Hospice Nurse Gets Role in Downton Abbey

In Beginners, a favorite movie of mine, Ewan McGregor does some internal monologuing to a montage of old photographs of his parents. This is what the sky looked like in 1955, he intones. This is what kissing looked like. This was fashion. Sometimes I do this for my life now. This is what grocery shopping looks like in April 2020. This is driving on the freeway. This is a meeting.

Yesterday I went to Safeway. The line outside was nice and short. The staff sanitizing the carts and letting shoppers in one by one were jovial, joking around from behind their homemade masks. Inside the store, I followed my list carefully, trying not to take too long. But some shelves were empty and I had to improvise. No jelly today, should I get maple syrup? No chicken thighs. Drumsticks? There was salad where last week there was none. I know that the sobering truth behind these empty shelves is that Covid hit a Safeway packing plant in Tracy very hard. I try to send those workers good healing energy as I shop. Mostly I’m just busy being thankful that there’s any food at all. India. Africa. 

At the checkout, when I finally get to the top of the line, I thank the checker for doing his job. I never did that before Covid. I’ve thanked firemen, street sweepers, office cleaners, and trash collectors for their service, but never grocery store clerks. I’m going to add them to my list going forward. I reckon you can’t thank too many people in this world for the jobs they do.

He tells me he moved back here last year from Australia to help out his parents, who are elderly. We agree on the good timing. I tell him I’m a nurse, and he thanks me, so I let him know I’m a hospice nurse, not an ICU nurse, in case he thinks I’m working 12 hour shifts with folks on ventilators and inadequate PPE. He asks if I have any patients with the virus. I tell him soon. 

Next week, I will get my first Covid positive patients. So I will move from wearing PPE only for visits to facilities where Covid lives, to wearing it when I visit my own patients. 

Now that we have folks with the virus on hospice service, we have a new thing at work to improve our safety. It’s called a Doffing Coach. Specially trained nurses stand outside the Covid positive patients’ homes and make sure the nurse doing the visit puts on and takes off their PPE safely. As silly as my new title is, I quite like the idea of being a Doffing Coach. We have been instructed to be assertive. I thought I would step out of some grand vehicle wearing a swirling black cape and top hat. Gloves first! I would thunder at my coworker nurse in their PPE. Drop the faceshield in the bag by its elastic. Drop it!

I did my first Doffing Coach visit. Strangely, there was no cape. I waited obediently outside and eventually my teammate came out from her visit in her stylish yellow paper gown, gloves, N95 respirator and plastic face shield. She had prepared her area beforehand for taking her PPE off. There was a table spread out with hand sanitizer, sanitizing wipes, and a plastic bag for her contaminated gear. She moved very slowly, thinking each move out before she made it.

I watched intently as she took her PPE off. My teammate has been working in healthcare since she was a teen and a nurse for half a century. She started in the operating theater, so sterile procedure is in her DNA. We’ve been given a few different ways we can doff the gear. Whatever she’s doing: that’s what I’m going to do.

After the visit, we stood six feet apart in the parking lot and had a fantastic gossip session. It’s the little things you miss. Not much gossip goes down during Zoom meetings except in the chat window.

The next day I had to go into my office for my annual N95 respirator fit test. Every year this is a chore we have to perform. You gather with a group of coworkers in a conference room at the office and an outside company fits us with N95 masks. This involves a bunch of weird stuff that you would not want to catch sight of through a window. We stand in a circle with our N95s on and giant white plastic hoods over our heads. The outside company person goes around the circle and sprays a bitter tasting spray through a small hole in our hoods. We are instructed to do some relatively simple and yet strange things: move our heads from side to side, bend over and stand up straight numerous times, count to thirty. Bottom line: if you taste the spray, your mask is not sealed properly and you fail the test. Takes about an hour. Lots of paperwork.

Of course, this whole weird and tedious deal is to help save our lives. Everyone knows that. We just usually grumble about having to do it every year. But this year? PARTEEEEEEE!!!! Twenty of us got to be together, six feet apart, in our large conference room. The chatter was intense. None of us had seen each other for six weeks. Then we got to stand shoulder to shoulder in the circle because of course we had our N95 masks on. Just that shoulder to shoulder contact with a bunch of non family members was exotic.

The following day I had to don PPE to do a covid test. As well trained as I am, it was my first nasopharyngeal swab for the Novel Coronavirus 19 and that gown and mask felt awfully hot. My patient joked around with me as he always does. We told each other how great it was to see each other in person after more than a month, even though I was dressed like an astronaut. I asked him if he was scared he has the virus. He shook his head. My Doffing Coach was waiting outside the house for me in her Toyota. She was not wearing a cape. Spoiler alert for the next season of Downton Abbey: the test came back negative. 

Hospice Nurse Shops for Free Cloth Face Mask

It’s shelter-in-place Day #9867403. It’s also the week after Easter. Amazingly, the Easter Bunny made it to our patio in these challenging times. There were some colored eggs and some little baggies of jelly beans in rather obvious place. There are unconfirmed reports that Easter Bunny was wearing a bathrobe and did not mobilize till after 8am, but really, who’s judging?

The recipient of the little gauze bags was delighted that Easter was still alive and well during the global pandemic. I told her that even though she’s 18 now, there will be an egg hunt for her until she is hiding eggs for her own kids. This may not strictly be true, but Easter Bunny got to eat a few handfuls of jellybeans before and during the whole hunt thing, so there is some investment in keeping up the tradition. I won’t even mention the Cadbury’s cream eggs. They never actually made it to the baggies. So relieved another candy-fest is behind us.

Easter being somewhat muted by having to stick-in-the-mud, we decided to console ourselves with a little online shopping. Mom, said teen excitedly, glued to the Urban Outfitters website, I have $1064 of clothes in my shopping cart! I told her this was wonderful news, and she could have them all, as long as she started college a month later than everyone else. Of course, it’s anyone’s guess whether college is even going to happen in August. So that one went down like a lead balloon.

This Wednesday, April 15th, was a big day for me. Not because it was tax day, because it strangely wasn’t. Ha! But I got to drive to my office and pick up my PPE. People on the internet are dressing up to go to their mailbox, or bring the trash out. Imagine the excitement of going into the office! I nearly put on lipstick, but I don’t have any. Instead, I put on a face mask and sanitized my hands. I also made sure I was wearing pants. If you’ve been in any Zoom meetings lately, you’ll know what I’m talking about. 

I let myself in through the locked front door of my office building with my special badge that makes the door k-chunk open in a satisfying bank-robbery kind of way. Then I walked through some weirdly propped open doors to the PPE room. My office, usually humming with activity, was eerily empty and quiet. A table blocked the door of the conference room where once a week my team used to sit around a big table and have our friendly team meetings. I stood a respectful six feet from the person giving out the baggies of PPE from behind the table. My baggie had a gown and mask in it, and a superfine washable face shield (new this week). I was also permitted to select a home-made cloth mask made by kind volunteers. It took me a while to choose which pattern I wanted. Don’t rush me, I wanted to say to the volunteer in case she was judging me for my indecision over a free face mask. I’m shopping here.

Then I went back out to my car, sanitized my hands and everything else I could see, including the entire parking lot, and drove home. The week’s been a bit downhill from there.

Thursday I spent from 9am to 1pm sitting on my kitchen chair in Zoom meetings. I also ate a lot of cinnamon raisin toast. Some of it was for breakfast, but some of it, interestingly, was for lunch. The second Zoom meeting, a presentation by a UCSF doc in how to provide telehealth, had 85 participants. Zoom was experiencing a few glitches in its muting capabilities. The host muted us all, but we could still hear one of the participants ordering a burrito to go. She did not need a straw with her beverage. 

You might be wondering how a hospice nurse can do her job effectively during shelter-in-place. If you find out, please let me know. I cannot see most of my patients in person. I cannot touch them, or hug them, listen to their lungs with my stethoscope, or check their skin for bedsores. I can’t put my hand on their arm to reassure them. I cannot lay my hand on their febrile brows. And I can’t sit with their families while they cry and laugh and tell stories and grieve. It is starting to feel like negligence, this socially distanced nursing, but it’s what we must do. I have to remind myself: would it be better to go see someone and maybe bring them coronavirus?

Today, I had to visit one of my patients in person. In-person nurse visits now have to be approved by my team leader. My patient is dying. For the entirety of this week, she has been exhibiting clear signs. She can’t swallow any more, she doesn’t want food, she closes her mouth against her medications, she’s sleeping most of the time, and today, she was breathing heavily. I texted my team leader: my patient seems to be dying, it feels like gross negligence on my part not to visit her, can I go? I gave some objective data, besides my subjective plea, and she said yes, by all means go.

I drove to the facility. Highway 101 was pretty empty, and so were the surface streets, apart from a marked increase in hazardous drivers. I like to think of it as coronarage. Young probably male drivers, stuck at home for weeks, suddenly let loose on the roads. Possibly with high levels of blood alcohol and illicit drugs. I’m not joking about this. The amount of reckless weaving on 101 today was shocking.

I made it to the facility where my patient lies dying. I put on my PPE in my car in the parking lot, including my trendy new clear plastic face shield. Frankly, I felt like I was about to board Apollo 13. Inside the facility, I had my temperature checked and the usual coronavirus screening questions asked, although today they were a little less rigorous. I did not have to explicitly deny having travelled to China in the past 14 days. The receptionist used her key to let me into the stairwell and I was on my way.

Let me just mention at this point that as soon as you put on an N95 respirator mask, your nose develops an irresistible itch.

At the top of the stairs I rang a bell and soon a medtech came to let me in the locked door to the second floor. There were signs everywhere saying full PPE needed to be worn, but the medtech was wearing only a mask. I assessed my patient. She was doing fine, considering. I went to the medtech station to chart, educated the medtech on when she should call hospice, and checked that all the right medications were present.

I was bumbling around in full PPE, rustling when I walked, my breath noisy, all a bit Darth Vader. The medtech was not even wearing a mask. I advised her to wear one. She said it made her feel claustrophobic, so she only wore it outside the medtech room.

Because, you know, Covid-19 doesn’t really like that room. It only likes outside that room.

When I got home, I left all my clothing and shoes in a plastic bag in the carport and nimbly darted into the house in some clothing that could not have come in contact with the covid 19 virus. Since everyone is sheltering at home, no neighbors witnessed this scene. I’m hoping.

Tomorrow is not a work day and I don’t have to dress up as Darth Vadar, so naturally I plan to climb a staircase with 187 stairs fifty times. See previous blog post. I just don’t have what it takes to explain this sentence. I like to tell people that the stair climbing is keeping me sane but actually tonight I wonder if I have that ass backwards. For the past few days, I’ve been making very poor headway in my training schedule for the whole stair climbing challenge thing. I was only able to climb the staircase 5 or 6 times and those were primarily propelled by annoyance. Trudging would be a good way to describe my climbing style. Quite a bit of muttering was involved.

However, I signed up for this thing and I’m going to try and see it through. My left knee hurts, and it being Friday, happy hour was a lot more prolonged than it probably should have been. I’m really looking forward to an inspiring speech by Bill McKibben at 8am tomorrow, encouraging us Climate Risers to get out there and promote change in the world. And if this means I do two staircases and then have to collapse in a heap, at least I will do it in a trendy looking cloth face mask. Maybe I’ll even wear my Darth Vadar face shield. Just for the sound effects.

Riding Fool Climbs One Gajillion Stairs During Global Pandemic

We riding fools cannot do our Climate Rides this year. I can’t even really ride my road bike right now. I mean, I could. It would be a great stress release, riding solo, in my face mask, on local roads. It’s just that when you ride a road bike there’s a first time for everything, and I have never yet gone over the handlebars. I keep imagining turning up in the ER during a global pandemic with a road-bike concussion. 

But the Climate Ride folks are endlessly resourceful, and they have come up with a shelter-in-place alternative for this year’s cancelled rides. It’s called Climate Rise, and it encourages us road bikers to sign up for some personal or team challenge that we can do at or close to home on a designated day. The day is Saturday April 18th. Examples of personal challenges are: writing 37 poems, baking bread for the first time, and climbing 18,700 stairs.

I include that last one as an example of just how bonkers humans can get when they are forced to #staythefuckhome. But also because I personally know the person who’s going to attempt it. Ok, I’ll just come out and say it. It’s me.

I loved the idea of a Climate Rise challenge. It would be inspiring to me, I figured, and also hopefully to some other people. I didn’t want to fundraise, we’re all strapped enough for cash at this time, but I wanted to do something that might keep climate change in people’s minds while also connecting us somehow in this time of separation and fear. I just couldn’t decide what my challenge would be.

As the social distancing restrictions tightened and we were constrained to staying closer and closer to home, it came to me. Right outside my front door is a staircase with 187 stairs. What if I climbed up and down this staircase some number of times on April 18th? 

One day I went out and climbed the staircase three times. It took me ten minutes and I was pretty winded. The next day my calves really hurt. So the day after that I tried it five times. 

When you are unable to go to the gym, hang out on the beach, ride your bike up a glorious mountain, or even drive to some local trailhead for fear of people who live next to that trailhead yelling at you (this has happened to me), you have to get creative. When you are climbing the walls from being indoors so much, you get a bit punchy. I decided a hundred times sounded good to me. So I signed up for Climate Rise and I started to train. 

When I am training for a Climate Ride, I ramp up slowly over several months on a carefully planned schedule. My training coach is a very inspirational friend of mine. She is a triathlete and she takes no prisoners. This is how conversations with her go on a 50-mile ride on a Sunday morning:

Her: We don’t need to stop at Olema for coffee, right? We can power on to Marshall?

Me: Ummmm

Her: Great! That’s how I feel too! Marshall!

However, training to climb 18,700 stairs during a global pandemic when I’m also still working full-time as a nurse is proving to be a little less scheduled and, let’s just say, kind of spotty.

One day recently I did the staircase seven times. The next day, six. I was sort of tired that day, but also happy hour came around before I had a chance to do my stairs. It was completely beyond my powers to prevent it. A word to anyone out there wanting to climb 1870 stairs: don’t have a glass of wine first. 

I have a great playlist that I have put together to keep me engaged as I trot up and down the staircase. It’s called Born Slippy after my all-time favorite workout song by Underworld. There are songs of different speeds on my Born Slippy playlist, because in the beginning you want to run up and down the stairs, but after a while you just want to sort of slowly slog. And sometimes, when it is getting a bit weird to be climbing the same staircase yet again, you want to get fancy: take steps two at a time, skip down, use a new rhythm that matches the song. Exciting stuff!

I feel lucky because as a hospice nurse, not only am I still fully employed but I get to drive around a bit. I’m not the kind of person who would do well being stuck in the house all the time. So despite the risks inherent in visiting patients, I’m thankful that several times a week, these visits are essential for hands-on care and I get to beetle up and down 101 with no trouble at all. It’s like a good dream, driving 101 during the pandemic. And then I come home and I get to climb a staircase eight times! I mean, what more could anyone want?!

You will not be surprised to hear that it becomes a little meditative, hoofing it up and down those stairs. I have deep thoughts. I can’t really remember what they are now. It occurred to me I could record them on my iPhone, but then I was afraid it might be like when you get really stoned and the next morning you read over your penetrating wisdom from the night before.

I do remember thinking this evening, at about stair twelve hundred, that my activity was a little like a metaphor for life: it’s a lot easier to go down than it is to climb up. Deep, no? I’ve also been soaking up the wisteria vine that hangs over much of the top half of the staircase. Every day, a little more in bloom, a little more fragrant. I think about how people in India can see the Himalayas for the first time in decades as the lockdown eases air pollution. Shoals of tiny fish are visible in Venice canals. Nature is taking back some of what we stole. 

In celebration of this momentous shift, of humanity’s epic fight against a microbe, of the kindness and humor and generosity and heroism that have blossomed during the pandemic, and of my own hopeless optimism, I’m climbing stairs. I don’t really know what else to do with myself.

At 8am on April 18th, Bill McKibben is going to virtually address us Climate Risers before we head into our challenges. After his talk, I will go outside and face my demon staircase. I honestly don’t know if I can do it. I’ve only climbed eight so far, and it’s a week before. Whether I make it to a hundred or not, I really hope I don’t trip and break a bone. Imagine turning up in the ER during Covid-19 because you were running down a staircase to the rhythm of Born Slippy.

Hospice Nurse Eats Half Her Weight in Ice-Cream

It’s April 2020. I haven’t blogged since late September. That was then. This is now.

I am sitting on the sofa and rain is beating down on the skylight. I am eating ice-cream from a mug with a knife. The ice-cream has raisins and honey in it, because these are things I found in the kitchen, and I haven’t been to the grocery store in a while. The knife? No clean spoons. Life has been very surreal recently, with the pandemic and all, but really, how much stranger did it have to become?

I am a hospice nurse, so every day at work I meet people who have been told they have six months or less to live. I long ago gave up trying to imagine what this must feel like. I just hope in my every interaction with these people to be kind and gentle, not to say anything too thoughtless. Keeping in the forefront of my mind their tenuous relationship with the future can be exhausting. Imagine what it must be like for them.

I have been present when my patients took the Aid in Dying medications, legally ending their lives in the presence of friends and family. You don’t walk out of those visits feeling that the world is anything but surreal.

Early 2020, along comes Covid-19. Nobody has any immunity to it. Kind of like death in general, like the entire human race just qualified for hospice. But now, everyone’s buying up zinc lozenges and rigatoni and toilet paper. My hospice patients never panic buy dry goods. I guess they know better.

People keep asking me whether I am safe doing my work during the pandemic. The short answer is, I wish I knew. But I think you can say the same of anyone who sets foot in a grocery store right now. Working in healthcare has its own specific set of risks, of course. And I know the two questions they are really asking: Are you nursing people with the virus? Do you have enough protective gear at hospice? Same answer: I wish I knew. 

My hospice has its store of gloves, gowns, and masks with face shields. We nurses all have at least one N95 mask in our car stock. There are solid plans in place to keep us supplied with protective gear as needed. The problem is, nobody knows how much that will be. Every Thursday, we have to let our supervisor know our projected PPE needs for the next week. On Monday afternoons, we drop by the office and pick up our allotment in a baggie with our name on it. A volunteer gives them out. Last week, my baggie had a pink paper cutout heart in it too. 

We are only making essential in-person nursing visits. You know, for hands-on things like wound care, critical end of life symptom management, and lots of bowel stuff you really don’t want me to describe in any sort of detail.

Every day I don’t have to put on a blue gown and N95 with face shield is a good day. I mean, it’s just really hard to look cool in those plastic gowns. I’m pondering this fashion dilemma as I get a new tub of Ben & Jerry’s from the freezer. To be fair, the first tub only had a few spoonfuls left. It’s not that I’m bingeing on ice-cream. But why do they have to put a crackly plastic seal that you need a sharp knife to open because you can never find the perforations? I’m jabbing at the seal with a knife and I’m imagining how fun it would be to have to go to the ER during a global pandemic with a Ben & Jerry-related knife injury.

It would not be fun. But it would be no less fun than breathing fiberglass. I say this because of the homemade face mask thing. The CDC vacillated for weeks over whether cloth masks for the general population were a good idea, even though South Korea, Hong Kong, and Taiwan had already clearly demonstrated that they were. Finally they said ok, yes, sew yourselves some t-shirt masks. 

Meanwhile, somebody figured out that HEPA vacuum cleaner bags filter out 97% of particles, so they’d be a great thing to stick inside your homemade t-shirt masks, no? No! Because after I did this, and breathed a couple days’ worth of air through my homemade masks, somebody else noticed that HEPA vacuum cleaner bags are made of fiberglass. So now, even if I survive Coronavirus, I’ve been breathing fiberglass for two days.

There’s just not enough ice-cream to go round right now.

On the upside, I’m seeing a whole lot more of my teen during ‘the Covid’ as the Irish are calling it. This is a good thing, even if the stress of a global pandemic has made her just a tiny bit more spacy than usual. I came home the other day from work and our front door was wide open. Teen was not home. I texted her. How long had our front door been wide open with nobody home? She could not say. A couple of days later, I come home from work to find the front door closed but with the key in it. I text her. Progress! Her response: Leaving the door open is really safe cos robbers will just assume you’re home. If you close your door but don’t lock it they’ll be like, stupid people, I’m gonna steal their stuff.

I’m not sure where the door with a key in falls on this spectrum. But I am loving on the more time with my teen thing. I did have to show her one day where my red folder of Important Papers In Case Mom Dies is in the basement. That was a special moment. We had a chat about it. During our chat, it was established that she would prefer if I didn’t die. Oddly, I feel the same way about her. I’m guessing these special chats are happening all over the planet right now. Sort of makes me feel like having a little ice-cream.