How Glasgow Royal Infirmary medical staff are recovering after 10 week coronavirus struggle

The team - from porters and domestics to consultants - has seen their working lives dramatically altered as the hospital mobilised to cope with one of the busiest Covid-19 wards in the country.

As the Scottish Government announced there are only six people in intensive care in Scotland, all in Lothian, it is time for intensive care staff to take stock and ask - what next?

For nurse Kirstin King, thinking of the future is part of personal recovery, as well as professional.

One of the fit mask testers at the hospital, Kirstin said her initial challenge was making sure everyone who set foot on the ward was safely fitted with a mask - from doctors to the joiners who came in to fit partitions as the ICU expanded into new areas - before the army came in to take over the task.

Kirstin, who has been nursing since 2010, is part of the InSPIRE team at the Royal, an award-winning rehabilitation and support initiative for Intensive Care Unit (ICU) patients and their families.

It is designed to support survivors of critical illness and their carers with physical, psychological and social problems following a stay in intensive care.

"When we were in the depths of Covid it was all survival, survival, survival and get people through this," Kirstin said, "But now we need to make sure these people have quality of life, the people who have survived this very unique hospital stay."

Kirstin is now setting up a virtual clinic for patients and their families that will allow them to meet with a nurse, doctor, pharmacist and physiotherapist over video call.

It is particularly important, she said, given that a covid patient's experience of intensive care is vastly different from normal.

Nurses will have been in full PPE, restricting their ability to bond with patients, and no visitors have been allowed on the ward, something usually an integral part of ICU.

To keep the bond between patient and family, each was given a knitted heart - one placed with the patient and the other kept with their relative.

Kirstin said: "Some of the patients will have no memory of this at all, none. It's just a massive blank.

"They need to ask questions, they need to tell us where they thought they were and what was happening to them and we can say, 'Well, actually, that was a dream,' or reassure them of what was real."

Kirstin is excited to set up the new virtual InSPIRE for the benefit of her patients but says it is also a way of processing what she has been through during the past 10 weeks.

She said: "I remember one day in here in particular when patients were more awake and just suddenly having that realisation that it was a really big ask for people to trust you when they can't see you and you look like everybody else who's come and gone.

"So I think it's really exciting to give these people a chance to see us and form some sort of a visual idea of the people who were looking after them and for family to put a face to those voices at the end of the phone.

"But it is also a way for us to heal. It's lovely to have something to focus on that could potentially make a difference."

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.

Across Scotland, around a third of ICU patients have died of coronavirus, a huge emotional toll for staff.

Claire Stark, senior charge nurse, has worked in intensive care at the Royal since 2006 and said she was overwhelmed by the "phenomenal kindness, caring and compassion" of her team.

She said: "We went from zero to 100, nothing to full on. Somehow it's been harder coming out the other end because we were living on adrenaline but now our patient numbers have dropped, it is for us to change our focus and regroup and almost heal a wee bit.

"There is a bit of grieving going on.

"That is a strange word to use but there is a naivety in thinking, 'Covid will come, it will go and we'll just get back to normal'.

"There is no normal that we used to know. The hospital will not look the same, the way that we work is always going to have to be thought of differently."

Each staff member describes some positive to be taken from the past few weeks and for Claire one of those is the introduction of Zoom video staff meetings, which will continue as "a real positive to get communications out to the wider team."

Barbara Miles, the clinical director of intensive care at the GRI gives a run down of what was necessary as her department prepared to tackle Covid-19.

She rattles through a vast list from introducing additional oxygen supplies, delivering new water supplies for dialysis machines to three expansion areas, additional ventilators brought across from the city's children's hospital, PPE training, training non-ICU staff to work in intensive care... the list goes on.

"This was all achieved in less than two weeks," she says.

"I started having discussions about this in the beginning of March and then we started admitting covid patients about 10 days later.

"The amount of change that was achieved by people working together in a very short period of time in an organisation that doesn't normally turn on a dime, I wouldn't have thought we could have done it but we did."

As the disease is so new, intensive care medics shared information between hospitals on WhatsApp groups.

The newness of the illness also means doctors have yet to see the full extent of its impact on patients who have been well enough to go home.

Barbara said: "That's the next stage of the learning.

"There is no expert in this disease because to be an expert you need a long history of exposure but everybody was learning.

"We didn't know what it was going to be like but it turns out to be a very long disease, people get really sick and they are sick for a really long time."

Now the ICU has discharged its final Covid-19 patient, there is a need to look to the future.

Barbara said: "We're now, with the rest of the hospital, working out how to run your workplace with social distancing, how to manage patients that we think may present with covid disease, patients we think might have covid disease and patients who definitely don't have covid disease, how you can separate those.

"And how you deal with patients who are shielded. And that is really challenging."

Patients will be screened for coronavirus, which slows down the normal processes of being admitted to hospital as tests are sent off and the results waited for.

Barbara said: "While we're stepping back down, we still have to be preparing for any further wave using what we learned in the first phase."

There was no roadmap for the first wave of Covid-19 but now medics have learned more about how to treat the virus and the Royal, with other Glasgow hospitals, is taking part in research.

They have also learned what new ways of working they would like to keep, one of which is increased communication across departments.

Senior charge nurse Janice MacLeod, the Royal's theatre recovery manager, and her staff were co-opted to support ICU during the peak of the virus.

Janice is acutely aware of the psychological toll the experience has taken on her staff, as the surgery department looks at how to restart elective operations after 10 missed weeks.

All staff have had annual leave to give them rest and a chance to recover.

She said: "Coming into work has actually been a help in itself as you get up, get your make up on, come in and have support from your colleagues around you.

"There has been psychological help offered and there's going to be a debrief for the staff as well."

Currently there are seven operating theatres open, compared the usual 22.

While services resume, there is also an awareness that there may be a second wave of the virus - and the department must still support covid patients and non-covid patients.

One major change is that covid patients are staying in theatre during the time they would normally be on the recovery ward, which means operating theatres are available for less time.

Janice added: "We are trying to rebuild and regroup and trying to get pathways for the patients to move safely through the hospital but we're also trying to get a bit of normalcy back.

"But patients will notice a difference: they are coming down to theatre wearing masks, they are seeing us wearing masks.

"It's going to be hard, rebuilding is going to be hard.

"But this is also an opportunity to step back and redesign and think how do we move forward, which is an important opportunity we have to make the most of.

"We will find a way, because we always have done."