A photo of two nurses embracing each other at the height of the Covid-19 pandemic has become a symbol for the difficulties that the health professionals went through to take care of patients who were taken ill because of the virus.

The Central Bank has recently announced that the photo will be used on a commemorative €2 coin which will be dedicated to all the heroes of the pandemic. The World Health Organisation (WHO) has also been made aware of the powerful photo and used it to commemorate the international day of both midwives and nurses respectively.

The photo was taken during the first wave of the pandemic by nurse Diane Faenza, Zammit and Cauchi revealed. “At the time when the photo was taken, we were just about to admit the first two patients who were Covid-19 positive in the Intensive Therapy Unit,” they said. 

The two nurses spoke about the physical and mental challenges posed by the pandemic, how they dealt with new procedures and equipment, and about the anguish of seeing patients succumb to the virus.

You are both being regarded as the symbol of heroism during the pandemic. Looking back to the worst Covid-19 had to offer, what does this mean for you, the nurses and all health professionals?

This pandemic significantly affected not only our health care system in general but also had a hard impact on us front-liners in a way that no one ever imagined. It has disrupted our routines, our lives and the lives of those close to us.

Some of us had to leave home and live separately from their families. This resulted in a lot of anxiety, stress and solitude. As front-liners, we had to adapt to new scenarios and acute changes in our approaches. We had to face major issues such as shortage of medical and nursing staff. On certain occasions, beds and equipment were also scarce. Not to mention the psychological impact and the fear of the high risk associated with caring for these patients.

We had to get accustomed to working in full personal protective equipment (PPE) for hours on end. On the other hand, this pandemic highlighted the team spirit, the willingness to protect one another as colleagues and the resilience to keep on fighting the hostility of such a virus. After witnessing people dying, even people who were previously healthy, this pandemic showed us that life is too short and that we should celebrate it as best we can.

What was the reaction of your family and friends once they found out that you were the nurses dressed in full protective equipment?

Charmaine Cauchi: The reaction of our families and friends to the photo was a sense of strength and courage. Some were proud and some showed fear. A sense of mixed emotions towards us.

Doreen Zammit: Only my close family and a few close friends knew that I was one of the nurses in the picture. We wanted to remain anonymous for as long as we could as our main aim was to represent all the front-liners and to create an awareness among the general public. My family’s first reaction was that of worry and concern as the picture represented the challenges which we were facing every day. Today they are proud of me being part of this remarkable team and what we achieved so far.

What is the story behind the photo?

The photo was taken during the first wave of the pandemic when the world was still learning how to take care of these patients, and very little was known about this virus and what the best approach to treat such patients was.

At the time the photo was taken, we were about to admit the first two patients who were Covid-19 positive in the Intensive Therapy Unit (ITU). It was at the end of our shift and my colleague and I were due to admit these two patients so we immediately donned our full PPE’s and eagerly waited to receive them.

Were we scared? Were we anxious? Yes of course we were…but we were there together supporting each other and resilient as ever! My colleague got this idea of taking this photo and orchestrated our pose to try and reveal our emotions at the time. She asked one of our other colleagues to take a picture to capture this moment. This took us only a couple of seconds and little did we know at the time what would become of this picture!

The pandemic presented health professionals with a lot of firsts. Treating people is what you as nurses do on a daily basis, but how has this changed? What was it like wearing protective equipment and having to treat patients?

Charmaine Cauchi: The way we treated patients during this pandemic vastly changed from what it previously involved. We experienced new adaptations, new protocols, new equipment and master plans to save the patients in a relatively short time. Wearing the full PPEs was even more challenging than I expected as it was very difficult to focus during hectic situations due to the fact that these patients were seriously ill and needed quick and constant care. We unfortunately knew that most of the patients had little chance of survival once they were admitted to the Covid ITU. We were stunned at how fast a Covid infection could deteriorate a patient, irrelevant of their age and health status.

Doreen Zammit: This pandemic taught us a lot. Although some of the basics were still the same as treating any other patient in intensive care, treating a patient with Covid-19 was more challenging.

For example, treating a Covid patient with ARDS (Acute Respiratory Distress Syndrome), which is a life-threatening condition in itself and proning the patient (putting the patient in a prone position) every couple of hours to improve oxygenation, presented its challenges.

One has to keep in mind that it had to be done by a minimal number of health professionals, wearing full PPEs inside the Covid exposed area. It was no walk in the park and we found ourselves in a constant state of trying to cope with the increased workload with only one or two nurses caring for a unit full of very sick patients amidst the noisy surroundings of alarm beeps from various ITU equipment, while also trying to follow continuous instructions coming from our colleagues on the outside.

At one point, nurses, doctors, carers and other front-liners were deployed between four Intensive Care Units, which was no joke. I think one of the hardest things to process was that despite doing all we could for our patients, despite exhausting all possible methods and practices, the virus is far too aggressive.

Unfortunately, this led to either quite substantial and life altering repercussions, or a great number of deaths. All this was very heart-breaking for us healthcare professionals. The feeling of not doing enough for our patients was too overwhelming and exhausting.

Did you get close to any patient who was under your care? How was the experience of dealing with the virus from a patient-nurse perspective?

Charmaine Cauchi: Personally, I never got close to any particular patient, especially in the Covid ITU, for the simple reason that I had to be focused all the time and remain mentally strong.

Getting close to any patient meant that it was only going to demoralise me even more, especially if he or she went downhill. We had many patients who lived and they are still suffering some of the consequences to this very day, and then unfortunately there were those who died. Therefore, I realised that the best way for me to cope was to be mentally numb and put my emotions aside.

Dealing with the virus from a patient - nurse perspective was very intense, especially in the beginning. The fear of getting sick myself from our patients or worse spread the virus to my loved ones was constantly digging at my mind.

This made it even worse when international news started reporting how many healthcare workers were being infected and dying in a very short time. I was becoming really frustrated seeing people out there who were not abiding by the health authorities’ instructions, hence increasing the daily cases substantially. Like everything else in life, somehow, I learned to cope and adapt to the situation always keeping in mind to stay 100% focused to avoid human errors.

Doreen Zammit: I think most of us, at one point or another managed to build a close bond with a particular patient. We are all human and this could happen for various reasons. It could be you might be present during a particular event where the patient was more vulnerable than others and needed more of your support and care.

Covid patients were more helpless, isolated and distant from their loved ones than patients in normal circumstances. Together with my colleagues (nurses, charge nurses, doctors, physiotherapists, carers, cleaners and others) we tried to fill that void and did our best to reassure and support them.

Families were continuously updated by our consultants and doctors. We used to help the consultants and doctors make that devastating call to patients’ families before we intubated them.  

I cannot forget one particular patient in his early sixties physically speaking to his son behind the thick glass of the Covid ITU before being intubated and put on a ventilator. I still remember the exact words instructing his son for the last time to take care of his children and his wife. This patient unfortunately didn’t make it, he passed away a few days later.

On a positive note, we had more recovery success stories than not, a lot of patients have made it through and joined their loved ones. Nothing is more rewarding than seeing these patients being discharged from ITU to the ward and eventually home after such a long ordeal.