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When I speak to someone on the phone they are often panicked, but then it is a sigh of relief when they can get to speak to somebody straight away and they know you are there. It's so lonely looking after someone at home and it's so scary.
Even though we can be there on the phone or in person when they need us, we’re not always there with them all the time, so they are always on their own. So to have someone on the end of the phone to say ‘look, it's fine, we're going to help you, we can get somebody out to you’ or ‘you know, we can deal with this’, then the panic subsides really quickly because they know that they're not on their own.
I can hear the absolute relief in their voice, because you would be relieved, wouldn’t you? It's hard to comprehend but I just think it must be so scary, especially at night; nights I think are scarier because people do feel more alone at night.
Any number of things could be coming through on a call. At any one time we could have someone having chest pain who needs an urgent assessment. Perhaps somebody struggling with their relative and needs some support. Sometimes it's a tearful patient who needs someone to talk to, and sometimes it's a rapid response for a verification of death or a stat dose for pain or agitation.
There are lots of situations it could be and it is so changeable so we can't really make a plan of what we're going to do that shift because things change so drastically.
On the night shift there are not many people around, only a nurse and health care assistant based in SinglePoint. There's always someone in the medical team on call if we need help or we have a complex issue, and the district nurses work at night too.
Nights are tricky if we're busy but we cope and we get to everybody who phones, even if they leave a message we get back to them very quickly; I’m very conscious of that because it’s not very helpful not getting an answer when you call for help.
Night shifts tend to be more intense because there is only you. We haven't got the other nurses in the office to bounce off and share visits with, but they are rewarding because you can make a real difference.
When I knock on someone’s door and the patient’s loved one answers, whether day or night, they basically melt. People are so grateful and so thankful that it's just too much for them, and in some cases they've been struggling along alone. As soon as I get there and as soon as someone answers the door and they've got somebody in the house with them to help them, it is like they just exhale and I see a feeling of 'thank goodness'.
People are so apologetic when they phone in as well ‘I'm so sorry to bother you’. Please bother us, that's what we're here for.
I’ve often got a crack in my voice when I'm with somebody because it's just so emotional. But it’s such great job, I love it. I love it because I love being there to be able to make a difference.
I know I’ve done a good job when I have had a conversation with the family - obviously if the patient is in pain and I've managed to make them comfortable, that's great - but the conversation I have with the family so they're not panicked anymore and they know there's a plan and they know there's somebody they can call on.
Once I've been to somebody, and maybe they've never had someone there before, and they know they can call us and they know when they call us, something happens, they actually get help, then I know everything is much calmer. I could walk into a situation, sometimes really stressful situations, where there's lots of family present and emotions are heightened.
But when I walk out, I've calmed the situation, I've made it more manageable, I've made the situation a lot better and made people feel more supported - and that's just really nice because I drive away thinking, yes, I’ve done a good job.
I also feel I’ve done a good job when I’ve made a patient who is in pain or agitated comfortable and completely settled, and reassured their scared family. The patient hopefully goes on to have a good death in the end because they are comfortable and settled at home and their family is calm.
A rapid response visit to someone in crisis could be to a patient who we've not really had anything to do with yet, where the patient has sudden agitation or pain. They may have been quite OK before and then suddenly they deteriorate, and they have no care in place and everything suddenly become unmanageable. There could be a hysterical, frightened person on the phone saying ‘I don't know what to do’ prompting a rapid response from us. That would probably be the first time we had ever met that patient because we don't have a caseload as such.
We make every minute matter in a crisis because it's important not to miss the cues, and by visiting them at home we get a full picture with what's really happening. Sometimes we go and it's much worse than we understood it to be on the phone, and sometimes it's not as bad as we were expecting.
If when we arrive, they are actively dying, we will try to stay with them for as long as is needed. At that minute it's really important to have very clear conversation with relatives, to use clear and concise language, to say they are dying, I think they're dying, I think they're going to die very soon. Not to just say he's quite poorly at the moment, that sort of thing doesn't really help. You have to be very clear, and it's not easy to tell someone their loved one is about to die but there's no point beating around the bush because that doesn't help. You have to get used to having difficult conversations and that doesn't get easier.
They've got their wishes and they're at home in their own surroundings and they've got the people they love around them. That's a great death. Sometimes you walk into a home and the atmosphere is beautiful; they've got photos of their loved ones next to them on the bed, candles, a really nice atmosphere. That's a good death and that's when I can say to the family, you've done brilliantly, brilliant job.
We are promising to support people in their time of need as much as we possibly are able to. That's all we can do. We treat everyone as individuals and everybody's got things that are important to them. Everyone's got different things that matter.
This story may not be published elsewhere without express permission from St Helena Hospice.
Ross Chirgwin is a rapid response clinical nurse specialist (CNS) and non-medical prescriber (NMP) in our SinglePoint team, who visits people at home across the whole of north east Essex when there is an urgent need or they are in crisis, day or night.View more
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