Being Well in Difficult Times- Zoe

Zoe is a registered nurse working in theatres. She has elderly parents and a young son. How is she staying so positive in the face of CoVID-19?

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It’s always helpful to hear how other people cope.  Over the next few weeks we are dedicating the Being Well blog to a series called Being Well in Difficult Times.  We asked a range of health professionals 3 big questions to see if there was anything we could learn from them. 

Zoe, what are your biggest concerns about the pandemic?

My biggest concern during the pandemic was for the potential vulnerability of my 82 year-old father who was living in an aged care centre here in Melbourne. I was concerned about him on many levels.

In the early days of the lockdown period when there was such a great unknown, and we wondered if we would go the same way as Italy and other parts of Europe, I was worried that a staff member or visitor might inadvertently bring the virus into the facility. That it would infect not just my father but many other residents there. That it would sweep through the home and cause great suffering and fear, and possible death. I believed that factors such as the shared dining room, lounge room, some shared bathrooms and staff who worked between many residents, all increased the risk for transmission. In the early days, individual hand sanitisers that usually sat in a bracket on entry into every single resident's room were removed as they were being stolen by unknown persons. Although there were sanitisers in other areas, this caused me some heightened stress as I was convinced that if you make it hard for staff or visitors or residents themselves to easily wash hands, then the chance of this being skipped increased greatly. In real terms, if someone has to walk down a corridor to find a sink with soap or a hand sanitiser, then they may not do this.

I worried that if the virus took hold at the aged care centre, then the residents were stuck, with little protection and defences. Personal protective equipment was not readily available in big numbers in all Melbourne hospitals, much less in aged care centres. Also, it was well known that to wear such PPE correctly there needed to be extensive training for the staff. It had been documented from around the world that this was a weak point in efforts to prevent cross infection within aged care centres. Also, I knew that it was not unusual for staff who looked after vulnerable members of the community whether that be in a hospital setting or a care home to come into work when experiencing virus like symptoms. Although not ideal, this was a known reality of real work life.

Many health care workers fear some reprisal, real or imagined when it comes to upsetting or disappointing their manager. This leads them to take risks with the health of their colleagues and their patients/residents. There would also be concern that clients will suffer if the sick staff member is not able to be replaced and the added strain to colleagues who continue to work that day and ‘carry the load’. There may be a lack of sick leave hours accrued, or sick leave entitlements so that the financial impact for days off work sick would be a big concern.  Even just having to find a GP open and appointment times available to fill out a medical certificate can add to the practice continuing. I knew that even during this Coronavirus pandemic, all it took was for one person to do something that was against all current health advice, and there would be a big problem for the residents at my dad’s care centre.

My second great concern with regards to my father was the potential for social isolation from his wife (my mum) and from his five adult children and many grand children who visited frequently. I was worried that he would feel sad and abandoned and that his life would lack joy. In all honesty, my greatest fear was that dad would get the virus, suffer, and die and that he would feel alone and abandoned at the end of a long and wonderful life. And that all our memories would be tarred with the knowledge that this was his thoughts........Dad's regular visits from mum and seeing his family were incredibly important to his enjoyment of life. Also not being able to go outside to experience the fresh air in the local park, to go for lunch at a favourite restaurant or just stand and watch the chickens and observe the work in the garden at the home of  one of his children were the things he was being denied during the lockdown.

 

How are you managing your anxiety about all this?

Dad’s aged care centre was following Australian Federal Government guidelines, and limited the amount of visitors to two a day (at the same time) and for no more than one hour. We felt fortunate however, because there were many facilities in Australia and around the world that barred entry to all visitors during this lockdown period. As my mother felt concerned for her own health if she went out in public, she did not visit Dad during this eight-week period. My brother and I then stepped up and visited Dad more often to keep him feeling remembered, to chat and share concerns, look at video messages and photos from other family members and old friends. We wore masks during the visits, sat an appropriate distance away, and tried not to hug him on leaving. On some occasions I broke my own rules through careless thinking, and I hoped that I had not exposed him to harm.

Dad told us how he had won at tennis! Up on the Mezzanine floor. Against the" old ladies". 'They were tough" he said. He introduced me to his favourite carer Jivan. "My manager", Dad called him. Jivan did all Dad's showering, shaving, dressing, toileting, etc. Catholic church services were cancelled during the lockdown but were eased so that five residents could attend. This gave Dad much comfort during this time. Zoom calls were set up by the staff at the home, and after three weeks, mum and dad had their first live face to face meeting. That was a great moment for my parents, and definitely was a wonderful and important action taken by the centre to keep up the spirits of their residents during this difficult and strange moment in time. The Zoom calls continued weekly.

When the strict lockdown restrictions began to ease after about eight weeks, and as we as a family came to understand that this virus was not going anywhere, we decided to accept some of the risks that were inherent with living with the virus in our community. Although all could change in the near or medium term future, we have allowed more visitors to see Dad, my mum is going now to see him regularly, and we have begun to bring Dad out for visits to family member's house. On a small limited scale for now, but a big advancement on where we were before. Dad is happier. 

During these last eight weeks I have continued to work as a Operating Theatre Nurse at a large specialist hospital. From the beginning of the lockdown, our manager put us into four different teams, and we have been rostered one week on and one week off thereafter. This was done to allow for any nurse who tested positive for Cronavirus to self-isolate with all other members of the team. The nursing staff working on the alternate week would then step in and take over the work. There was a lot of anxiety and concern, especially in the early weeks of the Coronavirus in Australia, by the surgeons, anesthetists and nursing staff about contracting the virus from our patients, and perhaps from each other. As most surgery is potential droplet and aerosol generating, the risks were considered high. We did daily drills on, not just how to put on and take off all PPE safely and correctly, but real-time role playing of every person's individual and collective actions during general anesthesia to reduce virus spread to staff. During this time, we continued to do urgent and semi-urgent surgery. Our non-urgent elective surgery did stop entirely at this point.

My personal concerns/anxiety within the workplace were maybe surprisingly low. For two reasons. We did not see the expected throughput of patients diagnosed with Coronavirus, so the risk to ourselves as an 'essential worker' now seemed much lessened. Although obviously there may be the asymptomatic carrier who gets through into the Surgical Unit without detection. Also, we started to get really good levels of PPE as the weeks went on. More of the highest quality N95 masks, full length gowns, face visors etc. That gave me more confidence and less anxiety about turning up to work during this time.

Our weeks of 'Working from home' during the lockdown period should rightly be called 'Studying from home'. We were very fortunate as we were paid our regular wage to complete a variety of online courses relevant to our work. Our nursing management encouraged us all to find courses in areas of interest that would help us be more informed, more knowledgeable clinicians. Hopefully to benefit our patients in the future. Initially I did short courses on Coronavirus through the World Health Organisation website. But I then moved onto to doing 'The Critical Care Skills' course for nurses run by The University of Melbourne.  This was a 20-hour certificate course and was really hard! I had not done such an intensive course since my nursing degree, more than 25 years ago. My working life has been for the last twelve years, a rush to bring our son to childcare or before school care by 7am , drive to the city to start by 8am, work a nine hour shift, and race back home to the suburbs to pick up our child from after care by 6pm closing.  Dinner to prepare, some down time, and start all over again the next day.

During this lockdown period I felt we had been living a “slow” life. I definitely don't mean this in a particular negative way. Whilst our 12 year-old son attended to lessons via Google Meet with his high school teachers in our dining room, I studied and answered questions for my online courses in the lounge room. At various times, I would stand up to make a cup of tea, eat some food or wander outside. To rebound the balls when our son practiced his basketball shooting for goal, or to weed, plant, mulch in the garden. Because I hadn't been racing off to work every day, there was more time for morning stretching, yoga, some jogging, evening walks and baking (way more baking and cooking). No basketball training and games to drive to and from. Less shopping, much less car driving, less appointments and less spending! We played lots of board games as a family, made food art, tried out online jigsaws, and rang people to see how they were coping. Especially my mother. I probably rang her every day. 

I think my anxiety levels fluctuated over those lockdown weeks. Because my partner and I had not lost our jobs and therefore not been put under mortgage and bill stress, we had avoided that level of acute stress the financial pressure. Also, because the level of illness and death in Australia was very low for Coronavirus at that time, we were not subjected to the severe anxiety from worrying about having close friends or family members fighting the disease. Because we had the warm sun, the big back garden to work in, and the time given by our employer to 'Study from home', this freed up many hours to try out new things that benefited us both mentally and physically. There was plenty of joy in just living in the moment: being healthy, working, studying, exercising and playing together as a family. I stopped complaining about the big ‘negative’ changes to our lives and realised that there were many positive outcomes too. I realised too that this time would end, and that the world did not end with the stopping and curtailing of regular experiences and pursuits.

Do I think my experience of this bit of history might make a difference for me for the future?

I would say yes, because the most stand-out thing for me was that since I had been 'encouraged' to do online courses by my employer, I realized that I actually enjoyed learning something new, that I was capable of learning something new and kind of hard, and that I felt challenged by the experience of further learning. As a 54 year-old, this has given me some real impetus to finally bring tertiary study back into my life as a necessary and rewarding activity.

As a complete sideline to all this, watching and being an integral part of our son's efforts to study, learn, and keep organized during Term two of remote learning as a high school student, we have as parents appreciated to a greater degree his strengths and weaknesses with regards to all things study related. With this new and more deep understanding we feel we can support him and be more understanding and more realistic with his endeavors for the remainder of his Year 7 year. Our son initially found the new arrangement difficult, but has matured greatly during this time and will I'm sure be forever appreciative of the efforts and unbounded patience of his teachers to make it work so well, the communication with his newly minted friends who have kept him smiling, and hopefully remembering the interest and support of his parents to make sure he did not lose his way. And kept him well fed and loved.....

 

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Dr Jan Orman

Jan is Sydney GP, private psychological medicine practitioner in Sydney’s inner west and a GP educator for Black Dog Institute.

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