The Face of Caring in a COVID ICU

My full-time role is in medical assistance working as a Coordinating Nurse for International SOS. It is a complex role where we telephonically triage patients from all around the world. We help them to access health care while abroad and arrange for them to travel home by conducting careful medical assessments to determine the risk versus benefit of air travel with their medical condition. It involves a great deal of clinical assessment, logistics, decision making, and an in-depth appreciation of global health systems. The pandemic was initially a challenge due to the exponential surge in case volumes and we had to think quickly and critically to get positive solutions for our clients and members. 

I worked in Intensive Care Units (ICUs) for many years, and use my critical care skills in the medical assistance environment daily. It is an exciting and rewarding career; however, witnessing the impact of the pandemic on the NHS I felt a strong calling to go back into clinical ICU work. International SOS were extremely supportive in making this happen and devised a policy to safely deploy those of us who wanted to support the NHS during the crisis, and safely integrate us on our return back to our normal medical assistance duties. This allowed us to use our clinical skills for the benefit of the NHS in the ICU whilst keeping everyone in the assistance environment as safe as possible.

I have just completed my rotation of clinical shifts in the NHS. My experience was overwhelmingly very positive. The critical care units I worked in had excellent infection control measures in place and, although the PPE was hot and uncomfortable, I felt fortunate to have had it - and enough of it. Every day, food donated from several different restaurants and volunteers was delivered to the areas of the hospital looking after COVID-19 patients. These donations certainly helped us to keep going strong! (A big thank you to everybody!).
 A colleague I worked with years ago saw the name written on my PPE and had to ask: “Is that really you?!” Dressed in PPE, the only part of anyone's skin showing is a small strip around the eyes and even this part is covered with goggles. Being able to see each other, read responses and understand how people are doing is fundamental to communication. I found myself often wondering if I found this challenging, how on earth did my patients feel?

All compassionate smiles are hidden behind masks. A blue gloved hand replaces the hand of a loved one trying to help sooth an anxious patient. Sometimes this hand and masked face is the last the patient will see.

These are especially difficult times for patients and their loved ones.  No visitors are allowed. Having family to see you, support you and encourage you is often something we take for granted. We use iPads for video calls, but this will never replace the presence and touch from a loved one.  It made it all the more important to do everything we could to make sure we put the patient first and make the best of such a difficult situation. It was often heart-breaking to think about, especially in patients who were near to death. 

One of my patients has been in hospital for 32 days - he is fully conscious with a tracheostomy and on a slow respiratory wean. He spends 24/7 in a room with other ventilated patients (some proned) and medical team members dressed from head-to-toe in PPE. The only thing really distinguishing us is the name written on our suits. One evening the crash bell went and curtains were pulled around his neighbour. Whilst we talked to him and supported him as best we could, this will undoubtedly be hard for him to comprehend and I worry how this will affect his thoughts and mental well-being. I imagine it is very scary to witness and sadly, he will not be alone in this experience. Those seriously affected by coronavirus and who experience an ICU stay will be affected for life, physically and mentally.

For those who have escaped serious illness during this pandemic, lockdown may feel hard at times but, however hard it feels, we who get to go home to our loved ones and have relative freedom have so much to be thankful for in comparison. 

I feel relieved that there seems to be an improvement at least locally, with fewer patients to care for and spare ventilators from theatres and other areas on their way back to where they came from. I also realise there is a long way to go until everyone is safe and over this crisis. 
 
This was an invaluable opportunity for me to reconnect with patients, and I feel honoured and privileged to be able to help during these times. Although it was challenging, I also feel certain that that the experience has positively impacted my outlook on patient care, empathy and my nursing career for the future.