'A living nightmare': the sobering reality of life inside KGH's intensive care unit

The emotional toll of Covid has left some staff needing counselling and others contemplating retirement
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Every single day, a group of nurses turn up for work at Kettering General Hospital's intensive care unit hoping their shift won't be filled with tragedy.

Normally they would put on gloves and an apron, provide one-to-one care for a patient and support a family who may be expecting the worst. But their job is currently anything but normal.

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What would usually be a 10-bed unit now has 11 seriously ill Covid-19 patients alone, a high proportion of which are on ventilation. One ICU nurse now cares for two ventilated patients, with the support of a non-ICU nurse who has been drafted in to help. They've seen 352 coronavirus patients die since March, including seven in one day on two occasions. More keeping coming through the door.

Some of the ICU team in full PPE working on a 12 hour shift in the ICU red zone.Some of the ICU team in full PPE working on a 12 hour shift in the ICU red zone.
Some of the ICU team in full PPE working on a 12 hour shift in the ICU red zone.

Nurses are tired, emotionally and physically. Some have been given counselling and mindfulness sessions with a psychologist joining the team. Other older members of the workforce are even contemplating retiring after the pandemic.

"It’s been very, very traumatic," matron for critical care services Jo Snow told the Northants Telegraph.

"Nursing is a vocation. If you don’t love your job I think it would be incredibly difficult to come to work at this moment in time."

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Additional barriers and doors have been installed to separate areas and the main waiting area has extra beds in case they need to increase their capacity.

Intensive care matron Jo Snow.Intensive care matron Jo Snow.
Intensive care matron Jo Snow.

Warning signs surround the Covid ICU ward - this is a red zone. Staff must change into full PPE to enter the unit, wearing gowns, coveralls, gloves, aprons, visors and respirators throughout gruelling 12-hours shifts. It leaves them hot and claustrophobic, makes communicating difficult and leaves everyday things like having a drink a burden.

Some are having to wear pressure-relieving devices that would normally be used on patients to stop them from getting horrendous sores on their faces.

Others have been left with bruising that makes them "look like they've done a couple of rounds with Mike Tyson", Mrs Snow said.

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Pictures of the toll the PPE is taking have shocked members of the public, but seemingly not enough for some to take the pandemic seriously.

Operating Department Practitioner Corrie Craig (L) and ICU Matron Jo Snow (R)
support a patient in the ICU red zone.Operating Department Practitioner Corrie Craig (L) and ICU Matron Jo Snow (R)
support a patient in the ICU red zone.
Operating Department Practitioner Corrie Craig (L) and ICU Matron Jo Snow (R) support a patient in the ICU red zone.

KGH currently has 174 Covid-positive patients across its wards - higher than the first wave - with numbers rising since the Christmas holidays.

And Mrs Snow, who was recently made an MBE for her work on the frontline, said her nurses are becoming frustrated as she urged people to follow the lockdown rules.

She said: “I think it’s starting to take its toll on them (the nurses) and although they are incredibly professional their frustrations potentially are starting to surface.

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"They want the public to be really aware of their plight. This is really happening. People are incredibly sick in hospital.

Staff nurse Josef Onojo doing paperwork in full PPE.Staff nurse Josef Onojo doing paperwork in full PPE.
Staff nurse Josef Onojo doing paperwork in full PPE.

"It could be their family, their nearest and dearest. It could be them. They really do need to follow the rules.”

The pandemic is also having a devastating effect on nurses' ability to support their patients' families.

More patients are coming into intensive care awake before needing sedation and then deteriorating.

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But with visiting banned to stop the virus from spreading, nurses are more often than not having to break bad news on the phone.

Immediate family members are only allowed to visit when their loved ones have just hours to live, and when they come in they also have to wear full PPE. It's a world far from a normal intensive care unit, which involves families through every step of the treatment.

“We see patients awake and we’re talking to them," Mrs Snow said.

Staff Nurse Charlotte Langer checks ICU monitoring equipment.Staff Nurse Charlotte Langer checks ICU monitoring equipment.
Staff Nurse Charlotte Langer checks ICU monitoring equipment.

"We make connections with those people and then their condition deteriorates, sometimes quite rapidly despite all your efforts, and you’re not able to turn that around and sadly they die.

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"It’s that lack of preparation for the family, the lack of contact with the family that then takes its emotional toll on them.”

The Rothwell Road hospital now has a surge capacity to potentially look after 29 patients across its two intensive care units, split between Covid and non-Covid patients. During the peak of the first wave 20 beds were in use.

But with cases across the country rising and with the full effect of the lockdown yet to be felt, there are fears over how stretched the hospital may become over the next two weeks.

Yesterday (Wednesday) the hospital declared an internal critical incident, urging clinical staff to focus on safe discharges and avoiding admissions. A memo to staff said the impact on its capacity was affecting their ability to care for patients in the most effective way.

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Since the month-long restrictions were lifted on December 2 patient numbers have been on the increase. A total of 44 Covid patients have died since Christmas Day alone.

Just after Christmas 13 beds were in use, and there were about another 13 patients who were being supported outside ICU with additional respiratory support. Some of those could have potentially gone into intensive care and the unit could have exceeded its bed base, Mrs Snow said.

They are expecting numbers to rise again later this week to take into account mixing over the new year period.

It's left Mrs Snow, who has worked for the NHS for 30 years, worried.

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Contingency plans are constantly being revised, with provision made for if they have to go beyond the available 29 beds.

And if their worst fears were to come true and the hospital were to run out of beds completely, an ethics panel made up of specialist doctors would have to consider each case and make a heart-wrenching decision on treatment. During the first stage of the pandemic in Italy, doctors were so overwhelmed they had to decide who to give treatment to.

In a stark warning, Mrs Snow said: “Difficult decisions may have to be made.”

Yet despite the NHS facing its biggest crisis in generations, there are still some people who believe it's all one big conspiracy.

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Comments under almost every coronavirus story published by this newspaper include that hospitals are empty, that it's a hoax and coin it a 'scamdemic'.

They, along with seeing people openly flouting lockdown rules, have left nurses on the verge of tears.

“It’s unbelievable," Mrs Snow said.

"If it wasn’t for the fact that we are professional and that we need to maintain privacy and dignity of our patients, those individuals should need to see what goes on here. It is absolutely devastating.

"It is a living nightmare really. The volume of people that are sick, how long they are sick for, the fact that some of them are not recovering, the trauma it’s having on families, I just find it unbelievable that they don’t believe that this is actually happening.”

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She added: “If they don’t amend their ways and follow the rules and regulations they will find themselves to come into Covid and they’ll see that actually it’s not a hoax."

Some people have been so ill they have been in intensive care for at least eight weeks.

And while the majority of patients they care for are elderly or with existing health conditions, the virus isn't selective.

Some patients needing ICU treatment at KGH have been in their early twenties.

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Mrs Snow said the progression on the vaccination programme will help in time but that the next few weeks are critical - and urged everybody to play their part to help beat the virus.

She said: “It’s so important that the public realise they need to keep safe. If they don’t they’re putting an increasing burden on the resources that we have available in the NHS.

“By not following the rules they are contributing to the long-term devastation.

"This doesn’t affect just nurses. This affects everybody that works in the NHS.”

Please support KGH by strictly following the lockdown rules. Stay at home. Don't mix where it can be avoided and help reduce the pressure on the NHS.

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