This is REALLY REALLY going to hurt – the reality of what it’s really like to be a second-year student nurse who had the unfortunate “luck” of being admitted to intensive care, not just once but two times during my current training, a story of how it happened, what it felt like and how I am doing now.
Firstly, I’ve written before, about the undeniably outstanding care that I received as a critically ill patient. Which is incredibly true, but there’s only so many characters you can tweet and I finally feel ready to give a more in depth version of my experience.
In July, last year. I was finishing my last ever shift, of my first year as a student nurse. I’d been feeling a little run down, with a fever for almost a week – I couldn’t wait to finish for summer. I had plans to go abroad and look back on what (I thought at the time) had already been one of the hardest years of my life. How wrong I was going to be, before this shift was even due to end.
One of the first things I figured out as a first-year student nurse; was that not many patients are aware that one: nursing is now a profession and that we are educated at degree level. Although, there were many passing comments about “you should all be paid so much more” or my personal favorite “I don’t know how you do it” – I know how I do it, I study, I read – a lot. I like reading thankfully, so I have become accustomed to peer reviewed articles and different nursing theories. I feel so proud to have both the knowledge and understanding I have behind me, as well as the skill that comes with the unfortunate unpaid placement hours. These placement hours reinforce the very reason why, on that very day in July, I hadn’t called in sick – although I felt emotionally, physically and mentally tired, and that gnawing pain in my abdomen, alongside a fever I tried so desperately to mask with paracetamol. I was frightened to call in sick, as I didn’t want the fear of “owing” placement hours hanging over my head going into my second year of my degree.
Regrettably, I should have put my pride aside when I initially felt unwell as I very unfortunately ended up as a patient in intensive care on the very last day of my first year. An extremely poorly patient.
I was sent home early by the Nurse in charge, I had a sudden stabbing pain in the upper right quadrant of my stomach as well as an onset of vomiting which didn’t diminish until I was coming in and out of consciousness in the very same A&E I work in and the trust I am training in.
After a detour home, a call to try and get a GP appointment and waking up on the floor to 111 – I took myself to A&E. Where I almost collapsed in the waiting room.
I had caught a glimpse of myself, I was grey, clammy and looked as though I was about to peri-arrest. I was seen quickly by one of the A&E registrars, who wheeled me to resus herself after seeing I had a systolic BP in the 50’s.
I was still wearing my student nurse uniform, and recall the nurses so delicately taking it off as though it was just as precious as my life – instead of the usual quick cutting with the trauma scissors. I had a dozen doctors surrounding me, from the incredible A&E consultant leading the team – to different specialties. From the medical, surgical, gynae and cardiology team.
I had a number of medical interventions done in resus, ones I’d never ever wish upon anyone. I had multiple cannulas inserted, via ultrasound as I was peripherally shut down. Instead of pressure bags, the doctors were pushing IV plasmalyste into me themselves. The A&E trolley I was on was tilted so that my head was almost touching the floor. The anesthetic team arrived and attempted to put in an arterial line (this gives a much more accurate reading of blood pressure and allows staff to take samples of blood from arteries in order to check a number of important metabolic and electrolyte factors.
The first arterial line was unsuccessful, I learnt recently this was because my body was trying to protect some of my major organs, such as my heart and lungs by constricting the blood flow elsewhere. This meant that I needed what was called a “femoral stab”, in order for the team to know some important metabolic values which could change, or even improve the course of my treatment. This is supposed to be incredibly painful, as the sample or line is take or inserted via the femoral artery. I felt no pain.
I recall the doctor leading the team, asking for my latest blood pressure, after they had managed to successfully place an arterial line. One of the team, perhaps even one of the senior sisters I work alongside shouted “62 systolic” – This is a critically low blood pressure, so I was given IM Adrenaline – still no improvement, I was then inserted with a CVC line, which was placed in a large vein in the neck. The advantages of CVC that leads directly into the heart are that it allows several medications to be given simultaneously. Including IV fluids, blood products or even inotropes, (which I don’t know much about) – all I do know I was extremely poorly – to be on their maximum cardiovascular support in order to keep a blood pressure of 70mmHg.
Once the Intensive care consultant and specialist intensive care nurse were happy, they escorted me to CT, to try and find out why I had essentially gone into severe septic shock. The CT confirmed “Acute Cholecystitis” (infection/inflammation of the gallbladder).
I was still floating in and out of consciousness and was then taken immediately to the intensive care unit. I’m estranged from my family, so at the time my ex -partner and his mum, who had become like a mum to me – eventually left. As soon as they did, the crash trolley was wheeled into my room and the senior doctor told me that in order to keep me alive – I needed to be intubated and sedated. I was absolutely petrified, I’d only ever seen really, really poorly patients intubated. This involved putting me to sleep and inserting a breathing tube, which sits just above the lungs. This took over the entire role of breathing (which is actually an incredibly complex process) for me.
I was then placed on hemofiltration (a little like dialysis) I did have an Acute Kidney Injury. My blood had also become acidotic and the IV fluids that were being pushed into my veins in resus, had gone into my lungs. This is called pulmonary edema, this had occurred due to the septic shock – I was still extremely hypotensive and due to massive vasodilation- my blood vessels had become leaky meaning instead of the IVI of fluid treating tissue hypoxia and critical refractory hypotension – this needed to reverse this damage with IV diuretics.
I was sedated and ventilated for five days. I can recall very little in this period of time (due to the constant infusion of propofol), However I can recall small pieces. For instance; It was important to observe the ET tube that was inserted and attached to the mechanical ventilation – that it wasn’t affecting my upper airway tract. It’s held in place with a small cuff of air. As prolonged endotracheal intubation is associated with dysphasia/dysphagia. In hindsight, who would ever believe something as insignificant as a small air inflated cuff could quite possibly affect my ability to ever eat/drink or talk again. Prolonged ET ventilation isn’t commonplace, usually a tracheostomy is performed in order to protect the airway.
Like I have already said, I don’t recall much – however I do recall two significant and paradoxical events – one being washed by two female nurses, I couldn’t place a name however all I knew, was that I lay there wanting to both cry & scream or shout to please cover me. I know for them, washing me was just commonplace and part of the job, but to me it was humiliating and undignified. This is a memory that will always sit with me, especially as a student and future nurse.
Despite this, I also had a nurse, who’s name I do recall. Despite still being sedated and ventilated, he told me he would be my nurse this evening. He told me what he was going to do from performing bedside checks, to administering important medication, to a point where I recall him telling me he was going to take an arterial sample from the line in my arm (this is done frequently on patients in intensive care or high dependency units) This line is the one that gives an extremely accurate measurement of blood pressure. At the time, I was unaware – but taking a sample from this line causes disturbance on the continuous cardiac monitoring. I can recall, this very nurse telling me not to be frightened but the cardiac monitor was going to alarm, and it did. In that moment, and during my recovery I understood just how very important the little things are, even when extremely important things such as mechanical ventilation, hemofiltration a continuous infusion of inotropes are. Sometimes, being informed about even the smallest parts of your care can empower you. Yes, even when you are heavily sedated and on a Fentanyl infusion.
The day I was extubated, was definitely up there with being quite possibly the worst day of my life. I did not expect, after finishing my first year of university, sitting exams, writing essays and completing two 240 hour placements alongside working full time that I would be waking up in intensive care – with a breathing tube in my mouth. My only method of communication being able to write on a piece of paper in order to convey my wants and needs.
For someone with 24 hour 1:1 care I felt incredibly scared & alone. Nobody else, in that moment knew how I felt. My own parents had no desire to come and see me. I had absolutely no control over anything that was happening to me and intensive care can quite quickly when you’re no longer sedated, become a very very scary and delirium infusing place.
I was finally extubated, I remember the tears streaming down my face, I felt as though because I was a student nurse, and a healthcare professional that I should be sat upright smiling and overly thankful. (I am BEYOND grateful for the care that I received) – nevertheless I couldn’t even control my own bowel motions let alone my facial expression. I was upset, maybe a little bitter that I was in that position. I wished so badly to be away, with my friends enjoying my summer and celebrating making it through first year, I always thought i’d be alive but I never anticipated how appt that statement could become.
That night, the ITU registrar wasn’t happy with the numbers on my ABG & wanted me to be on BiPAP NIV (non-invasive ventilation) due to type 2 respiratory failure. (hypercapnia & hypoxemia). This meant that a machine that was forcing my lungs open with differentiating airway pressure. It required me to be breathing for myself, however I was so exhausted, frightened, upset and extremely delirious. At one point I was convinced one of the nurses was suffocating me with the NIV. Nope, it just feels like it – which is ridiculously funny considering it plays a huge part in respiratory medicine.
My recovery from this point on was tough, I had been given several different antibiotics, which once stepped down to the surgical high dependency unit were only four times daily. A microbiologist was involved in finding the ideal antibiotic for the cause of my sepsis. (THAT’S WHY BLOOD CULTURES ARE IMPORTANT). Although. when I first presented to A&E I was given what are called “broad spectrum antibiotics” which are vital within the first hour of sepsis.
I really hope I don’t come across as ungrateful, it’s just the circumstances at the time were, character building and I suffered with severe PTSD following my admission to intensive care,
Thankfully, at the hospital I was treated in, they offer an (unfunded) outreach program I was visited every day by a wonderful nurse, who has come to be such an important part of both my recovery but journey as a student nurse. She visited me almost every day and offered so much insight into what had happened – she gave me a lot of information about sepsis – which has quite recently been a popular topic in my Anatomy and Physiology exam. (I also recently had a follow up appointment with the specialist nurse, an ICU doctor and physio. I was so very happy to tell them I was back at university).
At the time, I had a long period of recovery ahead of me and managed to pass the occupational health vetting – which meant I could start my second year as a student nurse. I was so proud of how far I had come, as at one point I was unable to even stand without the assistance of two physiotherapists (the unsung hero’s of the NHS).
I went straight into placement in second year, mine was gastroenterology and hepatology. I absolutely loved this placement, I can honestly see myself being a qualified nurse in this specialty. Sadly, despite finally feeling confident to be taking responsibility for the care of a bay of patients, discussing my patients in the daily MDT, managing their complex care needs throughout the day. Including ascitic drains & complex drug rounds as well as caring for patients with both physical and mental health conditions. Such as; anorexia nervosa.
Despite feeling incredibly healthy, happy and really enjoying my placement. It was sadly cut short – after a friend found me unconscious and hypoxic (sats in the 70’s). Which resulted in another admission to intensive care & the Medical High Dependency Unit. I was taken to my local hospital, found to have a GCS of 5 and bilateral Pneumonia. The decision was made to take me up to intensive care, thankfully I was only intubated for less than 12 hours – however I did wake up in the same room and I was absolutely petrified. It triggered some sort of delirious state and Iv’e been suffering with quite bad PTSD (especially after the second admission) Thankfully my GP is involved and this is being treated with a very mild medication that prevents me from waking up at night, a feeling of being tied to the bed, about to be intubated, I start hearing the sounds and even smells of being in intensive care, with this loss of control. When I do come round, I am laying there shaking, sometimes crying and generally feeling a bit pathetic.
Although since speaking to my GP about it, she said PTSD following an admission to ITU is normal, so iv’e been doing my own personal reading. There’s even other nurses, doctors and other HCP’s who have suffered the same fate. It’s something that i’m overcoming though.
I had been waking up at 0430 to ensure I was on time for my shifts, on placement as well as working two additional night shifts in order to survive – since the old nursing bursary system was replaced with tuition fees, and the student loan system, the only way I could realistically survive was by working alongside a very demanding full time degree. Which unfortunately means that I will be starting my career with a 60k+ deficit, despite this, I was and still am willing to wake up at 04:30 am, work as part of a large multidisciplinary team, work with an invisible “supernumerary” status, miss breaks & stay late to make sure I’ve done my very best in that twelve hour period. Because I really, really love what I do & I am so proud to be joining such an incredible profession. Nursing is such a rewarding career, but it takes an incredible amount of strength, resilience and discipline to get through (and I am only halfway there).
I have recently been under investigation of an immunologist who has confirmed that I do have a suppressed immune system, (almost a relief) there is thankfully a vaccine for it and strangely not remotely related to the first admission with severe septic shock. At no point had any Healthcare professional state that it was my fault that I evidently ended up so critically unwell. HOWEVER it was made very clear, that my illness was most definitely exacerbated by the fact that I was run down, from working so many hours. Especially on placement, sometimes up to 65+ hours a week – as well as not having a support system to help me get through tough times.
I don’t come from much, I don’t come from money, a loving or encouraging environment/background – in fact my parents couldn’t care less about my welfare or wellbeing, Once, my dad told me he could quite happily “cut me out of his life like a piece of cancer” – this will always sit with me, I can forgive in so many ways but as an aspiring specialist oncology nurse (I know I’m aiming high) nevertheless, even my armature self knows that the treatment for cancer is so much more specialist and intricate than that, thankfully instead of dwelling on my upbringing I became aware that kind people, are my kind of people.
Most nurses are kind and generally pretty awesome, I also learnt that life is tough, so very tough at times but so am I. I’m always happy to engage in conversation about my personal experiences as a patient, but It’s so much more than that. It’s not a competition – I don’t want to be poorly or likened to “the sickest patient on the unit” I just know that almost every day, I wake with such a grateful heart because I could have turned out to be so very different, biter perhaps. Yet, I am thankful, even for the smallest of things, like being able to breathe, or wash and dress myself.
I may only be heading to the start of my career, but I know that it is a job, a profession that I will always love and enjoy. You know that Monday morning dread people complain about? Or the TGIF? I don’t get that, ok – I work shifts but I know that, although it’s tough at times. Nursing is quite possibly the best job in the world, even if it means you really do have to see it through your patient’s eyes sometimes.
I recently attended a debate in Westminster abbey regarding the removal of the bursary, I personally spoke with at the time newly appointed health minister about my experience as a student nurse. There were a few loud voices, which certainly made an impact, but I felt as though my story may, in some way have opened his eyes to what training to be a nurse is really like.
It really is unlike any other degree, the debate was passionate, well versed (almost as both parties were singing off of the same hymn sheet) I felt incredibly proud to be there, representing all student nurses, my university UWL and those who are also at a financial disadvantage due to their socio-economic status. I just hope, with the 23% decline in applications something changes, quick. If not for me, because I know I am strong and resilient enough to endure the next year and a half, but someone in a similar situation to me, I hope they never have to endure some of the hardship I have.
We are so very lucky to have the NHS at our disposal, we are not so blessed to say the same about the number of nurses both joining or leaving the register. I always knew my nursing degree wasn’t going to be easy, but I know it’s going to be worth it. I honestly believe that although me way have no control over the events that may happen to us, but we do have control over how we are reduced by these events. They can put things into perspective, fill you with the gratitude and determination you may need to say, complete your nursing degree!
It was a great feeling to be in the(unfunded) but incredible ITU patient’s follow up clinic, finally able to tell the specialist ITU nurse, Consultant, Physio that I finally have an answer regarding my immune system & that I am happy and back studying in my second year at university.
P.S I am still awaiting a Lap Choley (removal of my gallbladder) I wasn’t remotely stable enough the first time, and when my surgeon found out about the second admission with pneumonia, he told me he nor the anesthetist would be happy to proceed. So, I’ve only had one flare up of Cholecystitis (horrible, absolutely indescribable pain and discomfort) and thankfully it’s an organ I can live without. So on with the training…
Tash! 🙂 🙂