Leading with compassion and rooted in evidence
As a state representative, I'm closely monitoring the immense impact COVID-19 is having on our state, our communities and our economy. My view of this crisis is not just from my role as a legislator though. As a nurse practitioner in our community, I am seeing the health care implications up close and personal every day. I serve members of our community who are homebound and unable to be treated in a traditional clinic setting. My patients range in age from
their 20s to over 100, with conditions that include developmental disabilities, dementia and other chronic conditions. I visit them in their homes and grow close to them and their families.
In the 20 years I have served as a nurse, I have never gone this long without caring for my patients in person. Like many medical providers across Oregon, my employer, Housecall Providers, temporarily suspended in-person visits and the acceptance of new patients. We did not have enough personal protective equipment to protect patients, staff and caregivers. The need to minimize outside visitors is balanced with the need to manage their chronic health conditions.
We practiced telemedicine, and if urgently necessary, we made home visits using personal protective equipment to keep our patients safe. Recently, I volunteered to train and offer the COVID-19 test for our homebound patients.
So, for the first time in weeks, I was able to care for a patient up close again. I missed them, and longed to help their family members. This particular patient has dementia, and was happy to see me. His daughter was being pushed to the limit, stressed by the results of her own coronavirus test and the pressures of caring for her father. I was excited to see and care for him — though the way we had to interact changed dramatically since COVID-19. Between us was a face shield and an N95 mask. I could touch him, but only with gloves and gown on. I couldn't help but think of the other kind of care we were missing — the ability to hug or touch someone's arm and just sit with each other and laugh. Normally, I would have stayed longer to talk through challenges and fears, a critical part of my work, but for their safety, I left quickly.
Instead, I put my gown and gloves in a bag to be thrown away immediately. I disinfected my face shield to be worn the next time I collect a sample from a patient for a COVID test. It was an entirely different patient care experience than I have ever encountered. I put my N95 mask in a brown paper bag, so I could use it again, and thought about the thousands of lives lost over the past month, and the frontline health care workers who are wearing the same mask all day. I thought of their bravery and the deep pain they must be in.
As palliative care clinicians, our priority is always to provide patient-centered medical care. Whether it's treating a cancer diagnosis, end stage kidney disease, a broken heart or end-stage dementia, clinicians always lead with compassion, stay rooted in evidence-based medicine and stay focused on the goals of care. Every day, we must decide between the benefits and risks of a hospital admission and the benefits and risk of treating the symptoms at home. These decisions are some of the most difficult a family can make, and with the spread of the coronavirus, they are even more complex, and even more difficult.
In these unprecedented times, my job as a primary and palliative outpatient care clinician is to do what I've always done: treat my patients, work with families, help them make scary decisions based on evidence and science and, most of all, do what is right for them.
I'm proud that our patients are safe and we are delivering the care they need. I look forward to the day when I can see all of my patients in-person again without so many barriers between us. I remain hopeful that soon I will get to laugh and cry with them while holding their hand without gloves or a mask.
As an Oregonian, a nurse and a state representative, I'm thankful to all those who continue to make sacrifices during this crisis to ensure that our health care workers have the personal protective equipment they need.
I know those sacrifices have been great. I see them in families who cannot visit their loved ones, and among small business owners, worried that they might close forever. Every day, I am listening and learning from Oregonians who are struggling. Their sacrifices are saving lives and protecting health workers, and we have to make sure they come out of this crisis and thrive.
Representative Rachel Prusak is a state representative serving District 37, which encompasses portions of Clackamas County and Washington county. She is a Family Nurse Practitioner currently serving homebound community members.
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