7 May 2020

COVID-19: Life on the frontline

Join Rosie Gavzey MCOptom as she takes you through her experience of volunteering at London’s NHS Nightingale Hospital.

“When I saw that the NHS was recruiting volunteers to provide support during the coronavirus crisis, I wanted to help in whatever way that I could. A week later, I was at the ExCeL conference centre at 8.00am on a sunny Saturday morning to attend a 10 hour training day, and learn about the hospital and what might be expected of us. It’s now been four weeks since I started as a Clinical Support Worker (CSW). I'm part of a team led by ICU nurses and doctors at the purpose-built Nightingale Hospital in London’s ExCel Centre. I’m working four twelve and a half hour shifts a week; usually two days followed by two nights. 

“The teams are made up of an ICU nurse, two registered nurses, two CSWs and a doctor, all managing up to six patients. At the Nightingale, patients are referred by other hospitals. All are suffering from single organ failure and arrive sedated, ventilated and catheterised, with central and arterial lines already in place.

“The first thing that strikes you about the hospital is the scale. I’d never appreciated that ExCeL is a kilometre from one end to the other. On arrival, we’re directed to pick up ‘scrubs’ from the porta cabins outside the hospital, and then walk about three-quarters of the way down to the other end of the building to ‘don’ our PPE. As you would hope, we are fully gowned, gloved, masked and visored before going on the ward. It gets really hot in PPE, especially with the face masks. After 3 or 4 hours we need a break, so we’re donning and doffing (taking on and off) our PPE every time. That’s a lot of PPE!

“The hospital was built with space for more than 3000 beds, one ward has 42 well-spaced beds, each without curtains so staff have a clear view of patients. I have only ever worn reading glasses, usually half-eyes of some description, but at 100 metres, the wards are so long I’ve had to try out my first pair of varifocals. I‘m definitely achieving my daily step count. They say we cover between 8 and 10 miles a day and my aching feet certainly bear witness to that! Thankfully, accommodation is provided at a nearby hotel between shifts, which helps enormously. After a long day, it’s a treat to have a shower, cuppa, put my feet up and disintegrate, without the worry of a three hour round trip by public transport.

“It’s a real privilege to be able to work alongside so many skilled professionals. Every clinical discipline under the sun can be found on the ward, whether they are cardiologists from the Brompton or Harefield, spinal surgeons from Stanmore or Stoke Mandeville, or ophthalmologists from Moorfields. Among the nurses are those from A&E departments, immunisation nurses, school nurses, ophthalmic nurses, and paediatric ICU nurses. Physios and anaesthetists are crucial of course, and my fellow CSWs include dentists, osteopaths, sexual heath advisers, cardiac rehab workers, and mental health workers. We all take our lead from the ICU consultants and nurses.

“It’s been a very steep learning curve, but we quickly learn the routines, how to anticipate needs and develop a range of new skills. In truth, I felt about as useful as chocolate fireguard at the start but can now understand the monitors (like those you see in hospital dramas!) which record blood pressure, heart rates and a host of things I’d never heard of before. They also do the observations, as well as other elements of patient care. 

“There is so much about the impact of serious illness that I hadn’t been aware of, for example, patients with no history of diabetes can suffer blood sugar surges and need insulin. I have also been struck by the overwhelming number of male patients and proportion who are BAME. So far, relatively few patients have been Caucasian. I am also surprised by the age of the patients, some being as young as mid-forties – many, previously fit and well without underlying health conditions. 

“The ward is always busy, but there’s a general feeling of calm. Surprisingly, it’s not that noisy - except in emergency situations when the alarm sounds and the emergency team rushes to where it’s needed. 

“Every patient is afforded the highest degree of dignity and attention, and every aspect of their health and care is considered. Some patients are placed on their fronts in the prone position for 12-16hrs. This allows the lungs to inflate more easily and improves oxygenation. Those on their back require regular turning, to keep them comfortable and avoid pressure sores. In addition, they have regular visits from the physios to keep their limbs flexible.

“Some patients can develop a swollen tongue when the tube has been in place for a significant time, and may need a tracheostomy so that their mouths can recover, and they can learn to breathe and swallow again. We provide oral care, brushing teeth with low-foam toothpaste, wiping gums with Corsodyl and lips with special moisturisers, as intubation really takes its toll. We also apply regular ocular lubricants for those coming out of sedation where their eyes are partially open, but they’re hardly blinking.

“Of course all the patients at the Nightingale are very poorly, and sadly, some are too ill to recover. COVID-19 is a horrible disease and in the worst cases, patients can be totally overwhelmed. I watched as one of the ICU consultants used an endoscope on a particular patient. I was fascinated and distressed in equal measure to see the sheets of thick hard mucus that had collected in the bronchi, and now understood the extent of what our patients are battling.

“I lost my first patient on my fourth day. He died just as I was returning from my afternoon break. I’d never been in the presence of someone at their death before, it was a humbling experience. Those who are in their last hours, receive the absolute best in compassionate care. Staff are present with patients to their very last heartbeat, calming, comforting and stroking. Individual family members can say their goodbyes at the bedside, when the time is near and multifaith chaplains are in attendance whenever requested.

“I am happy to say that patients do recover. After they’ve been brought out of sedation and successfully extubated, a step-down process is followed. If all goes well, we see them finally discharged back to their referring hospitals for intensive respiratory physio, followed by a long rehabilitation. It’s a special moment seeing a patient leave ICU on the way to recovery. As the bed is taken down in the ward everyone stops to pay tribute and applaud the patient. This is the ultimate reward.  

“I knew I wanted to help and was up for the challenge, without knowing what I would be expected to do or indeed, if I could do it. There’s no room for ego at the Nightingale, but a genuine passion from everyone to contribute something during this crisis, and a real camaraderie with respect and support for one another. You just have to be adaptable and prepared to learn fast! I’ve surprised myself with what I’ve been able to learn and cope with and have found this experience immensely rewarding, both as an individual and a practitioner.

“We are told that we have just reached the infection rate peak in the UK, but as of writing this, are not yet certain what the call will be on the Nightingale services. I’m currently rostered for the next few weeks and hope to keep going as long as they need me, and my feet are able to hold out!”

Since writing, plans for London's NHS Nightingale hospital to be 'wound down', and either used as a rehabilitation or step-down facility for corona patients, have been announced.

Rosie Gavzey MCOptom works in independent practice, is an optometric adviser to NHS England, a GOC Case Examiner and a Trustee of Eye Health UK. Rosie also works as a Specialist Fraud Adviser (Optical) to the NHS Counter Fraud Authority.

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