CA S E N OT ES

Alex

Novem ber
D ATE

Decem ber
Januar y
2020 / 2021
Day 1
This morning started a bit differently my lunch box yet. So today felt like
to normal. I wasn’t wrangling the a rare treat, as though I was sneaking
children out the door to breakfast off from work.
club. It was calmer and more relaxed.
The afternoon went well too. In fact it
Once in the car I do my usual morning was an unusually straightforward shift.
rituals, checking the final edit of my My evening calls were quick visits and,
patient list (for now; it can change before I knew it, it was time to let the
multiple times during the day) and coordinator know I was finished. I took
planning my logistical route through an extra call as I had a bit of time on
to the end of the day. This I decide my hands and I know the night shift
against: clinical need and dependency is short-staffed and busy.
first, timed calls for medication second,
and then geographically.  I’m a bit of That’s something I miss about working
a stickler for routine, although this on the ward: the feeling of camaraderie
job is anything but predictable. I like and knowing you have the support of
to know my car is fully stocked with others in a tricky situation. You can’t
the equipment I’m going to need to do your job without the help of others,
ensure I provide the best possible but in this job, in the community setting,
care to each patient I see. it’s a more lonely and isolated role. This
is particularly true working through the
The morning went to plan and everyone pandemic, an experience that has made
was well and in good spirits. The part me feel more aware of the vulnerabilities
of the job that I love most is building of being human. We all have a need to be
relationships with patients. You get social, but the reality is that most of our
to know each other in a simple but patients only see us nurses and carers
unique way. You know some of the on a regular basis. It’s made me aware
most personal and private information that I am more than just their nurse; at
about them and, in return, you share times I am a confidante too, and in my
parts of your own life. Today was my opinion that is something rather special.
weekly visit to a patient I’ve grown
very fond of and, as I was leaving her
house, she asked me where my children
were today. I told her they were at home
with daddy, and she handed me two
prepared bags of sweets and biscuits
for them. She knew they would be
without me all weekend. It’s these
things that drive you to be the best
you can be, because kindness is one
of the most powerful qualities anyone
can show. It made me feel appreciated
that she took the time to understand
her care and my life from my kids’
perspective, even though she is
in the less fortunate position.

I actually managed to have a lunch

break today, I honestly can’t remember
the last time that happened. I usually
become ravenous (at around 3-4pm)
when I realise I’ve not even opened
Day 2
Today was busy. My list looked good a positive and be as concientious and
to begin with, but geographically was vigilant as I can, always avoiding any
all over the place. A poorly patient threw preoccupation with tasks and focusing
a spanner in the works too and my whole on the person I’m visiting.
day was thrown into disarray.
Those clients also remind you to always
This isn’t anything new, but today be kind to one another. You really never
was particularly challenging. know what’s going on behind closed
doors or what a person is dealing with
Clinically, there wasn’t anything overly under the surface of how they present
difficult; nothing I hadn’t dealt with to you. The other thing that experiences
many times before. And, even though like this give you is a determination:
one of my patients was clinically pretty a fire inside that makes you want to
unwell, it was a different patient that fight for these patients and be the best
made a lasting impression today. advocate you can, because sometimes
you really are the only voice they have.
Empathy is everything in nursing;
sometimes it’s hard as you feel like Overall, what this job makes me
you feel too much. There is no magic is grateful. Grateful for my health,
‘off’ button, but what kind of nurse happiness, good relationships,
would you be if you did have? My rule love and support from those I hold
is to treat everyone the way you would close.
want to be treated.
I try never to take anything for
I left one particular patient today granted because, in nursing, you
with a sinking feeling in the pit of see a lot of really, really desperately
my stomach and a feeling of injustice. sad situations.
I’m not sure if that’s the right word
to use, but that’s the only way I can
describe it. This patient and their family
have flown under the radar for a long
time and, as a result, they are living
in a way that is less than desirable.
Experiences like this never leave you;
they are etched deep into your memory
and you can recall them in a flash.
Certain people, circumstances and
experiences shape you and the way
in which you practise. You don’t forget
them and you draw on the lessons
they teach you in the future. This might
be in the way of a clinical skill or, more
likely in my case, looking for red flags
or warning signs that things aren’t quite
right. For example, the start of a decline
or noticing something before it escalates.

I worry a lot that I’ve missed something

or should have picked something up
sooner. Was I being complacent that
day? Or was it just that it wasn’t visible?
But I suppose I try to turn that worry into
Day 3
Today was my day off. I woke up and
my first thought was work. It was so
busy at the weekend and so much
had changed that I wanted to give
the nurse in charge a heads-up about
what had happened.

My plan was to do this last night, but

I finished an hour late on a 12-hour
shift and I was mentally and physically
exhausted. I hadn’t eaten for eight hours
when I got home. This happens a lot.
You forget to eat and drink when you
are caught up with patients that are
so unwell.

I spent two hours on the phone to two

of my colleagues going over specific
things that had happened and what
needed to be done as a result, making
referrals and finishing my notes. Working
weekends can be frustrating as you
don’t  have access to all the resources
you have during the week, but they can
also be less stressful as you can enjoy
the simple care aspect of nursing, which
is the reason I enrolled in my nursing
degree over 16 years ago.

I thought I wanted to be a doctor,

but a work experience placement
showed me that nursing was my
chosen path, and I have been hooked
on it ever since. Even after the hardest
shifts, there has never been a time
when I thought this isn’t for me.
It’s part of who I am.

Finally, it is 9pm, so I check in again

with my colleague for an update on
the patient from yesterday. She has
had an incredibly busy day and this
was the first opportunity she had to
talk. We were on the phone for half an
hour, debriefing and off-loading the
seriousness of the situation. I couldn’t
get them out of my head all day. But the
update was positive, so hopefully
a good night’s sleep awaits.
Day 4
Today was a rush. From start to finish
I felt like I was on a treadmill that was
speeding up, not slowing down. The kids
were off to breakfast club, my husband
had left for work at six and I had been
up since half past three with a child that
didn’t want to sleep! I hate the feeling
of being overwhelmed and sometimes
it makes me feel like I’m not doing
a good enough job in any area of my life.
12
9 3
6 relatives are something that comes with
My work list started with 12 patients.
This can vary from day to day and it
almost never finishes the same as
it started out. Today I also had a student
nurse with me, but she has a lot of
clinical experience, and I really enjoy
teaching. I feel it can be mutually
beneficial too, as the new knowledge
they bring provides a useful update on
things that don’t always filter through
to frontline work. Luckily, the day had
a good mix of different clinical skills and
support visits. There are lots of things
you can teach in terms of clinical skills,
but there is so much more to nursing.
Today, more than most, I was just grateful
for the company.
I had a patient on my list that we have
cared for, for a while, but unfortunately
he had a new diagnosis which was
changing the course of his life. The day
was busy and we had two emergency
call-outs. These take priority and are
usually about additional pain relief
or end of life care. This pushed our
visit schedule back by about three
hours. We then got a message from
a family asking why we hadn’t visited.
I had a sinking feeling in the pit of my
stomach. I always try to be as amenable
and flexible as I can, taking into
consideration patient preferences
for call timings, but it can’t always be
met. Knowing this, I knew we would
be met with some conflict, and that
always makes me feel uncomfortable.
The family were frustrated and upset
that we called so late in the day. I always
explain that I work eight ‘til eight and
to expect a call anytime between
then, but that gets lost in translation
sometimes. The family felt let down,
and that made me feel awful. It’s the
last thing I would ever knowingly do,
and I felt personally attacked at times.
Unfortunately, frustration and swearing
the job and, although it’s a frequently
repeated mantra that it’s not ok to
be abusive to NHS staff, it is a regular
occurrence.
I felt vulnerable, but I also knew my
professional obligation was to provide
care to this patient regardless. I always
try to put the needs of my patients first,
and the logical side of my brain reminded
me that the frustration isn’t personal;
they are hurt and upset by a terminal
diagnosis. Unfortunately, it just often
feels like you are a punch bag taking
the brunt of their anger and hurt.
I set out every single day to do the
best job I can possibly do. I started
the day on three-and-a-half-hours’
sleep, didn’t get a lunch break and we
worked non-stop. I stand by my ability
to appropriately prioritise and safeguard
each patient’s wellbeing. Sometimes
I take things personally; I’m a sensitive
person. My colleague immediately
sensed this and we debriefed each
 12

9 3

other on the car ride back to her house.

We finished so late today that her car
had been locked in the surgery car park
overnight.

It wasn’t a great day and I could feel

my emotions rising in the car. As soon
as I walked in the door, I took a big deep
breath and started again, as my son was
still awake waiting to tell me all about his
achievements at school that day. I was
physically and emotionally drained and
due back on another 12-hour shift in the
morning.
 12

Day 5
9 3

This morning I wake up with a headache. away. I want to give her a big cuddle, but
I often do after a bad day. I can’t do that either. It is a bittersweet
visit. She is so joyful to be with me, but
My first patient of the day is her face turns so sad when I must leave.
unexpectedly unwell. It sounds I hope I made a difference to her. She
strange but this is what I love. had a huge impact on me.
My adrenaline is pumping and I am
confident that my clinical skills will I see my colleagues briefly in the office
be put to good use. By the time the when I return to pick up some stock.
patient is safe and stable, I am way Yesterday’s visit is still playing on my
behind on my schedule. I have training mind, so I speak with a colleague who
in the afternoon for a new intravenous is a friend. She reassures me that I did
device being launched, and missed nothing wrong, did nothing detrimental
the one yesterday because I was so to the patient and that I just happened
busy. Today is the last training session to be in the firing line that day. I realise
12 and I already feel guilty about
available that I worry a lot about what people
going as I know it means passing on think of me professionally. I want
a visit to someone. I find it difficult people to see how hard I try and that
to ask for help and I find I always put I do genuinely care about each patient.
my needs last in all areas of my life. To me, they aren’t just a ‘leg dressing’
9 3 are greater
As a nurse and a mum, I always think
someone else’s needs
or ‘routine catheter change’; they belong
to someone and are important. This really
than my own. isn’t just a job. It’s so much more and
such a huge part of who I am.
The highlight of the day is meeting
the most delightful lady on my round.
6 and welcoming, though I can
I am only there for a short visit, but she
is warm
sense how lonely she is. She opens
up to me about a recent bereavement
and tells me she hasn’t left the house
for nine months. I want to give her
a hug or hold her hand. The PPE
(Personal Protective Equipment)
I have to wear is such a barrier.
It’s not the same holding someone’s
hand with a bright blue glove on;
it feels so impersonal. She tells me
again and again how lovely it is to talk
to someone in person. She says her
family are so worried about giving her
Covid that they don’t dare come in the
house. I could stay all afternoon with
her, but I know I can’t. I feel so sad for
her. Her loneliness and longing for
human contact is palpable.

I stay for an extra fifteen minutes

while she talks me through the family
photographs displayed proudly on a
piano. She tells me she can’t bring
herself to play since her sister passed
Day 6
Because of the pandemic and trying
to work remotely, I start most of my
days the night before. I like to be
prepared and know I have everything
I might need. I check my list from home
on an iPad and note down everything
I may need to collect from the office,
if necessary.
I know today is going to be emotionally
heavy.
I am visiting a gentleman who is at the
end of his life. His wife is understandably
struggling as she watches her husband
fade away. I visited him a few days
previously and, reading his notes,
I see he has taken a considerable
turn for the worse.
When I arrive, he is in quite a lot of
distress. I begin by assessing his
needs and making sure he has the
correct dosage of medication for his
symptoms. The medication chart needs
amending, which means taking it back
to the surgery. I find this frustrating.
I can give medication in the moment
to help settle him, but it won’t be enough.
When I return an hour later, I check on
the patient, who is calmer and more
settled. His wife has gone for a lie
down while their son sits at the
bedside. I prepare the syringe driver
and return to the bedside.
heartbreaking. They had been married
for over 50 years.
It is such a personal moment for the
family, so I step away. I have witnessed
death many times, but it never stops
being distressing. The atmosphere
in the room, the pain and the anguish,
it’s all so raw even when it’s expected.
I try to comfort and support the family,
and they seem grateful. It’s funny how
differently people look at things. I feel
as though my being there is intrusive,
but the family tell me they are so grateful
they had support in that moment; that I
made the situation feel so calm. Hearing
that makes me feel so valued. It’s exactly
these moments that make me strive
to be the best I can be, not only for the
impact I can have on others, but for the
impact they have on me. Life is precious,
exciting and vulnerable, and it can be
taken in a flash.
I carry on my day with a truly heavy
heart. I can’t get the family and that
moment out of my mind. When I get
home, my husband greets me at the
door and I start crying. It is such an
emotional release after holding it
back all day.

Something in me, experience I think,

tells me there is a change and he is in
the last moments of his life. I say quietly
to the son to go get his mum and come
back quickly. I hold the patient’s hand
and tell him I am with him and that
his wife is coming. I’m not sure if it’s
true, but my experience tells me that
people can hear you right up to the
very end. My heart is racing. Although
this was expected, I wasn’t expecting
him to die now. His wife walks into the
room. He seems to sense this because
in that moment he passes. She grabs
his hand and sobs. I choke back tears
and try to remain professional, but it is
Day 7
This morning is different. I’m off to study
and it feels like a rare treat. This one
I’ve been waiting to have for over six
months. It will enhance my clinical skills
and improve the scope of my practice.

After the training, I meet a colleague

to observe her practice and sign her
off as capable in a new skill. Afterwards,
I go to see a regular patient on our
caseload who I haven’t seen for a while.
She greets me with a “hello stranger” and
a warm welcoming smile. She’s the type
that would have hugged me before the
pandemic, but we are all so cautious now.
It makes me really sad that we hesitate
and consciously stop in our tracks to do
something that feels so natural.

My next visit is a new patient on the

caseload. We get a rough idea of what’s
going on from the referral, but I really
enjoy getting my teeth into something
like this! I’m not task-oriented, and
I like to think I take a holistic approach
to patient-centred care. I like to ask about
their life, what’s changed, what they
are struggling with, and to unpick it all
to find if we can identify and help with
the root causes. You never get someone
back to who they were or where they
want to be if you just go in and address
their symptoms. If you do, it’s likely a
few months later they will bounce back
onto your caseload again with a different
issue. The patients we see are usually
quite complex, and everything delicately
interlinks, like a row of dominoes.

I complete a detailed assessment

of the new chap and all his underlying
needs. This means a lot of paperwork,
ordering of equipment and further
referrals to specialists for advice.
But the satisfaction I get from complet-
ing this is wonderful. The feeling of
accomplishment when you know you’ve
done everything you can, and the patient
will be better for it, really is one of the
reasons I do this job. I definitely made
a difference today, and that’s what
it’s all about.
Day 8
This morning I really have to drag myself
out of bed. I am TIRED! This is the fourth
12-hour day in the last six. As always,
I checked my list the day before and
knew I was in for a really busy one.
I don’t usually work a Monday and
Tuesday, but I was due for some training.
So, my manager has swapped my shifts
around so I don’t have a full week of
work and trying to juggle childcare.
I am lucky to have an understanding
manager. When I think back on the
pandemic, my husband and I have been
extremely lucky to be able to move our
shifts around so we could both work.
Being a nurse and he a police officer,
we had no option to work from home
and couldn’t be furloughed.
On the whole, I enjoy working 12-hour
shifts. I feel more accomplished at
the end of the day having the time to
squeeze in an extra assessment or two,
but more often a 12-hour day is actually
a 14-hour day with no break and me
writing notes at 10pm.
Today starts as normal. I check the list
and eat breakfast on my way to the first
patient. I start with 12 patients on my list
today and end with 16. This is standard.
I will never say no to an extra patient
because I don’t like to let anyone down –
the patient or the coordinator – and,
if I have time, then it’s the right
thing to do anyway.
Today is nothing out of the ordinary.
I had leg dressings, a few catheter
changes, a palliative support visit
and some insulin patients. My last
call of the day is for a wound dressing.
I have a good rapport with the lady and
we enjoy each other’s company for the
15 minutes I’m with her. Her relative
has tested positive for Covid-19, and
during her isolation she has now become
symptomatic herself. I feel a pang of
anxiety, for her not me. The way I manage
my own anxiety around the virus is strict
adherence to the rules around PPE and
hand hygiene. I wipe down my car daily,
strip off my clothes and put them
straight into the wash every evening,
and I don’t touch anyone or anything
until I’m out of the shower. It can be
tricky when my kids are waiting up to
have to explain that I can’t give them
a cuddle yet. They have grown used
to it though, and we have cuddles
once I’ve done my evening routine.
Anyway, my anxiety was for her. She is
a very young and vulnerable patient in
terms of this virus, and my anxiety isn’t
relieved after the visit because she
looks and feels very, very poorly. My
clinical assessment tells me she is
stable and, anyway, she didn’t want
to go into hospital. Though she has
a well-informed and capable family,
I feel a huge wave of responsibility.
In hospital you are in a much more
controlled environment, but in the
community everything feels much
more vulnerable.
I hate leaving her, even though she
has clearly managed her life so far
without a personal nurse!! I struggle
to let go sometimes and take on a huge
amount of personal responsibility. I think
tonight is going to be a restless night,
because I always struggle to sleep
or stay asleep after a shift with a very
poorly patient. When I got home my
daughter was still awake - a rare treat!
Sometimes I think that we overlook
the warmth and unconditional love
we receive from these tiny humans…
tonight I appreciated it more than usual!
Day 9
We had a message on our group chat
late last night. After what felt like months
of promise but radio silence, the silence
was finally broken... we could book our
first vaccination appointment for today.

I feel a mix of emotions. Excitement,

relief, worry. I almost feel like we are
jumping the queue. The message is
out of the blue, a sudden surprise,
but I have known all along that, when
it was offered, I would take it. We have
felt so vulnerable from the beginning
when we were begging for PPE but
told, unless the patient showed signs
of the virus, it wasn’t needed. I have
never considered not visiting a patient
if they are Covid-positive, but, if I’m
honest with myself, it’s always been
a worry that I may pick it up and infect
others. We’ve never turned down
a referral during the pandemic, but
at times it feels like we are sent in
as the easier option when others
don’t want to.

When I turn up at Southmead Hospital

it is busy and noisy. There is an excited,
nervous energy all around. I am lucky
and privileged to be stood in a socially-
distanced queue of NHS staff, and feel
really emotional. I know this will be a day
I’ll never forget. The whole event was
organised well and everyone was just
grateful that we finally have some actual
protection from this terrible virus. I hope
this is the beginning of the end.
Day 10
Today is Boxing Day. Christmas feels
so different this year with the pandemic,
and today is no exception. I usually don’t
mind leaving the children to go to work,
but we made the decision not to see any
family this year. This meant that leaving
the house today was hard, because the
kids were sad to see me go and had no
exciting plans for the day ahead. We
are all missing family and friends, but
I’ve had to be so cautious so as not to
inadvertently spread the virus, especially
to my more vulnerable patients.
The day is busy, with 15 visits
to patients requiring a wide variety
of interventions. I had arranged for
a singsong during a visit with one
of my patients, but had to cancel it as
I was needed elsewhere. I worried they
thought I’d forgotten our arrangement
(and that I had promised them some
homemade ham hock pies), so I stopped
by to quickly deliver them. I didn’t go
in as I was in such a rush, but it was
nice to see a warm, happy face.
Today has been strange and not what
I was expecting. I felt sad and lonely,
which is unlike me, especially at
Christmas. With everything going on
at the moment the isolation and sadness
was tangible today. I feel sorry for some
of the patients who haven’t seen anyone
but a nurse over Christmas, but feel so
lucky to return to a warm, welcoming
home, and to my husband and two
children who are waiting to welcome
me. I try to focus on that aspect of the
day and my gratitude.
Day 11
It’s the 28th December. This time of year
is really busy in healthcare, but especially
so this year. I can’t say I enjoy working
the week between Christmas and New
Year; normally everyone is enjoying their
two-week break, but we are slogging
onwards and have been all year.
Morale is still ok within our team, but today
we are struggling. All our lists are long and
I’m tired before I even start. I’ve got admin
to catch up on from Boxing Day so I start
the day feeling like I’m on the backfoot.
My first few visits go according to plan,
but, as I reach lunchtime, I know it won’t
continue. I have a poorly patient who is
declining to go into hospital, and I am
stuck with doing what I think is clinically
and morally right (admission) but going
along with his wishes because he has
mental capacity.
I find this incredibly hard. Sometimes
I want to shout, ‘Why won’t you listen to
what I’m saying? Do you understand what
will happen if you don’t!’ But you have to
respect their decision and the multiple
reasons that might be behind it. It’s never
straightforward. I don’t want to leave him,
but, after exhausting my clinical options,
I have no choice. I can’t get him off my
mind all day, so I phone his wife at the
end of my shift to try and rid myself
of the uneasiness I feel in the pit of
my stomach. I’m not sure I did though,
because, whilst sat here typing this
entry, I feel no different than I did
before the call. Still, his wife was grateful.
I am so tired and hungry when I get
home that I have to eat before I can finish
writing up my notes. I usually do this after
each visit so I don’t forget an important
piece of information, but there was no
time today. I finish writing at 10.30pm.
My mind feels fuzzy and I don’t feel like
I’ve done a great job writing them up.
I hate days like this. I feel I haven’t been
at my best even when things are out of
my control.
Day 12
I’ve been in a bit of a funk for the last
few days. The kids are cooped up inside
because it’s so cold, and we don’t last
more than an hour on our walks. I’m
exhausted from the build-up to Christmas
and just want to get the decorations
down. Dan is working 12-hour shifts
opposite mine, and work has been hard
and busy.
I wake up this morning feeling more
positive. Thank goodness for that!
I gave myself a talking to last night and
it’s worked! My list was busy as usual;
every day is the same. There is no
reprieve and at times I feel so rushed
I can’t do my job as I would like to.
I have so many care plans and carers
to chase regarding plans that I feel
a bit overwhelmed. My ‘office’
(the car) is also a mess. When I’m
busy, I just chuck things on the seat
or in the boot and think I’ll sort it later,
but later rarely comes!!!
and further assessment. He declines
and has capacity, but I am genuinely
concerned. I feel helpless in that
moment. I comfort his crying wife
and tell her to ring the ambulance
if he deteriorates.
When I leave, I feel a buzz of excitement.
I drive back to the office and speak
to a doctor who shares my concerns.
I ring his wife to tell her to expect a call
from the doctor and to pack a bag for
hospital. When his blood results come
back, my suspicions are confirmed
and he is admitted. I feel a sense of
accomplishment and, although of course
that’s not what you want for your patient,
I feel good that I haven’t lost the skills
I’d worked on for so long, but now rarely
use in community work. I can relax and
sleep well tonight knowing he’s in the
right place.

Mid-afternoon I attend the house of

a patient who we see frequently. She
lives with her husband who is always
present and chatty, but he didn’t appear
to be home today. When I arrive she is
quiet but then sheepishly asks if I will
take a look at him. She tells me that he
fell and hit his head a few weeks ago.
I ask a few questions and it seems he
isn’t well at all. I wanted to hurry up with
the planned intervention I was doing
for her and get to him. My instinct and
experience had kicked in.

I walk back to the car to get my

observations and bloods kits. In my
mind I am running through different
possibilities and outcomes. When I
see him, he looks like a different man,
and I feel that rush of adrenaline you
get in those moments. I miss looking
after acutely unwell patients. They can
change in a flash, so you need eyes
in the back of your head. I do my
assessment and take some blood.
I tell him multiple times he really
needs to go into hospital for imaging
Day 13
Today is yet another catch-up day. Work
is so busy and we are so stretched. We
are all feeling it. I’ve fallen behind with
some of my mandatory training and the
new Covid-19 vaccinator training we
need to do. I never put a claim in for
extra hours and always think maybe
one day I’ll get the time back, but I never
do. So I’ve decided that I’m going to put
in a claim, as today alone I’ve racked up
five additional hours.

I complete my vaccine training and

my mentorship training (I’ve been told
I have a student coming in February).
I feel a bit disappointed by this and
almost a bit of dread. I’m passionate
about teaching, but I like to give it
everything and, at the moment with
the amount of work on my plate, I really
don’t think I will be able to. Students
are already on the backfoot so I feel
bad about this, but I’m trying to be
realistic and manage expectations.

Tonight I’m going to have a hot bath

and try to relax before another weekend
of work. This week has been especially
tough with work, home-schooling and
trying to get this additional training done,
but I know I’ll feel better tomorrow when
I can focus and be present in work
without worrying about all the little
things I have today completed. As usual,
my needs fell to the bottom of the pile
again, and I’m trying to be so much more
mindful about not pouring from an empty
cup, especially when times are so hard.
Day 14
It’s cold outside and I didn’t want to get
up this morning. It’s a double-edged
sword reviewing your list the day before.
I like to be prepared and plan my route,
but the down side is you know what’s
ahead of you.
The masks we wear at the moment
form a barrier, but it doesn’t feel like
that now. All our emotions are raw
and we all understand what is coming.
As I am leaving, his son stops me.
He says he can’t thank me enough
for what I have done for his family today.
He tells me how kind and patient I have
been and that every question they have
has been answered with understanding
and empathy. I’ve said it before, but this
is what makes this job the best job in
the world. His words mean everything.

My work group alerted me to the

deterioration of a patient we have got
to know well. After a discussion with
my team leader, who is also working this
weekend, we decided that I would ring
and check in. Things had deteriorated
significantly overnight and he is in the
last hours/days of his life. I feel the
despair in his wife’s voice. They have
been married nearly 70 years. It’s hard
to hold it together in these moments
because I can’t help but put myself in
their shoes. After a lot of phone calls to
the out-of-hours GP and my team leader
helping me to source the equipment
I need, I arrive at the house. I take a deep
breath before I go in as I know this will
be an emotionally-charged and intense
situation. I’m not wrong. It’s funny how
instincts take over a lot when nursing.

You prepare all you can for difficult

situations and being truthful and tactful,
but somehow you just know what to say
and how to say it. And sometimes you
know not to say anything at all. I hold
his wife’s hand while she holds his.
Watching their interaction is something
I won’t ever forget. The visit is long and
I don’t leave until I know he is completely
settled. When I return a few hours later
to check on him, he is still settled.
Day 15
Today is busy and I feel physically and
emotionally drained from yesterday. All
the muscles in my back are sore. Some
of it I’m sure is from writing notes
hunched over in my car.

I look over my notes from last night.

Sadly, the patient I saw yesterday
passed away in the evening. I didn’t
sleep well last night.

I ring his wife to see how she is and

to offer my condolences, and I ask if
I can visit today. Bereavement visits
are tough. Sometimes I experience
a family that is broken, while some
are relieved that the suffering is over.
Today is emotional. I fight back the
tears as I watch his wife cry and ask
what she will do without him. I want
to wrap my arms around her.

The family are so kind and tell me that

I had enabled him to pass peacefully
at home surrounded by his family,
which was his final wish.

So, today is long and today is sad.

The kids are asleep when I get in,
but I go straight up (after completing
my Covid routine, of course) and kiss
them and tell them I love them. Days
like today really do show you how
precious life and the family you build
truly are.
Later.
It was really interesting to revisit my
journal. It has taught me that I am my
own worst critic. I find it hard to accept
praise, but crave acknowledgement of
a job well done. I realise that, while
I talk with a lot of passion, I was
exhausted and almost beaten.
One thing that really stood out was
what a difficult time we were in when
I embarked on this project. I can hear
a heaviness in my writing which I feel
has lifted now with the easing of the
pandemic’s social restrictions. I am still
proud to be a nurse, and that is a huge
relief. I truly couldn’t imagine being
or wanting to be anything else.
but it’s difficult sometimes, especially
when the result of a bad decision could
negatively impact someone else.
This year has changed me and shaped
me into a stronger version of who
I thought I was. You take one day at
a time, but, before you know it, months
have past and things are different.
They may only be subtle changes but
I feel they are positive ones. I’m learning
more about myself and trying to reassure
myself that it’s not selfish to spend time
on me. Self-care is imperative to self-
preservation in a job and a personal
life where I willingly give so much of
myself to others.

I realise that I do have a professional Caring for others is a gift. I’m lucky
‘hat’ that I wear, but it’s completely enough to have experienced it and
wrapped up in who I am as a person. hope to for a long time yet. I feel richer
The kindness and compassion I bring in so many ways for being a nurse.
to my work isn’t a learnt behaviour or
skill; it’s who I am and who I always
want and strive to be. I am proud that,
even though I can hear how much
I was struggling to balance work,
parenting, relationships and anxiety
about what was going on around us,
I could still support and care for patients.
I was honestly pouring from a pretty
empty cup.

I believe that life is one big lesson

and it’s up to you to learn from the right
mentors. My patients can be just that.
I have so much to learn, and nursing
is a wonderful journey on which to learn
it. Being privy to personal, complex
relationships between people who
are strangers to you, at first, is such
a wonderful privilege, especially when
it happens at a really tough point in
their lives.

I think something I would ask myself

would be, ‘Why are you so hard on
yourself?’ I can show compassion
and forgiveness to others, so why is
it so hard to show it to myself if I make
a mistake or a bad decision? Being kinder
to myself is something I’m learning to do,
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