Dear diary: I can’t wait for the day I doff my PPE for good
A community nurse chronicles the daily reality of caring in a time of COVID-19
Monday 6 April
Goodbye COVID-19 symptoms, hello work and full PPE
I started showing symptoms of COVID-19 seven days ago and they only lasted for three days so I am able to go back to work. Our trust policy is to allow people back to work if, after seven days from start of symptoms, you are symptom free, so I was cleared to return.
I hate being ill – I feel like I am letting my colleagues down when they need me, a sense of guilt that has been amplified during the pandemic.
We now have to wear full personal protective equipment (PPE) for all patient visits, which means an apron, mask and gloves. If they have COVID-19, I have to add eye protection.
Wearing full PPE is extremely hot and uncomfortable. Putting it on in a patient’s hallway is awkward and my hands get very sweaty under the gloves.
A patient I know well is unresponsive
A lot of my patients are becoming ill. I spend almost an hour with Mrs E today, an older patient with diabetes, which she normally manages well. I found her lying on her bed, unresponsive, due to a hypoglycaemic episode. She doesn't recognise me, even though we’ve known each other for years.
Mrs E is too ill to be left alone, so I call an ambulance and waited with her. The paramedics take her to hospital and I promise to see her when she comes home. I hope I can keep that promise.
Our trust has received a lot of donations from the public and I am given some fresh fruit and vegetables, pens and face wipes. I have never received a free gift just for doing my job. It feels nice to be appreciated.
Tuesday 7 April
A sad shift from beginning to end
I visit a new patient, Mrs Q, who was discharged from hospital yesterday after surgery following a fall. I met Mrs Q last year when she had been looking after herself and her brother and am shocked at how she has deteriorated.
She is sitting in her chair, unresponsive. She requires all her care needs to be met and her daughter – who had called the GP because she was so concerned – wanted Mrs Q to be re-admitted to hospital.
Re-admission is often the first option with an inappropriate discharge, but with hospitals full of patients with COVID-19, would this be safe or appropriate for Mrs Q?
An examination shows no signs of infection or a stroke, and after speaking to her GP, we agree that hospital is not the best place for her. I say I will refer her to social services for urgent assessment for a care home placement and ask for her home care package to be increased.
I’m the one there to face a daughter’s anger
My last visit of the morning is to Mr A, an older man with severe dementia who is receiving palliative care. Just as I was getting ready to remove my PPE, his next of kin arrives.
She is angry, demanding to know why neither the GP or palliative care nurse had visited Mr A, and insists they come and see him. When I start to explain that the only people doing home visits were district and community nurses, she just shouts at me. ‘I don’t care about that COVID, it doesn’t interest me. I want them to see him now,’ she yells.
I am standing in front of her in full PPE.
I made a promise I cannot keep
Back at the office, I learn from one of the hospital palliative care nurses that Mrs E had suspected COVID-19 and had gone into multi-organ failure. She only has a few days left to live, and I feel terrible; I persuaded her to go to hospital on the promise that I would see her again. Now it is looking unlikely that I would be able to keep that promise.
Saturday 11 April
It’s impossible not to feel guilty
When I return to the office after seeing my morning patients, I find out Mrs E died two days ago. I cannot help but feel guilty, as though I have failed her. I also discover that our team is down 25% due to COVID-19, with staff self-isolating due to suspected symptoms in themselves or a family member.
With so many of us self-isolating, the NHS is crying out for staff testing
My colleague A has suspected COVID-19 but cannot get tested. If she could, she would know for certain whether she has the virus and could return to work if her test came back negative. Health and social care secretary Matt Hancock promised that 100,000 NHS staff would be tested daily for COVID-19 by the end of April, but those tests don’t seem to be coming our way. Are community nurses not as important, or is this 100,000 figure impossible to meet?
Sunday 12 April
Broaching a difficult subject, and struggling with PPE
Mrs Q’s daughter tells me she is struggling to look after her mother. She looks tired, like she hasn’t slept in a week, and I am concerned she is heading towards burnout. Nervously, she asks if I think it is all right for her mother to go into a hospice. I reassure her it will be fine, and that I will email her mother’s palliative care team and GP to ask about it.
I get back to the office late and am so tired. Wearing full PPE in this heat totally saps my energy, and my hands are macerated and sore due to the sweating under the gloves. I am using hand cream daily, but I seem to be fighting a losing battle. When I take my gloves off, my hands are so wet the sanitising gel just slides over the top of them.
Monday 13 April
PPE is so uncomfortable to work in, but I realise it’s essential
I have only been wearing full PPE for a week and I already hate it. Today is a lot cooler than yesterday but the PPE is still hot and uncomfortable to wear. The worst part is that it’s such a barrier to communication; the mask hides half my face, which makes non-verbal communication very difficult, and there is little point in smiling reassuringly at a patient because they can’t see it.
The gloves are a physical barrier too. If I place my hand on a patient’s hand or arm, all they feel is my nitrile glove. I understand why I have to wear PPE and do so for every visit, but I am really looking forward to the time when I no longer need it.
Mrs Q’s daughter tells me that the palliative care team are trying to arrange a hospice bed for her mother. She stills looks tired and drawn, and I am reminded of the physical and emotional toll of looking after a dying relative. I am so relieved to have got her some help.
When I get back to the office, I learn that 38% of our team is off sick with COVID-19. The virus is spreading so quickly among nurses, I wonder who will be left to work next week?
Tuesday 21 April
An invitation to volunteer at the Nightingale
Our senior manager comes to the office to tell us the trust had been asked for nurses to volunteer for a three-month secondment to the London Nightingale Hospital.
We would be required to work four days on – two long days followed by two night shifts – and four days off. There are only three trust-employed nurses in the room, and our manager needs a reply by 4pm.
I decline as the shift pattern would make me ill; I stopped working nights because they aggravated my asthma. One of my colleagues has no intensive care experience and also feels uncomfortable with the shifts, and the other needs to discuss it with her husband, who had been furloughed so was looking after their children.
It doesn’t sound like staff welfare is a priority
None of us volunteer in the end, and with that working pattern I’m not surprised. The Nightingale was supposed to be an overflow hospital, taking the pressure off London hospitals. But if London hospitals are being asked to provide the staff to run it, it only puts more pressure on them.
We have a huge nursing shortage in London, and trusts need every nurse they have to help fight the pandemic. They cannot afford to be sending staff to run the Nightingale, and the shift patterns do nothing to reassure us they are concerned about staff welfare.
Wednesday 22 April
One day, we’ll throw a party
One of my colleagues retires today. She has worked for the trust for more than ten years and is a valued member of our team. We had a collection for her, but COVID-19 meant we couldn’t do much more than that. We can’t throw her a party, or even have a night out, but we will.
As soon as it is safe to do so, we will raise a glass to her and all the other NHS staff who have worked so hard during this pandemic and deserve to be celebrated.
The author is a community nurse in London