COVID-19: diary of an emergency nurse
Extracts from the diary of an anonymous emergency nurse provide a moving account of what it means to be on the front line during the COVID-19 pandemic
- Everyone, from nurses to cleaners to doctors, work flat out as cases mount
- Areas of the emergency department have been reallocated for different types of patients
- Each shift ends with heartache and exhaustion, but also pride in the people she works with
Day 1
7.15am Arrive at work. My shift starts at 8am, but I haven’t been at work for two days and things may have changed drastically – if I’m going to act as an effective shift leader I need to spend some time figuring these changes out before the rest of the team gets in.
8.15am One of the matrons walks me round the emergency department (ED). It has changed drastically. The resuscitation room is no longer where our sickest patients are being taken – it’s a clean zone. The sickest patients are being taken to an area that has previously housed our cardiac monitored patients. You’re not allowed in unless you’re in full personal protective equipment (PPE). This volume of change is almost overwhelming.
‘The mother looks at us with complete desperation, we’re all wearing masks and goggles, she can’t see our faces’
9.20am I get a phone call from an area of the ED caring for the sickest COVID-19 patients, they urgently need a CPAP (continuous positive airway pressure) circuit. I’m informed we have four circuits left. I find one and take it to the nurses asking for it.
11.15am Security call – a patient is being abusive. He’s very intimidating. I try to reason with him, but he won’t listen. I’m scared so I can’t imagine how my band 5s must feel. He won’t stop calling me names, swearing and physically intimidating me. Security remove him. Sadly this is a daily occurrence.
1pm Safety huddle. We’re running out of cubicles to put patients into. Previously we would have spilled over into the corridor – we can’t now. They all need to be isolated. We make the decision to open another area and I pick some nurses, explaining that the allocation for the day has changed and I now need them to work somewhere different. They don’t bat an eyelid, they just smile and agree – ten minutes later we’re able to safely put patients into that area.
‘We all know we are not going to be able to save this life. We go in to tell the mother, she screams the scream that only a mother who has lost a child can’
5pm There’s a paediatric cardiac arrest coming in. Previously we would have cared for this patient in resus. Not now, it’s too high risk. I go to our paediatric department to see what I can do to help. I don PPE and agree to be the ‘clean’ runner for the arrest. The child arrives, cardiopulmonary resuscitation (CPR) is still ongoing, the mother looks at us with complete desperation, we’re all wearing masks and goggles, she can’t see our faces.
The child has been in cardiac arrest for over an hour, we all know we are not going to be able to save this life. We go in to tell the mother, she screams the scream that only a mother who has lost a child can. We take her into the room with CPR ongoing, she wants to be with her child when we call time of death. We all want her to be there too. There are no curtains in the rooms because of the infection control risk so myself and one of the paediatric nurses scramble to hang a sheet over the window from the corridor; this mother and child deserve some privacy.
6.30pm My friend, another band 7, has heard about the child death. She makes me give my phone to another charge nurse and we stand outside for five minutes. We don’t talk we just stand there. I am so grateful for this.
7.15pm A young person who has been stabbed is coming in with the air ambulance. His injuries are significant and he needs to go straight into the theatre. I call the surgeons and arrange a theatre. The trauma team around him are working silently, without prompting.
‘He can’t tell I’m smiling because of my mask. He's petrified and wants his mum. His mum can’t come in’
I go over to the patient, smile and introduce myself. He can’t tell I’m smiling because of my mask. He's petrified and wants his mum. His mum can’t come in (we can’t have visitors in the hospital). He asks me if he's going to die, I tell him no – we’re kind of fabulous at our jobs, I say, and tell him that he's safe.
8.30pm I leave the department after handover. I am exhausted, everything aches and all I want is a shower. I reflect on the day. My heart is broken but I love my job. I am in absolute awe of all the people I work with.
Day 2
7.30am Arrive at work ready for handover.
8.15am I’m in charge of an area specifically for COVID-19 patients who have an oxygen requirement but aren’t requiring aerosol generating procedures (AGPs). Patients arrive by ambulance, I allocate them a room and they’re met by a doctor and nurse immediately. This morning I’m lucky enough to have six nurses and an ED assistant working with me. I have a catch-up with the senior doctor in the area, we agree on plans for patients and get to work.
‘He wants to talk to his wife, but visitors aren’t allowed. I find a phone for him to use. I’m very aware that this may be the last time he’s going to talk to his wife, I think the patient knows it too’
9.30am I now have six COVID-19 patients waiting for beds in the hospital. They’re all sick, many of them elderly. Every time a patient is moved up to a ward we have to get the room ‘deep cleaned’. We now have extra cleaners based in the department and they are working so hard. I try my best to make sure I check that each of them is okay.
1.30pm The ED is getting busy, it’s time for me to move onto my next area. In the afternoon I’m in charge of our ‘red zone’. This is an area that provides care for COVID-19 patients who are profoundly unwell and likely to require AGPs. It’s sealed off from the rest of the department and you can’t enter without full personal protective equipment (PPE). I find the newly qualified doctors who are helping us don and doff PPE and suit up. The new doctors are working so hard, we’re so grateful for all that they’re doing for us.
‘Most of the patients are awake and look terrified. It’s difficult to watch, I want to go and sit with them, comfort them, but we’re so busy it’s difficult’
3pm We have a really unwell COVID-19 patient in the red zone with us. He’s not oxygenating despite being on Optiflow and being proned, he needs to be intubated. We call the intensive care team who come down to review him, they take an arterial gas and agree he needs to be intubated. They head back up to the intensive treatment unit (ITU) to make sure there’s a bed before we intubate him.
4pm Still no ITU bed for our unwell patient. He now looks tired and I’m worried. We ask him if there’s anything he needs – he wants to talk to his wife, but visitors aren’t allowed. I find a phone for him to use. I’m very aware that this may be the last time he’s going to talk to his wife, I think the patient knows it too.
4.30pm The patient has been moved to ITU and was intubated immediately. We’re now getting multiple blue calls arriving. All these patients are profoundly unwell. I have six nurses for seven rooms and we’re all working flat out. All the rooms have windows so we can see into them, most of the patients are awake and look terrified. It’s difficult to watch, I want to go and sit with them, comfort them, but we’re so busy it’s difficult.
‘I think he probably will die but I don’t say so… He asks if he can phone his daughter, I pass him his phone… It’s all I can do not to cry. He’s the same age as my dad’
7pm We have a patient arrive who needs immediate intubation, we’ve made this decision just by looking at him. We run an arterial gas which confirms what we already know – he’s not oxygenating. I go into his room to increase the flow on his Optiflow but he looks so tired. He asks me: ‘Am I going to die?’ I don’t know what to say. I think he probably will die but I don’t say that, instead I try and reassure him that we’re looking after him. He asks if he can phone his daughter, I pass him his phone and overhear their conversation. It’s all I can do not to cry. He’s the same age as my dad. We prepare to intubate him.
8.15pm The night team arrive and I hand over the care of patients to another senior nurse. I’m exhausted, everything hurts and it feels like I’m developing a pressure sore on my nose and behind my ears. I reflect on the day. Again my heart aches, but I love my job. Again, I am in absolute awe of all the people I work with – they are amazing, resourceful, intelligent, kind, funny people and I’m so grateful I get to work with them in this very special department every single day.