Reflections by a palliative care nurse on the COVID-19 frontline

As I start to return to my usual role, I wanted to take some time to reflect on the last couple of weeks and acknowledge and thank the vast number of people in Canterbury DHB who have poured countless hours in to supporting the patients, families and staff of Rosewood Rest Home and Hospital.

I volunteered to be redeployed in the COVID-19 hospital ward at Rosewood. I worked 60 hours over seven shifts as a palliative care clinical nurse specialist.

It is still hard to describe the situation we were faced with. Firstly, we changed into scrubs in the clean area, then got into our personal protective equipment (PPE) in the transition zone (under the watchful eye of our fabulous PPE champions). Then it was brief introductions to those who would be our colleagues for the day (registered nurses, enrolled nurses, student nurses, theatre nurses, paramedics, dental nurses and caregivers, all redeployed from other services) and straight into the ward. From there, it was all hands on deck to keep up with the never ending tasks of caring for elderly, sick and fragile patients, whom you’ve never met before.

Meanwhile your brain clouds over until your lungs adjust to breathing through a mask, becoming increasingly breathless with every shouted conversation to an unidentifiable colleague. Patients’ symptoms would flare up, with little to no predictability or recognised pattern (yet) alongside other underlying health issues presenting their own symptoms. Diarrhoea, back pain, dry cough, delirium, the occasional temperature, lungs filling up fast with thick mucous and decreasing oxygen saturation that betrayed the underlying seriousness of their illness. For some, positioning became a matter of life or death.

Everyone worked tirelessly in the built up heat of PPE to keep up with the heavy nursing tasks required, while still taking time to fuss over the personal touches for each patient, like finding the right station on the radio or singing happy birthday complete with a little cake and candles. Gloved hands struggled to make the touch-screen of the electronic drug chart or smart-phone work, or to type the right letters into patients’ electronic records for the GP to read remotely.

Fortunately, after the initial onset of acute symptoms, most patients appeared largely untroubled by the roller-coaster of symptoms that lingered as days turned into weeks. It seems to be the one positive in all this, on their bad days they would just go quiet, refuse food and fluids, tuck up in bed and sleep peacefully. But this is when we worried about them the most.

The most heart-breaking of all of this though will always be the inability to unite families with their loved ones in their time of need. I cannot imagine the worry and fear this must cause, despite our best efforts to keep in touch by phone or video call. Dying and death are so steeped in our social rituals and traditions. Not being able to be there with them, and not being able to accompany other family members during funerals and the grieving process will, I’m sure, leave many lasting scars. Families just hoped we could get their loved ones through the illness until they were able to be with them again, come what may. We tried, we really did.

Meanwhile, on the other side of the glass door separating us from the outside world, we could see many others working equally as hard. Deliveries arrived; a constant stream of clean linen, more scrubs, boxes of PPE, equipment, food for patients, food for staff, medical supplies, gifts for Rosewood from neighbours and industry colleagues, all of which we were using as fast as they arrived. More staff arrived, ready for induction in to their new roles as receptionists, cleaners, administrators, or to receive training on the use of PPE in preparation for work within the clinical areas. Beyond that, there were security guards who stood alone on the footpath in 10-hour shifts.

Unseen but greatly appreciated, was the Canterbury DHB Emergency Coordination Centre (ECC) team that coordinated us all and devoted themselves to ensuring the smallest details were accounted for. I cannot begin to imagine the mammoth task of staffing and operating an aged care facility in the throes of a pandemic, and all from afar. But what I can say is that I’m deeply grateful to each and every person who sorted their piece of this giant puzzle and kept us all safe. The residents at Rosewood may be elderly with many suffering advanced, long-standing illnesses that render most unable to communicate, but they still delight in their favourite music or their favourite meal. They could still let me know where to stick my thermometer when they were tired of being poked and prodded. They were once soldiers, teachers, mothers and athletes and they still matter deeply to their families, to the Rosewood staff and to those of us who only met them briefly. I will be forever grateful to, and proud of, all those who honoured these people by going above and beyond the call of duty to do everything possible to care for them.

I am also humbled by the continuation of care for those of us who stepped in and out of Rosewood. I received phone calls and multiple emails from ECC staff preparing me as best as possible for the role (although in truth, it was more intense and heart-breaking than I could have possibly imagined), as well as phone calls and emails from occupational health now that I have finished my work there; making sure I am ok and that I am clear about the services available to me and what is required in the weeks ahead as I return to my usual role. Having unrestricted access to a full range of PPE during my work, as well as health assessments and swabs on completion, has been a significant psychological support throughout, and has enabled me to feel confident about my safety at work. One less thing to worry about in this extraordinary set of circumstances. Thank you.

I would also like to acknowledge the often unsung heroes of our health system; the staff working in aged residential care. Without knowing anything about the residents when I arrived, it was still very obvious that these people were not just well cared for, but loved. The little messages left around the place signalling to others that ‘Bob’ likes fruit with his Weet-Bix but ‘Nancy’ hates mushy carrots, the smiling faces in photos on the wall of outings with staff. I know they were deeply distressed by having to leave their patients, heart-sick when hearing from afar about the devastation COVID-19 was wreaking on those they consider family, and completely lost when returning to a workplace so unrecognisable and with many missing faces. For sure we will have put things in all the wrong places and missed filling in a few forms, but we did our best to replicate their love and care of patients in their absence. The smiles from patients on their return told us they were greatly missed though.

No doubt it will take a long time for the Rosewood community to pick up the pieces and move forward. I hope we will all continue to offer them the support and resources they need.

With my most humble gratitude for all the mountains that have been moved by many in recent weeks,

Jo Hathaway

Regional (South Island) Programme Facilitator – Palliative Care
South Island Alliance Programme Office

[This article was first published as “Reflections from Rosewood” on the South Island Alliance website in May 2020. Reproduced with permission.]

#PalliCOVID #PallANZ tweetchat 5/5

#PalliCOVID #PallANZ 5_5

Check in with other Australians and New Zealanders involved and/or interested in palliative care during the COVID-19 pandemic during our third #PalliCOVID #PallANZ tweetchat on Tuesday 05/05/2020.

Join our special guests Rohan Greenland @PCACEO (CEO of Palliative Care Australia @Pall_Care_Aus) and Dr Richard Thurlow @Richt13Thurlow (Board Chair of Hospice New Zealand) to share your experiences and exchange resources.

When?

Who?

  • Palliative care clinicians, researchers, managers, policymakers, patients and carers
  • Interested / involved in helping our communities live, die and grieve well in the face of the life-threatening COVID-19 / novel Coronavirus pandemic
  • Living or working in Australia and New Zealand

How?

What?

We hope you can join us for another great discussion!

 

#PalliCOVID #PallANZ tweetchat 7/4

#PalliCOVID #PallANZ (3)

Please join us for another tweetchat on Tuesday 07/04/2020 to discuss palliative care in Australia and New Zealand during the COVID-19 / novel Coronavirus pandemic. Find out from special guests Prof Meera Agar @meera_agar (Board Chair of Palliative Care Australia @Pall_Care_Aus) and A/Prof Leeroy William @drleeroyw (President of the Australian and New Zealand Society of Palliative Medicine @ANZSPM) what has been happening in this space since our last tweetchat – and share your experiences and resources with other palliative care practitioners from across our region!

When?

Who?

  • Palliative care clinicians, researchers, managers, policymakers, patients and carers
  • Interested / involved in helping our communities live, die and grieve well in the face of the life-threatening COVID-19 / novel Coronavirus pandemic
  • Living or working in Australia and New Zealand

How?

What?

  • Topic 1: Social distancing rules (e.g. restricting visitors & limiting funeral gatherings) have changed the way we care for the dying & grieve for the dead. How can we help patients & families to live well, die well, grieve well AND flatten the curve?
  • Topic 2: Telehealth and working-from-home poses unique challenges to a touchy-feely, team-based specialty like palliative care. Please share a story about how you’ve adapted (or not!) to these evolving work practices.
  • Topic 3: Meera & Leeroy – can you please give us an update on the work of the Australian COVID-19 Palliative Care Working Group? Does anyone else have any updates / policies / resources that they would like to share?

We hope you can join us for another great discussion!

 

#PalliCOVID #PallANZ tweetchat 23/3

#PalliCOVID #PallANZ

Please join us and other palliative care clinicians from across Australia and New Zealand on Monday 23/03/2020 for a tweetchat on the COVID-19 / novel Coronavirus pandemic.

When?

Who?

  • Palliative care clinicians, researchers, managers, policymakers, patients and carers
  • Interested / involved in helping our communities live, die and grieve well in the face of the life-threatening COVID-19 / novel Coronavirus pandemic
  • Living or working in Australia and New Zealand

How?

What?

  • Topic 1: Please share a story about your #COVID19 #Coronavirus experience so far – at work, at home and/or online
  • Topic 2: Have you come across any useful #COVID19 #Coronavirus resources that others might find helpful?
  • Topic 3: How can we look after ourselves and each other during the #COVID19 #Coronavirus pandemic?

We hope you can join us for a great discussion about this global public health challenge!

 

#ANZSPM18 Conference – New Frontiers

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The Australian and New Zealand Society of Palliative Medicine 2018 Conference #ANZSPM18 is off the a great start, with many excellent plenaries & proffered papers presented on day 1 – following an excellent Trainee Day & pre-Conference workshop on thought leadership.

Day 2 promises to be even more awesome, starting off with keynote speaker Tom Le Blanc sharing his insights on collaboration & integration between palliative care & haematology. The rest of the day will feature a variety of plenaries & concurrent sessions on the new frontiers of palliative medicine – the theme of the conference. I’m also looking forward to the conference dinner tonight!

You can find the sides for my presentation on Palliative Care in Heart & Lung Transplantation here: HLTX PC ANZSPM18 Chi Li

Enjoy!

#ANZSPM Study Day for trainees & new fellows

VCCC

Beautiful spaces inside the Victorian Comprehensive Cancer Centre, the new home of the Peter MacCallum Cancer Centre in Melbourne, Australia

[The following article by Dr Sarah Dunlop, advanced trainee in palliative medicine, was first published in the Australian & New Zealand Society of Palliative Medicine (ANZSPM) Newsletter. The next ANZSPM study day will be held on September 6th in Sydney prior the the upcoming ANZSPM 2018 Conference. Follow #ANZSPM18 for updates from this biennial meeting – Chi] 

While there are many benefits of living in Western Australia (the weather, the beaches, and charming, debonair palliative medicine trainees), there are also downsides to living in one of the most isolated cities in the world… specifically the isolation! The decision to travel interstate to a course or conference usually hinges on three questions: can I get the time off, can I afford it, and is it going to improve my practice? So after charming my colleagues into giving a debonair trainee a day off and boarding the red-eye to Melbourne, I can confirm that the Study Day for Trainees and New Fellows met all my requirements.  Continue reading

A reflection on voluntary assisted dying and conscientious objection

Dying sculture

[Image by rmac8oppo from pixabay]

[The following essay by Dr Adrian Dabscheck, an experienced palliative care physician in Melbourne, explores the evolution of our society’s views towards death and reflects on the role of palliative care and voluntary assisted dying in this context – Chi]

During a recent period of enforced rest, I had time to reflect on my attitude to the recently enacted voluntary assisted dying legislation in Victoria and consider my response.I will detail my reaction to the Act and why I have chosen to become a so-called conscientious objector.

In his essay Western Attitudes Toward Death,French historian Philippe Ariès illustrates the evolution of our attitudes to death.

Initially, and for millennia, there had been a general resignation to the destiny of our species for which he used the phrase, Et moriemur, and we shall all die. This was replaced in the twelfth century by the more modern concept of the importance of one’s self, and he used the phrase, la mort de soi, one’s own death.  Continue reading

What matters most? #NPCW18

 

National Palliative Care Week 2018 is just around the corner. This year, we are asking Australians what matters most – to them, to their family & friends, and to their communities?  Continue reading

#COSA17: #PalliativeCare reflections on the 44th Clinical Oncology Society of Australia Annual Scientific Meeting

Circular Quay

Despite being a Melburnian, I must admit that Sydney really is an irresistibly beautiful city when the sun comes out, especially by the water. The 44th Clinical Oncology Society of Australia (COSA) Annual Scientific Meeting was held in the newly renovated International Convention Centre in Sydney between 12-15th November 2017. With the sunlight streaming in through its many windows, reflecting off the waters of Darling Harbour, it really was the perfect place to be at the beginning of summer.

I attended the pre-conference workshop on cancer supportive care, which was organised by Judith Lacey, a palliative medicine specialist at Chris O’Brien LIfehouse. The whole-day workshop featured an interesting mixture of passionate speakers promoting a range of complementary treatments including medicinal cannabis, massage and probiotics; alongside others examining the evidence base for acupuncture, reviewing current clinical trials and prescribing pathways, and comparing different funding models for supportive care. It was a long but worthwhile day that set the mood for the rest of the conference.  Continue reading

An open letter to Victorians on #PalliativeCare #VAD #euthanasia

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PC clinician open letter Final