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The Simple Truth About Nurses

Dear Nurses

In another world I would have been an engineer sitting behind a computer solving other management problems.

But thanks to an inspirational ICU nurse I changed from engineering to medicine.

Now in this world, as a doctor, I am a humble part of the team at Kingsway Hospital that is managing the Covid-19 threat.

We are all, the public and health care workers, faced with the stress of the effect of the pandemic. There are economic fears of retrenchment and real money issues. Then there is the psychological stress of losing our right to move as we please, and with whom we please. 

Covid-19 is a disease whose spread we cannot control. Even worse, some  patients who get a severe infection cannot be cured, and will die in our care. I ask the public to think about the precautions we have to take to reduce the spread of the virus in our hospitals. We have to be vigilant: anyone can spread it in the asymptomatic carrier stage. We screen endlessly. We wash our hands so often our skin cracks. We live in masks, and as the risk increases we spend the day and night in uncomfortable protective gear. I challenge any member of the public to watch a video on the donning and doffing of our PPE (Personal Protective Equipment). Some of this process is not entirely new to people exposed to the operating environment. But I can tell you, as a surgeon, the new processes are not easy for me, and are much more demanding and tiring.

The nurses have been forced to learn so much that is new. This is not like dealing with a superbug in the sense of the word before Covid-19. Superbugs like MRSA and CRE remain a challenge for all hospitals. The management of those is difficult, and we have extended and increased our systems of safety and control for the Corona Virus at least a hundred fold. 

Some of our nurses have been in isolation, and fewer have actually been ill with the virus. Thank you to them for taking time out of your life to keep us safe. Thank you for accepting sometimes blunt orders from your hospital. I understand the trauma you have been exposed to. 

Some of nurses have temporarily lost the job they were so good at. I think especially of the theater staff, where no operations have been undertaken in over ten days. I know you want to contribute. The only way we can contribute is to train even more to deal with this threat.

Other nurses with great clinical skill have been put on point duty to man sieve and screening areas for 12 hours at a stretch, exposed to the elements. Durban is not such a mild place if you are outdoors all day. Thank you for being so patient with the public that still come in needing our hospital.

We all have to pay so much more attention to detail. The equivalent performance by a sportsman or woman would be a hole in one or an ace with every shot, or a goal with every penalty shot in soccer. There is no one that can do that. Let’s not beat ourselves up about failures from which we can learn and do better the next time.

I know we all use Facebook to stay in touch with each other. A lot of good comes out of being in touch with people far and wide, and being able to share your life with them. 

What’s happening with the negativity toward nurses by some members of the public on Facebook is just not right. But Facebook gives strength to the weak, and should never be the judge of the calling you all hold dear to your heart.

What is happening in our community with nurses being ostracized in public and common areas speaks to the lack of understanding of what we face with this pandemic.

Those people, like us, need to learn to manage their stress and ask for help. There is no need take it out on the nurses who will care for them when they are sick.

Our nurses are the superheroes of our new world. Take some time to acknowledge them. 

They will be the ones looking after your loved ones in hospital.

For those patients that die in our care the nurses are the closest they will have to family. They will be with them when their family members who want to be close, cannot. Many of the nurses will feel the pain of their passing as keenly as family, with the added weight that they may feel they failed. They have not failed.

The disease is the killer. Not the nurses. That’s the simple truth about nurses.

Winner of the 2014 MPS/ SAMA Photographic competition
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A Dream in the Time of Covid

Is this all a dream?

Six weeks ago I was placed in self-isolation by my hospital for ten days.

“I had a dream that you asked me to polish your shoes” my maid, Londiwe, messaged me a few days later. Now you should know I have never asked her to shine my shoes. Erasmus does my shoe shine at the airport regularly (I fixed his shoulder years ago so please look out for him at King Shaka Airport after lockdown). I had asked Londiwe to stay away from work until I was cleared of a possible Covid-19 infection.  Londiwe in Zulu means “protected or kept safe”; I truly hope that both of us stay safe.

I knew immediately what her dream meant.

It has been a long journey and we are still in the early hours of the first morning of the months that will unfold in social and economic upheaval. I have found it important to choose my words carefully during this time. This pandemic is a global crisis but I believe it will change who we are and how we do things for the better. At a price, I know.

Yesterday at the screening entrance of my hospital I saw the matriarch of a Zulu family with her daughter and twenty-year-old grand-daughter. They were tense, as most people are now, and were huddled too close around the Perspex shield protecting the nurse attending to them.

In my surgical mask outside the hospital I introduced myself, and then asked them to move apart and stand two metres behind one another. There was a sense of loss and fear in their eyes, from old to young. 

“I’m sorry” I said, “we need to keep social distance to protect each other.” They didn’t move apart and I stopped myself from being authoritative. 

“Can I help?” I am saying that many more times than I used to. I act on it many more times as well.

I cannot remember what the nurse said. I should. It was important. But it was a blur of “they have come to see or pay last respects” to the grandmother’s husband who had died in ICU. 

No visitors are allowed into the hospital now. No one can be at the bedside of a dying family member, and no one can gain closure by seeing or touching the cold lifeless body of the departed.

“Please wait here. I’m afraid we cannot allow you in. I will find a manager to help you”. You have to speak clearly and loudly in a surgical mask in order to be heard. That removes any tone of sympathy. The assistant nursing manager grasped the urgency and went out immediately to explain. As I turned to look back the daughter and granddaughter walked away, their souls battered by the new normal. The next I saw was the nursing manager opening a big official book, with carbon copies, for the matriarch to sign away the body of her beloved outside the hospital.

I was shattered. Even in my first world hospital I had once seen a young man reverently carrying a branch of the Mpafa tree, the Zulu Tree of Life. A Straight thorn points to the future, while a curved throw connects us to our past. He was taking a branch to the ward where his father had died. He would rest it on the on the body and capture the soul of the departed and take the branch home to tuck into the eaves of the homestead. On the way home he would buy a ticket in the taxi for himself and the spirit in the branch.

In this dream in the time of Covid I thought we could allow families to bring a branch of the Ziziphus mucronata,  the Mpafa tree, and we could put it in yet another safe plastic bag, and leave it with the body. They would never be allowed to take the branch home. It would burn or be buried with the body.

Londiwe, may we be kept safe, had a dream to prepare my shoes for this long journey. A dream in the time of Covid.

A storm over the Indian Ocean, Friday 24 April 2020
Posted on by basilBLOGinc · 21 Comments

Stay safe..

Dear Nurses

I am so proud of all of you.  You have applied yourself to everything that is new. You have patiently listened as we explain protocol after protocol, and then frustrated  you by changing it the next day. I am proud of how you showed care to my 99-year-old patient whose hair is perfectly coiffed and her makeup is ready for a BBC interview.

Like you I don’t know what day it is. I need to check a calendar to see if it’s a working day or a weekend. Not that it makes any difference to you, working shifts and three-day weekends every second weekend.

I try, and yet I fail to talk to you in the corridors and in the nurses’ stations and in your offices in management suite.  

I failed to act ten days ago when someone asked me to write something motivational for you. This is a time when failure is commonplace: the only solution is to acknowledge it, learn from it and move on. With this letter I hope to move on.

We are facing a global crisis in our little hospital that has always served our community to the best of our ability. It seems sometimes that nothing we do is enough for our patients, our hospital, the whole world. But we have not failed!

The sense of failure, the fear of not being in control, the quarantine, the concern for our families causes us all to feel anxiety.

Feeling anxious about things in today’s world is completely normal. Although I am no master, I’d like to share with you how I have learnt to deal with my anxiety over the years and what works for me now:

We need to deal with it. Learn from our failures. Consolidate and move in a new direction with calm and strength and compassion. I believe we all, and especially you, have this ability.

In our medical training and our experience at the workplace over the years we have all faced stressful moments: a patient’s death, a complication, a disagreement with a colleague. Think back to those times. Now empower yourself by reminding yourself that you dealt with those crises before, and you have the tools to deal with this crisis. You have achieved so much, and will continue to achieve.

Over the last decade I have been blessed to meet many wise and caring people who have helped me deal with fear and anxiety. The essence of their help for me can be distilled into three words: 

Remember to breathe (even if it is behind a suffocating mask).

Breathing is the essence of life, and we can control it. In the beginning just acknowledging your breath is enough. Start to feel the place where your in–breath gently fades into your out–breath. Feel your diaphragm move. If you want you can pause, and count to four at the end of each breath.

It is as simple as that. Now you have something you can control. In controlling that you can reduce your fear and anxiety. 

I salute you all. For once the world is recognising your calling.  They are appreciating your service for the greater good of humanity. They understand your sacrifice. 

Stay safe.

Ask for help if you need it.

Best wishes

Basil

Sunrise over the Indian Ocean …