I kissed her hand, then half an hour later she was dead. I’ll never forget her
In the third part of an M.E.N. special series, staff and patients tell Thomas George about the heartache and struggles faced on the Covid-19 frontline at Manchester Royal Infirmary
SAM Clarke took the mask from its packet and pulled it over her face. It was a routine she had been through hundreds of times before. But this time, the instant the fabric touched her skin, she froze. The air heavy, her throat tight, she gasped desperately for breath.
As a nurse, Sam knew she was having a panic attack. It would be the first of many - each time triggered by the feeling of personal protective equipment closing around her nose and her mouth.
The Manchester Evening News met the Sam, 36, earlier this month, on her second stint on Manchester Royal Infirmary’s frontline.
Normally, access to the units where Covid-19 patients are treated is heavily restricted. Covid can wreak such havoc on the human body that even families cannot visit sufferers being cared for in hospital.
But, so that the outside world can fully understand the reality of the disease, and the challenges it places on the people who are fighting it, we have been granted rare behind-the-scenes access to NHS wards for a series of stories. Each looks at different faces of the battle against the pandemic, as medics, patients and their loved ones are put under immense strain by it.
Sam was just six months into her nursing career when she was drafted onto Covid-19’s frontline, deployed to care for patients on the adult critical care ward at MRI.
But it was only when the number of
Covid-19 patients had dropped, and Sam had returned to her normal duties in paediatrics at the Royal Manchester Children’s Hospital, that she paused long enough to face up to what she had been through.
The weeks of relentless work in fear of infection, the suffering she had seen, all caught up with the nurse at once along with the grief.
“She had nobody,” Sam says of one Covid patient, her voice cracking as she remembers.
“I felt like I needed to look after her. She was such a character. One minute she’d be your friend, the next she’d tell you off for something.
“I went to see her the morning she passed away. I kissed her hand, then half an hour later she was dead. “I’ll never forget her.”
Sam recalls the first wave of the pandemic as a ‘massive eye-opener,’ ‘like being thrown in at the deep end.’ She could be forgiven for wishing never to return to the Covid frontline. But instead, when the second wave arrived in the autumn and reinforcements were needed once more, she was among the first to step forward, even though that meant reliving the worst horrors of the pandemic – and the emotional toll – all over again. “I wanted to do it for myself – to show I’m strong,” she says.
“I felt like I had to do on my terms. Last time it didn’t feel like it was in my control.
“I feel like a better nurse for what I’ve been through.”
Many of those who lose their battle
I’ve asked for a T-bone steak but the chef says he can’t afford it Paul Duplex
with Covid-19 do so alone, like the dying woman on whose hand Sam left a last kiss. Visitors are allowed only in the most extreme circumstances.
For staff, watching patients suffer without loved ones by their side has been one of the hardest things to cope with.
But amid the horror and sadness have been moments of joy, some bittersweet.
When one woman took a turn for the worse staff helped arrange a lastminute wedding to her partner. As it became clear she was not going to see out the night, the woman requested a priest.
Her partner, who was also being treated with the virus, was called in, along with the woman’s children, and vows were exchanged in the most unlikely of settings. Hours later, the woman died. “Being able to do that for her was probably the high point of my career,” says ward manager Beth Hopper, who works on the Covid-19 respiratory ward, a step down from intensive care, where the most serious cases are treated.
Patients come and go from here every day. Some are gearing up for a return home, while others take a turn for the worse and need to be transferred to intensive care.
“It’s been emotional and exhausting,” she adds. “We’ve never stopped.”
When first admitted, patients who display respiratory issues are taken to a separate receiving unit where they are tested for the virus. If the swab comes back positive, the patient is then transferred to a dedicated Covid-19 ward.
Wards across the hospital have been repurposed as Covid-19 wards, with staff deployed from other areas and hospitals in the trust to staff them.
The risk of becoming seriously ill with the virus is constantly assessed throughout a patient’s stay, and the possibility of someone without the virus becoming infected in hospital is a constant worry.
The youngest patient in the respiratory ward is 25.
PATIENT Paul Duplex is spending his 60th birthday in his bed on the respiratory ward. Normally, he and his family would go out for a meal to mark the big day, but this year he’s making do with hospital grub.
“I’ve asked for a T-bone steak but the chef says he can’t afford it,” he jokes.
“It’s my big one, but there’s not a lot I can do. Everyone here is in the same boat with not having visitors.”
Mr Duplex, who lives in Harpurhey, was first admitted to hospital last month for a quadruple heart bypass.
Following the surgery, he returned home but tested positive for Covid19.
When his blood pressure began to fall, he returned to hospital.
He appears to be doing well, and says he’s hoping to be back home with his family in the coming days.
A keen Blue, being able to stream City matches to his phone has helped him through his stay.
“It’s a bit scary in here at first,” he
says. “I feel fine, though. I have been lucky really.”
In the next bed along, Mahmood Akhtar, from Fallowfield, breathes deeply into an oxygen mask.
The 59-year-old is fortunate. Just days ago, he was rushed to hospital in an ambulance after developing a high temperature and experiencing trouble breathing. “I was worried,” he says. “I couldn’t speak or move. The infection was all on my lungs. Every day I was getting worse.”
A medic explains that Mr Akhtar is receiving the maximum amount of oxygen and is on the cusp of needing a ventilator – although the patient insists he’s turned a corner.
“I’m getting better every day. I just want to see my family now,” he adds.
While about 25 patients a day were being admitted in late January’s third wave, it is now less than half that, and medics are hopeful that the worst of the pandemic is behind them.
Doctors credit the delayed impact of the national lockdown with last month’s drop in admissions, with the number of patients being treated at the hospital for the virus falling from over 200 in late January to 130.
The recent wave of admissions was also a lot more gradual than the first, which MRI’s deputy medical director, Dr Leonard Ebah, likened to ‘going into war.’
“We went from zero patients to 200 to 300 in about three weeks,” he says.
“Not knowing how far it would go, that was worrying. We were all doing longer hours and preparing for the unknown. We were scared. Scared for our colleagues, scared for ourselves and our family.”
As the virus spread last year, some in the hospital feared they could end up overwhelmed with cases. To avoid that grim prospect, MRI, normally one of the country’s busiest hospitals, had to change radically, and quickly.
“We were saved by not doing much else,” explains Thomas Gorsuch, a consultant respiratory physician at MRI.
“We dropped most other clinical activity and there was very little going on in the hospital other than Covid.
“Even emergency medical admissions slowed to a trickle. Had it not been for that, we would certainly have been overwhelmed in April. We were very worried that we might run out of oxygen supply. We were some way off in the end, but the worry was there because we’d never dealt with something like this before.”
For Dr Ebah, Covid evokes memories of another, once little understood infection which surged to frightening proportions, back when he was a trainee doctor in Cameroon – HIV. He says what he has witnessed in Manchester over the last year is worse. “You could not see a way out of that,” he says. “A significant proportion of people died.
“This feels like that, but the numbers are just so much more huge.”
For Dr Ebah, the prospect of becoming infected with Covid himself was particularly troubling.
“As a black man, at the end of March and April when we started losing colleagues... a lot of them looked like me. Those things play on your mind, but you try to stay positive and control the things you can control.
“I went to the Covid wards almost every day to speak to staff. Every time I crossed that line I knew I was putting myself at risk, but I had to do what I had to do. Those were dark days, but we pulled through.”
WHEN the number of Covid patients eventually began to fall in early summer, the hospital tried to get back to some kind of normality. But just as the hospital started to get on top of everything it had been unable to do in the previous months, a second wave hit.
“We all hoped there would not be a second wave, but it happened,” says Dr Ebah. “That was hard to accept. There was a feeling of ‘not again.’ You don’t want to do this twice, never mind three times.”
Then, last month Dr Ebah was in a meeting when he realised his voice sounded croaky.
Later that night, he woke coughing. The moment he had feared had come. After calling in sick for work he took a Covid test, and it came back positive. “I was really worried...I have seen so many people who look okay for the first seven to ten days, then they just go downhill,” he says. I never knew what the next day held.”
Fortunately, Dr Ebah recovered and, like the majority of staff at the hospital, has since been vaccinated.
But while infection is no longer as much of a threat for staff as it was in the first wave, much of the pressure remains, and medics are in desperate need of some respite.
It’s unlikely they’ll get the chance. When things return to normal, doctors and nurses have a backlog of work they need to catch up on.
“People haven’t had an opportunity to switch off,” explains Dr Jonathan Schofield, a consultant in acute medicine, diabetes and lipidology working in the respiratory receiving unit.
As an Army reservist, he’s no stranger to high-pressure environments. But the demands of the last year have proved a challenge even for him.
“The light at the end of the tunnel is there, but I’m not sure it’s getting closer. When I’ve been away with the Army, you’re made to sit at home for your mental health. But as soon as things quieten down here, I’ve got a backlog of people I have to see.
“The catch-up will be harder than what our jobs were in a pre-Covid environment.”
For Dr Schofield, one of the hardest things has been telling patients that they have the virus.
“In my career, I’ve had to unfortunately tell people the worst diagnoses, but this was a different level because of what everyone has come to understand.
“When you tell somebody ‘this is what you have and this is what we’re treating you for,’ some people take that as being essentially a death sentence. It’s the one thing people do not want to hear from me as a doctor.”
The continued roll-out of the vaccine means many of the most vulnerable patients are now partially protected against the virus.
And while people are still being admitted to hospital each day with the virus, there is now much more hope of a positive outcome.
The mortality rate for patients is now far lower than it was during the first wave – in part down to research trials such as RECOVERY, which MRI has helped to pioneer.
Clinical trials have found that dexamethasone, a cheap and widely available steroid, boosts survival rates for people hospitalised with coronavirus, and the drug is now part of standard care at Manchester University NHS Foundation Trust (MFT) hospitals, including MRI.
“It’s reassuring to be part of something that is making a difference to us locally, but also nationally,” Dr Schofield says. “We faced uncertainty at the beginning but now we’ve got confidence that we have treatments that make a difference. If we go back to last year, we knew so many of the people we saw were just not going to do well. Now we have real hope.”
Hope, and personal coping mechanisms, are the little things that have seen so many hospital staff through these times.
For Sam Clarke, time off with her loved ones and her dog is precious.
“I try to do very little on my days off,” she says. “You have to draw a line at the end of the day. It’s so busy all the time and you don’t get a minute to stop. You go home and you’re physically and mentally tired. It really takes its toll.
“I’ve had to be kind to myself and try and leave things at the door because I don’t want to be like I was in June. I can switch off but I do think of patients. You never forget”.
When things eventually return to normal, Sam wonders about the mark that will be left by the pandemic on the mental health of her NHS colleagues.
Looking back to that day in June, when panic unexpectedly gripped her as she placed the mask on her face, Sam says: “I was fine leading up to that, but it was like a comedown from everything that had happened.
“Now that I could finally breathe and relax, that was when the severity of what had just happened hit me.”
“You hear about burn out all the time,” she adds.
“People are just so on top all the time, working above and beyond.
“You just go on autopilot and do what’s needed of you. Who knows what happens after that?”