I kept personalised diaries for my Covid patients in ICU
I held my breath as I walked through the door to the Intensive Care Unit for the first time.
I remember looking around the wards and thinking: ‘Oh my god, all these patients have got Covid.’
Then I told myself I had to breathe, that I had to trust my personal protective equipment (PPE). This was the start of my time on ICU through the first wave of the coronavirus pandemic last March.
Earlier that week, one of our hospital matrons called a meeting asking for volunteers to help in the ICU, otherwise the unit just couldn’t cope, she said.
I can still remember the matron at the meeting telling the staff: ‘It’s here. It’s in our ICU and it’s in our A&E.’
The ‘it’ was coronavirus.
I had the skills, so my hand shot up. But inside I was thinking: ‘What the hell are you doing?’
My usual role is on day surgery and theatres. I’m an operating department practitioner – an anaesthetic sister, which means my expertise centres around the airway.
It’s funny when you hear people say that you just react, you don’t even think about the process. You just do what you need to do. It’s so true.
Before this, the severity of the pandemic hadn’t really hit me – like most of the world.
At first there was a feeling of ‘here we go again’. We’ve tackled bird flu and swine flu in the NHS before, so I didn’t fully appreciate at first how serious it was.
Politicians and people on television were doing fist bumps or knocking elbows to greet each other and there were memes and gifs circulating of people singing happy birthday as they washed their hands.
But quickly that all changed and I was getting fitted with PPE and entering the ICU on my first shift.
My first patient in the ICU was a 76-year-old woman whose husband had passed away the week before. One of the nurses walked me through the routine of what you need to check, talking to the patient to explain what is going on and within an hour I got used to it.
The shifts were between 12 and 13 hours long and at the end of my first one I remember sitting in the car thinking: ‘What have I just done?’
It takes a while to process it, but each time I became accustomed to the routine.
Then one shift, probably my third or fourth on the ICU, I was rummaging through a cupboard and I found a diary. One of the nurses told me that they keep the journals for patients as they can lose a huge part of their lives on the unit, so this was a way of filling the void for those who recover.
I had a look to see what people had written and they were beautiful.
The entries were all very light hearted, such as talking about the weather, the time of year it was, what was going on in the unit. I joined in.
‘It’s been snowing, we’re keeping you lovely and warm in here. I’m watching the snow fall down and we’re listening to Christmas carols on the radio – sorry about my singing.’
‘You’re doing really well today. I’ve just given you a wash and reduced your oxygen levels.’
‘We’ve had a call from your wife, she’s been in the garden today and she sends her love’.
These are just some of the entries we would write.
It was actually something that I looked forward to doing. There seemed to be a natural lull on the unit at either 4am or 4pm (depending on the shift) and you would think: ‘it’s journal time’.
I’ve kept a diary every day since I was about 14 so for me it came naturally and I felt it was important.
There was one man who was in the ICU and his wife and grandchildren would write to him. The kids would talk about the potatoes they had just planted, and I was documenting this in the diary, as well as reading the letters to him. There’s no guarantee that the patients can hear you, but we like to talk to them just in case.
I will never forget the letter his wife wrote: ‘Oh my darling, I miss you, I am writing to you but I don’t know how to write to you. I’ve never written a letter before. You’ve always been there for me to talk to.’
That was really hard to read and document. I have a husband and I used to write to him when he was in the army.
It should have been them there next to their loved one, not me.
The journals were given to the patients once they were discharged from hospital so I never saw them receive the diaries unfortunately.
However, I heard through colleagues about an 83-year-old man who was discharged from the ICU and absolutely loved his journal. He said it just filled in this huge void and helped him come to terms with how close he was to dying, and how precious life is. It helped him mentally fill in some of the gaps of being asleep for the best part of a month.
That connection is so important. We’ve all gone through our own kinds of tragedy in the last 18 months and anything we can do to help people process that is important.
If the patients did not survive then the journals would be given to the relatives if they wanted them. I never saw a relative who said ‘no’. We just had to quarantine the journals before we could pass them.
It was also so important for the relatives to know that we loved and cared for their family members.
For me, my husband and teenage son were the anchors that I needed. Going from an extreme environment like ICU to your home environment in a short space of time is challenging.
Sometimes you need a relaxing bath, a cup of tea (or glass of wine), occasionally you need time on your own to process what you’ve seen, and other times you need to be able to talk with loved ones.
I hope the journals that we kept for our patients (or their relatives) helped them to process what they went through, and know that we were there for them.
Ali is one of StoryTerrace’s Unsung Heroes and is featured in their book of the same name. StoryTerrace is now looking to honour teachers who deserve recognition and you can nominate someone here.
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