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Anita—Registered nurse
Palliative care
Metropolitan Melbourne

‘If needed, the pop-up mortuaries will go up in the carpark. We can erect tents there if we need extra beds.’ The clinical services director was speaking over Zoom. I sat with the director of palliative care, cramped together in her office, wearing surgical masks. We were both terrified by what we were hearing. It was early 2020.

‘Do we have enough morphine and syringes?’ I’ve zoned out after yet another staff meeting on Zoom. I’m on an isolated beach as a tsunami gathers speed, ready to hit me with full force. How on earth would I know how much morphine we would need? What kind of numbers were we expecting?

I had read news of doctors and nurses around the globe dying from COVID. The images coming out of Europe were terrifying. My nursing friends in the UK had started to get sick. I read messages about their hospitalisations, requiring high-flow oxygen. They reassured each other that they would pull through, but they sounded so afraid.

My old UK ward sister called me before the first COVID wave hit Australia, saying, ‘It will be terrifying but, as time passes, so will the feelings and you will find your new norm.’

How right she was, until the nightmares began. In them, I found myself alone, tending to several patients dying on mattresses on the floor because we had used every hospital bed. There is only one syringe left. It is 50 ml and filled with morphine. I go from patient to patient, administering a small amount as they struggle to breathe. We all work in isolation. Most staff have left or died from COVID and our hours are long. I dreamt this dream over and over for the first two years of the pandemic. It remains vivid and raw, despite never being a reality.

Sadly, the reality was equally confronting.

In my role as a palliative care team leader in a public hospital, I witnessed the arrival of aged care residents who’d contracted COVID. They were very sick, sometimes actively dying. They couldn’t be cared for in their homes, so were now also isolated from their loved ones. They were only able to see our eyes, eyes of the strangers who cared for them, behind masks.

There is one incident I recall. A single light shining on the face of a dying patient. The room, devoid of any other light, seemed vast. Standing in the ante room, I peered through the window watching their chest rise and fall rapidly. I summoned the courage to enter the room for the first time. Like many other patients I met, they’d been referred to palliative care late in their illness, leaving little time to alleviate their suffering.

This image has had a profound effect on me. It has imprinted itself on my brain. This was not the dying I knew. The bedside ritual of loved ones sitting, sharing memories and having time to say goodbye was no longer possible. Phone calls to families were met with mixed responses. Many families were angry and distressed that they couldn’t be present.

It is only when you are fully gowned, gloved, masked and behind a face shield that you really appreciate those basic nursing communication skills. To hold the hand of a dying patient, soothe their sweating brow with a refreshing wash or stroke their arm feels so removed when donned in PPE.

Attempting to break down these barriers, I took a mask home and practised in front of a mirror. What did my eyes look like when I tried to communicate? How did I exhibit compassion, joy or concern through my eyes? I studied the expressions my eyes and eyebrows made. I wondered how I would exhibit compassion while in PPE.

I realised our eyes, voices and hand gestures had now become our greatest tools for offering compassion, and that, despite the limitations of PPE, I had found a way to do so. Unconsciously, I had often placed my hand over my heart when talking with patients as a way of expressing my honesty, empathy and compassion. COVID had not taken that away from me.

Donning PPE and scrubs created other barriers. I soon realised we all looked the same. It was hard to differentiate between doctors, nurses and allied health. I printed my name in large letters on the front and sides of my face shield to try to break the barrier created by the face shield and the N95 face mask.

It wasn’t only our patients we felt responsible for; it was our colleagues and teams. Early in the pandemic, we were unsure if the virus lived on our skin, clothes, hair or surfaces. Returning to the office there was genuine concern: ‘What if I’ve taken off my PPE incorrectly and infected my team?’ The twice-daily ritual of cleaning our office surfaces began.

We felt fear for our families. Heading home was filled with huge trepidation. The overwhelming sense of apprehension as I opened the front door was palpable: What if I carried COVID unknowingly into our home? What if I infected those I loved? There were reports of tigers and lions at New York’s Bronx Zoo testing positive for COVID. I feared I would infect our cat!

Each night when I arrived home, I would remove my scrubs inside the front door and place them in a sealed container. Shoes in a separate container. I showered and washed my hair, hoping that any trace of COVID on my body was removed. I was terrified that my regular contact with those dying from COVID would result in me losing the ones I loved.

I struggled with the images I saw during the COVID pandemic. It awakened dormant images from the AIDS pandemic when I had worked as a student nurse in the UK. Unsure then of how it was transmitted, I recall waking to find myself scrubbing my hands at the sink in my room. I worked predominantly with young men dying painful deaths, many estranged from their families. Many felt guilt and shame as they became aware that they’d infected others. It was heartbreaking to watch them dying with no cure in sight.

Three years into the COVID pandemic and I haven’t had COVID, yet I remain ever vigilant. Memory and nightmares are powerful things.