We know the hell we’re in. It will get worse before it gets better | Melbourne ICU nurse

Jennifer E. Engen

My therapist says it’s OK that sometimes I feel dead inside.

I’m a critical care nurse. I worked in intensive care for all of 2020 and 2021.

I’ve seen people die without their family. I’ve cried at work. I’ve scrubbed salicylic acid into my face before going to work so that my N95-induced acne doesn’t scar.

I’ve held my pee because we didn’t have enough staff to watch my unstable Covid patient. I’ve supported incredible nurses brand new to ICU with extremely sick ventilated patients. The cognitive load used to bring me to tears.

Now I just feel weary.

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

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

When fearfully bringing this up in session, my beloved therapist told me that this is a defence mechanism to prevent being overwhelmed.

As much as I am an advocate for meditation, yoga and self-care practices at the best of times, there’s not a mindfulness practice that slaps a Band-Aid over the pandemic itself.

My non-medical friends get angry on my behalf at protesters and anti-vaxxers, because I don’t have the energy. I obtained my critical care registered nurse qualification in 2020 after nursing in ICU for a few years, and almost all of the colleagues I graduated with have attempted to leave intensive care since.

The vast majority have been redeployed back to ICU. Some ICUs have been birthed from the pandemic, and more have opened additional beds and floors as we strive to cope with the sheer number of patients.

Those beds need staff, so doctors are pulled from wards, nurses pulled from theatres, and the “experienced” staff are darting between their own patients and those of junior staff to support them in the incredibly complex care that an intensive care patient requires.

An ICU admission is a nuanced beast. People haven’t stopped having strokes, heart attacks, car accidents, transplants and any number of other treatments that we can perform.

We need to titrate life-saving medications, prioritise daily goals, manage a ventilator or dialysis, and that’s not even mentioning the higher-tech interventions like heart and lung machines.

Traditionally, these specialised treatments required specialised training – but in the absence of appropriately trained and energised staff, and with an abundance of patients, we make do.

Redeployed staff members learn on the fly and we do our level best to support them. Through all of this we strive to treat our patients with the humanity they deserve.

We move the breathing tube regularly so it doesn’t create sores on the lips. We roll our patients to prevent pressure areas and keep them comfortable. We brush their teeth, we wash their hair, we fill up a basin and shave their face so they are somewhat recognisable for a telehealth with their family (who are still sick and isolating at home).

At times, family members will drop off pictures of their loved one to put in their cubicle. I’ve found myself staring at those – trying to find similarities between the animated and joyous photograph of someone’s father and the sick individual in a hospital bed.

It sounds selfish to say but it’s hard on the body.

An N95 for 12 to 14 hours leaves you with dented cheeks and the raspiest voice imaginable. Interventions such as proning (turning a patient on to their belly to maximise the interaction between oxygen and blood) can be physically demanding.

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

I’m 24 and, strangely, I have spider veins now.

Even though I am now splitting my time between intensive care and supporting those isolating at home with Covid via telehealth, I have seen the system groan under the weight of all it needs to support.

The guilt I felt in reducing my contact time in intensive care was damn-near insurmountable but I realised I was not able to provide good and thorough care if I was completely burnt out.

Preservation of energy became a priority for healthcare workers. It has been heartening to see the vaccine work, to hear those at home have mild or even no symptoms, and to find people get better quickly.

In both the hospital and the community there are always some who bring up ivermectin, or go retro with hydroxychloroquine, but overwhelmingly people are vaccinated and ride out their symptoms at home with minimal issue.

Sure, our system is still not there yet. Testing sites are closing before they even open due to lines more than a kilometre long. Pathology centres work 24 hours a day. Rapid antigen tests are sold out almost everywhere. GPs don’t take new patients and the wait for 000 can be a terrifyingly long time.

The work is not done and it won’t be for a while. There is a camaraderie, an even darker sense of humour, pervasive among medical people. We know the hell we’re in and we know it will get worse before it gets better.

Sometimes I enact a no-Covid talk policy. It helps, because sometimes I feel things deeply again.

https://www.theguardian.com/commentisfree/2022/jan/07/we-know-the-hell-were-in-it-will-get-worse-before-it-gets-better

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