the 46 bulletin
A thoracic specialist physiotherapist’s reflection of redeployment during the COVID-19 pandemic Michelle Gibb
T
he COVID-19 pandemic has been an overwhelming and exhausting time for all who work within the NHS presenting challenges and stresses never seen before. Many staff were redeployed into an unfamiliar and the unknown world of COVID-19, including myself. I am a clinical specialist physiotherapist who has worked on our busy thoracic surgery unit in Leicester for the last five years and prior to this have worked in respiratory wards and ITU’s. In April 2020 I was redeployed into our adult iTU as the number of critically ill COVID-19 patients increased with us spilling out into three clinical ITU areas including our theatre recovery which brought our thoracic operating to a halt. Initially critically unwell COVID-19 patients were the unknown, the early reports from colleagues in other countries were that patients presented as serve ARDS with high oxygenation needs but a low secretion load and were not requiring intensive airway clearance, in these early stages patients were not ready for rehabilitation. At this point many of my colleagues from other specialist areas of physiotherapy had been redeployed to work with us on intensive care and the respiratory wards. We began to see a change in the need for physiotherapy. Patients after being unproned had larger secretion loads often with thick and difficult to clear secretions, this accompanied by patients having an absent cough requiring more intensive airway clearance whilst balancing interventions alongside the
patients cardiovascular stability. Some of these interventions included percussions and shakes to a patient’s chest to loosen secretions, the use of nebulisation, manual assisted cough, and rehabilitation. This was all heavy work in full PPE. I quickly found that after a few hours working in a bay wearing full PPE it was time for a break. I had mixed emotions throughout my time of redeployment into ITU. There were some very sad moments when patients lost their battle with this horrible virus and to see family members come in to say goodbye to their loved ones. To the highs and moments of success when patients began to make progress. A moment I will never forget is our first patient admitted to ITU with COVID-19, being ready to trial a speaking valve and hearing his voice for the first time and hearing him speak to his wife. All the successes were excellent motivation to keep going, I would often
think about the thoracic patients having to wait for life saving surgery and how agonising that must have been for them and their families. On reflection working clinically as a physiotherapist in COVID ITU challenged and progressed my rehabilitation with breathless and anxious patients with higher oxygen needs. These are factors that we see post-operatively in the thoracic population, but this was a new extreme and something I will adapt into my clinical practice for years to come. As COVID-19 numbers in ITU began to settle I went back my home to the thoracic surgery unit and surgeries began to resume. Unfortunately, as winter came around COVID numbers increased and myself and colleagues were redeployed once again to the ITU, this time for myself it was to another UHL hospital to aid with senior physiotherapy support. This time around we knew more of what we were dealing with, but everyone was tired and overwhelmed by COVID.
“A moment I will never forget is our first patient admitted to ITU with COVID-19, being ready to trial a speaking valve and hearing his voice for the first time and hearing him speak to his wife. All the successes were excellent motivation to keep going.”
