Niall Eames, a consultant spinal surgeon with the Belfast Trust, volunteered to work in a Covid-19 ward. In these further exclusive extracts from his diary, he marvels at the dedication he sees all around him.
Saturday April 11: The sun is shining today as I head in. I'm on day shifts now. Feels easier. Car park completely empty again, except for staff changing over. Roads are almost empty. Even on the motorway coming into work, virtually all the cars are health service workers. At the roundabout at the Falls Road, cars seem to go to either the Royal Victoria Hospital or Belfast City Hospital today. No one else is about.
I meet Wu in the changing rooms. He presents me with a pair of new welly boots. They are long and green, right up to my knee. And they fit. It seems so strange to be wearing them here, walking into the theatre block, but it feels safer, in a strange way.
We meet as a group again for the handover round. We are called a "pod" now. Darren is also wearing new boots. We laugh with each other. Wu has got him some, too.
Numbers of patients have increased again overall. Not an enormous surge yet. John takes us through each patient, one by one. The numbers they quote about patients now speak to me more easily.
Some patients are clearly very ill. John briefs us on our tasks. A last trip to the toilet.
We don the PPE again and enter ICU. It feels more normal now. Familiarity is starting. Less intimidating. My nose hurt last time - just where the mask sits on the crown of it. I saw pictures of this on the news. I take longer making sure it's sitting comfortably today.
We all check each other. Tim fixes the back of my gown. The door opens and we go in. Daily tasks begin. Everyone in the unit needs assessed. Our pod spreads out and starts working.
I say "hello" to the unit sister. She is so welcoming. I wonder what she is thinking, watching all these new staff in 'her' unit. I approach a patient's bedside and slowly start to work through all the numbers. All gets documented.
The nurse with me is from ICU in the RVH. He speaks with such authority and composure. He is also working his way through his list of tasks for the patient with such care.
He checks every aspect and detail of his patient meticulously. He bustles backwards and forwards, adjusting and checking. We chat. He helps me with my tasks.
A Covid-19 ward in the Nightingale hospital, Belfast
Another nurse comes over and asks my advice on a patient. I look at the numbers. They have changed slightly and a minor adjustment is needed. I notice over her shoulder another nurse. I don't know him. It says 'Senior ICU Nurse' on his visor.
I give my advice. He nods approvingly at my opinion. I feel relieved.
Later, in the rest room, another nursing sister appears at the door and asks for help moving three patients back to the ward - they are ready for discharge. John volunteers us. We both don PPE and begin to wheel the patient from ICU back up to the ward.
They are pushed out of the unit towards us standing in the corridor. A few nurses clap. What must he be feeling? He is sleepy and quiet. John stays to talk to the team on the ward.
I return to ICU to pick up the next patient. Wu is waiting for me. The patient is awake. We chat to her in the lift.
The two of us, in our green boots, masks and plastic aprons, wheel her into the ward. Security staff block the corridors while we go past, wearing their stab vests and surgical masks. There is no one about, though. Empty corridors.
The ward is high up in the tower and the view from the windows in the ward is beautiful. Critical Care has very few windows and she has been ventilated there for some time.
Belfast Lough is bright blue against the green fields. Belfast looks at its best. Our patient looks out the windows for the first time. She looks like a child on Christmas morning, staring out the window at their new presents. She keeps saying thank you to everyone.
We wheel her empty bed back to ICU and park it beside the other empty bed outside the unit. We wash and don PPE again.
Easter Sunday April 12: 'I walk by an empty bed, somewhere a family is grieving'
A new anaesthetic colleague appears today at the briefing. She was the same year as me in medical school. It has been some time since I have seen her.
She is in fluorescent pink scrubs. She, too, wears welly boots, but hers are multi-coloured and stylish. We laugh.
Tasks seem more routine now. Some eyes behind the masks are familiar to me. But there is an empty bed in ICU. One of the patients has died overnight. The bed space lies empty — for the moment. I walk slowly past the empty bed. A family is grieving somewhere.
The patient opposite is awake. I have seen this patient a few times now. He is recovering slowly. But today he is awake. He looks at me disarmingly with his open eyes. I say hello to him. He tries to speak, but it takes too much energy. I can’t make out what he is saying.
He squeezes my hand. His hand feels warm. He is wakening up seeing someone for the first time, in full PPE gear. He must be terrified. I try to reassure him. He sleeps again.
John starts his ward round of all the patients. At each bed, the nurse and doctor tell him how each patient is progressing. I watch Darren, then Gillian, then Eugene discuss their patients with John and Brenda. They listen patiently and intently to each, taking in what they are saying with the skill and experience of experts in their field.
John asks the nurse looking after the patient for their report, too. He gives instructions and we move on to the next bay.
Crisis management: staff wearing PPE cleaning a hospital ward
It’s my turn next. I find myself actually feeling nervous, like I was a junior doctor again. I slip away from the ward round to quickly check my facts before he gets there.
It’s time for a break. We doff our PPE, clean, wash and get a meal. Turkey and stuffing. It is delicious.
I watch the canteen staff as we all sit in isolation from each other. They are all bustling away at their work.
Their care to the staff is the same as I see downstairs from the staff there. It is so striking. Everyone is in this together. Everyone supporting everyone and pulling together.
I haven’t seen the health service work together like this before. I tell myself we must not lose that when this is over.
The afternoon seems long. My nose is really hurting now. It is infuriating not to be able to touch it when in all the PPE, but I know not to. A nurse brings a blood result to me. It has changed a lot since the last one. The numbers are wrong. We sort the problem.
The night shift arrives and it’s time for me to head home. I doff PPE with some nurses heading for their break.
My nose is numb now. The nurses are exhausted. I remember what a friend said to me earlier: we aren’t discovering these heroes; they have always been there. They are just being recognised now.
Friday April 17: 'We watch as the oxygen levels climb slowly to normal'
Numbers of patients are beginning to reduce. More people are being discharged than admitted. Thankfully, the numbers of patients dying is lower in the unit than predicted. Brenda wears the brightest pink scrubs I have ever seen today. We all laugh with her when she appears. Wu tells me I should stick with my blue ones. He is right.
The cycle of donning and doffing PPE continues all day. Some patients are very sick today. The charge nurse is standing near a patient’s bed. It is clear he can sense something is wrong. He isn’t happy. Within a few minutes, we go from chatting casually to dealing with a crisis.
We need to act fast and work as a team. Brenda gives orders to each of us. We all do our jobs. The crisis passes. We watch the oxygen levels that had just plummeted slowly climb back up to normal. For the moment, the patient is stable again. We stand there, watching the numbers.
A nearby patient needs “proned” — turned onto their front to help their lungs. It takes seven people each time. Carefully, we wrap the patient up in sheets to protect all the lines supplying them with all their needs. We lift together as a team and roll, just as we had been taught.
The patient is very unstable. If this doesn’t work, there are few options left. For the moment he is slightly better.
A local restaurant delivers lunch for all staff — plastic boxes, packed with meatballs and rice, or salads, in cardboard boxes. What a thought. I have the meatballs. Food abounds. Again, it feels everyone is pulling in the same direction.
Friday April 24: 'We're being stood down, I don't know if I'm happy or sad'
More patients have been discharged to the wards again today. I sit at home getting ready to start my next night shift. I wonder what the night will bring. My phone goes in my pocket. It is John. We are being stood down. I sit silently. I don’t know whether to be happy or sad. So many thoughts.
Professionally, I have had the privilege of working with a fabulous team of people. Just people doing their best for people. No barriers.
A nurse in personal protection equipment on a ward
Just everyone working together. It has been exhausting, frightening at times, sad, happy, invigorating and inspirational. I read that the “frontline” is moving from here to the nursing homes. I wonder what they must be feeling.
But my time in the Nightingale Critical Care unit, for the moment, is over.
Niall Eames is clinical director and consultant spinal surgeon at the Belfast Health and Social Care Trust