View from the frontline

She is the only person with them when they die, and this has happened so often she has lost count.

Guernsey girl Lydia has been working in London, on the frontline in our fight against COVID-19, for the past year.

This is her powerful first-hand account of working 13 hour shifts in a warzone. Somewhere where there is a dedicated crying room for the team. Where every day is just about survival.

‘It’s safe to say that COVID has infiltrated every element of my daily work and life. I’m not really sure how to start.’

Lydia was a fresh-faced nurse, embarking on a career in the profession she loved. She was the poster girl for working for Health and Social Services in the Island.

After training on Island at The Institute, and working at the Princess Elizabeth Hospital, she was ready to spread her wings. Little did she know she was about to be frontline in a global pandemic that has claimed more than two and a half million lives.

She said we are used to reflecting on something after the event but, in the case of COVID, the end seems to be an impossible guess. It is still part of our daily lives. While she would love to use the past tense, be free to fly home, to hug her family and her friends, she has no idea when any of that will happen.

Since moving to London, Lydia has worked in a large Neuro Intensive Care Unit (NICU) at a major trauma centre, completed part of her Masters in the care and management of the critically ill patient, and had, what she calls, a brief dabble in the world of private healthcare – all before COVID-19 hit English shores.

Lydia is now working as a Clinical Research Nurse within the department of Infectious Diseases for a distinguished London University but during the first wave, she returned to the NHS and worked in A&E. In the second wave, she was redeployed to an Intensive Care Unit (ICU), whilst also working with the NHS Test & Trace as a Clinical Contact Caseworker, as she has throughout the pandemic.

‘I consider myself lucky, I have only been in ICU during this second surge. I admire those who have been in the trenches for a year now, I don’t know how they still are, I know that many have left. It is beyond challenging, in every possible way.’

She can’t recall the exact order of events or when exactly COVID hit her radar.

‘The panic and fear grew with the increasing attention in the news, I knew deep down that my skills meant I’d be more useful back in the NHS. In a blur, my colleagues went down with it, one of whom is still unable to work due to the effects of long COVID.’

London was plunged into lockdown, and with that, uncertainty for the frontline teams.

‘Initially, there was a lot of confusion over PPE, do we wear surgical masks or do we wear hazmat suits? I had to bring my scrubs home to wash. I stripped outside the house and boil washed them. The fear of bringing it home on my skin, in my hair, on my clothes, was colossal. There was green A&E (non-COVID) then red (the dreaded virus), it wasn’t long until everything was red.

‘It felt like a war was upon us and I wanted to do my bit.’

Thanks to the flexibility of Nursing, Lydia was able to come home to Guernsey for an extended holiday in the summer of 2020 and even did a few shifts with, what she calls, her Emergency Department family at the PEH.

‘It was mask free, dreamy. I am incredibly lucky to have had that time, that break. I say again, I don’t know how the Nursing workforce are still standing a year on, no real break. No real recovery time.’

Lydia said Lockdown 2.0 passed in a flash but, before long, Lockdown 3.0 was there and she had been redeployed to a new ICU, where she remains.

‘This ICU was already understaffed and had now extended beyond overflow wards into theatres and separate buildings. I was rusty, it took a while to remember how to care for a patient requiring multi-organ support. It was scary. I didn’t know anyone. Everyone in full PPE. And the patients were sick, really sick.’

She said, prior to the pandemic, it was a ratio of one nurse to one patient. Twelve-and-a-half hour shifts, the Nurse was there. However, in the surge of the pandemic, the ratio has changed to one ICU Nurse to 4 or 5. She said hierarchy went out the window with Neurosurgeons, Consultants and people much higher up the pay scale than her, acting as a runner and topping up supplies, it was all hands-on deck.

‘The day is less about providing the personal 1:1, high standard of care which Nurses strive for, but more about survival and attempting to get through the never-ending list of tasks. For the team to survive, for the patients to survive. There is a dedicated room for crying. When it all gets a bit too much.’

In NICU, Lydia was exposed to a lot of trauma, a lot of death, every injury was life changing, every patient came in with their story, their relative, friend, family.

‘As the bedside nurse, you go through this critical time with them, beat by beat, day by day, sometimes month by month. For me, the exposure to the trauma, the death, the heartache never got easier, my skin didn’t toughen.

‘The sheer volume of death faced by the ITU team during this pandemic is gigantic and not even NICU could have prepared me. A COVID death isn’t like those that came before, there is limited time for personal touches and the small things, which I think, make a death more peaceful and dignified. The heart-breaking thing for me is that so many families haven’t been present when their loved one has passed. Which to me, has always been the most important.’

Lydia has held up an iPad to the back of a person’s head, as they were proned and there was no way of seeing their face, telling the family that he loves them.

‘I had never met that person awake, so who am I to know that those would be his chosen final words? I’m guessing, I’m just thinking of them and what might offer them some comfort. I just did my best, steaming up with tears inside my mask and visor. I didn’t have time to go to the crying room that day.’

This wasn’t a singular event for Lydia. She has no idea how many have died, there have simply been too many to count.

‘When break time rolls around, if and when someone is able to take over for a while. The satisfaction of taking off that PPE is like stepping off an aeroplane when you arrive at your holiday destination. A quick check for any facial pressure sores then straight to a chair, any chair.’

She tries to escape, check the world of social media.

‘I hope that my loved ones are having a better day than me, I ache to see their faces. It's a few seconds until a conspiracy theory pops up or someone telling the world that COVID only kills the old, the vulnerable. Tell that to the family who just said goodbye to their perfectly healthy 60-year-old husband and father. Through a screen. I take more deep breaths to supress the burning feeling inside my chest, I don’t have the energy to explain to the truth. I find it insulting to read the fake theories. It is insulting to me, to the team I am working with, but most importantly, it is insulting to those families and to those who have died.

‘Who are we to decide what is old? Who are we to decide who has lived enough of their life to make it ‘acceptable’ for them to die? Each death has been a loss for a family, has been a life that wouldn’t have ended if COVID-19 wasn’t around. A human. The stress and the death, they stick with me as I journey home at the end of the day. My shoulders still up to my ears. The fight or flight mode still fully engaged and has been for 13 hours now. It takes a while to switch off, sometimes even days.’

She said so many nurses have left.

‘We are only human and we can only take so much.’

Lydia said it wasn’t all as bleak as it sounded, and there were lovely, kind, funny and heart-warming elements of the job - a camaraderie and a shared understanding between the Nursing team, that they are in it together.

‘Each day I try to make a point of saying ‘this will be a good day’ to whoever it is I am working with, chances are it’s the first time I’ve met them. I likely won’t see them again due to the sheer size of the department. In my research role I have seen people present to hospital, have a severe illness with an ICU admission, and then seen them a month or two later, walking and talking.

‘I’ve used the iPad for a positive family call, when an 8-year-old son could see his Dad awake for the first time, he told him he loved him, he told him he loved him back. There were tears of joy inside my mask then.

She said the small things are everything. The small moments of humility, of human strength in their purest form that keep her going.

‘It’s a huge motivating factor when you can just try to make this a little lighter, a little brighter for a person facing a very real, a very dark and a very scary time.’

Lydia has had her first dose of the vaccine and is due to have her second soon.

‘For me it was a no-brainer. It is the ultimate PPE. I am exposed to the virus every single working day. It became even more of a must for me when the data was published about the reduction in transmission. I need to see my family, I need to see my friends, and not just see them 2 meters away. I need to hug them. I need to hug them with a reduced risk of bringing it home, reduce the risk of them being one of my next patients.’

She said she understood that some people were reluctant to have the vaccine.

‘I understand the concern. It’s been a year of scare mongering, fake news, a year of fear. I understand that it’s hard to contemplate having a vaccine when you personally haven’t experienced the wrath of COVID-19. But for me, I have and I’ll take a scientifically backed, tested and approved vaccine over having to endure another winter like this. I am here for scientific evidence, for medical research.’