All I need is the air I breathe

All I need is the air I breathe

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It was Tuesday October 27th and I had been taken into the Ben Muir Intensive Care Unit (ICU) for Covid 19, at St George’s Hospital, Tooting. Having taken every possible precaution against exposure to the pandemic, we received a call on the 17th October stating that one of the parties who visited our offices had tested positive and we should take the necessary precautions.

By Monday 19th Covid had set in with its resident cough, unquenchable thirst and exhaustion. Obtaining an ‘at home’ test was impossible. The NHS system bizarrely insisted my residence and existence of 25 years was invalid. Their mistakes prevented my diagnosis; I was too unwell to travel to an outside test centre and my condition deteriorated.

By the weekend Covid had won and paramedics took me to St George’s Hospital, Tooting. Tests found I was Covid positive and I was transported to the Ben Muir ICU Covid unit. The ward had 4 bays, 3 patients and nurses with forensic efficiency. Each bay was standalone, with bed and plenty of space for medics and nurses. There were no seats in the ward and bright lights prevailed overhead. Machines beeped constantly, whilst mobile lung x-ray units and heart ultrasound equipment were wheeled from patient to patient.

Cleaners, like silent silhouettes, emptied bins full of medical waste. Graceful witnesses moving seamlessly and swiftly, hourly cleaning all disposable bins and packaging. The nurses diligently fulfilled pharmaceutical orders and medics’ requests, simultaneously managing patients’ needs and ward procedures. Unpacking and checking stock on arrival, maintaining accurate notes; all an essential part of their daily task of providing analysis and vital information for the 12-hourly handover. Also essential for the accountability of actions, costs and medical analysis.

Patients were in various stages of Covid. A new arrival, already intubated, was carried face down on a black stretcher; a silent still body, lifeless but alive, sent over from a hospital in Brent Cross. Another was wearing a full-face mask and a third was face down to facilitate breathing. My breathing on the first night was manageable, but on waking delirium had set in and my first vision was of a masked assailant cutting open my wrist.

This was for an Arterial Line which leads directly from the artery to the heart. It is used as a vital assessment tool to monitor blood pressure and obtain samples for arterial blood gas analysis. A thin catheter is inserted into an artery which has a direct line to the heart. Insertion is painful and local anesthetic is administered to reduce this. Results can be returned within minutes, allowing medics to supply the necessary medication swiftly.

The following night all three patients were struggling, as breathing required a herculean effort. Fear, emotion and anxiety added to the mix; like a marathon without training, courage and hope were ill-equipped to manage the task. The other patients were now to be intubated, and families were called. Intubation takes place when patients can no longer breathe on their own, and failure to secure an adequate airway can quickly lead to death or disability. The decision is not taken lightly, and family members are rung and given the opportunity to say goodbye and any last words before the sedation process starts.

It was unavoidable hearing these conversations; the nurses and doctors have to deliver the news to family and patients via video phone with speakers that amplify the trauma of the situation. Once intubated the physicians remain with the patient, administering drugs to the various organs, monitoring results, and replenishing medication as required. They work for several hours at a time, standing, wearing the punishing PPE uniforms, double masks and face shields and the tightest of cuffs on the sleeves, all causing extreme discomfort. Gloves are changed with each medication, action taken, or patient touched. Hands are raw with washing.

A small radio played music in the background bringing some cheer over the long nights. It was during this time that the 70s love song, All I Need is the Air That I Breathe penetrated the room. The poignancy of the lyrics, written over 3 decades ago by Mike Hazlewood and Albert Hammond, was not missed. Who could imagine this poetic and melodic tribute would translate into an anthem for a world-wide pandemic. The song was made a hit by the Hollies in 1974 and Simply Red in 1988. My senses were in overdrive during this time, not helped by early November fireworks and the sound of St George’s emergency helicopters landing every few minutes on the floor above us. The noises and activities reminded me of dramatic scenes in the TV series M.A.S.H., the mobile army surgical hospital, operating in the middle of a war zone.

My breathing was getting worse, each breath shorter, impossible to find or hold on to. The CPAP/NIV mask was now offered to me, a non-invasive ventilated full-face mask. My fellow patients had been through this process, unsuccessfully, and were now intubated next to me. The mask is an airless plastic face covering, fixed tightly to your face. It has no air inside until you make a gasping sound which forces the mask to push oxygen into your lungs. The natural instinct is to tear it away from your face and give up, but delirium has its uses and I used it for support. This is where delirium started for me. I had to find another route to keep going. The alternative was intubation. The wall facing me became my projector screen.

In my mind, my father, runner of two marathons back-to back at the age of 69, and my own marathon trainer, was standing with his back to me at the bottom of a hill. He had guiding reins down his back. Next to him stood my dear cellist chum Liz Davies, with her 17th century cello, bow in hand, her back to me also. The cello was to become my breathing metronome, bringing down the all too rapid breathing tempo I had adopted. I followed the bow’s movement, breathing slower at the same time and pace of stroke. My father placed some walking reins behind him and I grabbed hold of them. My mother sat at the top of the hill. An author of 21 books and mother of 7, she was smiling, with a rainbow above her. One step, one small breath at a time. Each breath was a monumental achievement and I could see the toll it took on my father. Exhaustion had quickly set in for him. The warmth and friendship between Liz and my father was an immeasurable boost for me and more breaths were achieved. When I could not keep it up any longer, I was lifted, my arms stretched across my father’s shoulders, back and arms, and his lungs took a breath for me. Liz played some of his favourite music whilst he coaxed me to try for another, and another.

In the morning the nurses decided to move me to a solo room, after the trauma of the night’s events. Some of the patients were no longer with us. My new room had a white wall in front of me, my new in-house projector screen. I now needed to find new ways to work with it and with the mask. Some of these came to me as extraordinary revelations, as the November fireworks continued throughout and the helicopters boomed through quadraphonic auditorium-size speakers in my ears and head, set at full blast.

The mask stayed on for many days, during the 32 day stay in ICU. The body becomes very weak at this time, due to the impact of physical exertion and illness. Mobility, speech, and muscle control all depart. Our November issue was due to be published, and like most editors, deadlines drive us on. This was probably another route to my survival. This was to be our 100th edition, and I was determined to see it published. On November 24th I left the ICU unit, sent off by a team of doctors and nurses who had cared for me. They clapped and cheered. It was the affirmation of a lifetime.

But in life lessons are quickly learnt, and in the next ward a young woman was waiting for an operation that had little hope of success, which both she and the surgeon knew. There were no ‘last breath’ options in her tool box, just a matter of a few months, and no choices either. The next stage of the journey for long-term Covid patients is Recovery and Rehabilitation. Respiratory Recovery is a vital stage in survival and learning to live with this disease. Loyda Canejero heads this section at St George’s, and with her team of physiotherapists I learnt to move again, sit up, stand, and take my first steps. Damage to the heart and lungs, as with all long term patients, remains to be seen. Lungs can develop fibrosis, leaving breathing permanently damaged, and long-term heart and other organ problems can also occur.

 But what about the carers, nurses and doctors, their 100% dedication, utter selflessness, and the danger they expose themselves and their family to? We must surely do more for them. Many of the nurses that attended to me had been ill with Covid, some were intubated and some passed on. What are we doing to support them; when will they receive what they deserve?

PLEASE HELP THE NHS and the community by WEARING YOUR MASK.

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