Joe. Last time I met you, I didn't really meet you.
I don't think I was in the world really, was I?
Can you describe what sort of state I was in?
Well, there's two places I saw you
so I was working in intensive care when you were in a medically induced coma.
But I did come to the ward one time when you had been discharged.
So I came out to see you on one of the geriatric wards.
But I don't think you remember me then either.
No.
When you were in a cubicle.
Obviously, a time in ITU, you were induced into a coma.
And even then, when we stopped the sedation that you were on
and we tried to wake you up, you took quite some time to wake up as well.
So I think there was a time there when we were expecting you to start doing a little bit more for yourself.
But you were you were still sort of in your own world there for a time.
Yes.
And when you have somebody like me in there in the ITU, are we just a sort of chunk?
Are we are we like a human being? Or are we...
...when I've seen the photograph of myself and seen a bit of film
it feels a bit like I'm just a body.
I suppose what we do is we dress you in a hospital gown.
So all the patients are in hospital gowns as well, and we dress the beds quite similar as well.
So there is a bit of standardisation when it comes to looking after the patients.
But we did ask your family to bring in some photos of you as well.
So photos of your family, your friends, pictures of good times as well,
so that the staff could get a better sense of what you were like before you came to us.
Because when you came to us as far as I know,
I think you were intubated in the emergency department before you came to ITU.
So you were already sedated on a bed on a ventilator.
So we didn't even hear your voice until we took that
tube out many, many months later, actually.
So there is an element of the patients can look quite similar
because I think when I first saw you, I didn't realise how tall you were standing up because you were always in the bed.
So there is that sense that you can get some dehumanisation when you're in ITU,
but it's just fantastic to see all of your family photos from Emma and the rest of your family as well.
That was really nice.
How do you do it?
I mean, I just, you know, having read the diary
and having thought about it, you know...
you're, I'm not saying, playing God, that's unfair,
but you're juggling with life and death with all of us.
I mean, I think I heard from the consultant for example
that about 42% of us died at that time.
The weight of that of knowing that any second
one of us could have you know, could pop off, did pop off.
I mean, that's a heavy burden for you to bear, isn't it?
I think in the first wave, we really didn't know what to expect.
We didn't really know how the patients would respond to traditional treatment.
And we were kind of working in the dark, in so many words.
I knew that our consultants had WhatsApp groups with consultants in intensive care across Europe,
so especially Italy as well.
So they were getting real time information from consultants to see what was working
and what wasn't working.
I suppose every nurse, we're all registered practitioners,
so we have a sense of what that registration, that accountability holds
about providing quality care and compassionate care.
We have that training as well, which is there to hone your decision making skills
so you can make the right decisions for your patients.
But again, I suppose just didn't know what to expect.
I think one of the consultants called it carnage during the weight of the pandemic
and it certainly at times felt like that
because what we were asked to do with what we had was extreme.
I don't know if you remember, we were meant to be working one ITU nurse to one ITU patient.
And in the end we ended up with three, four or five.
And sometimes my colleagues also had six patients to one ITU nurse as well.
So just think about trying to do your job with your hands tied behind your back,
in a cupboard dunked into the sea.
And that's probably how some of the nurses felt.
Just trying to keep your head above water
to make sure that the patients had the best care that you could possibly provide for them.
One of your colleagues and I called him Joe.
Though you're Joe!
He sent me his journal that he kept.
Yes!
And he called me Mr. Jacobs.
So it was my pseudonym, my pseudonym for him is Joe.
And he said one time that he came in in the morning,
and his comment in his diary was 'Mr. Jacobs is still alive.'
What he was saying was that when he went home the night before, he didn't know whether Mr. Jacobs...
I felt quite sorry for Mr. Jacobs actually, when I read that, and then I realised it was me!
But I just thought, you know, you guys, you go home at night
and the person you've cared for all day, there just might be an empty bed.
Or filled with somebody else the next day.
Just to be really blunt about it.
And you've got to you take that or not, you just dash on to the next person but maybe it
I mean, did you, did you find it took its toll for you?
Yeah, well, there wasn't any empty beds.
There was always beds.
We had more patients that actually we had space for them.
So that was a bit worrying.
We even had the anaesthetist from theatres bring in their anaesthetic machines
that they would use for surgery, which is not used for intensive care purposes.
So we had to double up in the small areas already with multiple pieces of equipment.
So if you managed to get through your shift without tripping on a wire
or a tubing or something like that which trailed across the beds, it was... it was a win.
So small wins would really, really help.
But I do remember one particularly hard day
where I had three patients and one of my patients passed away in the morning
and then one of my patients passed away in the afternoon as well.
So I was left with one patient who was really, really unwell.
So you do have that sense of impending, you know, what am I doing?
Am I doing everything that I possibly can do here?
Is it something which I could have done differently, which may have made the difference for this individual?
But there was always an element of that wanting or feeling like you
you could of perhaps should have done something differently that you always take with you away.
And I remember that particular day the only times I had
a break was after my first patient died.
And then I had a quick break after that.
And when I came back on to the unit that patient had already been taken away to to the mortuary.
So there was that very, very much disconnect.
And the same happened in the afternoon because the only time I actually had time in the day
to have a break was actually when my patient had passed away.
So that was probably one of my darkest days, actually, because it was just, I felt so disattached
because normally we would see to the family, make sure they're well supported.
And at that time we weren't even allowed a family to come into the intensive care.
So, you know, we had a lot of ethical considerations to battle with as well.
So that sort of, the morality of what the work we were having to complete as well.
Mm hmm.
And selfish question now,
did you think at any time I might have died?
I tend not to think like that.
I always think perhaps there's something else that we could do.
I feel like looking at you now and seeing how well you are
compared to how skinny and frail you looked and how grey you looked in the bed,
I can see obviously such a massive difference.
But, you know, the way that I think intensive care nurses and doctors feel about what they do
is constantly trying to think, is there anything else that we could do?
Is there any stone that we haven't unturned yet?
Is there another novel treatment that we haven't tried, which could be the tipping point?
And I think that's really valuable because
we're not false hope, but we're hopeful
that something might turn the corner as well.
And I think there's a lot, you can get a lot of
satisfaction, actually, from looking after the family.
But also there's a lot of respect, dignity in looking after a patient
who is dying or who has passed away as well.
So that dignity and respect to care for someone always remains.
And then there's this business about waking up.
I'm still confused about this because we got two words,
we've got conscious and unconscious.
So they're the words that we use talking around.
Oh, I was unconscious then, then I was conscious but actually that doesn't tell the story does it?
Because you put some stuff in me that makes me sedated, unconscious, in a coma.
Whatever words you want to use and then...
I'm woken up
In fact it was Emma coming in, who sort of partly woke me up.
But actually there's a period when I've got no memory of it.
I mean I don't remember really Emma coming in and I don't remember stuff until maybe ten, fifteen days later.
And even then it's all confused and we haven't got a word for that bit, have we?
That bit, sort of, between.
Yeah.
And some people,
well they, can I say this?
They don't wake up exactly.
Have I said that right?
I think what we're getting at is that when patients are sedated
and they're critically unwell in the beds...
treatment would be prioritised according to their immediate needs.
So we don't always have an MRI scanner or a CT scanner ready to go.
So to see what's going on underneath, you turn off the sedation,
turn off their paralysis, and you try to wake a patient up.
Technically, they should be able to wake up of their own accord.
So that's when the team will start to look and say, 'why is this person not waking up?'
But I think what we're looking at is having awareness and that moment of awareness that you had
when you saw Emma and you started to perhaps show some behaviours
or you said a few things which show that
Michael was coming back.
That's when the awareness was kicking in.
Whereas before, I remember when we wake you up and actually you wouldn't close your eyes,
there was days you had your eyes open and you just staring at the ceiling.
Yeah.
And we were very worried for you then because you wouldn't even blink your eyes or anything.
So we had to give you hourly drops for a couple of days.
So I think awareness and that memory coming back, you know...
what makes you, you, coming back is the important part.
It's the quality of life after you leave intensive care.
Not about just leaving intensive care.
It's quite mysterious, isn't it?
These sort of territories in the mind,
you know, that I can't bring back, I can't retrieve them.
You could see me.
I couldn't see you. Even if my eyes were open.
I wasn't seeing you.
We haven't got words, really.
As somebody who is interested in words.
I'm quite interested in the idea that I can't find the words
to describe this sort of hinterland, this middle stage of not being totally out of it
and not being back in it.
There's this whole area and there's this, sort of ungraspable bit.
It's as if I'm underwater...
Or lost at sea with no land in sight.
And if you can grab that land, you might get that memory back and start to feel like you used to be.
And what makes you, you.
I wonder if that's how sometimes we try to explain it.
Well, and the other thing you wrote in the diary that you shaved my beard.
Yes!
You admitted that Joe!
You said sorry, mind.
You said in the diary, you said you were sorry for shaving my beard.
Yes. Yeah, yeah.
But needs must eh! You had to do it.
I'm a beard man, you see.
So I'm never one to be shaving any one of their beards.
But at the time, I think, you know, depending
on where you were laying on, I think there was a bit of patchiness going on there as well.
And we wanted you to look good because we were having a video call with with your wife later.
So I wanted you to look as good as you can be.
And for some reason, shaving someone sometimes makes them look a bit better.
But I think in your case, maybe you look better with a beard, so...
Well, who knows?
I've reported you to my friend who runs the Beard Liberation Front
and he's given permission.
I mean, the excuse that you gave in the in the diary was
that you were worried about the beard infecting the tracheostomy scar.
But maybe you just made that up.
I had to put something in there to give the rationale behind it.
Yeah!
Thank you for reminding me.
I feel more guilty now than ever before, so I appreciate that.
Well, there's no need to feel guilty.
You were part of this incredible team who saved my life, Joe.
It's just overwhelming what you guys did for me.
I mean, quite overwhelming. It's amazing.
There was so many staff that came and helped out as well and worked outside of their comfort zones
because it wasn't just nurses working there and the staff that were already working there
they worked from the very beginning and continued working for all of that year.
Whereas I came in maybe a couple of weeks after the patients started coming in,
and I left just before there was already a tail down in the Covid admissions into hospitals.
So you could argue that I had a bit of a break,
whereas my colleagues in intensive care, they continued for all of that time.
So to be in that situation for even longer and then having another wave
and having to go back again and knowing that my colleagues took six patients to one ITU nurse,
you know, it's really, really difficult for them as well.
The most I had was about four.
But it did mean that at least I could take some of the patients away from my other colleagues
who could have had six patients as well.
And to help them cope and be able to do as good as a job was they could do as well.
So it is definitely a big shout out for all of the ITU nurses and all of the helpers as well
because I think in your book, there's a lot of helpers that have written in there.
Physios, speech and language therapists, dieticians, dental nurses.
They all came along and we all worked together.
It's incredible, incredible.
Well Joe, wonderful to meet you properly.
As opposed to... what kind of meeting was that?
Anyway, it was a meeting.
You met me even if I didn't meet you.
Joe, thanks.
Wonderful.
Thank you.
It's good to see you looking so good, Michael.
Doing my best!