Hello, my name is Rachel Stout and I wanted to share my reflections on covering ward 18 during the coronavirus outbreak so far…

Ward 18 was the first critical care unit to accept COVID-19 patients at Newcastle Hospitals.

The changes started with cubicles becoming isolated and multi-coloured tape being used to square off portions of the floor. This quickly escalated into the central double doors being taped up to block off ITU entirely.

Before we knew it, beyond the doors was a mysterious environment nominally identified as ‘dirty’. It felt so wrong to not only have a segregated unit, but one which was split into ‘dirty’ and ‘clean’ zones within a usually impeccably clean environment.

To make light of the situation – and make visits across the border more bearable – we took it upon ourselves to rename ITU as ‘going abroad’. It felt much better to envisage the donning and doffing area as duty free – where specific items were free and in abundance, before stepping through the mysterious doors to go abroad.

I’m not sure any of us will ever forget the feelings we had during our first visit beyond those double doors. That feeling of foreboding and apprehension, which steadily rose with every additional PPE layer donned, building into a culmination of anxiety as we stepped over the threshold into the unknown.

A lot of people described a feeling of being underwhelmed once over the threshold, as at the end of the day, it was just the same ITU with an added element of guess the nurse behind the visor!

As COVID-19 was an unknown entity, the breadth and intensity of learning became quickly overwhelming. The first two weeks were a whirlwind of pathophysiology, ventilator manuals and setting personal challenges in order to quickly muster confidence. Comfort zones were breached daily; teaching visiting therapists on a regular basis about ventilation and guidelines, in an eager bid to embed our knowledge, as well as trying to set up ventilators in anticipation of what our emerging role may require.

In pre-Covid life, the whole MDT on the unit were accustomed to treating neurologically impaired patients, whose other organs were usually unaffected. Yet, suddenly, ARDS (acute respiratory distress syndrome) was in every other sentence and we were more focused than ever on chest X-rays, rather than brain scans.

The first patient to be successfully extubated was one we will all remember. It was a scary toe to be dipped into the water of progression. From there, we had a lot of successful stories in this otherwise sad time. One unexpected learning point was how quickly Covid patients fatigue and that a seemingly passive patslide to the chair one day could mean a ventilator the next. This meant that, bizarrely for a group of neuro physios, we were now actively discouraging our nursing colleagues from getting the patients out of bed! Who’d have thought we would ever see the day?

Overall, it has been a very strange couple of months. However, morale has never been low: the whole MDT grouped together to welcome new faces, to never judge a colleague for their questions and to provide a constant stream of sugar based snacks with a comforting smile.

Our blood sugar levels have never been so high, but the overwhelming generosity of people has certainly helped us all during this incredibly difficult time.

 

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