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On the frontline:  “We must look after ourselves to be strong enough to care for others”

Photo 1 Dr Jonathan Riordan in his scrubs on the Inpatient Unit at St Clare Hospice_

Jonathan Riordan is a Consultant in Palliative Care at St Clare Hospice in Essex. His role is usually split between working with patients in the community, on the hospice’s Inpatient Unit, and at Princess Alexandra Hospital in Harlow, but during the pandemic he’s been based mostly on the IPU. Still in his first year at the hospice, he shares how the pandemic has affected him and his colleagues. I’ve spent a lot more time at work since the pandemic began. My longest run was doing 24 out of 26 days – that was really tiring and felt relentless. Three of our doctors were pregnant so they couldn’t be in the IPU because they were in the high risk category. Our most junior doctors went to the local hospital because they were needed on the acute wards. This left one or two of us to do what would have been done by five or six doctors normally. PPE has been a much bigger barrier than I thought it would be, as I didn’t realise how much a smile helps to put patients at ease. Nor did I realise how much I rely on it for communication and to show that I empathise.  These days, I’m often left hoping that patients know I understand what they’re saying – I go away wondering whether they’ve taken on board that I care. Emotional challenges We’ve had to work out how we can best work together while social distancing, and still deliver high quality palliative care. The environment we work in isn’t as personal now – the communal areas where people used to gather and share thoughts had to be removed, here’s no open visiting and no family spaces – these things are challenging. When I see patients in their homes, it feels more like an intrusion now. I worry whether I’ll be making people feel more anxious by visiting them. We’re having to manage their stress, as they feel their treatment might be affected by Covid. It would be impossible for us to be unaffected by the last few months. The pandemic has definitely taken its toll at times; we’ve been tired and stressed, so just making sure that we’re there for our colleagues has been so important. I’ll be honest – sometimes it’s with varying degrees of success, but we try to give each other a bit more time, space and understanding. Compassionate care in difficult times Spending more time on the IPU gave me a chance to witness some of the care that our patients are getting – for example we’ve had a lot of young patients, with big families in some cases, and explaining to them that we have to limit visitation was so tough. Seeing how skilful and compassionate the nurses can be in such sad circumstances was a real privilege, and it made me very proud to work here. It’s not just the nursing staff; I’m so impressed by how everyone – nurses, healthcare assistants, housekeeping, kitchen staff – all pulled together, pushed through, and did their jobs so well. It’s natural to look back and ask yourself what you could have done differently. But it’s important to remember that the first time round everything was new; we went from just knowing Covid existed on one day to developing policies on how to run a hospice in a pandemic the next. At one stage the Government was giving briefings in the afternoon and we needed to have guidance in place the following morning. Hats off to our Senior Leadership Team, who managed this so smoothly. Self-care and supporting others The biggest lesson has been how important it is to look after ourselves if we need to be strong enough to look after others, physically but also emotionally. This is the first time in my career where sometimes I got home and felt like an absolute mess, and I know it was because I wasn’t taking enough care of myself. It’s easy to burn out that way. My first nine months as a consultant have been a steep learning curve, but I’ve taken a lot of positives away as well. Firstly that the care we provide is truly outstanding, and I couldn’t be prouder of that. Secondly it was really nice realising how much support I’ve got around me, whether that’s the nurses on the unit or in the hospital, the senior leadership team, or our GP colleagues, ready to step in and help when we needed them. And that makes me confident that although the next few months aren’t going to be easy, we’re in a good place to cope with whatever is thrown at us. More information Our Frontline is a partnership between Shout, Samaritans, Mind, Hospice UK and The Royal Foundation of the Duke and Duchess of Cambridge. It offers round-the-clock one-to-one support, by call or text from trained volunteers, plus resources, tips and ideas to look after your mental health. Hospice UK’s Just ‘B’ Counselling & Trauma helpline.  The service is a free confidential national helpline available 7 days a week from 8am to 8pm on 0300 030 4434, providing bereavement, trauma and emotional support for all NHS, care sector staff and emergency service workers. Call the ‘Just B’ Counselling & Trauma helpline on 0300 030 4434 Visit the Our Frontline site

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