Working Frontline in a Pandemic
Anxiety has taken hold in many of our lives in new ways over the duration of the Covid-19 outbreak. We also all have a renewed appreciation for the work of the NHS staff who have worked so selflessly on the frontline. We spoke recently to Nicklas Arkensparr, an ICU nurse working in Belfast, who shared with us about the mental impact that the Coronavirus pandemic has had on his working and personal life.
With being on the frontline in ICU, you clearly had concerns for the welfare of those at home too. How did you as a family manage the situation?
“I work in CSICU, Cardiac Surgical Intensive Care. I think the initial plan for the role was that we were going to get the COVID patients into our unit. We were going to be the last to get them, but because we thought that was going to happen we decided to make plans here at home and so my wife and children went to Bangor to stay with my mother in law.
“At that stage, we knew I was going to be exposed, so we thought it was safer for the family. We decided it was the best thing not just for us as a family but also my mother in law who needed some extra support for her own medical issues. It meant they all had company. For my wife, it was really hard because she had to go through that. Being a mum and a teacher, as well as supporting her own mum and her health issues.
“Altogether we were separated for 8 weeks which was tough on all of us. The not seeing them and having physical contact was an emotional struggle. We did see each other from afar though as I did the shopping for them and when I left it to them, I sat outside. Our boys are 9 and a half and nearly 8, and there is our youngest who is about to turn 1. The boys are big enough, so they understood that they couldn't be close to me. I got to see them, but I struggled with the lack of physical contact, because we would usually have hugs and kisses. It was tough for all of us.”
“At times I have found other people’s lack of adherence to restrictions quite mentally difficult. Being without my family around me and seeing people on ventilators struggling with this disease I often felt a range of emotions from anger to hopelessness. To be very blunt, I was jealous of those who had the luxury of safety with their family around them and felt bitter that there was no chance that me and my children were going to be able to bake bread or enjoy their time out of school together. These are the more difficult and “negative” feelings I carry.”
That was a tough time. What was the reality of your work?
“There was a lot of waiting and anticipating, we had the whole unit prepared. Ordinarily, our unit was divided into intensive care and the high dependency unit. As we got closer to the possibility of it coming to our unit, we closed the ICU and had all our patients in the HDU. It was a waiting period with a lot of uncertainty. Our managers were excellent throughout and worked hard to be well prepared. If you had a day off, you didn't know if there was a surge. You went into work and you didn't know what you were going to face.
“Then there was a lot of change. The decision was made that we were going to be moved to where regional intensive care is in the Royal Victoria Hospital and that we wouldn’t be receiving Covid-19 patients. It was actually quite stressful because it’s not our unit, so we had to bring a lot of resources and supplies across, so there was a lot of running back and forth to make work manageable.
“Another time, I arrived for a night shift and the unit was empty. It made things really unsettling and the staff were becoming frustrated. At the time no one had the answers to the questions we had, and I think that has been a problem throughout the whole process, the lack of information.
“We knew that ICU staff were needed in the Nightingale hospital (Belfast City Hospital), so I volunteered along with about 15 of my colleagues as were overstaffed in our unit and not operating at full capacity. We worked over there for about a month, up until it slowed down.”
What was your experience like in the Nightingale Hospital?
“It was good to be there as we knew what we were doing, it was harder before because we didn't know and there was so much uncertainty. Yes, it was quite hectic but going over to the City Hospital was good as I felt a little bit more at peace with what I was doing.
“The first shift, I wouldn't say I was scared, but I was anxious because I knew that medical staff had been infected in other parts of the world and had died, so the risk of being exposed to a high viral dose was real. The more we worked there, the more confident we got; everybody else who worked there was excellent.”
What was different about caring for Covid 19 patients compared to your usual work?
“Ordinarily, we would look after a lot of cardiac surgical patients who could be extremely sick with perhaps being elderly or other comorbidities before they come in for surgery. So, we were used to patients being in our unit for days and we were used to the continuous dialysis, balloon pumps, and ventricular assists. Generally, it wasn’t too different.
“When we came into Nightingale Hospital as ICU nurses, a ward had been repurposed as an intensive care so we were looking after a bay of 3 or 4 patients and each patient would have one of the ward nurses who hadn’t worked in this environment. That was stressful at times, but the team and the camaraderie was amazing. Everyone just helped each other out and supported each other.
“Usually in an ICU setting, limited family are allowed to be with the patients for set times, but this, unfortunately, wasn’t possible in this situation. I hadn't thought about it until one of the charge nurses passed me an iPad and I thought this was for making records for cases, but I looked at the sheet that came with it which had guidelines of giving bad news on a video call to the patient’s relatives. That really hit me. We did do calls with relatives to give them updates that allow patients to see their relatives on the screen. In my usual work in CSICU, we would always have a very close relationship with relatives and would often provide a lot of care for them too, so it was strange not seeing them. However, without family there physically, it meant you could focus on your patients and as sometimes it was quite busy, if you had had the relatives there it would have been an extra stress factor. In that sense, it was good. You could focus on the patients which is what was needed at that time.”
How did you leave the emotional stuff of work behind and look after mental and physical wellbeing?
“If I had a day off, I would try to do something, but it was really hard to motivate myself. I would run a lot normally, but I only did 1 or 2 runs as I found it hard to motivate myself to do that. I thankfully had a lot of friends who cooked for me, so I didn't have to worry about feeding myself. My diet would have been bad if it wasn't for them.
“I was always thinking about work, even if I had 2 days off, I would start to get stressed because I didn't know how my patients were doing or if they had got more admissions. I had to stop watching the news too. It was really hard to unwind, and I don't really know if I have now.
“I was worried about my family here and my family at home in Sweden as well. That was tough on my days off. I was thinking about them a lot. But also, the fact that I don't know when I'm going to be able to see them again. Sometimes the best thing was being at work, getting on with it and not overthinking those things to cope.
“I had hoped to be able to take some time off after Nightingale ICU but was straight back into work in the CSICU and looking after cardiac patients. There hasn’t been a chance for us all to have a breather, though we understand that services need to get back up and running again.
“There is a clinical psychologist who is doing sessions for frontline staff now and we have an option of availing of that but it’s difficult as duties need attended to and it’s difficult to go to debriefings or therapy sessions outside of work hours.”
“At the start (and probably still) worrying about having to care for people I know, colleagues, friends and family and potentially seeing them die. I am left with the fear that we possibly will have to go through this again maybe for longer.”
If there's anything you could take away from this experience what would it be?
“People from different backgrounds just came together and did an amazing job. You were thrown in with a bunch of other nurses and doctors that you didn’t know, and it was a really good thing, as it brought out the best in people. It was a reward in itself to be a part of that.”
Nick’s experience of Covid-19 is most likely very different to the majority of us and of course he has some mental stress to recover from as well as the physical. It is inspiring to hear his appreciation of the positives within a horrendous situation, whilst also facing the realities of that time.
We are all vulnerable to the stresses and anxieties of these times and can face a loss of motivation or energy, experience the feeling of being despondent, having an excess of worry and a fear over the uncertainty of the future.
There are times when we all need to access help and care, so we shouldn’t be scared or embarrassed to ask for it.