The Glasgow Royal Infirmary staff fighting Covid-19 on the front line

There is a constant background whooshing noise as air is circulated round the room, a familiar sound in what has been an unfamiliar time for the nursing staff at Glasgow Royal Infirmary.

The highly experienced team in ICU are used to dealing with large scale incidents, having coped with both the Clutha and bin lorry disasters, but the coronavirus crisis brought unprecedented challenges.

"As we started hearing what was happening all over the world there was a bit of a heads up in terms of what might be coming our way and what we should be thinking about," Claire said.

"The patient was always our focus and the challenge for us was to give the best patient centred care we could under extreme circumstances.

"So it was really how we pooled our resources together to do that, making sure we had the right equipment and the right staff there."

The world outside the hospital was slowly grinding to a halt.

Schools then workplaces closed, public transport reduced, restaurants and retail closed down. The message was simple: stay at home.

But while the streets outside were empty and the city unusually quiet, inside the GRI, the pace was frantic.

Staff knew they were preparing for a once in a lifetime event that would require support from across the hospital in order to give critically ill Covid-19 patients the best chance of survival.

Normally the ICU and High Dependency Unit would have 20 beds in total, with 12 of those for "level three patients" - those who need to be placed on a ventilator.

This would not be enough to deal with the expected influx of patients and so the hospital had to rapidly expand its critical care capacity.

Facilities staff were called into to transform the operating theatre reception area into a temporary ICU, along with the gynaecology recovery area and the surgical HDU.

At the peak of the crisis, there were 34 patients being looked after at once across the five areas and 22 of those patients were on ventilators, requiring the highest levels of care.

The layout of the hospital had changed - and so did the lives of the staff.

In intensive care one of the most vital elements for the nurses is building a personal connection with both patients and their families, creating a picture of the patient as an individual.

But under these new circumstances there were literal barriers.

Before anyone could step into any of the Covid-19 areas they had to don full Personal Protective Equipment, covered head to toe in gowns, gloves, an FFP3 mask, cap and visor, leaving only eyes visible.

Staff were unrecognisable to one another and so their names were written across their chest.

Once on the ward, nurses and medics could not leave to ensure infection control and so they carried walkie talkies to radio out for vital supplies.

The main change was that visitors were banned from the ward, a situation the nursing staff found incredibly difficult.

It meant patients in their final moments could not be consoled by their loved ones and their loved ones were not given the comfort of being with their family member as they died.

"It was always difficult," says Ruth Whyte. "I can only describe it as working on a really hot day.

"But the PPE was not the most difficult thing."

Ruth, a charge nurse, has been nursing in intensive care for 19 years and for her building relationships with her patient and their family is the most important thing.

"It's been the hardest thing the full 11 weeks because that's one of my favourite parts of my job," she said.

"With the PPE and without visitors, things that would come naturally to you, you had to work that bit harder for.

"Finding out about them and building a picture of them as a person was a bit like being a detective.

"Touch as well, touch is so important to us, but they didn't have somebody there holding their hand so to me I felt like I was their nurse and their visitor.

"We were willing our patients to get better because it is so new, it is so personal this feeling of wanting people to get well and see their families."

To ensure details were shared about patients, little personal details such as their children's names were written on whiteboards above their bed and family members were asked to make YouTube videos with messages or favourite music.

Ruth said: "Most of these patients left in an ambulance, came in to hospital unwell and opened their eyes to this with not a face in sight or a voice they knew.

"So it was important to find something about them that would make them feel understood.

"Not just surrounded by the machinery and the noise but that we understood who they were, because that makes you feel safe."

Nurses, says Ruth, are used to being self-sufficient and aren't very good at caring for themselves - so it was vital everyone on a ward looked after each other.

After two or three hours in stifling PPE without drinks it was important to take a rest, "because everybody fainting round about you doesn't make the day any better."

On some nights nurses would appear from other parts of the hospital to ask if they could help.

"It has been the quickest 12 weeks of my life," she said, "I don't even remember some of the shifts."

As well as work being radically altered, staff also had to adapt to a new world outside.

Ruth said: "People were going home to a different life as well. That for me was very difficult.

"I have three mixed aged kids, I have a wee baby of one, and a seven and a 13-year-old and I've got a really busy life, I've got a really bustling house, I've got elderly parents, I've got lots of childcare and everybody just mucks in.

"My husband worked full time throughout this as well so I can see the toll a wee bit now on our children too."

Ruth said on bad days when there was more than one death on the ward, it was her colleagues who saw each other through.

She added: "I am so proud of what we've done. I could get emotional thinking about it.

"We've had some horrendous cases and I don't want to take away for a minute how horrendous this disease has been for people, people have lost their lives, but I am so proud of how we've worked together.

"If you had ever told me that we could have done this and came out the other end...

"You were allowed to scream and cry but then we all picked each other up.

"We've watched videos of people who got home and that's been really emotional, it was worth every bit of sweat and every tear that ran down my nose.

"I wouldn't advise crying in PPE - and you can't touch your face to wipe your tears."

Janice MacLeod is a senior charge nurse and recovery manager for the GRI's 22 surgical theatres.

Theatre recovery has similarities to ICU in that the until has piped gas and equipment for critical care so it was natural that the area would be taken over for Covid-19 patients.

For Janice, a nurse with 39 years experience, the simple thing of a WhatsApp group helped her to manage the staff rota and cope with an influx of staff from the plastic surgery recovery team, the Stobhill Hospital recovery team and other areas of the GRI which led to her organising 130 full time staff.

She said: "When we set up the reception area we thought, 'They'll never cohort down here, they'll use the area upstairs' but then we got the phone call that we were receiving a patient, I think that was around about the beginning of April."

Janice was mindful at all times of the stress on her staff who were undertaking new tasks in a new environment. "The hardest thing was dealing with the deaths in intensive care and having no relatives present because we are not used to being in that situation," she said.

"But the first thing we noticed was our nurses faces were all marked from the masks, they were really thirsty, they just wanted to come and sit down and have something to eat and drink.

"It was also really important that they could come together in their own staffroom and talk about how they felt and what they were going through.

"So we started doing things like a cooked breakfast in the morning."

It was also vital to Claire, who has worked at the Royal since 2006, that her staff had the practical and emotional support they needed to get through.

"I guess I didn't expect it to happen as quickly as it did," she said. "And I hope it's the only time I have to cope with a pandemic.

"We had to get lots of help from staff who don't normally work in critical care areas so it was making sure they were supported well enough to do what was being asked of them and making sure our staff were supported.

"So the question was how do we deliver the best possible patient care and look after our staff and wider team in doing that.

"It was about trying to recognise and understand and appreciate what they're going through because this was a huge team effort, I can't stress that enough, from domestics and porters to theatre staff.

"Our lead nurse has guided us through this, she really has, with phenomenal leadership because our patients always come first but if we don't look after our staff, they can't look after the patients."

At the GRI 58 patients who tested positive or were thought to have Covid-19 were treated in ICU with 40 of those surviving their stay.

Just over three quarters of those who survived ICU are now at home with other 25 per cent still in hospital.

Ruth, who worked through the Clutha and bin lorry crash, said that the momentum of major incidents keeps staff going but now, as things slow down, is the hardest time.

"If you had to stop and think about having to work in it," she said, "It would be absolutely horrendous. Coming out of this is worse than going in, this part is more difficult.

"There is lots of reflection. You walk about and you think 'This place was full the other week.' Everywhere was full of patients.

"I've never been to war and I've no desire to be any kind of soldier but I imagine it would feel like leaving a war zone.

"You need to not dwell on the bad things so I think, 'The lady from that bed is away home, that lady is away home.'

"So I am still smiling because there's a wee bit of, 'We did that'. We did a lot of good together as a team."