Started working for NHS in Feb 2020
Hello I’m Joel, I’m twenty years old and this year I started working for the NHS, on the lower rungs of the ladder, as a Theatre Support Worker. It was a bit daunting going in because there is a lot to know, a lot of stuff to get your head round, and it approaches you as a tidal wave when you first start! I work as a TSW within the emergency theatres, because I am interested in working in emergency care in one way or another. This is Unit 2, and comprises ten theatres which cover all emergency surgeries from trauma to transplants.
I started in February of this year. I had all my initial training and by the end of the month I was in theatres, having been introduced to hospital life, protocols and a local induction into theatres. Three weeks didn’t seem a lot, and after the first week of proper work most health care workers will have a moment taking in what they have gotten themselves into, particularly how much people depend on you in a theatre situation to do your job well.
I worked for a month and two weeks, getting used to my role, and gradually working through my competency packs. You’re put into a buddy system, so a more experienced TSW is your buddy and a nurse your mentor. You should be put on shifts with your buddy and work with them for three months. A mentor is there in the background and you are effectively considered a student for the first three months, until you finish these competencies.
Coronovirus started to appear in Addenbrookes
I was doing this for just over a month when the Coronovirus started to appear in Addenbrookes and the hospital started to feel the true effects the virus was having. Operating theatres began to shut down. Whereas on a normal day ~8 emergency theatres will be running with 4-5 operations a day, when Covid hit we were able to run only 2 operating theatres with a list of maybe 2 cases in each. This was purely because there was added risk to all surgeries, particularly with transplants where people are immunosuppressed.
At this point the buddy system went out the window because due to shielding or actual sickness staff were away, so there were far fewer people in theatres. Then a new way of working was introduced. Initially this was quite confusing because protocols were coming into being but not finalised into an overarching system. Theatres adopted a red/amber/green system. The main operating room was red, ie you can only work here in full PPE. This consisted of a mask, a visor, a sterile gown, and at least two pairs of gloves. The temperature in an operating theatre should be around 20 degrees, it was significantly higher wearing this amount of PPE, and for certain cases where X-rays are required all staff must also wear lead aprons, it is considerably more than 20! The anaesthetic room with all the supplies for anaesthetic staff was an amber area. This was also a full PPE area. The green area was the corridor outside in which only a mask and visor was required. The next complication was ensuring a one-way system, so staff can only travel one way from green to amber and amber to red and then red to the back corridor (the dirty corridor) where someone would be waiting to assist ‘doffing’ – taking off PPE safely.
Work as a Theatre Suport Worker
By this time all non-essential operations had been cancelled. My role in the emergency wing of theatres continued for another couple of weeks under these conditions. A TSW is the assistant to any theatre staff that require help. Pre-operatively they prepare the theatre room and collect the patients. Intra-operatively they find necessary equipment, run for blood, deliver specimens to the labs, keep count of instruments used, and occasionally scratch the surgeons nose when he gets an itch! Post-operatively means cleaning up the theatre and preparing for the next case as quickly and safely as possible. It is perhaps easy to see how much more complex these tasks were when you couldn’t leave the red area. If blood needed to be obtained I would have to write it on a piece of paper, show it at the window to the amber person and the amber person would do the same for the green person who would then run to get blood. On any shift I would be located to an area to work, mostly as I was young and fit and healthy I would be in the red area. It was really tricky and the whole process could easily add an hour onto the time of a surgery.
Despite all precautions in early March I developed a consistent cough and immediately had to self isolate. It took a day before the symptoms worsened, then I was in bed with rigors, sweats and a soaring temperature. I couldn’t eat or drink, and took constant pain relief for a terrible headache. I didn’t need to be hospitalised as I was generally fit and had no co-morbidities. Thankfully I didn’t develop the serious respiratory symptoms so common with this disease. After 5 days my symptoms gradually started to subside and by day 8 I had an appetite back and a longing to return to work.
A move to the intensive Care Unit
After Covid I went back into the theatre environment. In the first week of being back the managing nurses came to interview all TSW’s in small groups, explaining the current hospital situation, particularly the busyness of Intensive care (ICU) which were understaffed. I sat in a small room with four colleagues, and we were asked if we would feel comfortable working in the intensive care wards for an unspecified period of time? They made it very clear that this was a decision for us to make, and only if we felt comfortable with it. This was never a question for me, I knew I wanted to work in the area in which I could make the most difference. Two of us in that group agreed to do it. Later, when the practicalities of the new role were explained, the full implications of that decision hit me. I didn’t feel afraid, but I did have a sense of how far out of my comfort zone I would be in for the foreseeable future.
At this point the critical care unit was full of Covid patients, and there were Covid wards in the hospital that were also full.
On the first day I arrived in critical care, I was greeted by a critical care nurse who collected 4 of us together and told us we would be setting up a satellite ICU on what was an empty ward at that point. The equipment had been delivered but was sitting in boxes everywhere. We spent the best part of two days, unpacking, organising and stacking the equipment into storerooms, moving ventilators over and preparing them next to the bed spaces. Although my knowledge of theatre supplies was relatively good, my experience of ICU equipment was zero so this was a steep learning curve! I can remember picking up equipment and Googling what it was, what it did and then working out where it fitted into the arrangement of equipment. To say it was a bit hectic, would be an understatement.
At the end of those two days we had completely organised ward J3 and it was ready for operation. It felt really good looking at the new layout, transformed from a load of boxes on the floor. We had created a ward in just 2 days so people could be better cared for. Almost immediately patients were transferred into the bed spaces.
I was in the critical care unit for ten weeks. I most remember a lot of learning, and teamwork with the TSW’s who volunteered. We figured out our work together and there was a massive sense of commitment to it. But it wasn’t a case of the harder we worked the better situation got. We saw that if we didn’t work harder than we did the day before, then it would be even worse. We were fetching and carrying for nurses who had to be by the side of patients all the time. We were spending time in the bays helping to clean patients, rolling them so they could breathe more easily and not develop sores, and cleaning equipment. You would spend the whole day in PPE; you would don up at the beginning of the day as you would for the red area of theatre. During a period of twelve hours (with the exception of a lunch break) you were not able to drink, eat, or even wipe the sweat off your face, you had to let it run – it was summer out there, it was boiling! You saw people at their sickest condition. There were some people who resided there for months, who were moved to wards, but the nature of critical care at that time was that you saw a lot of deterioration, a lot of people in their final days. I saw countless patients be given their last offices, and last rites. The TSW’s would sit with people, hold their hands, and wait with them until they died. Some would want to listen to music and we would set that up. Families would be brought in via FaceTime. When they died, we would clean them and prepare them. They would be taken away, and the bed space would be thoroughly cleaned and prepared for the next person.
What kept me going
As a new member of staff it was traumatising, and some TSW’s could not work in that unit for any length of time. There were a small group of us who went through the whole 10 weeks. Now I think about it, it was the worst time I have spent in my whole life, so far. The most prevalent thing was death. Around me, were amazing health care professionals doing an amazing job, and still I knew that each day people were going to die and there was nothing we could do about it.
What kept me going was just caring for these people when not a lot of other people could, not even their families. The thing you have to remember was that I was not these people, as horrid as it was to witness all this, it was worse to imagine what they were going through, and we could at least provide the love and care that they needed at that time.
We were also so boosted by the generosity of the general public, which genuinely kept us going. We were, occasionally, so rushed we would not get time to have lunch, but someone had paid for a stack of Dominoes pizzas and we as a team could enjoy these on a short break. It was great to sit back at the end of a six hour stint, eat a pizza as a group, and enjoy being together out of the chaos, before we donned up again for the second six hours of the shift. I remember, too, cycling into work and seeing for the first time a huge chalked message on the bridge into the hospital : “ Bless you NHS we’re all cheering for you” . It’s amazing that despite you knowing what you were facing that day, chalk on the road was enough to keep you going!
An experience I truly value
By the time we got to June theatres had started running cases again and I was recalled to my original role. At that stage it felt a bit odd, I wanted to stay, it felt I was leaving a job that wasn’t finished. Although I was going to a place where I was needed – I had spent time in a place where I had seen so much and endured so much, that I wanted to be there for the time when I could see no cases in ICU, or even in the hospital – that day is still yet to come!
This has been an experience I truly value. As tough as it was I learnt a great number of lessons. It has made me much more confident and sure that health care is the area I want to work in into the future. I feel really blessed by God that I was put in a position where I could help as much as I was able to at this point in my life.
I hope people who read this will be able to remember it, as we continue living with this pandemic. As much as I learnt from working in critical care during this time, I would not like to return to working in a Covid-filled hospital.