extreme. There have been healthcare professionals who have been injured or even killed. We’re often threatened with rape and spat at. One of my colleagues was screamed at and hit around the head when she asked someone to move out of the way so she could pass with an elderly patient in a wheelchair.
One afternoon a few years ago, I had a visit from two police officers saying they had received a call from a man who was threatening to kill me. He had mentioned me by name after he’d glanced at my badge when I was treating him in the department. He had been discharged and later decided to ring the police. I laughed it off, telling myself that if he really wanted to kill me, he wouldn’t have informed the police of his intention to do so. Even so, it didn’t stop me glancing over my shoulder as I left work that evening.
I assessed my latest violent patient and deemed him safe for discharge back to police custody. As he was being escorted out of the hospital, he started shouting, ‘I’VE GOT THE CORONAVIRUS.’ We all laughed nervously and tried to give reassuring smiles to the patients he passed.
Later that week, Covid started to loom larger over A&E and everyone’s minds. It seemed to go from nothing to everything in quite a short amount of time. By 10 March, a sixth person had died in the UK and the number of confirmed cases was at 373. There were bound to be many others though, because there wasn’t widespread testing at that point. Airlines cancelled all flights to and from Italy as the Italian government’s decision to put the entire country on lockdown came into effect. I’d just booked a holiday in Pembrokeshire at the end of April to celebrate my birthday. It’s strange when I look back at how I was planning normal life right up until lockdown changed everything.
A few days later, the department was turned completely upside down. A&E spread across almost an entire floor of the hospital, taking over many other clinics, in order to create capacity. We had an isolation unit with around ten beds, and there was a Covid resuscitation area on top of that with nine beds. The department was split into hot and cold areas. Hot was coronavirus, cold was everything else. We were running two A&Es because we still needed a resuscitation area, and a minors and majors part of the department for those patients who weren’t infected and needed to be kept that way. (Minors is our shorthand for the walking wounded – people with a minor illness or injury – and majors means those with more acute problems who come in on a trolley.)
A few days later I had a meeting with all my ACP colleagues where we were told that our shift patterns were changing. With three days’ notice, my entire rota had been completely rewritten. Most of it now comprised of shifts that finished at midnight, or night shifts where I would finish at 8 a.m. Afterwards, we tried to cheer ourselves up with the thought of all the extra pennies we would be earning by working unsociable hours; ones that would be saved for when this was all over. At least I didn’t have child care to juggle amid all this chaos. It did present a bit of a challenge for the dogs, though. Our dog walker had stopped working because of the coronavirus situation and as I was starting later in the day, I was the one that had to take them out. They need a lot of exercise. I used to have dog-walking as a back-up career dream plan. That soon became a little less attractive when waking up early every day for weeks on end to take them out lost its novelty.