Last Thursday when the Australian government put out the call for 20,000 registered nurses to upskill to ICU I slipped into autopilot and emailed my old workplace where I’d worked in ICU for a decade. It had been 10 years since I’d worked there, would they be interested in my return?
I also filled out the government’s expression of interest form offering myself up, again, for the ICU sector. I felt my chest tighten a little, but I brushed it off as apprehension around my rusty ICU skills, whether I’d be more hindrance than help, would they even want me, and the stressors involved for my old workmates in having nurses fast-tracked into ICU and what that might look like.
That night I lay in bed, unable to sleep, torn between feeling like it was my duty to offer up these skills in a time of crisis and potentially signing my own death certificate. The horror images of the ICUs in Italy could not be unseen. I knew the deal.
While social media was busy praising the bravery of frontline health workers, I didn’t feel brave, I felt terrified. If I had the choice I’d be staying at home like everyone else. But then that was being selfish, not putting my community first. I resented my courage being tested like this.
The thing is, I already work frontline, as a community palliative care nurse. I’ve only recently returned from two months’ leave, bunkered down like the rest of Australia, so to leave my safe bubble and head back out into the world of visiting other people’s homes seemed undoable.
I knew the world had changed when I walked into work on my first day back and my manager handed me a precious PPE kit telling me to treat it like gold. While work now has a rigorous Covid-19 screening tool in place, it’s only as good as the information people give us. There’s an element of trust and risk going into each home, and as time passes the chance of being in homes where there are unknown Covid-19 positive cases increases.
My first visit back felt uncomfortable. I was so focused on maintaining social distancing and overthinking everything in my hypervigilant state that when I walked back out to the car I wondered what care I had actually done as I slathered sanitiser all over my hands, my computer, my phone. How do you maintain social distancing in someone else’s bedroom, hallway, kitchen?
I sat at their table, talking to the family, calculating if we were too close. An elderly grieving relative brushed past me as they left the bedroom and I took a deep breath and instinctively pressed myself back against the wall as we smiled at each other. How to be in this new world.
I stood next to the dying person’s bed, knowing I couldn’t go closer, couldn’t hold their hand, sit next to them, do my job while keeping to clinical intervention only. So much of our work is inside this personal space, and not being able to touch is like losing a small part of ourselves. So we’re learning to develop new skills, ones that will translate across the abyss of being apart, together.
Like hospitals, visiting times in all palliative care units across the country have been reduced to the bare minimum. One visitor per day for one hour between 4pm and 8pm in one unit, a slight increase in numbers when the person is actively dying. That’s a heartbreaking hour of offering. It means we may see more families opting out of admission to palliative care units because of this, preferring to keep their loved ones at home. Our service will need to be adaptable and flexible in creating different ways of maintaining and providing our high level of care.
We fear the unknown of what’s coming. A colleague working as a palliative care nurse consultant in a public hospital commented: “There’s an eerie sense of anticipation in the air. I feel like I’m standing on the shore, watching the water recede, knowing, and waiting for the tsunami wave to come. We just don’t know what to expect.”
While the focus for now is on increasing ICU beds and staffing to that capacity, it will be palliative care that will come into its own in the months to come.
I watch the pop-up morgues spread out across playing fields and parks across the world. I watch as families decide who gets to attend mum’s funeral. I wonder when I’ll get to hug my dad again. My colleagues and I are in for the long haul. We need to look after ourselves as much as our clients and their families in order to stay the distance. As a wise friend and colleague said: “We need to treat this as a marathon, not a sprint.”
I’m not sure what happened in that mad moment of putting up my hand for ICU. Perhaps the media fear got to me. I know my best work is to be done here in palliative care. As the community grieves those who have died, and for the families who are yet to suffer loss, my colleagues and I will be there to care and grieve with you.
• Anne Myers is a Melbourne palliative care nurse
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