After 23 years in critical care, nothing prepared ANTHEA ALLEN for war zone at her London hospital
Senior sister Anthea Allen has been a nurse for well over 20 years and thought she had ‘seen it all’ in her long NHS career. Then came the coronavirus pandemic.
When it hit, she was — still is — among those in charge of the critical care unit at St George’s Hospital in South London, one of Britain’s biggest clinical teaching establishments. Now it is in the eye of the Covid-19 storm.
Even in the days before lockdown, some shops within hospitals were refusing to serve nurses in scrubs because of fear of infection. Critical care staff found themselves unable to buy biscuits or a chocolate bar to see themselves through 12-hour days.
So Sister Anthea, a mum of two, appealed to family friends. She was soon inundated with food donations. A Twitter funding page called @CriticalNhs was launched, which has raised nearly £100,000 so far.
She also began a weekly internet diary — to share with a few dozen associates. Now she has agreed to parts of her diary being published exclusively in the Mail, a gripping and deeply moving account of NHS life on the front line.
Senior sister Anthea Allen (pictured in her PPE) has been a nurse for well over 20 years and thought she had ‘seen it all’ in her long NHS career. Then came the coronavirus pandemic
WEEKS 1 & 2: THE GATHERING STORM
MARCH 19 TO APRIL 6
I’m so proud of my colleagues. Before this happened, nurses were stretched to the limit; now they are under truly immense pressure, exposing themselves daily to the threat of Covid-19.
There’s not enough room and not enough people to deal with this gathering storm, so we’re opening up other areas to care for the critically ill, and employing agency staff.
I’ve seen tears, fear and exhaustion among colleagues working long hours, skipping breaks and going the extra mile to ensure patients feel safe — all the while wearing this strange, cumbersome protective gear.
Still, there are shafts of sunlight in the gloom. On Friday, a friend dropped off a huge box of doughnuts for the nurses on my unit — within an hour they had gone!
One night, when I returned home exhausted, there was a tin of homemade chocolate brownies sitting on the doorstep with a card saying ‘Thank you, nurses’. I’ve no idea who made them, but thank you, too. A local school has emailed, offering to arrange deliveries of sandwiches.
The kindness of strangers, the spirit of the community and my very dear friends have warmed my heart. I did not expect this response — bin bags packed with biscuits, chocolate, cake, and cereal bars. We’ve had pizza, curry, homemade bread, cheese and huge baskets of fresh fruit.
The staff on critical care are being kept afloat by this support and we are sharing what has been donated.
Everyone here is performing beyond the call of duty; doctors, nurses, reception staff, ward clerks, porters, cleaners, security, nurse educators, technicians, lab workers, blood bank staff, pharmacists, dietitians and many others, including the fabulous volunteers.
One nurse said: ‘We are like the band in the film — we keep on playing while the ship goes down.’ But this ship will not sink and we will keep on keeping on.
When coronavirus hit, Sister Anthea (far right) was — still is — among those in charge of the critical care unit at St George’s Hospital in South London, one of Britain’s biggest clinical teaching establishments. Now it is in the eye of the Covid-19 storm
WEEK 3: KEEP CALM AND CARRY ON
It’s like being in a sci-fi movie; staff gowned up with visors, masks and head covers. From three critical care units with a total of 30 beds, we now have 147 beds in seven areas.
Highly trained nurses who usually care for one intensive-care patient now have three to four, with helpers who are ward nurses. Many have never set foot on an intensive care unit (ICU).
It’s tough. It’s claustrophobic in the personal protective equipment (PPE). We’re always thirsty; enclosed in the same room for 12 hours, the only escape is to eat or visit the loo.
It’s raw and real, and we also have our non-Covid critical care patients. Accidents, illness, cardiac arrests, stabbings still happen.
Part of my job is nurse recruitment and the younger ones call me ‘Mama Anthea’.
I’ve become a temporary parent to some, mopping up tears and cuddling those who miss their families. I’m also proud to have recruited my daughter Claudia as our new ward clerk until she can return to university in Bristol.
It’s tough for us but tougher for the patients with no visitors and scared of this vicious virus.
WEEK 4: ‘WHEN THIS IS DONE, SO AM I’
Attention to detail on the ICU is high on our list. I have friends who carefully label every jar in their larder because we are so conditioned to labelling drugs and equipment to ensure we are alert to expiry dates, to what a specific drug is and its dose.
We keep a diary for patients so when they recover they can know their journey. If they don’t survive, we know these diaries are a comfort to family.
We brush patients’ teeth, we change their position, we talk to them even if they are unconscious. We explain to family, we wash hair. We smuggle in a dog to visit, we put a favourite teddy in the bed.
We respect religion, race, sexuality. I have repositioned a bed to face Mecca and dropped off a Valentine’s card for an elderly patient’s wife.
Sister Anthea (pictured with her daughter Claudia) began a weekly internet diary — to share with a few dozen associates. Now she has agreed to parts of her diary being published exclusively in the Mail, a gripping and deeply moving account of NHS life on the front line
We are a competent, highly-knowledgeable, kind, caring group of individuals who are proud to be critical care nurses.
It’s different now, though. We are in a growing storm. We just fire-fight to do whatever we can to keep someone alive, to try to help them beat this unrelenting, deadly virus. The personal touch is impossible. One nurse said to me: ‘I don’t even know my patients’ names.’
We all have trouble sleeping and many of our permanent nurses (who come from all over the world) want to go home. They probably will do after this is done. We are broken.
But there is hilarity amid the madness. We laugh and cry and support each other. We have offers of counselling but are too busy.
Our priority outside the ward is to eat, sleep and have a very long shower.
We feel wretched and exhausted while at work, and guilty when not at work.
I walked through one of the ICUs a few days ago and blew kisses at the nurses I recognised beneath swathes of fabric, plastic and paper. Today, I received a text message from one of the Italian nurses: ‘Please come by and send me flying kisses again.’
The level of anxiety increases each day. It’s particularly tough for the junior staff, suddenly expected to lead and guide staff deployed from other areas.
We continue on and on and on, and still more patients arrive, ill and scared.
One man said: ‘Please don’t let me die.’
This is a different way of nursing. Uncharted, with no end in sight.
There are many NHS workers, some unseen, who are struggling. The mortuary staff, for example — our mortuary is full.
There are the lab technicians processing the stream of swabs from patients with Covid-19 symptoms, as well as the routine testing of blood and specimens.
Our technicians must keep servicing and cleaning the ventilators — some are more than 50 years old. The pharmacy is keeping up with the supply of drugs required. Recruitment is processing new, redeployed and temporary staff.
A junior doctor told me: ‘When this is done, so am I. No amount of money could make me stay.’
Week 5: Death stalks my ward
If this is the front line, then we are fighting a war without weapons. One of our doctors who has worked in Afghanistan says he feels the ‘dramatic level of trauma’ is somehow worse than what he experienced out there.
This monster is worse? But yes, in this Covid war the enemy is unseen, and all we have is our dwindling supply of PPE, supposedly to protect us.
On Sunday I cared for patients in a makeshift and cramped ICU in what is usually a neurosurgical ward. Cables trailing along the ground, monitors balanced on top of ventilators and the emergency oxygen supply for my patient attached to the bed of another patient with roles of green tubing that looks like a garden hose hanging off the end of the bed.
The PPE is suffocating. It’s hot, it’s tight. I’ve a cut above my left ear from the mask elastic. We have to shout or we can’t be heard.
At one point I felt an overwhelming desire to break free and rip it all off. To lift my visor up and just breathe. My nose was blocked, my throat was sore — but then an alarm went off. A patient became unstable and I was distracted.
One man died. He was 60 and, apart from being diabetic, a working husband and father.
A junior nurse and I held his hands as he died; we spoke to him, talked about the photo of him at his daughter’s wedding last summer. I tucked that photo into his hand. There were no curtains around his bed, no family with him. Another Covid victim, snatched from life. The junior nurse had tears running down her face. ‘This is not how it is supposed to be,’ she said.
Later, I spoke to his daughter on the phone and I could hear her pain as I tried, inadequately, to describe his final moments and reassure her he was not alone when he died.
The dying man had been sedated. It’s hard for the patients who are conscious because they cannot see our faces. But I hope they can see us smile at them from behind our mask. We touch their face and hands so they feel reassured that we’ll do all we can to help them.
I recognise one patient — one of our own nurses. He had refused to be ventilated at first because he was scared.
Now I am programming his ventilator, giving him medication. He is doing well and I hope will make a full recovery.
A patient who was ventilated for 21 days left critical care today. As he was wheeled out, staff lined the corridors clapping and he smiled, waving his arms in victory.
A fantastic moment — patient and NHS staff united together in success.
We are shattered and do what we can to ensure we all have space to shed a tear or time out to eat and drink.
Hospitals seem to be designed with only a spare inch of space but the genius who designed the Atkinson Morley Wing at St George’s added a large balcony.
We can eat hot lasagne provided by @CriticalNhs and, just for a moment, we sit with our face in the sun and feel like the world is normal again.
I received a text from a Portuguese nurse: ‘I need some chocolate, a Coke and a new hair cover. Is there a pink one?’ I was able to fulfil all three requests!
We are brilliant, and to quote my daughter, Claudia, who I have the great pleasure of working beside: ‘The nurses are beautiful, hilarious, tireless heroes.’
I found one of our young nurses in the changing room, sobbing. I cuddled her as she cried, wondering what hideous thing she had just experienced. After a few minutes she said simply: ‘I miss my mum.’
This is our normal and we are adjusting to a new way of working until we have won this war.
Week 6: THIS MUM SHOULD NOT BE DYING
I’ve not cried at work for years but yesterday I felt a deep sadness that stayed with me all day. I cried on my lunch break. I got home and cried in the shower. I then cried again. I had a large glass of wine and cried some more. My patient was dying. I pride myself on my end-of-life care but I’d never imagined taping my iPhone to a drip pole with Elastoplast and angling it so the camera looked on to my patient’s face so her husband and children ‘could be with her’ as she died.
It was the best I could do but far from good enough. Usually, families are with a patient, holding their hand, brushing their hair, even lying next to them.
This felt so wrong and crude.
This woman should not be dying. She should be at home nagging her children to do their homework or brush their teeth. Discussing with her husband what to have for supper. Normal mum and family stuff.
I’m a marathon runner. The sheer exhaustion felt in those final metres to the finishing line is how I feel at the end of a shift on a Covid ICU — minus exhilaration and the smile on my face. But the crowd support and the kindness of strangers is the same.
Today, the new and amazing community network that was fired up by an email from me asking for biscuits has provided one of my lovely European nurses with a flat to live in for a few weeks. No rent, no bills, just a set of keys and the WiFi password.
It is quieter now at the hospital but a level of crazy still fills the air. I miss the old way of working, the routine, the familiarity.
Yesterday I didn’t recognise a friend in her PPE, and when she spoke I couldn’t hear her as my hazmat suit covered my ears. We did laugh and bump elbows.
How I took for granted our cool, navy, cotton scrubs and seeing colleagues’ faces.
The tide has changed direction somewhat. The resilience of staff has blossomed and we are settling into our new normal.
We have fewer admissions, but none of us want to relax as the invisible monster can rear its ugly head at any moment.
We can only do our best and the staff I have the privilege of working with are doing that and so much more.
We have many staff from all over the world, from Europe, India, the Philippines. These dedicated and fabulous people help hold up our health service.
We have the strength to keep fighting this battle. We will go to work — you stay at home.
- #CriticalNHS is now providing food to staff at 15 hospitals across London and Surrey. The Daily Mail has made a donation to @CriticalNhs. If you want to help @CriticalNhs, which provides meals and many other items to support the staff at St George’s and other hospitals, click on the link below. https://paypal.me/pools/campaign/ 113431121376689453.
Additional reporting: Simon Trump