For most people, changing jobs and joining the staff of a new organisation can be a time of trepidation as well as excitement – but what is it like when your arrival and induction happen to coincide with a global pandemic?  Claire Fisher, who joined us as Head of Finance in early June, shares the background that led to her joining our charity and reflects on her first six weeks in post during such an unprecedented time.

Claire said: “Being born and bred in Plymouth, the name of St Luke’s was very familiar to me and I’ve always known it to be synonymous with dignity, respect and compassion. So, when I heard about the opportunity to join as Head of Finance, it really sparked my interest and I wanted to find out more.

“My whole career has revolved around finance, which is not that surprising given that maths was my favourite subject at school, and it was joining Plymouth City Council at the age of 18 that gave me the chance to train and qualify as an accountant. Then, when Plymouth became a unitary authority, in 1998, I was promoted to the role of Group Accountant, leading a team providing technical accountancy support to the whole authority, on topics such as VAT and treasury management. I also took a lead role in the production and audit of the statutory accounts and submission of government returns.

“The council played a really important part in my life, and not simply because it’s where I spent the first 24 years of my career. It’s was also where I met my husband, but later – after we had our children – my perspective began to change and I found myself seeking a new professional direction where I could hopefully see more of a tangible positive impact for my efforts.  Teaching was a career I’d considered at school and, though I decided again not to take that path, the idea of broadening my horizons and working in a school remained attractive.

“It was the opportunity to join Lipson Co-operative Academy as Assistant Business Manager, in 2013, that saw me take the leap into a very different work environment. I had the autonomy to review and shape all aspects of the school’s financial activities, and I’m proud of the improvements I made during my seven years there.  I also managed other aspects of the school business activities, including main reception, which helped me to get involved in all aspects of school life.”

“I wasn’t actively seeking change of job when the advert for the Head of Finance role at St Luke’s was pointed out to me by a friend.  However, the chance to develop professionally – while also making a valuable contribution to one of the charities I personally support – made it an opportunity not to be missed!  For me, part of the attraction of working for a charity is that rather than the focus being on expenditure, as in my previous roles, the key is to develop and sustain income streams.  Of course, the delivery of quality services to local people is at the heart of what we do here, and that has been an important aspect for me throughout my career.

“What no-one could have foreseen, of course, was the pandemic and the huge impact it would have on everyone’s lives, including at work. I won’t pretend that my induction period has been without its challenges, given the very unusual circumstances, but the warmth of the welcome I’ve received from everyone has been truly humbling and helped me to quickly feel part of the team. In particular, my Finance team colleagues have gone out of their way to help me settle in.

“I’ve really appreciated the friendliness and support, especially as I joined just a week before the main annual audit, an exceptionally busy time made all the more demanding by the additional workload brought about because of the COVID-19 situation, including the financial modelling that’s been urgently required to help our charity steer its way through these unchartered waters and keep providing such outstanding end of life care.

“This role and the organisation itself both feel a really good fit for me. My great auntie and my husband’s auntie were both cared for at Turnchapel, where I’m based (though currently doing some of my work from home), so I already knew it was an uplifting place, and I feel a real affinity with all that St Luke’s stands for.

“I only have to look as far as the messages that come in with some of the donations to sense the overwhelming love and respect our community has for St Luke’s and the fact there are so many ‘stories’ lying behind the £ signs I see in our accounts. For example, there was one just recently from a regular volunteer, who said she was making a donation in lieu of putting in her usual shifts – she wanted to continue contributing to the cause she holds so dear while she awaits the call to return to her voluntary role when it’s safe to do so.

“That sums it up for me. St Luke’s is the city’s best-loved and most respected charity, and I feel excited and proud to now be playing my part in helping to ensure a sustainable future for the vital service it provides.”

When your vital work caring for terminally ill people already takes its toll on you emotionally, how do you cope when your job is made so much more challenging by the pandemic and its impact on not only the families St Luke’s serves, but the welfare of you and your own loved ones, too?

Selina Rogers and Becci Stafford are Healthcare Assistants (HCAs) with our End of Life Urgent Care Service, which runs from 8am to 10pm seven days a week. In partnership with Marie Curie, it provides co-ordinated, bespoke end of life care and support to patients who need this at home during a time of crisis or change in their condition. The team’s remit extends across Plymouth and out as far as Salcombe, Tavistock and the moors, too, meaning frequent travel to isolated areas where accessing all kinds of services can be more difficult.

As HCAs, Selina and Becci are central to the high-calibre care the team provides, ensuring our patients are as comfortable as possible – and their loved ones as at ease as possible – in the midst of very challenging circumstances. The ‘storm’ of the pandemic has meant that their sensitivity and compassion have been even more critical than ever, with the past few months seeing them pull out all the stops to remain the reassuring presence families desperately need, all while managing their own anxieties and concerns around COVID-19.

Selina said: “Helping to look after people who are dying is not an easy job, but we do it because we understand what a difference it makes to patients when their dignity is respected and they feel understood. We know how hard it is for their family members, too, who are often shouldering a lot of the caring responsibilities for the person who is terminally ill.

“That’s why we’ve been determined to maintain the outstanding service so many rely on, despite the many challenges of carrying out our work during the pandemic. As with NHS frontline staff, we’ve had to use all the necessary PPE to help keep our patients, colleagues and ourselves safe, and though we understand just how essential it is, it has been very tough knowing patients can’t see our smiles, or feel the warmth of our hugs or the reassurance of our hand on their shoulder.

“It goes against our natures not to be tactile, so we’ve adapted by telling them when we’re smiling, and even saying to them, “It’s right now that I’d have given you a hug”, just to make sure they know how much we care.”

Even more difficult has been the shock of seeing their patients die much more quickly than in pre-pandemic times. Whereas normally patients live for up to around 40 days from the team’s initial visit, giving time for a comforting familiarity to build between them, many have sadly passed away within just one or two days.

Becci said: “It has felt really hard comprehend at times, especially seeing them looking reasonably healthy one day and finding out that sadly, they have died the next.

“We understand the reasons for this – many people have been getting referred to us much later than they normally would because of the difficulties they’ve had accessing their GP during lockdown or deteriorating more rapidly due to the pandemic delaying their hospital treatment – but understanding it doesn’t take away the shock and sadness we feel.

“As a team we’ve all had to pull together more than ever to help each other through because every one of us has found it very hard-going.”

Of course, as well as their care and concern for their patients and the families around them, our clinical teams have also faced making tough personal sacrifices to reduce their own loved ones’ risk of contracting the virus.

Becci, who has young children, made the heart-wrenching decision to live separately from them for seven weeks, taking them to live with their father to help protect them while she cared for two patients diagnosed with COVID-19.

“I felt huge guilt in choosing to stay apart from my children, and although I knew it was the right thing to do, I struggled. It’s at times like that I appreciate the team around me even more. At various times, we’ve all been close to breaking point due to the fear of the virus, anxiety and fatigue, but we’ve got through by being there for one another, laughing and crying together. As a unit, we’re stronger than ever.”

Selina concurs: “It’s been an emotional rollercoaster, but we have so much empathy for each other and we’re like a family now. We’ve had superb leadership from Sharon Mayer throughout and all our nurses have been amazing, too. It gives you great faith in your team, knowing the resilience that’s been forged through what we’ve all been through.”

Listening to Becci and Selina, it’s clear from the emotion in their voices that they’ve been so tested in recent months yet remain completely dedicated to those in their care.

Becci said: “When a family thanks you for being alongside them from the very first visit to the last, saying how that continuity was made such a big difference to them, it’s incredibly fulfilling. It feels really special.”

On Wednesday, Becci and Selena – accompanied by Sharon and Claire – will be putting their best foot forward, walking from Brooklands to Turnchapel, via several St Luke’s charity shops, to raise money for our charity. They’re doing it as part of Make your own Midnight Walk, the fun, flexible ‘replacement’ for Midnight Walk, which has had to be cancelled this year due to COVID-19.

Sponsor our incredible Urgent Care Service ladies via Facebook donate.

Written by Dr Jeff Stephenson, Consultant at St Luke’s Hospice Plymouth

I didn’t pay much attention to the news stories about Wuhan, and the Facebook posts from fellow Christians there asking for prayer. I probably said a few ‘arrow prayers’ but didn’t really engage. It was all far away, and it wouldn’t ever impact us. I’m challenged once again to widen my circle of concern and engagement.

COVID-19 is now here. Changes we have been talking about around our ways of working get a kick-start as staff move out of buildings and embrace technology. Skype and PPE intrude on working days. I dislike both of them. The very thing that brought me into hospice is the human contact. Presence and proximity and touch are fundamental to palliative care. It’s not the same caring for the dying from behind the barriers of mask and gloves.

I read of the experience of Italian colleagues who found that palliative care had to be “brutally” adapted. Early on in our own experience it is restrictions on visiting that injure most, both families and staff. Seemingly inhumane and rapidly changing guidance, in the name of safety. And common sense in applying the guidance for a while goes out of the window, a testimony to the prevalent fear. Thankfully, pragmatism and compassion soon prevail for those at the end of life.

I sense the fear all around. I sense it amongst some of our staff. Society’s new mantra is ‘Stay safe’. Precautions are necessary, but what are such messages doing to the collective psyche in a culture that already idolises safety? I reflect on the early Christians who stayed behind in Carthage and other cities across the Roman Empire to care for plague victims, and the fruit of their service and sacrifice.

Stories from London start to mirror those from Italy, and we begin to take seriously the possible impact on our region. There is talk of a local Nightingale unit. This is a defining hour. Inwardly I sense that it isn’t going to be as bad as they are predicting here. We are not London. I tell colleagues that, based on prophetic conviction rather than science. But I prepare for the worst and trust for the best. And we need to support the wider healthcare community in this crisis or else the credibility of hospices may be in doubt.

We adapt our community and hospital support, and we temporarily increase the number of our beds (all with precious piped oxygen) from twelve to eighteen. We offer to help out with the Nightingale. The option of us taking COVID patients comes to the table.

I meditate for several days on worship and sacrifice. I am genuinely not afraid for myself. I dwell in Psalm 91, reciting it aloud every morning when I arrive on the ward, declaring its truths over the hospice, staff and city. But I am burdened by the possibility of losing one of my nursing or medical colleagues. It seems a reasonable sacrifice to lay down one’s life while trying to save others. But almost all our patients are already dying. Laying down one’s life to enable them to have a better experience? If I died as a direct result of my work, wouldn’t that be a terrible waste? A life poured out in service and worship is never a waste. Greater love has no man than this…..

I recommend that we isolate part of the hospice to take patients dying with or from COVID. It is the right thing to do but it will put staff in harm’s way. I tell my team that I will personally attend any COVID patients admitted to the unit, even if it means coming in when I am not meant to be at work. Their response is humbling and inspiring. They won’t hear of it. In fact, they will preferentially protect me, as my age puts me at higher risk.

The kindness of strangers is all around us in this crisis. It makes me believe that great blessing will come out of it. That and of course the certain knowledge that God works all things for good to those who love him (Romans 8:28).

As the weeks go by it feels like a bit of a ‘phoney war’. There have been cases in the city, and some deaths and the heart-breaking stories surrounding those. But the expected surge hasn’t happened here.

A month on there has been no need for our eight designated COVID beds, so we open them up again to general palliative care. All our services have been strangely quiet. Where are all the ‘usual’ patients? We have had hundreds of empty hospital beds, everything gearing up for a deluge that thankfully never comes.

Three months on and we still haven’t had a patient in the hospice with confirmed COVID.

Now the talk is about the ‘even bigger’ second wave that is going to hit us over the winter. Here we go again. I refuse to buy into that kind of fear. But the toll on staff is showing. Call it ‘COVID fatigue’ if you like, but fatigue seems too bland a description. There is a pervading weariness, bordering on exhaustion in some.

The ‘usual’ patients are coming back, but are generally more poorly than before, often more advanced. The turnover for all teams is ‘brisk’. The emotional impact of the drip feed exposure to suffering is intensified by the post-adrenaline crash, and defences on the line between self-preservation and the need to embrace it in order to engage meaningfully can seem all the more fragile.

But there is hope. And learning. And blessing. Some incredible blessing – He floods the darkness with brightness, even the darkness of the shadow of death (Job 12:22). We talk about and plan for restoration. I am immensely proud of those I work with. Our services will never be the same again – and that for the better. We have shown ourselves to be agile and flexible and resilient. There have been tensions along the way, but we have a greater cohesiveness across clinical teams. We have collaborated effectively with external services. We stepped up to the plate and responded to the need and we will reap the benefits of that. And we have been given the opportunity and privilege of redefining who we are and what we do going forward.

by Dr Jeff Stephenson, Consultant at St Luke’s Hospice Plymouth
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