“Vows made in storms are forgotten in calm.” ~ Thomas Fuller.
I have one very clear memory of nursing during the early days of the AIDS epidemic. A young man had developed a collapsed lung, which required the insertion of a tube into his chest wall to suck the air out of the pleural space and allow the lung to reexpand. The young man had tested positive for HTLV3 as it was known back then. We were practicing ‘Universal Precautions’ in those days, personal protective equipment designed to protect healthcare workers from this deadly virus that so little was known about at the time. All we knew was young (mostly) gay men were dying from it. Conspiracy theories abounded. We could not go home and tell our loved ones that we had been providing direct care to a patient with AIDS. There was too much fear.
The young man sticks out in my mind for a comment he made. The surgeon who had placed the chest tube came to see him (made rounds). He stood at the door of the isolation room, covered from head to toe in a disposable surgical jumpsuit, shoes covered, head completely covered in what looked like a welder’s mask, but disposable. “How you doing?” he called to the patient. “I’ll see you tomorrow.” After he left, the patient started to cry. I finally got him to tell me why he was crying. If the doctor was so scared to come inside the room, how was he going to remove the chest tube when it was time to come out? Would he stand at the door and give it a big yank?
Nurses have always been at the bedside in the most scary of times. Nowadays we call it ‘direct care’, the hands-on, sleeves rolled up get stuck in attitude of the ones who cannot turn their back on you, no matter how scary your situation. Good nurses, that is. I have no doubt that this latest challenge to our system will separate the goats from the sheep. In your everyday life do you have to choose between the wellbeing of your family and the patients you have chosen to care for? Hurricanes, earthquakes, tornadoes, these are the usual natural disasters that call for nurses to commit to their profession, putting aside their personal lives for the good of the whole.
But when the natural disaster threatens the ones who are responsible for leading us through it, the concern ratchets upwards. It is sweet reward for the nursing instructors who for generations (since at least Florence herself) have been yelling ‘hand hygiene’ at nursing students to hear it now leading the news cycle. And yes, young lady, your hair is beautiful, but when it falls into your face and you are constantly having to sweep it back, you are increasing the probability of introducing pathogens into your mouth or eyes.
But the simple basic steps will not be enough when what we are facing is a pandemic. In the early years of AIDS, the general public often congratulated itself that it was safe. I’m not gay, I don’t do intravenous drugs, I’m not in any of the high-risk categories. It wasn’t until heterosexual males like Magic Johnson disclosed their status, it wasn’t until you knew someone personally who had contracted it that you realized that unlike many of our fellow humans, pathogens do not discriminate. And as history repeats itself, there was a lack of leadership (in fact the outright obstruction from the White House) which delayed research, funding and interventions that could have arrested or slowed the spread of the disease. It takes people of vision and acts of courage to do the best thing for the most people, regardless of who they are.
It is tough to be a decision maker in the absence of strong leadership. All that I have read suggests that it is only through extreme measures that we can get ahead of an outbreak like this one. At our school of nursing we are already adjusting for clinical sites that have started to limit access to the vulnerable patients they care for, so we are having to replace real human experiences with virtual ones. The next step will be to teach remotely, not ideal, but not impossible. But for those who work in hospitals, they are the ones who will be stretched to the limit over the coming weeks. Let us hope that by implementing extreme measures now (the social distancing, reduction of exposure, limiting public gatherings) we will be able to mitigate and slow the spread, to allow hospitals and staff to manage the care of those who will need them the most.
I keep hearing the phrase ‘out of an abundance of caution’ and singing in my head the words of Bob Marley ‘in the abundance of water the fool is thirsty’. There is good information out there, but we have to avail ourselves of it and not rely on scare mongering and panic. We need to practice (proper) hand hygiene, be conscious and considerate of our fellow human beings by keeping our distance, and keep ourselves as healthy as possible. This too shall pass. But we have a responsibility to spread only good information, not germs!
I read an article about the flu epidemic of the early 20th century, when they realized that there was one remedy that seemed very effective at promoting recovery and preventing death – fresh air! For those who could not go outside, the nurses would open the windows in the wards to allow for cross ventilation, keeping the air circulating. That was also one of Florence’s tenets: ‘A nurse is to maintain the air within a room as fresh as the air without, without lowering the temperature.’ In 2020, the year of the Nurse, Florence must be mouthing ‘I told you so’ from on high!
Have a wonderful weekend, Family! While you are avoiding crowds, may you find fresh air and an open space to maintain your equilibrium. May you balance fear with pragmatic optimism, and may the time of ‘social distancing’ bring you closer to an appreciation of the simple things of life.