Working during a Pandemic is hard. There is a lot of anxiety as well as poorly people and difficult decisions. When this all started I was working extra hours in a busy emergency department. I worked in Majors, Resus and Rapid assessment and triage. The role for me was new. I had not worked in a busy emergency department before.
On this day I was working in Majors, cubicles 16-22. These cubicles were side rooms and were for patients who needed isolating. The work was full on. I was responsible for these 6 patients. At the beginning of the shift the consultant in charge of the department gathered us all together.
“As you are all aware – we are seeing cases of COVID-19 within this hospital. We do not have the swabs to test everyone, and our intensive care is nearing capacity. Any patient with respiratory symptoms will be isolated in side rooms – this is including those that would normally be seen in resus”
I already had one patient in a side room who I took handover for. She was a lady with cancer who had an infection. She did not have coronavirus and was being isolated to protect her as her immune system was so low. I went in, placed an IV line in her arm and took some blood. I then went to the drugs room where I got her antibiotics ready. While I was in there two of the health care assistants came in and were talking amongst themselves.
“We dont have enough PPE. We are low on masks and aprons.”
Hearing this made me anxious. I was working in isolation bays where I would need to change my PPE every time I went in and out of a room to see a patient. I went to the trolley where my PPE was laid out and made sure I had enough stock for the day.
My next patient was a lady in her forties. She had called an ambulance that morning as she was coughing and having difficulty in breathing. The ambulance crew had pre-alerted her to hospital and instead of going into the resuscitation room she was coming into one of my side rooms. I watched as she was wheeled in. She was on high flow oxygen and looked agitated. I asked the crew to take her into the isolation room while I put on my PPE.
Once all my PPE was on I entered the room. I introduced myself and the patient was only able to grunt in response. Her breathing was so bad. Her shoulders heaved, wide eyed she looked at me. She was obviously very scared. I set about taking an initial set of vital signs. I took her pulse, it was quick. Her breathing was also very fast. Her oxygen levels were low (despite having the oxygen on full) and her temperature was high. The only positive was her blood pressure was spot on.
I went to escalate this – I needed a doctor to come and see this patient. I stepped out, removed my PPE and went to find one. I felt she needed ventilating as well as some sedation. I was aware that she was panicked and that her oxygen levels would affect her level of conciousness. I found a doctor and told him. He came and looked through the slats in the door. This struck me. Was he also scared to enter the room?
He agreed. I was to take the blood from the patient and pop a cannula in to start some antibiotics and give the patient some medication to lower her fever in the hopes that she would start to feel better. The doctor would speak to his senior to see what the plan would be moving forward.
I obtained all the pieces I would need to set up an IV and prepared the drugs that would be needed. I placed on my PPE and entered the room. The patient was trying to pull her mask off. She was claustrophobic and struggling to breathe. This for her was fight or flight. I wasn’t sure which one it was yet.
I tried to reason with her, but she was so confused. I placed the mask back on and this helped a little. I then told her I would have to place a cannula in her arm. This was when she panicked. Unfortunately, she did not have capacity. Her oxygen levels were so low that she could not make a decision. I placed the cannula anyway. As I was holding the cannula to secure it – her other arm came around in a fist and punched me square in the face.
I was torn. On the one hand – she was not fully aware of her actions. She was fighting for her life. On the other hand, she had just punched me. Somehow I managed to bandage that cannula, and start her treatment. With the medication the doctor had prescribed she calmed down.
I went to report back what had happened. I was asked if I would continue and I did. About half an hour later the patient had a chest x-ray. They were planning on placing her on ventilation and needed to make sure one of her lungs had not collapsed. The bloods I had taken had come back unfavourably and showed that the patient was extremely unwell.
The chest X-Ray came back and the patient was classically showing signs of COVID-19. Unfortunately, we were unable to swab her. I managed her until she was ready to move up to a high care respiratory ward. At one point we used the ipad her family had given her to facetime them. She wanted to talk to them before she was potentially intubated. She managed a few words, they said a few back.
She was one of 20 patients I saw that day. All with varying levels of respiratory distress. When these patients are escalated and need ventilation we up our PPE to match the level of care. However, I did not feel protected. It is a vulnerable feeling working in a pandemic.
Unfortunately, more recently I am seeing more of this again. The cases have increased and the government has announced a month long lockdown. I want to see my family at Christmas. So I welcome this.