This is the worst it can get with COVID-19, but ITU nurse Clare Borg tells Fiona Galea Debono “we’re resilient and ready to go”.
ITU nurses want to face COVID-19 head-on, get through it and get over it, says Clare Borg, who has been in the job for 10 years.
Despite her composed disposition in the face of the pandemic, she admits it is the “awful trepidation of tiptoeing around the situation until it actually happens” that gets to her. And, of course, having no end date does not help.
It’s a matter of when – not if – things turn ugly, the mother of two says, warning of a scenario that could see people suffering from other conditions too scared to go to hospital because of COVID-19 and resulting in the young and healthy dying.
Being on the frontline, Clare’s understanding of the pandemic’s repercussions is understandably more realistic – and possibly more pessimistic – than the public, which is still somewhat in denial.
But she does not use alarmist tones when she talks about genuine fears of whether her father would be walking her sister down the aisle next year.
It is hard to convince the ITU nurse to talk about her job in these coronavirus times. But when she finally agrees on condition of “speaking for every other healthcare worker in an equally frontline role, from the clerks and the cleaners to the radiographers and lab technicians”, her eye-opening walk-through of the unit instils confidence in the setup.
So far, the hospital’s ITU has seen a maximum of five patients at a go. But when the outbreak really bursts into the unit, every nurse is committed to face any working challenges, and Clare too will drop everything to be available from a shared apartment in Swatar that a friend has offered.
Every day, she leaves the house for work with its keys… and to her daughter’s burning question about whether she would be returning that day.
It is not so much contracting the illness that is on her mind, but more having to leave the family home, including a one-year-old, when the virus peaks.
“I have never been separated from them and did not even book to go on my sister’s hen party abroad… But I would leave home for this.”
Clare has broached the subject with her five-year-old, telling her there may be a time she won’t return for a while.
“We will need to self-isolate and everyone is willing to do whatever is needed,” she says.
At the same time, “you don’t want to be the bullet for your own family. You never know how they will respond to the virus.”
We will never let anyone die alone
So, while the public stays safe and adopts a leprosy-like approach to others, how does an ITU nurse consciously enter the storm? Clare recalls the Libya crisis, adding that “we are not new to dealing with highly infectious diseases either, so we have been weaned into this”.
So far, the cases have trickled into ITU, which means the team has not been thrown into the deep end and the environment is calm.
ITU nurses are knowledgeable in every medical speciality, dealing with all types of organ failure. They work in a high-tech environment, operating sophisticated machinery.
It is this level of autonomy to administer prescriptions as per protocol, reading results and adjusting accordingly, that is “overwhelming” the cohort of nurses currently undergoing training to assist the 60-strong team if the need arises.
Until then, the ITU nurses themselves have been training for over two months in new techniques and machinery used for a “white-out” – Acute Respiratory Distress Syndrome, where the lungs give up, which commonly afflicts COVID-19 patients.
“Credit goes to those running the show, the Anaesthetic Department and charge nurses for their coordinated strategies in record time.
“COVID patients are put in the isolation negative pressure rooms, which are equipped with very expensive HEPA filters we are so lucky the hospital invested in and which other countries do not have! These change the air around 36 times an hour.”
Even their showers have been segregated for “clean” (non-COVID area) and “dirty” nurses, she says.
Nurses in the two control rooms bang on the glass to alert their colleagues if they see them about to touch their faces.
Still, the scariest part of their working day is doffing their Personal Protection Equipment; and having it compromised.
“If it were up to me, I would make every factory in the world produce them and the government should incentivise companies to start making them,” she says, labelling “ridiculous” those who upped the prices at a time when everyone should come together and just start giving them out.
“A lack of PPEs would put nurses in a very difficult predicament. It would be impossible to work without them... They are already being rationed.”
Their masks give them approximately four hours of 100 per cent efficiency, Clare explains.
The number of ventilators in the ITU is what will mark the difference from countries like Italy, Clare says, where doctors have had to decide who lives and who dies. The hospital pushed to procure as many as possible, and got what they could, including old ones that were fixed and upgraded, while even anaesthetic machines could be used for that purpose.
“The more we have, the more we are armed to fight this silent enemy.”
The ITU is working to be pre-emptive. The focus is on structured care and not crisis management, opting for elective intubation, Clare explains. “Patients can deteriorate just like that and it means we will have to work fast and be compromised.”
Acknowledging that dying patients would not be able to have their relatives by their side, Clare says they are kept updated by the consultant anaesthetists, who run the ITU and personally phone them regularly, preparing them if intubation is warranted.
“The point is to protect as many people as possible, so it is my role to take the relatives’ place and comfort the patient. We will never let anyone die alone…”