Having worked as a junior nurse in oncology and been present at many hospital deaths, Christine Hammond felt well-equipped to deliver palliative care in the community. Within two years she was burnt out, struggling with vicarious trauma and needing a career change. Ms Hammond shares her story, hoping to encourage other palliative care professionals to stay in tune with their emotions and seek support when they need it.

When I visited the young man at home, he was confused, fidgety and in and out of sleep. I knew he was battling stage-four metastatic melanoma. I didn’t know he was terminally restless. I was a junior nurse working for a community-based palliative care service as a clinical nurse specialist.

He deteriorated overnight. His pain and restlessness increased. A district nurse attended his home, administering medication to settle him and ease his pain. He died the next morning, with his sister by his side. I visited a few hours later.

I was numb. I had no idea what to do, or how to react. I asked his mother how she was doing. As she wiped the tears from her face, she looked at me as if to say “Duh, my son just died”.

When I left the home, I felt strange. I wasn’t necessarily upset, but I knew that it had affected me.

"A good counsellor at work said I had vicarious trauma, which is a bit like post-traumatic stress syndrome."

I somehow walked past the fleet car I was driving and tried to open the door of another white car. Addled, I went back my car and pressed the automatic button to unlock it. About 10 seconds later I realised I was sitting in the back seat. What was wrong with me?

Now I understand that I was shocked and terrified. Yes, I had seen many deaths in my nursing career, on the ward working in oncology. Yes, my grandma had died when I was sixteen. But this was the first death I had been part of while working in the community.

To be in someone’s home, with their grieving family and friends, was different altogether to working in hospital-based palliative care. I could no longer call the doctor to pop his head in to the patient’s room and explain the trajectory, or why the patient’s condition was changing. It was up to me. I generally did visits on my own as a sole practitioner.

I reflected on that experience about two years later, when again, I was parked in front of another client’s home. I had burst into tears which were no ordinary tears. They were the wailing tears of someone trapped, dealing with serious trauma. I could not do it anymore. I had burnt out.

I was working with very experienced nurses who were independent and knowledgeable about palliative care. I wanted to appear strong and in control. But not reaching out for help and support had taken its toll. I never really discussed my feelings or debriefed after difficult visits. I just wanted to feel like I was okay and that I could handle it.

Working in people’s homes means you develop an even greater connection with patients. It wasn’t all doom and gloom, but I must have been burying the emotional impact somewhere, because it really crept up on me.

A good counsellor at work said I had vicarious trauma, which is a bit like post-traumatic stress syndrome. I’d known her for a long time and she could see I needed help. I started seeing a psychologist who helped by giving me some direction, and getting me to take my time and deal with things slowly. I also spent a lot of time with my GP, who I’ve known since I was a kid and am really close to.

Work tried to ease me back in slowly, but I couldn’t go into the building. I just burst into tears. After about six weeks off work, I realised that I had to resign and that the career pathway I’d planned in palliative care wasn’t going to work out. That was hard. I had achieved a scholarship, was enrolled to start a post graduate diploma in palliative care and had planned to work as a palliative care nurse for at least five years. It was tough to throw this all away, but it was also bringing me down. I no longer felt grateful to be part of one the hardest parts of someone’s life. Resigning brought great relief.

I took three months off to figure out my true calling and what I really wanted to do. It was one of the hardest times of my life. I felt depressed and lonely and it really affected my sense of identity. I didn’t know who I was anymore. With time off, counselling, and support from my partner, family and friends, slowly I started to feel myself.

Now, I’m 28 and excited about starting a Master’s Degree in Public Health and Tropical Medicine, while working three days a week.

It’s about two years since I handed in my resignation. Since then I’ve done casual and agency work. I have done shifts on palliative care wards without a problem. I might even go back to part-time palliative care in five or 10 years’ time.

When I look back at what happened, I think regular supervision and debriefing might have helped a little bit, but ultimately I was probably just too young and inexperienced.  I’ve realised the experience was a privilege and I will forever carry it with me.

I learned that I needed to be more open about my thoughts and feelings. I had to learn the art of saying no and asking for help and support when I needed it. I now have more protective barriers around me and I know when it is too much.

I have come to realise that I did some good work in palliative care. I helped people going through a difficult part of life and I felt grateful to have been part of their story and to have eased their pain. I have learned important lessons; everyone grieves differently, no two deaths are the same and all you can do is your best.