In April of this year, Christie Watson was working at a Nightingale hospital at the height of the pandemic. She had left the register in 2018, after 20 years as a paediatric nurse, but like thousands of others, had rejoined to help out. Every evening for nearly eight weeks she would come home after a 12-hour shift as the lead nurse for compassionate care, disinfect her car with antiviral spray and go into her flat, spraying doors down as she went. She’d shout up at her children to stay in their bedrooms, then shower, clean her shoes and everything she had touched, and put all her clothes in the washing machine.
Often she cried in the shower, thinking about the devastating events of the day, but then she’d come out of the bathroom and hug her children. ‘And they were big hugs,’ she says. ‘It was hard. But the ICUs around the rest of the country had it a million times worse than what we were struggling with.’
Watson, 44, has blonde hair, an enveloping smile and intense blue eyes. We have met up in a park in south London and the temperature is 36C, yet she looks cool and composed in a blue dress – she is on her way to visit her grandmother, who is in her 90s and shielding. She has an air of calm control about her; you would definitely want her to be your nurse.
It was The Language of Kindness, A Nurse’s Story (2018) that made Watson’s name. A bestseller, it has been translated into 23 languages, with a television adaptation in the pipeline – for which Watson is writing the script. There had been a multitude of popular doctors’ books, but we hadn’t yet heard from a nurse – and certainly not in the visceral, entertaining, poetic and occasionally funny way that Watson presented life in a hospital. Some of her stories were profoundly upsetting, but they vividly conveyed what nurses have to do.
In her new book, The Courage To Care (written before Covid but with an updated introduction), Watson writes, ‘I had no idea how poignant and timely this book would be. Nurses have always been at the forefront of society, and it is nurses who are saving lives during all of this, and nurses who are holding the hands of our loved ones as they are dying… And it will be nurses who bear the weight of Covid-19 long after the peak.’
The details of her time at the Nightingale – a huge emergency hospital set up in east London to treat Covid-19 patients – are, she says, too horrific to talk about. It’s too soon. Watson was deployed in the compassionate- care team, in charge of end-of-life care and the family liaison and support unit. The Nightingale, although built for 4,000, only had 34 patients at one time at its height, the same as the busiest intensive-care units.
‘The team consisted of military, senior ICU nurses and doctors, and clinicians from all areas you could imagine,’ says Watson. ‘There were also people helping out who had no ICU experience – school nurses, for example, and people who had no hospital experience at all, including airline cabin crew.’
The risk that thousands of former nurses and health professionals took by returning to work is not to be underestimated: this was at the time of inadequate PPE, and when many healthcare workers were dying. (More than 300 front-line British health staff have died so far from Covid-19.*) But for Watson there was no question about whether or not she should go. She discussed it with her family: her mum didn’t want her to do it, but understood; her two children (aged 13 and 16) actively encouraged her; her daughter even volunteered to do the cooking and oversee her brother’s homeschooling.
Watson made sure her will was in order (‘a horrendous thing to have to do’) and had one day’s training at St Thomas’s (as an ex-ICU nurse of many years’ standing, that’s all she needed). But it was extremely hard. ‘Every single day someone was in tears – and these are very senior, experienced people. All I can say is that because of the nature of the illness, and what people were having to face, it was the most challenging thing I’ve seen or done in 20 years.’
Christie Watson grew up on a council estate in Stevenage. She was a wild teenager, and left school at 16 with seven GCSEs. But after volunteering at the disability charity Scope, where she met some nurses, she felt she had found her vocation and became a student nurse aged 17. She spent the next 20 years in hospitals in various disciplines, though chiefly in paediatric intensive care.
But she had always wanted to write, and her first book, Tiny Sunbirds Far Away, about a young Nigerian girl, won the 2011 Costa First Novel award. It grew out of a beginner’s course in creative writing – then she won the Malcolm Bradbury bursary, which enabled her to do an MA in creative writing at the University of East Anglia (UEA). In 2013 she left practical nursing behind, and her second novel, Where Women Are Kings, was published. She started teaching writing at various institutions, and five years later came The Language of Kindness.
Her new book, The Courage To Care, draws on her nursing experience and that of others, including military, prison and forensic nurses. There is Aditi, a community mental-health nurse who looks after patients at home – like Mr George, a hoarder, whose house smells like a sewer and who ‘is the saddest human being’ that Watson has ever seen. And there are the paediatric nurses who work in residential respite care, where they bring in buckets of sand so that profoundly disabled children can experience the feeling of sand between their toes.
She spent 18 months meeting nurses from all sorts of disciplines. ‘I thought it was a book about nurses, but actually it’s about family – nurses’ families and patients’ families, and the web of complications that surrounds them.’ Families such as Breda’s – an adult with severe autism, who spits, bites and eats cigarette butts and soil, and whose parents are too old to look after her, so her sister Bernadette, who herself has depression and an eating disorder, has to. It sounds like such a hopeless situation, yet Bernadette tells Watson, ‘She inspires me to carry on every day. I wouldn’t be without her.’
‘I wanted to talk about the impact of everything on families,’ says Watson. ‘And about vulnerable people in society, and the fact that most patients you look after are not all sweet and lovely. They are sometimes really difficult and you still have to look after them – it’s your job. It’s a less rose-tinted view of nursing.’
It is also a book about Watson’s own family (although at their request, there are no names mentioned). It was her mother, a social worker, who taught her the language of kindness, Watson says. She has a younger brother, and her father, who died of lung cancer eight years ago, was a vigorous presence in her life. The way he was looked after in hospital made her appreciate the crucial importance of nursing even more.
And it is about her own children. Watson has a 16-year-old daughter with her former partner, a Nigerian paediatrician whom she met while working at St Mary’s. Ten years ago the couple adopted a little boy of mixed race (now 13). In the book she writes about the first time she saw a photo of him: ‘My son aged two, looking at me with wide-open eyes. I know instantly that this child is my son. Nature–nurture doesn’t matter. He’s completely my son. I am in love in a second.’
Her daughter took to her new brother instantly, and they still get on splendidly. ‘Yes, it’s incredible – thick as thieves they are. And they look so similar as well. Sometimes I do forget. They’re planning to live together in a two-bedroom flat when they leave home.’
Initially her son had problems bonding with her, which she describes in the book in a chapter entitled ‘F*ck off Janet’ (her response to a woman who shouted, ‘Is that the adopted one?’ at her, across a crowded room). But it didn’t take too long for him to settle, though the adoption process itself was fairly tortuous and stressful. ‘I’ve got friends who’ve adopted and friends who were adopted themselves, and I know families who’ve lost children to adoption, and children who’ve come through the care system – and it’s never easy for any of those people. Like one of my adopted friends says, “There’s never a happy ending; it’s just a different ending.” Though, in my case, it has been a really happy ending.’
She discusses racism in the book, and the terrible day her three-year-old daughter was first called the N-word, by some men in a park. These days, she says, she and her children talk about everything. Her daughter ‘is very alternative and she teaches me a lot. Not just about racism and privilege, but gender, sexuality – she challenges me, in a good way.’
Watson worries about systemic racism, ‘even in the NHS actually. And I worry about organisational racism and knife crime and the fact that we have so few black leaders, and that four times as many black people are dying from Covid… But I’m really glad the Black Lives Matter conversation is happening. It’s the first time in Britain that we’ve even acknowledged we’re a racist country – and we are a racist country, and we need to change that.’
Nursing infuses everything in Watson’s life, and it’s in the family: when her daughter was five and playing with her new brother, Watson overheard her shout out, ‘Cardiac arrest: stand clear!’ and ran upstairs to find her performing chest compressions on his abdomen so effectively that he projectile-vomited.
It has its downside. ‘Nursing has given me the gift of understanding the worst-case scenario in all things,’ she writes. When her daughter was a newborn, Watson couldn’t help thinking of all the possible afflictions that could befall her: ‘all the respiratory illnesses she might catch, or what if she contracts a bacterial infection that is resistant to antibiotics? Or congenital heart defect, sepsis, metabolic abnormality, cystic fibrosis, liver disease, meningitis, hydrocephalus… The list goes on.’
Her nurse brain seeps into all aspects of her life – even the smell of burnt toast reminds her of the woman in A&E whose hair had been caught up in one of those moving toaster grills. But so, too, does her nurse heart, and it is this instinct that makes her stop on her way to hospital when she sees a rough sleeper, semi-conscious and with his trousers half down. While everyone else ignores him, it is Watson who makes sure he is OK. She checks his breathing and pulls his sleeping bag over him.
But Watson bridles when she hears nurses reduced to epithets relating to their kindness; she thinks nursing is on the whole poorly represented. ‘It’s a highly skilled, safety-critical profession that is hugely academic – and nurses get p—sed off at being pegged as heroes or angels.’
She did not go along with the weekly clapping either. ‘It was fine initially, a positive thing to boost morale, but I was against it continuing. Nobody understood the extent of what we were getting into. I know it gave communities a sense of purpose, but the time had passed, and the mood was becoming more sombre in hospitals.
‘I felt the whole hero narrative was convenient politically. You can then make it seem like people are going to war, and actually nurses are not going to war: they are professional people who want to be safe doing their jobs.’
With hindsight, what would she have done differently? ‘The Government made some terrible decisions and they’ve made some good decisions. We should have gone into lockdown sooner; we all know the unnecessary death rates, the issues with PPE were unbelievably shocking, and the track and trace thing hasn’t worked.’ She is appalled that at one point Britain had the highest Covid-19 death rate in the world (per million of the population). ‘It’s really showed us up. It makes me embarrassed to be British frankly.
‘I’ve got no doubt that we will come through it, though there will be a horrendous fallout – but I do hope that we’ll emerge kinder, in the long term, and with more understanding that time is not for ever. There’s a phrase they have in Nigeria: shine your eyes. Like wake up and smell the coffee. I think we’ve all shined our eyes…’
Watson will not go back if there is a second wave. ‘That may change but I’ve got to crack on with all my other projects.’ She is patron of the RCN Foundation, the charity arm of the Royal College of Nursing, and she campaigns vociferously for the bursary that nurses used to get to be reinstated, and for a pay rise. For now, though, she is concentrating on her writing – ‘I am desperate to get back to fiction again’ – and her new role: she has just been appointed professor of medical health humanities at UEA. ‘I’ve always loved medical humanities – it’s a subject I’m passionate about. It’s everything I love in one job: anthropology, medicine, nursing, creative writing, art, politics, poetry.’ What would she put down on a form as her occupation? ‘Tricky. On my Twitter account I had “writer and former nurse”, but even if I come off the register again I’d still write “nurse”. I think it’s more important than ever. Ever, ever, ever.’
*according to the ONS, 313 deaths of healthcare workers were attributed to Covid-19 between 9 March and 20 July
The Courage To Care: A Call for Compassion, is published this Thursday (Chatto & Windus, £16.99; books.telegraph.co.uk)