‘In 10 years of nursing, I’ve never been so anxious or so terrified’

North Westmeath native Neil O Bradain is an Emergency Department nurse in a hospital in Kent, one of the parts of England worst affected by the third wave of Covid-19. He previously worked in a hospital in Leinster and wrote in the Westmeath Examiner about his experiences there during the first wave of the pandemic.

Below he outlines how he spent New Year’s Eve and gives a brief overview of what things are like in now in the south east of England.

00:00

A firework display from across the road lights up the room, distracting me for a moment – my mind momentarily casts back to Christmas Day, as I administer drugs to a young man. I hear a sarcastic “Happy New Year” from one of the team of nine who have just responded to my medical Emergency call.

I had the basics complete on the arrival of the medical emergency team; airway, cannula, defibrillator pads, arterial blood, gas and drugs ready to sedate this man, knowing this was his only chance of survival. I expect a list of questions from the consultant when I announce: he’s young, fit, a father of two young children, with no medical problems other than contracting Covid-19 and subsequently suffering a stroke, just hours earlier. Two of my six patients have suffered strokes in the last 12 hours despite aggressive anti-clotting medication as part of a clinical trial. Both, if they survive to discharge, will be left with long-term disabilities.

I’m ready to fight his corner. He’d waved goodbye as I left my previous shift. I had spent time on the phone with his daughter, answering questions and reassuring her that he had improved over the last 24 hours. But there is no list of questions. It would appear this is now the norm. We place him in a medically induced coma and take over his breathing, putting him on a ventilator. The consultant calls his colleague – there isn’t a ventilated bed left in the hospital, nor a patient fit enough to transfer to another hospital. I wonder if we’re going to have to make the decision to withdraw care from a patient unlikely to survive, but thankfully a plan is made to avoid this scenario.

02:00

As we stabilise the patient to transfer, knowing his chances of survival are less than 10%, I hear an alarm I’ve not heard before. Oxygen pressure to the unit is low. We have a major incident plan for oxygen disruption, but there is no fault with the system, we are simply providing more oxygen to more patients than we’ve ever experienced or expected.

Everything about this shift feels unreal, more like articles I’ve read during a humanitarian crisis in third world countries or terrorist attacks with multiple casualties. For now, my aim is to keep everyone alive until morning, literally. The guilt of doing just that, and not providing the level of care I used to before the pandemic, won’t hit until morning.

I wasn’t able to explain today’s events to any patients, describe their condition in detail, offer to call relatives or ask that one question I ask each patient, “if I could do one thing for you tonight, what would it be?”. Two weeks on, and it’s still on my mind.

03:00

I take 20 minutes; remove the drenched personal protective equipment (PPE), shower and change scrubs before finally returning to my remaining five patients, expecting to give them my undivided attention. Both clinical site managers arrive on to the unit, I naively think things are about to improve. But a friend, a colleague, needs the high dependency bed. In 10 years of nursing, I’ve never been so anxious, so terrified. I just can’t watch her die.

I highlight the risk, the ethics, my concerns, as my voice shakes. A clinical support worker is sent to join me. I’m no longer alone, but that’s still just one nurse, as opposed to the recommend minimum of four. I’m also virtually supervising another six patients being cared for by two more junior nurses, but this still remains the safest option.

08:00

My 11-minute train home is cancelled, but the 45-minute bus journey gives me time to reflect, lose my wallet, work ID (begrudge monthly fine for losing my ID) and make a list of everything I should have done last night. I call the unit with my list, the staffing level is no better so we laugh – I’m still not sure why, one of those hysterical ‘laugh or cry’ moments.

I fall asleep on the couch, still dressed. The only positive, I survived 24 hours without a death. The initial monthly deaths in my HSE role have turned to daily in the NHS, each a victim to a pandemic. Victims of each gender, all ages and health backgrounds, not one patient is to blame.

12:00

I’m awoken by a unique alert on my phone – a cardiac arrest in my local village. I grab my jacket, kit and jog just under a kilometre. As I do, everything is perfectly quiet. I should hear multiple sirens or the air ambulance. As I complete CPR, all I can hear are the screams of relatives.

I spend some time with the family but I can’t wrap my arms around two distraught daughters or grandchildren, even in full PPE. This hits very close to home and I call my Mam as I leave, exhausted, taking the scenic route in lashing rain, to avoid any hills or eye contact with those out walking.

Initially distraught, an odd moment of contentment washes over me as I realised for the first time in 12 months, this woman’s death was, while traumatic for the family, relatively peaceful; at home, surrounded by family after a loving Christmas. I can’t recall the last time a patient died surrounded by loved ones.

14:00

I’m home, carefully removing any items that entered the house for deep cleaning, jumping into the shower before returning to multiple missed calls – I’ve taken the ambulance keys home so I have to jog back in the rain.

19:30

I return to work for another 12-hour shift, still recovering. Tonight, I deal with three further deaths. A grandmother waved to her grandchildren from her window hours before her death. Simultaneously the death of a colleague’s father-in-law (an associate director I shared an office with pre-pandemic) occurs. Unusually, both patients die peacefully with family at their side.

It seems likes minutes have passed and I’m admitting a member of our domestic team.