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Stories from the frontline: What it’s like to be a physiotherapist in Intensive Care during COVID-19 - Joe's story

“The scenes you see on the news are just part of the story - it didn’t show how much emotion was swirling around for both the patients and us as healthcare workers.” 

During this continued time of uncertainty, extraordinary people are making extraordinary things happen. Nationwide, nurses, doctors, carers, and other healthcare and key workers have re-trained, been re-deployed and some have even come out of retirement to join the effort to help tackle the ongoing pandemic.

As restrictions ease, and the transmission of COVID-19 in the community decreases, people who have been redeployed within Solent NHS Trust and to other Trusts are starting to return to their normal roles. There are so many stories of people going above and beyond, with such flexibility, to help people in our communities.

Joseph Smith is a senior physiotherapist who has worked with the Musculoskeletal team (MSK) at Solent NHS Trust. Due to the current pandemic, Joe has not been able to return to his MSK role at Solent and is still working differently, carrying out treatments on the acute stroke ward at Queen Alexandra (QA) hospital in Portsmouth.

He said: “As a physiotherapist, it’s common that we will rotate and undertake placements in various specialities. As the pandemic grew ever closer and talk of redeployment was happening, I opted to go on the wards at the QA. The plan was for me to move from the team at Solent NHS Trust, a Trust on the South coast providing community and mental health services, to the acute stroke ward at Queen Alexandra Hospital to help with demand, but the same week I was transferred to the stroke ward, I was told I they needed me in intensive care (ICU).”

Joe joined the ICU at QA hospital in April.

“I was a bit surprised to be asked to go to ICU,” he said. “I’m not a respiratory physiotherapist, but I have had a few rotations in that field, so the managers were confident that I could adapt to the role. In a strange way, I was excited about the prospect of learning new skills.

“I expected a warzone in terms of patients, but it was the sheer number of staff that surprised me. You would normally have about four physios in ICU, but we had at least 20, plus nurses and doctors were coming in from all over. There was a constant buzz.

“Because redeployment was happening all over the county, we had staff come in with lots of skills  so we all saw the patient in a different way and chipped in from our own perspective of what could be done – I don’t think you would have got that kind of collaborative care in normal circumstances. I’ve even gone on to teach nurses and doctors how they can help the patients in ICU avoid injuries before they start their recovery process, such as issues with shoulders and other limbs. It’s been a real success and the teaching is due to continue after I have left the hospital.

 “As physios, we saw patients from start to finish, from when they were completely sedated to waking up. In my kind of role, one of the few things you can do for them whilst they are asleep is to try and position them appropriately and use manual techniques so that you can remove the phlegm that was blocking their airways and filling the lungs.

“Our job at this stage was to get as much out as we could to avoid infection – we did this in two ways.  One is via a tube that goes deep into the throat and acts like a hoover. Or, we’d have to be a bit more physical, with an assisted cough. We’d place our arms under the diaphragm and force the mucus out – imagine hitting a ketchup bottle until the sauce comes out - it’s not pleasant. 

“We would also change their positioning, this is called ‘proning’ so they would be moved on their front to free up the surface area for the lungs to move. Patients responded to this really well, until after a few weeks, when they just stopped, it was weird. It was almost like COVID knew we’d found a way to help these people, so it was fighting back.  

“The scenes you see on the news are just part of the story - it didn’t show how much emotion was swirling around for both the patients and us as healthcare workers.”

“At first, you don’t know the patient’s name, if they have family or anything to do with their normal life, and you just get on with making them better. Things took a more emotional and ‘real’ turn when families started to send in pictures and letters of support – “Grandad you’re such a fighter and you will get through this”, sadly they didn’t always. A lot of the physios would turn over the letters and pictures so they couldn’t build a connection. It was just too emotional for them to deal with at that point, especially when patients were passing away. I used to read them, because I wanted to know who it was I was trying to save.

“When patients started to come round we could begin to move them to the end of their beds and sit them up, they would then eventually start to talk and we could be more responsive with them, until they were well and strong enough to be able to move to the recovery wards - that was always an emotional day.

 “There are still people who I helped to treat recovering in the hospital and I visit them from time to time to see how they are getting on. One particular lady spent the longest time in ICU on a ventilator and it was touch and go for a number of days, but, against all odds she pulled through, which is amazing, and I feel proud to be a part of her recovery.

“Some patients don’t remember who you are, or what you did for them, but I’m happy knowing I helped them on their journey and in fact, I should also thank them, they’ve taught me so much that I will carry with me forever.”  

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