Sunday 12 April 2020

It's been almost five years since my last post. 2015 was rather an eventful year, and for various reasons I didn't feel like writing, or if I did, I didn't feel like publishing. But in the last few weeks, for us, as for so many other people, life has changed considerably again. Whenever I feel stressed, I tend to find writing things down helps me, and suddenly the urge to not just put pen to paper, but to actually publish it, was there again.

A quick update: just over 5 years ago, my relationship with B. came to an end very abruptly. Although it wasn't my choice, with hindsight, it should have ended much earlier, but then hindsight is a wonderful thing. A few months later, in fact, three weeks after my last post, I met Simon, funnily enough at the concert at the church that I mentioned in my last post. I was helping out, he was part of the 'choir' that came to sing (it's an octet), we got chatting at the end, and four years later I walked down the aisle of that same church to marry him. In 2017 I sold the house that we'd lived in since 1996 and where the children were born. Not an easy decision, but the house needed so much doing to it which I couldn't afford on my own, and we were getting fed up with living in two houses. The children are now grown up and live with us full-time. 21yo is reading English Literature which suits her down to the ground. 18yo was doing his A-levels which obviously stopped very suddenly. He is hoping to go to university later this year, all being well.
The last of the big changes is my career. After 23 years as a translator, I resigned in September 2018 and joined the NHS as a nursing assistant in our local hospital. 18 months on and I've not regretted it a single second yet. I sometimes wonder if I should have gone into it sooner, but I think having a bit of life experience helps me.

Of course, being in the NHS means I'm in the thick of the corona pandemic. And that is why I've started writing again. Emotions and tensions run high and one way of dealing with it, for me, is to write. I've noticed that people on the outside seem to be interested in hearing what life is like 'on the frontline', so I thought I'd resurrect the blog. And even if nobody reads it, it will still help me by writing about it.

A bit of background: I work on a ward that specialises in diabetes and kidney disease, and acute general medicine. In the main, we see a lot of elderly patients, often with dementia. In the last week though, we have become the latest Covid19 ward in our hospital, the 8th ward to date. So far, we have patients who have tested negative, but where there is strong suspicion that it was a false negative. I have done 2 full shifts now, and started writing the day before my first day shift, just after we had had our training:

Thursday 9 April 2020

Tomorrow is my first shift on a Covid19 ward. There had been rumours for weeks that it was going to happen, but apart from getting fewer and fewer patients as the pandemic grew, nothing much changed on our ward. At first it seemed so far away. Of course we talked about it, at work, at home. Then the first case was confirmed in the UK and everything seemed to happen faster and faster. Still nothing much changed on our ward. It became quieter, most bays having an empty bed or two. Then we started talking about staff getting ill. The first case was confirmed in our hospital. The first Covid19 ward was opened in our hospital. There were lots of goodies for NHS staff, which made me feel weird: it was nice but I felt it was almost undeserved as I wasn't doing any of the scary work that you'd see pictures of in the news. Then the lockdown came into force, and there were lots of new rules. We had to get changed at work rather than come in in our uniform. Visitor numbers got limited and then had to stop altogether. And then the ward next to us, separated by fire doors with windows in them, was turned into a Covid19 ward. We knew it wasn't long before it was our turn.
We got the go-ahead on Saturday. At this point, most of the staff started to feel nervous and jumpy. Some staff were off with possibly Covid19 (no way of telling unless we're tested), some were isolating because of household members showing symptoms, some were shielding, some were off with anxiety. I felt (and feel) very lucky that the four of us at home aren't vulnerable. The next few days were very strange - so many questions, so much nervous energy.
During yesterday's shift, the five remaining patients were either discharged or moved to other wards. We were empty from around 11 o'clock, and we spent the afternoon tidying, studying, talking about our worries and making a silly little music video.
This morning we had a ward meeting with the whole team, our CEO, and various other people who you know by face but can't quite place unless you've worked with them. All very knowledgeable, experienced, approachable and reassuring. We had our masks fitted. Mine failed and I felt like a failure for not being able to get it airtight. I thought I'd come away from the meeting feeling reassured, instead I felt tired, scared and tearful. I came home and cried - at people flouting the lockdown rules, at my stepdaughter-in-law for working in ICU, for not having bought any Easter eggs for our mad Easter egg hunt.
I spent most of the afternoon knitting and chatting in our ward WhatsApp group. The anxiety is quite overwhelming and I just wanted the comfort of the others going through the same thing.
I'm now all packed, alarm is set. 18 months ago I took a huge step into a brand new world. So much I had to learn from scratch. But just as I felt more confident, this world is turned upside down and I'm having to start all over again, but this time with a scary, unknown and sometimes fatal virus in tow. And I'm frightened.

Friday 10 April 2020

I don't think anyone doing today's shift slept very well. By 6am our WhatsApp group was already chatting, mostly about sleeping problems.
I got to the ward early and sorted out a set of scrubs. The two patient bathrooms are now for the staff to use, and both have sets of scrubs in them in various sizes and states of wear and tear. The uniform dress I normally wear, has four deep pockets and I can carry so much stuff with me - scissors, tape, sachets of cream, handover, my FitBit, lip balm. Scrubs mostly only have one pocket and a shallow one at that. Anything you don't want to lose, can't go in there. The trousers were too short of course, and you have no idea what people's roles are anymore. After 18 months I have a pretty good idea of most uniform colours and who wears what, but scrubs come in a rainbow of colours and everyone wears whatever they can find. I didn't realise until now that I feel quite proud of my uniform - to me, scrubs just look scruffy.
I had 4 patients on my handover, with two other nursing assistants and two nurses. One female bay and one gentleman in a side room. After handover was finished, we were all a bit of apprehensive. It was obvious that our normal routine wouldn't work. Normally you nip in and out of your bay, but all bays are now sealed off with plastic (with zips in them to create an entrance), and you spend as little time as possible in there to minimise the risk of getting infected. You go in there and try and combine as many tasks as you can. We also quickly found out it was easier to have one person outside watching and waiting, who can pass things into the bay or take them out without the person inside the bay having to leave. We all wear surgical masks at all times, but getting into the bay means more PPE: plastic apron, gloves, visor. When you exit the bay, the apron and gloves come off and go in the bin inside the bay. You use hand-gel to clean your hands and leave through the entrance in the plastic. You then clean your visor and store it away for the next time, and you wash your hands thoroughly with soap and water. It's not something you can do quickly and you don't want to do it too often if you want to save on PPE.
I didn't actually go into our bay until 10am. I'd just happened to be the one staying behind and handing things in or taking them from the nursing assistant or nurse inside. I was nervous about going in, although I'm not sure what I was expecting. But as soon as I was in there, I realised the patients  were no different from our usual patients: human beings who needed care. And once I realised that, all my fears were gone.
We spent the rest of the day trying to get to grips with the PPE, the most comfortable way to wear a surgical mask (the elastic does hurt your ears), telling people when they weren't using PPE correctly (including doctors). And cutting and laminating shapes for our new board with post-pandemic wishes, trying to bring some positivity to it all. Lots of people taking part and lots of lovely wishes appearing.
We visited a colleague who had been admitted to hospital and had tested positive.
We chatted, we laughed and we all felt very tired - the release of weeks of tension.
I'm going to sleep well tonight. Tomorrow's shift will feel far less daunting.

Saturday 11 April 2020

A far less anxious start to today's shift. Beautiful sunrise as I drove to work. The weather has been glorious the last few days, in fact, for most of the lockdown period so far. I deliberately arrived early so I would have enough choice from the scrubs. They are still a novelty; today we seemed to have only large sizes, making some people look like they were wearing pyjamas. They come in various colours, and the aim is to find a matching set. Oddly enough most of us were in blue today, with the nurse in charge in turquoise, which set her apart a bit. There is still the weirdness of seeing your colleagues in ordinary clothes as they arrive for their shift, although most of us are now in clothing as close to PJ's as possible.
I had the same set of patients as yesterday, albeit with a different team. The nursing assistant I was paired up with, hadn't done a Covid19 shift yet, so there was lots of telling her what we'd done the day before, what worked, what didn't. Having someone in the bay doing as many things as possible in any one visit, while the other stays behind to be on hand for passing things in and out, that works well. The problem arises when people don't understand the rules: the patient who comes out of his side room to let us know his water jug is empty, instead of using his call bell; the doctor who doesn't realise that there is a computer inside each bay to be used and comes out with gloves on to use the clean computer in the corridor. The principle is very simple: what is inside the bay, is potentially contaminated and has to stay there. Patients aren't allowed outside of their bay (or room), so we try and keep as much as possible of what they and we need in there: computer, obs machine, commode. Anything that comes out, has to be thoroughly cleaned, including us. Today I tried to keep track of how often I'm washing my hands, but I lost track very quickly. I think it might be close to a hundred times a day (a long shift is 12.5 hours) - our hands are definitely showing the signs. I'm going through endless tubes of handcream, but more often than not when you have only just applied the cream, you have to wash your hands again. I don't think my hands have ever been this clean, and my skin is very tight.
Although all our patients have tested as negative, these might be a false negative as the test is only 70% accurate, and we have to work around and with them as though they are positive. So far, we have had two patients become poorly; one of them was moved to an isolation ward and the other seemed to have something not Covid19 related.
The type of patient seems to have changed. I don't know if that is a coincidence: does Covid19 not occur in our usual type of patient or are they going to other wards? We usually have a lot of elderly patients, often with dementia in various stages. They pretty much always need our help, washing, dressing, moving, feeding. It is the part that is the most tiring, but I often find it the most rewarding too. If you have an independent patient, which doesn't happen all that often, you're usually relieved as it means that you have more time for the people that need help. There are plenty of shifts where you need more staff and you wish you had ten pairs of hands. Now, most of our patients are a bit younger and independent. Of course, it is only the second day and it is the Easter weekend, but right now it is working well, as it gives us the chance to get used to the new routine and we don't have to spend long periods inside the bay. It might all change still, I'm very aware.
The downside of the new routine is that I'm missing the patient contact. All the bays are sealed off which means there is far less visibility. Normally I pretty much know all our patients at least by face, and often most of them by name. Now I have no idea who the patients are in the other bay or even how many there are. When you go inside a bay, your mask and visor make you sound muffled, and patients can't really see much of your facial expressions either. None of this benefits patient contact. Not being able to wander in and out of a bay doesn't help either. It feels functional, which is how it has to be for now, but I miss the human side of nursing.
At the end of the day though, when I go in to a patient's room to take his observations, he tells me he has a relative waiting by the hospital entrance with some things for him, including his phone charger. I've come to realise how incredibly isolating a hospital stay is now and being without a phone must be very hard. He says someone was going to fetch his things, but that was 20 minutes ago and his family are still waiting. I tell him that after doing his blood pressure, I will go and find them. I meet a very grateful granddaughter, talk to them briefly about the lovely summery weather that we don't notice at all on the ward, walk back through an eerily deserted hospital and deliver the bag to the equally pleased patient. He asks my name. At the best of times most patients struggle with my name; add a visor and mask and it's worse. After a couple of attempts this patient gets it. Half an hour later I pop my head around the door to ask if he's been given something he'd asked for. Yes thanks Cybèle, he says. He's remembered my name and I leave the room with a smile. This is what nursing is all about for me. I think in the weeks to come, these moments are going to be even more important to hang on to.

Last summer, long before lockdown