Friday, April 12

We know what the hell we are in. It will get worse before it gets better | Melbourne ICU Nurse


My therapist says it’s okay for me to feel dead inside sometimes.

I am an intensive care nurse. I worked in intensive care throughout 2020 and 2021.

I have seen people die without their families. I cried at work. I scrubbed my face with salicylic acid before going to work so my N95-induced acne doesn’t leave scars.

I held my urine because we didn’t have enough staff to keep an eye on my unstable Covid patient. I have supported amazing new ICU nurses with extremely ill ventilated patients. The cognitive load used to make me cry.

Now I feel tired.

I started noticing it when I couldn’t bring myself to really feel the emotions. I might say, “Oh that’s sad,” when I talk about something, but not feel it.

According to traditional descriptors of burnout, compassion fatigue is a mainstay that most often affects caregivers.

When I fearfully mentioned this in the session, my beloved therapist told me that this is a defense mechanism to avoid feeling overwhelmed.

As much an advocate for meditation, yoga, and self-care practices at best, there is no mindfulness practice that will put a band-aid on the pandemic itself.

My non-medical friends get angry on my behalf with the protesters and anti-vaccines, because I don’t have the energy. I got my intensive care registered nurse degree in 2020 after ICU nursing for a few years, and almost every colleague I graduated with has tried to leave intensive care since then.

The vast majority have been reassigned to the UCI. Some ICUs have been born out of the pandemic and more have opened up additional beds and floors as we struggle to cope with the large number of patients.

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Those beds need staffing, so doctors are taken out of the wards, nurses are taken out of theaters, and “experienced” staff are thrown in among their own patients and those of junior staff to support them in the incredibly complex care they provide. requires an intensive care patient.

An ICU admission is a nuanced beast. People have not stopped having strokes, heart attacks, car accidents, transplants, and other treatments that we can do.

We need to value life-saving drugs, prioritize daily goals, administer a ventilator or dialysis, and that’s not to mention high-tech interventions like heart and lung machines.

Traditionally, these specialized treatments required specialized training, but in the absence of properly trained and energetic staff, and with large numbers of patients, we managed.

Redeployed staff members learn as they go, and we do our best to support them. Through it all, we strive to treat our patients with the humanity they deserve.

We move the breathing tube regularly so that it does not create sores on the lips. We roll our patients to avoid pressure areas and keep them comfortable. We brush their teeth, wash their hair, fill a basin, and shave their faces to make them somewhat recognizable by telehealth with their family (who are still sick and isolated at home).

Sometimes family members leave photos of their loved ones to put in their cubicle. I found myself staring at them, trying to find similarities between the cheerful, animated photograph of someone’s father and the sick individual in a hospital bed.

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It sounds selfish to say, but it is hard on the body.

An N95 for 12 to 14 hours leaves you with dented cheeks and the huskiest voice you can imagine. Interventions such as proning (turning the patient face down to maximize the interaction between oxygen and blood) can be physically demanding.

Face shields can create tension headaches. Double gloved hands struggle to open the packaging and the reliance on everyone outside your glass-walled cubicle to bring everything to you creates a sense of helplessness.

I am 24 years old and strangely now I have spider veins.

Although I am now dividing my time between intensive care and helping those who isolate themselves at home with Covid via telehealth, I have seen the system complain under the weight of everything it needs to support.

The guilt I felt in reducing my contact time in intensive care was almost insurmountable, but I realized that I could not provide good and complete care if I was completely exhausted.

Preserving energy became a priority for healthcare workers. It has been encouraging to see how the vaccine works, to hear that those living at home have mild or no symptoms, and to find that people are getting better quickly.

Both in the hospital and in the community, there are always some who mention ivermectin or go retro on hydroxychloroquine, but most people get vaccinated and resolve their symptoms at home with minimal problem.

Sure, our system isn’t there yet. The test sites are closing before they open due to lines over a kilometer long. Pathology centers operate 24 hours a day. Rapid antigen tests are sold out almost everywhere. GPs are not accepting new patients and the wait for 000 can be excruciatingly long.

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The job is not finished and it won’t be for a while. There is a camaraderie, an even darker sense of humor, ubiquitous among doctors. We know what the hell we are in and we know it will get worse before it gets better.

Sometimes I enact a policy of not talking about Covid. It helps, because sometimes I feel things deeply again.


www.theguardian.com

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