How I see it …. bursting bubbles?

After two weeks in lockdown to prevent the spread of COVID-19, I have left my home a total of three times.

Once to pick up a prescription and once to buy vegetables and once to go for a walk. In these times, I have come closer than 2m to three people who are outside of my isolation “bubble”, and in all cases, they were wearing some form of PPE.

While the process of isolation is a change to the life I have become used to there are positive aspects, for example, I can, for the most part, work from home. My work has been less interrupted and at times, more productive. At home, there is also less traffic noise at night which means getting to sleep is easier.

Socially we have adapted, we now have virtual coffee, virtual drinks and today a virtual afternoon tea for a staff member who is leaving. A further example of adaptation is related to grocery shopping. Instead of more frequent visits to the supermarket, I find myself waiting up until midnight to get delivery slots for groceries instead of same-day order and delivery before lockdown. Even though ordering over a week in advance is a new thing for me, it is not a big problem.

Overall, I would consider myself pretty resilient, a problem solver and someone who strives to make the best of most situations and logistically isolation has not been as hard as I expected it to be. However, I did underestimate the emotional toll of loneliness, uncertainty, fear and loss of family contact.

My isolation bubble is small and consists of myself and a flatmate. My family have two other bubbles in NZ. The first is my mother and brother (who also have the same genetic respiratory condition). The second is my father, who is in a bubble of his own with Hospice staff.

Today my morals were challenged. The hospice Doctor discussed the fact that I could visit my father in his last hours which could be soon. Currently, the COVID-19 lockdown means no visitors other than compassionate at the end of life.

While it will be fantastic to spend time with Dad, the context is not the best. Over the last few weeks, I have been finding not seeing him or helping with his care very challenging, but this is with the knowledge that in breaking the rules, I could cause harm to others.

The dilemma I face is the safety of others versus my own and my father’s desire. Just how many bubbles do I burst to spend time with him versus the risk of harm?

Having low vision means that I can not drive. For travel, there are usually other means, such as rideshare, taxi, busses, friends and more but in lockdown, options are more limited by availability, cost and time.

There are a lot of things to weigh up. I really would like to see my father, just as he would like to spend time with me. However, there are other factors in play, such as cost, time, emotions, lockdown, the potential spread of disease, and putting others at risk.

As a nurse, and personally helping others is important, this includes my father and the others I may encounter. In lockdown, helping myself and my father means not assisting others, in other words, both options are mutually exclusive.

My father is in a hospice that is 35 minutes drive from my house. It would take me 3 to 4 busses and at least 1 hour 35 minutes weekdays. In taking this travel option I would potentially burst at least 5 bubbles (not including other passengers). Taxi companies have quoted around $220 for a 35 minute trip with three bubbles burst (mine, the driver, my father).

Asking my brother to take me is an option; however, his car has no warrant and registration, and the local testing station is only open for essential vehicles making this a less viable option. While there may be compassionate grounds around the warrant and registration, this is a risk my brother is not willing to take. It would also burst three bubbles.

Typically, organisations such as Hospice, Cancer Foundation and Blind and Low Vision may have volunteer drivers for visits like this. However, in lockdown, these options are not available.

What I have come to realise is that no matter what option I take here, there is a cost whether it be timing (e.g. the time it takes me to get to hospice to see Dad in his last hours), financial (the price of a taxi), emotional (not seeing Dad or putting others at risk) or risking spreading COVID-19, travelling outside of my local area (breaking the law).

What writing this post has reminded me is one of my personal and professional values is around showing compassion for those around me and myself when we are all challenged by the world that we live in.

How I see it … Seasons

I realised today that it had been quite some time now since I wrote a blog post. While, there have been a number of family issues that have needed my attention over the last few months, the beauty of the summer is noteworthy.

Takapuna Beach from the boat ramp.

What struck me today was the impact of the seasons on my life. For example, summer has been fantastic, it is lighter for longer each day, and there is more time, the weather is better, being outside is much more enjoyable, and in this environment, I feel much more relaxed.

Trees in bloom at Milford Shopping Centre.

The reason that I noticed this so much today was that it appeared to get darker earlier than it has lately, which made getting home from work more challenging.

Recent changes in my vision mean that too much light often decreases my ability to see detail; however, this is usually alleviated by wearing sunglasses, a hat or facing away from the light. What I had forgotten was the other extreme, at dusk and night where the brightness decreases, taking away the detail and the halo and flaring effect of light coupled with the glare.

Over summer, the impact of this was minimal, and I rarely needed to use my cane as it was light for longer. My confidence in getting around had grown, and there were even a couple of times I thought to myself that I was confident and perhaps safe enough to drive again (although this isn’t an option as my visual acuity does not legally allow this).

What this illustrated is just how much of an impact the environment can have on the quality of life. In particular, for me around mobility and therefore, independence.

I believe that noticing this phenomenon is worthwhile as in the moment (winter) when getting around is more complicated, it allows more natural separation of what is within my sphere of influence and what is not.

… And just because I can, I have added a photo of my cat Katie (2005-2020) that I took several weeks ago.

How I see it … accentuating the positive

When you are striving for the best, with a number of things going on such as family in hospital, vision changes, the end of the academic year, crowds at Christmas, public transport, PhD oral examination and thesis amendments, co-chairing, marking, several conference presentations and a lot of deadlines / submissions to journals simultaneously it is sometimes hard to see the wood from the trees or in other words the positive in some situations.

As a reminder to myself that there is positive out there – I have put together a synopsis of my 2019 achievements to remind myself. Collating them like this has helped me to see the big picture.

Work

  • Paid Work
    • Lecturer (Full Time) at Auckland University of Technology
  • Volunteer Work
    • Area Youth Manager (St John Youth) – resigned late 2019
    • Course Coordinator (St John Youth) – current
  • Study
    • Completed, submitted and defended my PhD
In one of the lecture theatres at AUT – AA234

Awards

The Robyn Carr Cup for Excellence in Nursing Informatics 2019 awarded at Digital Health Week.

Appointments and Memberships

Speaking

eAllied HealthWhat does it mean to be digitally competent clinician

Presenting to allied health professionals about what it means to be a digitally competent clinician.

Health Informatics NZ – What nurse educators want to assist them develop a nursing workforce for the future: Nursing Informatics Competencies for New Zealand Nurses (presented with Michelle Honey and Emma Collins)

Discussing the nursing workforce in relation to Nursing Informatics at HiNZ 2019.
Brendan Wood (also from AUT) and I at an Auckland St John Investiture

 

eHealth NursingChallenges and enablers nurse educators face teaching nursing informatics (presented with Michelle Honey)

Presenting our Keynote around the challenges and enablers of teaching nursing informatics.
The auditorium was huge and rather daunting.

 

Media

eHealth TV Interview regarding being awarded the Robyn Car Cup (click here to watch the video)

Just for fun – two of me!

NZ Woman’s Weekly Article – click to see the full story.

Article from the Woman’s Weekly

Campaigns

#alttextforall – look under our services for my video.

  • Social Media has gone a little viral on Facebook with more than 12,000 hits

Reviewing

  • Reviewer Clinical Case Studies and Scientific Submissions for Digital Health Week (HiNZ)
  • Reviewer Journal of Clinical Nursing
  • Reviewer Emergency Medicine Journal
  • Reviewer Emergency Medicine Australasia
  • Reviewer PM&R: The journal of injury, function and rehabilitation

Other Achievements

TBC

How I see it … conflicting diagnosis

For 10 years I have thought that one of my eye conditions was narrow or closed angle glaucoma with episodes of acute angle closure. As a nurse and academic I have been happy in my knowledge of this disease process, signs and symptoms of angle closure glaucoma. The literature and clinic letters support my assumption of this diagnosis and am happy with identifying signs and symptoms and at times can guess my own intraocular pressure from the way I am feeling.

Normal intraocular pressure is 11-22 mmHg, my own experience, has been that at 20 mmHg my eye is irritated, I develop moderate eye pain at around 25 mmHg, I start vomiting and my cornea begins to opacify due to lack of oxygen at 30 mmHg and once the pressure reaches 60 mmHg the pain is to unbearable to move.

A month ago I was informed I had normal tension glaucoma, in other words damage to the optic nerve and field loss are evident at normal eye pressure, along with this diagnosis I started different eye drops.

On review several week later, I was informed I had open angle glaucoma. My understanding of the pathophysiology of glaucoma was that these two mechanisms do not usually co-exist. I questioned this and was informed that this is very unusual.

Firstly I reviewed a video to ensure my understanding of glaucoma was correct.

After searching literature there is little information on people who have both open angle and angle closure glaucoma. There is a type of glaucoma called mixed glaucoma but this appears very little after the 1970s in basic literature searches and does not match my presentation.

Over the last week I have been trying to fit symptoms and knowledge with these new diagnosis. What frustrated me is that these diagnosis do not generally co-exist. What this has reminded to me is the need we have as humans to categorise things such as these diagnosis to understand them and that medical science is not black and white.

It has also illustrated that this is an uncomfortable place to be outside of the “logical” or “normal” paradigm. As a nurse and academic I consider myself knowledgable, however, if I did not have these skills to unpack this or realisation that medical science is fluid this could be quite intimidating or even “scary”. This has reminded me of what our patients face without knowledge or insight into healthcare system. It is a timely reminder of the power imbalance that knowledge or lack of knowledge can influence.