For some of us, the worst days of our lives are spent in hospital intensive care units (ICUs) or cancer wards, there either for ourselves or our loved ones. There are some heroes who have chosen to spend their days making those experiences the best they possibly can be for those of us who find ourselves there.
A number of my friends are nurses, and after my last post Pondering death and what it all means I contacted two of them to ask them, quite simply, how the hell do they do it?
Andrea is currently a Haematology Trial Coordinator, but worked for a number of years prior to that in haematology and oncology nursing, and Jess works in a busy ICU.
Meet Andrea – Haematology Trial Coordinator
Andrea has been nursing in various forms since she graduated University for her first nursing degree in 1999. She is currently a Haematology Trial Coordinator in Melbourne, Australia, but before that had four years’ experience nursing in haematology and oncology units in various hospitals in the United Kingdom (UK) and Australia.
Haematology specialisation refers to blood cancers, whereas oncology deals with cancers in various organs.
In her current role, Andrea overseas patients referred for clinical trials for new treatments for blood cancers to see what works. To get into the trials, patients have to show the particular symptoms and demographics the new treatment is approved to try treating whether it is the type of cancer, stage of the cancer, age of the patient and so on. There are various ethical tests they must go through to be accepted into the trials. She also administers and monitors the trials for those patients accepted.
Andrea took this job because of its more stable, Monday to Friday, 8.00am to 4.00pm existence for her young family. As you will hear from Jess, switching from day to night shifts in hospital wards is exhausting and incredibly disruptive, which can be tricky raising a young child.
She went into haematology nursing because she wanted an exciting career. As a nurse you deal with multiple lines of chemotherapy and antibiotics so your patients are all different. You are learning all the time, and it is a fast paced environment.
Meet Jess – Intensive Care Unit (ICU) Nurse
When I spoke to Jess, she was just waking up and preparing to go for a 12 hour night shift in the ICU in a Brisbane hospital. I always wondered the thought process behind overworking medical staff and taxi drivers or anyone who holds our lives in their hands, when having them exhausted can cost lives.
Jess does six 12 hour night shifts per month and six 12 hour day shifts per month. She said it means she gets more time off to recover. She has an eight-day off stretch coming up soon which is not holidays, it is just how it is worked out given their rosters.
“To be honest, the eight hour shift roster for the nightshift was 10 times more fatiguing. You still need to do the same amount of nights, you just wouldn’t get that time off to recover,” Jess said.
She said if you do eight hour shifts, you would do something like eight to 10 shifts in a row which is way more fatiguing than having six on and a few days off.
“It is okay to work eight-hour shifts when you don’t have to work nights. Then an eight-hour shift pattern is brilliant. It is easy to do and I wouldn’t mind it at all,” she said.
“It’s just I don’t sleep on nights; that’s my problem. Like on Monday I had three hours sleep. I tried to sleep but couldn’t and had to go into work. Work was batshit busy and we had a ecmo patient (a heart-lung bypass) and I was in charge. There was no one else to be in charge so I had to be in charge. I was so tired and so stressed because I was so tired, I couldn’t think straight. I was in charge and it was all on my head and it was fucked Claire. It was honestly one of the most stressful shifts for me.
“Then trying to hand over in the morning, like I knew what was going on, but I couldn’t actually handover. I just sounded like a dickhead because I was so tired.”
Jess started off as a ward nurse, then worked in the UK in a high dependency respiratory ward for some time. She had a couple of shifts in an ICU and thought she would love to do that when she returned to Australia as it was a lot more technologically advanced and one of the pinnacles of nursing.
She has worked in the ICU of her current hospital for 14 years since 2007, is a bit burned out by the night shifts, but still loves the clinical work. It is extremely rare to get a Monday to Friday day job in the ICU so she is looking around for other opportunities to diversity, but mostly to get off nights. She is also studying for postgraduate qualifications in nursing while she works.
Coping with patients dying
Andrea is no longer in palliative work, but during her time in haematology and oncology wards, like Jess in the ICU, death was a constant part of her job. When I asked her how she dealt with dying patients, she said it was about the little things.
“You just have to try and make every minute for them as enjoyable as possible. People that are in a bed dying for weeks, we sometimes got out and washed their hair and gave them a head massage when it wasn’t really busy. We would try and do little things that sometimes they wouldn’t even know, like paint their nails or other things hopefully they would appreciate and make their life better,” Andrea said.
“The first few you do take home with you,” she said on the effect patients passing had on her. “I spent so many nights crying my eyes out after someone passed around me, and I’m still capable of doing that. After doing it for so long, and ICU is like that because there are a lot of people that die in there, I don’t know how to explain it, I guess you just get tougher and it doesn’t sort of affect you as much.
“It took a long time to get used to people who knew they were going to die, and I’m putting my foot in it every time and saying really dumb things,” she continued.
She said there is a palliative care team, they can do palliative care and end of life courses, and phone counselling is available.
“It is nice to think that a course could help, but it doesn’t. It can give you some ideas, but it is not going to change much. If there has been something really traumatic, they often have a debriefing. It is often for something really traumatic like if a colleague has killed themselves.
“As a nurse you get really close to the other nurses. I think most of my besties are nurses. Because we all do the same thing, we understand if someone is having a rough time of it, or if someone is having a rough time in their own life. As a good manager, you would not think about giving them someone that was dying that day. Hopefully.”
For Jess in intensive care, the environment is very different, and often the patients are not conscious, or they might be delirious after an operation. It still affects her but she gets on with it.
“As much as it is horrible, I mean, you obviously need to distance yourself from it and it is very sad. It is one of those things that has got to happen and you try and support the family, and try and make it as meaningful as possible,” Jess said.
“It is really hard to have a good death in ICU in such a technological environment. It is quite cold and callous. Then you have got the machines and things like that. But if you can try and support the family through, you actually get a sense of satisfaction when you’ve done a good job; that you’ve actually got the family together to say goodbye to their loved one. You’ve got that focus on so it is easier to deal with.
“It is harder is when you have young patients who died in traumatic circumstances. Sometimes that’s really hard to deal with. We do care for quite a few patients who eventually go for organ donation. There is a lot of preparation and gathering the family to say goodbye which is hard. I guess it can be very traumatic.”
Jess also notes there is support available but she hasn’t had to use it yet and deals with it in her own way.
“But I haven’t had some of the super, super full on cases like some of the nurses.”
“At the moment there is a big government push for mental health and wellbeing. I cope with it by talking to colleagues, which you shouldn’t because of confidentiality, but you do talk to your mates and destress and debrief that way. There are a lot of deaths, but that is all part and parcel of it.”
Patients whose deaths impacted a little more
Inevitably there were some patients who affected them more than others.
“There was this one lady,” Andrea recalled. “I knew her from the chemo day unit. I had known her for years and years and years and I knew her husband really well. I knew her kids. She would have only been in her early 30s and she had breast cancer.
“She was such a fighter because, well she was, but her kids were still really young, like seven and 10 or something. And she was just such a cool chick as well.
“I remember the day before she died, they tried one last thing. There was something on for her. It could have been a birthday and she didn’t want to die on someone’s birthday. They gave her a mini dose of chemo just to try and get her through, but it didn’t work. She went unconscious and passed away.
“That was really challenging. All of us were crying in the room with her husband. A couple of months later her husband walked back on the floor again, and I saw him again and just burst into tears again because it brought everything back.
“He said, ‘I just wanted to come up and see you guys and just be back here.’ I was really young at that point and I really struggled to know what to say to him. But I think we just hugged it out and cried.”
For Jess it was someone she met only briefly, but who has stayed with her.
“There’s one case that was really hard because I was again on night shift, and it was a younger patient that died,” Jess told me. “Normally when they are that sick, they’re not so awake. And she was really awake and really alone because her family couldn’t get there and she was freaking out. And they decided to tell her that she was dying and there was nothing we could do and that was incredibly traumatic.
“And I didn’t know how do support her, and I didn’t get a lot of support from my senior nurses at the time. It was incredibly hard.
“It would be different now, but I just didn’t know what to say or do. I should have got her partner in and, yeah, it was just so awful. She was so awake and then she died at 7.00am which was the end of my shift.”
Jess said with her experience now she would have spoken up more for her and brought in a support person from the hospital as she wasn’t particularly religious. She said they had to tell her she was dying as she was asking and had a right to know. She said the doctors wouldn’t let her sedate her either so she was quite distressed.
“I wasn’t supported and I didn’t support her. That’s pretty shit. So that one always sticks out in my mind,” Jess said.
“It makes it easier if you have a focus on getting the family together and supporting the family and making the patient as comfortable, looking as comfortable and nice as possible, and getting everyone around. Then you can put all your energy into that instead of… You need to distance yourself otherwise you will get emotionally involved and upset and things so…
“When you hear the family grieving, you know, and they all come in and they grieve, you’re grieving and crying. It just sends chills through you, you know? That’s my job.”
Heroes wear nurses uniforms
Both Andrea and Jess said the patients generally cope better than their friends and families.
“I mean, they’re probably not thrilled about the idea (of dying), they’re just getting on with it,” Andrea said. “If we’re still pushing on with treatment, then there’s a lot of fear whether it is going to work.”
She then went on to say when they are close to death, they spend a lot of time unconscious. Patients in the ICU are also often unconscious for the duration of their stay.
“It is really the families that are impacted at that point,” Andrea said.
“You’ve got to keep them in the loop. You’ve got to keep telling them what is going on and have family meetings and stuff like that. But a lot of it is driven by what the patient wants.
“I had a patient recently who I think has passed but I don’t know for sure because he wasn’t with us, but we had him for his last line of treatment before he went palliative. He didn’t want his family to know. He had not had his family involved. He had been on chemo for 11 years and his family had no idea. They knew he had cancer and they knew he was on treatment, but he never wanted to worry them.
“At that point, what do you do? Do you tell them when it is against the patient’s interests? You don’t.
“There is a lot of patient support after the patient has gone unconscious. It is all those little things I was saying before, like washing their hair or giving them a hand massage and that sort of thing I think that helps the family as well, knowing they are being really well cared for and taken care of in their last moments. Having them look peaceful and clean and neat and, all of that sort of stuff is really important.
“We try to answer as many questions as possible. We get spiritual people involved which is great because even for atheists they say, ‘we can just talk.’”
Jess also said communication and compassion are key.
“Our social workers are brilliant. They are amazing people. We would be stuffed without them. They do such a great job in supporting them because obviously in times like this when a family unit is a bit messy or complicated, it really, really flares things up. You’ve got some people not talking to each other, or you know, they can’t cross paths or they will end up in fisticuffs in the waiting room, so just trying to deal with all of that.
“Keep them in the loop, get the doctors to update them,” Jess stressed.
“Often the patient will arrive and, you know, we’re in there cleaning them up and trying to stabilise them and they are out in the waiting room. I like to go out there and let them know what is happening, that they’re here, or what we are doing so they are not sitting there waiting for hours not knowing what’s going on. I always try to do that because I just couldn’t imagine how stressful that would be sitting there waiting for your loved ones.
“Then you end up with the messy family members, coming in drunk at all hours of the night so you’ve got to deal with that,” she adds.
Advice to cancer patients
“Trust your doctors,” Andrea said when asked what advice she has for cancer patients. “If you want a second opinion, get a second opinion. There are generally other options for treatments. Try to avoid not taking chemo then going and taking peppermint oil, you know?
“I guess decide early if you want it to be prolonged, or if you just want to go out gracefully.”
Advice for those thinking about ICU or haematology/oncology nursing as a career
Andrea’s advice for anyone considering being a haematology nurse is clear.
“Do it. It is an amazing career. It is really fulfilling and rewarding. I mean, it’s hard work, and it does pull on the heart strings, but if you want to feel good about yourself, at the end of the day, you will see that,” Andrea said.
Jess has a lot to say to nurses considering an ICU career path.
“I would warn them it is going to be the hardest 12 months because they have a 12 month transition program. But if they worked in our unit, they would get a lot of support, we are really a great unit to work for. We have a really good learning environment. Everyone is willing to teach. But the first 12 months is incredibly stressful and you have to be prepared to put the work in.
“You will see some full on things, and some crazy, crazy things, and it’s stressful, but you’ll get there and it is very interesting,” Jess continued.
“There’s so many things that still interest me. You are always learning. It’s not like you just do this 12 month course and then that’s it, you are always learning something, and relearning because you forget. But you can’t just go and expect to do your training and that’s it.
“Definitely hang in there because it is worthwhile and rewarding. It is a great career.”
Both of these incredible women have been in my life since long before they were nurses, and both could not be more perfect for their callings. I feel incredibly lucky to have them in my life, and if I end up in hospital for any reason (which let’s face it, is not so unusual for me) if the nurses and support staff taking care of me are half the humans these two are, I will be extremely lucky.
Until next time!