Louise Curtis - A Nurses Story: My Life in A&E During the Covid Crisis

To our parents, and to those who suffer whose voices go unheard

The stories told here are all grounded in reality, but we have changed names of patients (if mentioned) and identifying details so that no one can be recognized. Many of the individual patients described are typical of a large number of A&E attendees.

Occasionally, a story may draw upon a composite of different experiences from Louises career, to ensure patient confidentiality is upheld.

Louise Curtis is a pseudonym.

A woman in her forties lay before me. She was struggling to breathe, she looked exhausted and her oxygen levels were dangerously low. Fifteen minutes ago, she had been fine. Now, it was time for intensive care to get involved and for her to go on a ventilator. I knew that her chances of survival were growing less with each passing moment. Id heard about the rapid deterioration in coronavirus patients, but this was the first time it had played out in front of me. I couldnt help feeling responsible. Had I somehow brought about this series of events? The guilt was overwhelming.

Shirley had been admitted into A&E about fifty minutes before I came on shift. The doctor who I had taken over from had ordered some blood tests and we were waiting for a chest X-ray. She had also been tested for Covid-19 but we didnt yet know the result. When I met her, she was very worried; I wasnt.

Am I going to be OK? she asked me.

Youll be fine, you just need a bit of oxygen, I replied. At the time, I honestly believed it.

I looked at her notes. Shed had nine days of coronavirus symptoms, but none were terribly serious. She had no prior medical history, was fit and healthy and not part of the high-risk group who were more susceptible to succumbing to the virus. I couldnt understand why she was so anxious.

Some years back when I was newly qualified as a nurse, there was a man in his thirties who came in with chest pain. He was normally fit and healthy and looked fine. He was due to go to a ward elsewhere in the hospital to wait for a blood test to come back.

Am I going to be OK? he said.

Of course, I replied.

Will you tell my wife I love her and tell her to look after the baby.

I reiterated that he would be fine, but passed the message on when his wife called up to check on him. She said shed be arriving soon. I later found out that a few hours after he had gone up to the ward, he had a cardiac arrest and died. Ever since, Ive had this gut feeling, a sense of dread in the pit of my stomach, when patients think theyre going to die. Lots of healthcare professionals talk about it, and its usually a warning sign. I did not get that feeling with Shirley, however. And knowing that makes it even worse. I even reassured her mother that everything looked as though it would be all right. I could tell she was also really worried on the phone.

Shes not going to end up in intensive care, is she? she asked.

We would discharge her home if only she didnt need a bit of oxygen to top her up, I said reassuringly. Shes going to be fine. I dont anticipate that she will need to go into the intensive care unit.

That was the only time I spoke to her. I never got a chance to phone her mother back and speak to her myself. The ward would do it, but it should have been me to break the news.

Back on the isolation unit, Shirley kept ringing her bell. I had spent a long time with her explaining everything as clearly as I could. A short while later, one of the nurses asked me to explain again because Shirley had said she didnt know what was happening. Was she just a worrier or was she starting to become seriously unwell? I checked her over again and she seemed fine. Her observations oxygen saturation, heart rate, temperature, etc. didnt look bad.

Then we got her chest X-ray back and it was the worst one I had ever seen. Her entire left lung was infiltrated with Covid-19. There was very little air getting in there. One of the consultants in another area of A&E rang to check Id seen it. Im looking at it now, I said. He told me to call up the respiratory ward. I did and we agreed that Shirley would go there.

There was only one crew that could transport Covid-positive patients and so we had about a two-hour wait before they arrived. It was often the same two crew members, so I assumed that the others were shielding because they had health problems and were high risk. Either that, or the funding wasnt there. In the meantime I went in regularly to check up on Shirley, who was still very worried. Her bag of fluids finished. Do I need another one? she asked desperately. I prescribed her a second bag. Her blood pressure was teetering on the low side, her heart rate was up and her sodium was a little low too. All three things could be helped by some fluids.

When the transport arrived, a nurse went in to check on Shirley. Its policy to check a patients observations before they go anywhere. The nurse came back. Shirleys oxygen level is low and its fallen rapidly. I think you need to come and see her, she said.

I went in to check. She was slumped halfway down the trolley, which was not unusual they must be slippy as it happens all the time but she was alert and had colour in her cheeks. We got her into a better position, expecting her oxygen levels to rise now that she was sat upright, but as I stood there and watched, they didnt get any better. The crew could not transport her and everyone was frustrated because a bed had been made ready, but I maintained she wasnt fit to be moved.

A little while later I took an arterial blood sample to check her oxygen levels. They were very low. I went to my senior in resuscitation and told him I was worried.

Bring her here into resus, he said. Well give her some more oxygen.

We gave her the maximum but nothing was helping. I got on the phone to intensive care.

A doctor from the ICU came down, decided she needed to be intubated and took her away. By this time it was beyond my shift finish and I was meant to have gone home. I felt I couldnt leave, though. I wanted to know that she was going to be OK. The registrar came over as it was time for me to leave.

Right, Louise, can you tell me what happened with this patient?

It all happened so quickly. She was fine and then suddenly she wasnt.

What drugs did you prescribe her?

I told him everything Id done before he rushed off to see another patient. He offered me no reassurance and that conversation, and all that preceded it, left me feeling horrendous. Not only had I potentially misled her mother, but I wondered if my actions had somehow contributed towards Shirleys deterioration. This is all my fault, I thought. I was reminded of how little I felt I knew and it was a stark reminder of the fragility of life and that, despite all my training, sometimes I feel I dont really know what Im doing.

It was the end of my shift and I was getting undressed in the changing room when a colleague came in who had admitted Shirley when she first came in to A&E.

How is she doing? she asked.

Shes gone to intensive care, I said.

Yeah, I knew something bad was on its way, she replied.

Just before I left to go home, I went into the office and saw my colleague Phoebe sitting at the computer doing some work. She was in the same role as me but had a few more years experience.