Transforming day surgery into an ITU

February 2020 

The virus begins to generate media coverage. I share memes, smile, and look forward to my upcoming holiday to the Domican Republic. Unconcerned, surely this is just a media hype, flu-like symptoms – everyone calm down.

March 2020

Capacity, capacity, capacity! The agenda is advanced to convert our day surgery unit into a critical care area. The teams swarm in … project leads, builders and engineers. My role: show, direct and keep up with the ever-changing plans. I make frantic calls to source tube clamps, art line cables and do my best to stay calm. We can do this … Like a formula one pit stop, 10 bed spaces built, donning and doffing, patient flow - done! Feeling proud. The nurses looked flustered and eagerly wait for updates … information I didn’t have. 

“We will stick together as a team! We are in this together. All we can do is prepare.” I print off all the action cards and place them in a red folder. Helplessly, I plead with the team to simulate, familiarise and use this valuable time, as the virus comes closer and closer to home. Three days later bed spaces empty, ready to go … nothing happens. Apprehension, uncertainty and palpitations fill the unit. 

The news travels from critical care. They are struggling with demand and urgently need help. The order comes in: ”Get everyone SURGE Trained!” My first instinct - lead with compassion. I inform the team that we will all be trained to go into intensive care and look after COVID patients. Some cried, contemplating resignation, whilst other just froze. The guilt consumes me, sending them to war. 

The office door closed - alone. I break down - inconsolable tears. The sense of duty, obligation and responsibility fills my heart. I know I have to go, I have to be careful- mum is at home, shielding. 

April 2020 

First day in critical care - nursing handover. At full capacity. The nurse in charge keeps it brief, professional, and it’s business as usual. He looks depleted, the colour drained from his face.

Armed Police and security surround the unit. “ID please!?  ID please!?” I look ahead -a sea of nurses, all huddle by the PPE station. Masks, aprons, gloves galore. We’re ready for battle.

I don my gear, lipstick on, the mask is TIGHT. As I scramble to my allocated bed space, all I can see is patients, equipment crammed into one bed space that has now become two. My heartbeat synchronises with the ventilator alarms. My eyes fill, blurring my vision - it is scary. For the first time, I hate the virus – it’s alive, it’s devouring our patients. As tears stream into my mask, I compel myself to focus!

We take our bedside handover. I drift in and out of concentration, distracted as my first visual observation. Why were there so many black and ethnic minorities? People like me? Confused, maybe I am overthinking it. Devastation, disease, and death unfold around me. Next-door, the patient is dying - CPR continues. It echoes in my ears …“Can someone call the family please!” “Guys, I have a gas!” “Another dose of adrenaline!” From that moment on, I knew I was here to serve, fulfil my duty and be the best nurse that I knew I could be - brave, strong & resilient.

It is 3 am. There is a slow drip in the ceiling above our patient. I try not to think about it and focus on our duties. My band seven brain reassures me, they have reported it. It will stop soon. A few minutes later, the drip becomes a gush! BOOM! There is water everywhere!! Pouring from the ceiling. I have one job - Keep this patient alive! 

Airway doctors come in “Let’s move these patients, as quick as you can guys!” Like a military operation, three patients on ventilators and filters moved into side rooms within five minutes. Help arrives armed with a mop, buckets and several incontinence pads. The housekeeper with his huge liquid suction device, the shift engineer stems the leak. True heroes … on the night of the flood.

As the nursing duties continue hour by hour, days turn to nights and nights turn to weeks. As the number of cases surge, I secretly draft my final wishes, my will and letters for my family. The ink blurs as my eyes haemorrhage endless, raw tears of pure anguish. A pain so, so deep, nothing soothes. 

A few weeks in, familiar faces bring comfort like never before. I see my team. Nurses, anaesthetist from our theatres here in critical care - with me. We truly are in this together. Coffee room banter begins to spread smiles and treats fill the air. We smile through the scars from the mask, grit our teeth as the pain from the straps penetrate deep behind the ears. Not long to go now … home run.

Ruheana Begum