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Rory Gleeson, an assistant professor of English at Northeastern University in London, is writing a novel based on his experience as a non-registered support worker, a role designed to assist under-pressure nurses.
LONDON — Rory Gleeson knows what a beautiful death looks like. And he knows that patients he cared for while covered head to toe in protective personal equipment during the COVID-19 pandemic were not being afforded the life ending they deserved.
Gleeson is a novelist and assistant professor of English at Northeastern University in London. But, in an experience echoed the world over during the coronavirus pandemic, repeated lockdowns killed his creative spirit and the writing dried up.
Having interviewed senior staff at the hospital in Codogno — a town in Italy’s Lombardy region that was at the epicenter of the first European COVID-19 wave in spring 2020 — about the turmoil they had endured and the abandonment they felt, he was determined to put himself to practical use if the virus struck again.
And it did.
The second wave rocked the United Kingdom that autumn, encouraging the writer to apply for a job with the country’s National Health Service (NHS) as a non-registered support worker, a role designed to assist under-pressure nurses.
Now, Gleson is producing a novel based on his and others’ experience working on the frontlines.
“I had two grandparents of mine die in hospice in a very beautiful way,” Gleeson recalls. “They were cared for, they were spoiled rotten and they were given love, attention and kindness as they died.”
He says it was “important” for his family to see their loved ones “go with dignity” and know that the medical workers were “doing the best for their patients as they leave.”
But that experience was a world apart from when he started his three-month stint working in Hammersmith Hospital, west London, in early 2021 during the period when the third COVID wave in Britain was not long past its peak.
What he went through during shifts could be “upsetting” while also leaving him feeling shame and guilt at being unable to provide the level of care he wanted to at all times.
In more normal times, intensive care units will often see a nurse deployed with a single patient on a daily basis for the entirety of their weekly shift pattern, a deployment that allows strong bonds to form, Gleeson explains. He says during COVID overloads, nurses could be given as many as three high-dependency patients to care for, with support workers like him assisting them by helping with the physical labor of turning patients, washing them and changing beds, while also running ward errands.
“There were a number of things that were upsetting that you see and that you do,” he tells Northeastern Global News. “A lot of people in ICUs are uncomfortable, they’re in pain, they’re delirious or they’re in a very dazed state. And you are there to try to console that person and to try to make things easier for them — and a lot of times you can’t.
“Sometimes you don’t have the time and sometimes you have to move to other people or sometimes you have to do other things. So you literally don’t have the time and the space to give them the compassion, dignity and care that you would want, which is your job. A lot of the time there is a great sense of failure when you are watching somebody get worse or watching somebody suffer needlessly when you could help that person if the circumstances were different, if circumstances in the hospital were different,” he says.
The pace of the work could be so frantic and disconnected, especially because having to wear personal protective equipment like gloves and face masks fractured the personal relationship between coronavirus patient and caregiver, that the sick Gleeson had cared for died without him knowing.
“At one stage, somebody asked me about a patient and I thought, ‘Actually, I haven’t seen them in a while.’ I did a database search for them and I realized that the patient had died — he died two weeks before without me knowing,” he remembers.
“And then I looked through the list and I realized that there were seven or eight different patients that I had known who had actually passed. I’d never known, and that hit quite hard. Nobody had told you they had died because nobody knew who anybody was, nobody knew what the relationships were.”
It was while speaking to a staff member who was training ICU nurses that he became “struck” by a term she used to describe what health care professionals were experiencing — moral injury.
“She said there were a lot of nurses who felt that their patients had gotten worse under their care and that it was their fault,” says the screenwriter and novelist. “Those nurses had found that very emotionally damaging and they were ashamed and deeply offended by watching patients decline unnecessarily under their care and feeling personally responsible for it.”
The trainer had told him that this form of moral injury was causing many to “abandon their profession,” having felt let down by the health care system and the governments in charge.
Moral injury has tended to have been associated with the guilt and shame that soldiers can return with from war after potentially having witnessed or been privy to something that offended their moral character, such as the killing of a prisoner of war.
But COVID instilled those same feelings of regret and betrayal in those who served on their own type of frontline during the pandemic. NHS Wales says moral dilemmas that some staff faced during coronavirus included being “unable to optimize end of life care” and “providing care with constrained or inadequate resources: for example, insufficient ventilators.”
“Health and social care workers may be exposed to morally injurious events, from instances where they are asked to act, or in some cases instructed not to, which go against their training and sense of right and wrong, or where they may experience betrayal at work,” according to the NHS.
Gleeson says he became intrigued by the concept of moral injury in health care.
“I found that very interesting,” he says, “because it was about how giving bad care impacts the person who ends up giving it. It is not something you think about a lot.”
Gleeson wants to speak to ICU workers and hear their stories. He will then use these conversations as inspiration for a novel that he will write as part of his three-and-a-half years of research for his PhD in creative writing.
He believes fiction, in this context, can be used to “express core emotional truths and new knowledge, but in a very emotionally impactful way.”
What Gleeson especially wants is for those to come forward who feel their story or account has not been heard in the media or through other mediums.
He says there is a “superhero narrative” in the NHS that puts medical workers up on a pedestal. But this, he argues, has cultivated a culture whereby these workers’ vocations are used against them, imposing long hours and low pay. “You can treat them poorly, because they’re supposed to take it, because they’re superheroes,” he says.
Gleeson continues: “But they’re people and they’re people who get tired, they’re people who make mistakes and they are people who have a variety of very complicated feelings about their job.
“So what I’m hoping to express with this is the amount of complication and complexity that a job of being a health care professional entails by getting people’s unspoken or less spoken about feelings about their jobs, their experience in their jobs and their experience of things they’ve done that they might not necessarily be immediately willing to tell people.”
He is hoping that his own travails of working in a major hospital during the pandemic will help him to connect and empathize with interviewees. “What I’ve learned when conducting some of the early interviews is you have to make it two-way,” he says.
“They are semi-structured interviews. But if it comes up during conversation that I have an example of something that I did or something I saw on a ward and you tell somebody about your own experience, that can give them a context and an idea of the way that you’re gathering information and the way that you’re processing stories.
“And the one thing I know about health care workers is they all have stories and they love telling them — they are very good storytellers. It is about getting the story they haven’t told somebody before.”
Those wanting to speak to Gleeson about their personal ICU experiences can email him at rg3503phd@students.nulondon.ac.uk