BLOG: COVID diary of a hospice Consultant
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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