‘There is no worse call to make. There were a lot of those calls…’

Dan Danaher speaks with nurse Carole Molyneaux who laboured at the coal face of the fight against Covid-19

AN ENNIS nurse has outlined the challenges of battling against Covid-19 at University Hospital Limerick (UHL) during the height of the second and third wave.
Having worked as a senior nurse manager in a Covid-19 dedicated block, Carole Molyneaux has come full circle working to prevent the spread of the virus vaccinating patients as a clinical nurse manager in Treacy’s West County Hotel.
She has completed the unenviable task of telephoning family members to inform them their loved one was dying.
“We would ring people if we thought their family members were deteriorating. It is the worst call you have to make in the whole world. There is no worse call to make. There were a lot of those calls made.
“It would go along the lines of ‘ I am really sorry, your dad has taken a turn for the worst, isn’t very well and you are welcome to come in and be with him. We can get the priest for a blessing if you want.”
Nine times out of ten family members came in to be with their loved one but some people who had the virus couldn’t come into the hospital. They were assured the patient would be looked after and wouldn’t suffer.
Once visitors completed a Covid-19 checklist, they would be cleared at security and had to wear full Personal Protective Equipment to be with their loved one at the end-of-life stage.
When asked will the patient survive, she said nurses say they don’t know, but will outline it is hard to see the patient recovering and advise it would be a good time to visit them.
If a nurse is asked is a family member dying, she said a nurse has to give an honest answer and say the patient isn’t doing very well and they will probably die from Covid-19.
She saw patients dying from the virus and is aware of a person in their early fifties who passed away with no underlying disease.
“Young people can die from Covid-19 with no underlying conditions. What is frightening is you don’t know who the virus will affect.
“You can take over the body functions with a machine but people still fail. The mortality rate for multiorgan failure from Covid-19 is more than 90%.”
She will never forget March 17, 2020 – the day she was redeployed from Ennis Hospital back into intensive care in University Hospital Limerick (UHL) for the first wave of Covid-19, where she remained until the end of July.
She described her first deployment as akin to preparing for a “war” against Covid-19 in the face of the unknown.
“It was very surreal. We prepared for the worst. We had a lot of positive outcomes but we didn’t have the high volumes of patients that required intensive care.”
A few weeks after returning to Ennis, she secured a senior nurse manager post in the 60-bed block unit at UHL.
When the top floor of the 60-bed block opened on November 23 with isolation facilities and single negative pressure rooms, it became the first nominated Covid-19 ward in UHL.
She often left her house in Ennis at 6.40 am and wouldn’t get home until after 10pm and recalled nurses counselled each other to keep their spirits up during the pandemic.
“The second wave was a lot more difficult and hit UHL a lot harder. We started getting our first positive Covid-19 patients in December.
“At one stage we had 20 Covid-19 patients in the block. The staff in all the team were brilliant. Everyone gave extra in terms of working hours. It was a massive learning curve.
“Covid-19 positive patients came in a lot sicker and younger. For a lot of periods they couldn’t have visitors with them because over the Christmas period they were with family members and we couldn’t allow anyone in who was Covid-19 positive. We had a lot more deaths in the second wave. One in five Covid-19 patients who ended up in critical care had a clotting dysfunction.
“Patients with Long Covid-19 are left with chronic fatigue, inflammation on the heart, respiratory dysfunction. This will have to be dealt with at a national level because we don’t know how the virus affects people long-term because it is not around long enough.”
Covid-19 patients in 8D were on non-invasive ventilation that blows air out of their body, which necessitates even greater protection for nurses who are treating them.
Working with the patient liaison service, video calling was introduced to maintain communication between patients and family members who couldn’t or were afraid to visit because they were elderly or had underlying health conditions.
In addition to the increased communication, she recalled visitor restrictions allowed nurses spend more time with patients and get to know them as people.
In spite of the provision of on-site counsellors and other supports, she admits that the deaths of patients from the virus does impact nurses who are also human, leaving aside their professional duty to continue providing care to the highest standards even if they are upset by the loss of life.
“When this pandemic is over and we have realised what we have been through we should be very proud we have worked through it. It would be very difficult to go through it again knowing what we know already.
“I don’t think people really understand what Covid-19 is unless they have been affected by it.”
At the back of her mind she was always fearful of unwittingly bringing the virus home to her husband and three children, despite stringent disinfection procedures including having a shower and following strict guidelines for taking off and putting on Personal Protective Equipment.
When she was working in the Covid-19 ward she wore PPE for a full day including eye protection and a face mask for 13 hours and social distancing was strictly observed.
“It was very intense and challenging, particularly in the critical care setting where there are a lot of machines such as ventilators that also generates heat. It was very hot but we got used to it.
“When you have to wear a FFP2 mask, it is much tighter and hotter. I did come home with marks on my face from it.”

by Dan Danaher