INSIDE AN ICU | 'We're filling hospital beds as quickly as Doves takes away the bodies of the dead'

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Two nurses are seen next to a machine that checks oxygen levels of a patient infected with Covid-19 at ward number 20 of the Tembisa Hospital.
Two nurses are seen next to a machine that checks oxygen levels of a patient infected with Covid-19 at ward number 20 of the Tembisa Hospital.
Guillem Sartorio / AFP

Pat du Plessis* is a professional nurse at a leading private hospital in Johannesburg. She tells Pieter du Toit that the third wave is worse than the first two, and how she holds the hands of the dying.

"This, the third wave, is crazy. I've never experienced anything like this before. Neither have my colleagues. This is worse than the first and second waves. We're seeing younger people, without any underlying conditions - and many of them fit - dying.

"We're all anxious, worried. We don't know where we're headed, we don't know where it's going to end. We want to help as many people as we can.

Dying alone

"I stood next to the patient. She was a woman in her late sixties, early seventies. She was under sedation because of the pipe in her throat connected to the ventilator, which pumped oxygen into her lungs. So, she was intubated.

"I held her hand because she was alone. Her family wasn't there. And no one must die alone. I don't know if she knew I was there, holding her hand. 

"Then her pulse rate went up, and her blood pressure started to fall. The body basically goes into septic shock because of the high fever. I once spent an entire day bringing down an intubated patient's temperature from 39 degrees Celsius to 38 degrees Celsius, using ice packs which I put underneath his arms and his body.

"And then she died. Alone in the intensive care ward.

READ | Opinion: Mike Roussos: My Covid-19 ICU experience and dance with death

"Patients see people next to them dying. And that makes them afraid. They see the undertakers come to fetch their neighbours' remains, and then the bed gets filled the moment the body is taken away.

"They look at what's going on around them, the patients, and they see everyone scurrying around like ants, moving in and out of wards and to and from nursing stations, and they just stare out in front of them. We're also afraid; we don't know where it's going to end.

Clearing beds of the dead

"Compared to the first and second waves, this wave feels worse. I feel like that if you're now going to be put onto a ventilator, you won't make it. If you're on a ventilator now, you probably won't be walking out of the hospital.

"And we try to encourage the patients to fight as hard as they can when they're on oxygen, before we need to intubate them. They look at us and say they're trying, but in their eyes you can see it's coming. When we intubate them, they know they might not wake up again.

"Patients see their neighbours in the intensive care units (ICU) or the high care wards being intubated, and then they see them die, in the beds next to them. We fill those beds with new patients the moment Doves or Avbob (funeral undertakers) take the bodies away. It takes us 30 minutes from the moment someone dies to the moment we put someone new in the bed.

"There simply aren't ICU or high care beds available. If you were to go to the hospital and you need one of those beds, you won't get one. There aren't any available. Last week we had to call around to find an urgent, urgent bed, and the nearest we could get was in a city 500 kilometres away.

Working in the hospital

"I leave home in the darkness at 06:30. At the hospital, I enter via the staff entrance, where my temperature is taken, and I fill in the health questionnaire. I put on the hospital issue scrubs, put a buff over my hair. Put on a yellow, plastic apron and gloves.

"When I go into the ICU or high care wards, I wear a N95 mask and a vizor that covers my face. When we work with the patients, we often put on a second, white plastic apron. I'm hot all the time. And we sanitise our hands a thousand times daily.

"There are four stages when patients are sick. Patients who need oxygen masks, then high-flow oxygen, where it is literally pumped into your nose. Thirdly, you have non-invasive ventilation, which is horrible, with a mask clasped to your face, and lastly, intubation, when you are also connected to a ventilator with the pipe down your throat.

"When we see that a patient is going to be intubated for a week or more, they are given a tracheotomy, which makes it easier to get oxygen into the lungs. A tracheotomy is when an incision is made at the base of the neck and a pipe inserted. It is better than intubation.

Doing what we can

"Our hospital has expanded its Covid-19 wards. First, we had only the ICU and high care wards, but we have since also turned all the wards on the ground floor and those on the second floor into Covid wards.

"Every bed in the ICU and high care wards are occupied. People need to know that. Even if you are so sick that you must get a bed now, you won't be able to. There aren't beds available.

"Management is constantly looking at turning other wards into Covid wards. The hospital is really going out of its way to try and take in as many patients as it can, to help as many people as it can.

"They are deeply worried about the availability of beds. Because no one knows where this is going to end. Management are always busy rearranging wards and moving beds from here to there, looking at wards. They work 12-hour days, seven days a week.

Battling with staff shortages

"But what people also don't realise is that we have enormous staff shortages. We simply don't have enough qualified nursing staff to deal with all the patients. I get ten requests on WhatsApp daily from hospitals and staffing agencies requesting staff at other hospitals.

"We have daily staff shortages, and we're a well-resourced, private hospital.

"It's not as if it is chaos inside the wards. We're not shouting at each other, and people aren't lying on the floors or anything like that. You won't see that happening in a private hospital. We might be under pressure, yes, and we're full. But we'll still give people chairs to sit on during an emergency.

"People don't realise, however, that it's not only the medical staff that is straining under pressure, but the support staff too. The kitchen, cleaning services, pharmacy, the laundry... everyone is working damn hard and doing what they can.

"You won't believe how much resources we're using and consuming every day. I use at least half a carton of gloves per day.

Trying to breathe

"The patients just lie there, trying to breathe. They can't receive visitors. They only see us and the doctors. We hold their hands. I think human contact means something to them.

"When we tell them the time has come to have them intubated, we can see the fear in their eyes. They don't know if they'll ever wake up again. Nor do we.

"And then the families call all the time, asking about oxygen levels and saturation levels and CRP scores. They Google stuff and then they want detail.

"But the patients suffer alone. And then they die alone. It's heartbreaking.

"All the nursing staff... we're trying our best, but we're also afraid and uncertain. Where will this end?

"I have to admit that we're scared.

Vaccination the only way

"I get so very angry when I hear that people don't want to take the vaccine. It's crazy. We were all inoculated when we were children to prevent disease.

"There are no two ways about it; people must vaccinate, vaccinate, vaccinate. It works. I've seen it with my own eyes.

"And don't wait when you get sick; go to the hospital and the doctors immediately. Three or four days on oxygen can save your life. Keep an eye on your saturation levels and oxygen. And listen to medical advice. Medical professionals are professionals for a reason.

READ | Mandy Wiener: We've declared war on Covid, so where is the wartime efficiency for vaccine rollout

"Don't get sick! There are no beds available. Be responsible.

"But I'm frustrated at the lack of progress with our vaccination programme. We're not going to reach herd immunity quick enough.

"I've been vaccinated, and I'm desperate for my husband and children to be vaccinated too.

"The third wave is serious. People are dying all around us."

*Pat du Plessis is not the nurse's real name. She spoke freely on condition of anonymity because she does not have permission from hospital management to grant interviews. She is a professional nurse with 20 years' experience and holds a qualification in nursing and a further qualification in intensive care.

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