“The hardest thing is when someone breaks down and I can’t hug them”

Archie Vasiliou’s role as a healthcare assistant for St Luke’s Hospice Plymouth sees him visiting patients who need urgent care in their homes. We spoke to Archie about the new challenges Covid-19 has brought him and his team, and about balancing compassionate care with the need to keep their patients, and themselves safe from infection.

I work in the end of life Urgent Care Service at St Luke's, and we work in partnership with Marie Curie. We provide palliative care to patients in the community, so anything from personal care to emotional and psychological support to the patient and their family. It could be monitoring symptoms with syringe drivers or medication changes for example, and we mostly do this by liaising with our nurses, GP practices and out of hours doctors. We try to cover every need from medical to spiritual care for the person to die at home, feeling comfortable and settled, and making sure the family are supported too. Then after their death we refer them to the proper services, making sure everything's done in an appropriate way, and that everyone is as happy as they can be.

Because of Covid-19 things have become much more impersonal, sadly. We have to wear a mask because we need to shield the patients, who are extremely vulnerable because they're receiving palliative care. Nine times out of 10 they've got an elderly spouse who is also vulnerable, so we have to protect them too. One of the things I've caught myself doing constantly is explaining that I'm actually smiling, and trying to personalise who the guy behind the mask is. So there's been a change in trying to communicate facial expressions to patients.  

I think we're doing a good job at keeping the personal touch where we can, but it is a massive challenge. We've got other challenges, and one of the biggest is trying to source supplies such as medication because there's a massive demand with limited supply at the moment. With so many people working from home and the GP practice not working at capacity, it might take a bit longer to get a prescription chart, and we'll rush to the pharmacy to find a massive line outside which means it'll take longer. We're having to plan ahead by scouting what pharmacies have instore beforehand, and knowing what route will be faster for us.

There is definitely fear of the health risks we face, and any healthcare professional is going to feel that at the moment because this is a scary time. We're seeing nurses sadly pass away, and a Marie Curie nurse died the other day. But within the team we're very good at looking after each other because it's the nature of our job. We know we're going to have wobbles and down days, so we give each other time out to go and get a cup of tea, and if we can we'll suggest they sit the next round out and we'll see the next patient in their place.

One of the problems we have is that we can't test patients in the community. We have a red and green system, whereby patients who have no symptoms will be classed as green, and PPE (personal protective equipment) for these patients is an apron, gloves, and a normal surgical mask that basically shields the patient. If a patient develops a cough or fever we go into the amber mode and add extra eye protection. The third type is red, so that would normally be for someone who has tested positive, but because we don't know it's when someone has a cough or fever, is on high flow oxygen or has a tracheostomy. Then we have to wear the full space suit - a gown, a mask and a visor.

We will probably never know how many deaths or cases there are in the community. The only way we would know is if someone came out of the hospital positive and returned home.

The hospice does have the availability to test staff, so if I get symptoms I can get tested. If my family member or partner becomes unwell she can get tested too. That takes the pressure off so we know what we're dealing with.

Family members not being able to see each other is really difficult. The idea of going home to die has always been a good option because people can be with their loved ones. Now that's impossible, and they can't have kids or grandchildren visit even if they live nearby. I had a patient whose daughter lived down the road but because she was vulnerable she could only see her by looking at her through the window, which was really odd.

The hardest thing is, and this happened to me last week, when a woman broke down about her husband and I couldn't hug her. It's really difficult because we're huggers, we put our hands on people's shoulders to support them and then suddenly we have to stand there and convey our message by speaking.  So I'll say, "I'd normally give you a big hug, but I can't right now".

On Thursdays, when people stand at their windows and balconies to clap, it's amazing. It's nice to know there are so many people supporting so many keyworkers.  It just shows how vital this service is.  Everyone's clapping for their own reasons, somebody might have had someone in their local hospital who recovered, someone might be at St Luke's, or might have lost a loved one,  and they know we're still here for them.

Yesterday I was driving around in our car with the St Luke's logo on it. There was an elderly lady standing in her garden, clapping and serenading us on. My colleagues and I just want to do the best job we can, and we're very proud of the quality of care we give.  That's going to continue no matter what happens. No disease, not even Covid-19 is going to stop us from doing that.

For more information visit St Luke's Hospice