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A nurse's experience of isolation

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VOL: 99, ISSUE: 07, PAGE NO: 57

Trish Oldman-Pritchard, BSc, RGN, CertEd, is clinical nurse specialist - infection control

I work as a nurse specialist in infection control and as part of my job I have helped to develop policies for the isolation of patients who have infections, or who are vulnerable to infection. In the past I have researched how patients and nurses perceive isolation in hospital (Oldman, 1998). Ironically, I'm now finding out about the subject first hand. I have follicular lymphoma and when I became neutropenic after my first CHOP (cyclophosphamide, doxorubicin, vincristine and prednisolone) chemotherapy, I was moved into isolation. I kept a record of my feelings while I was in the dark room.

I work as a nurse specialist in infection control and as part of my job I have helped to develop policies for the isolation of patients who have infections, or who are vulnerable to infection. In the past I have researched how patients and nurses perceive isolation in hospital (Oldman, 1998). Ironically, I'm now finding out about the subject first hand. I have follicular lymphoma and when I became neutropenic after my first CHOP (cyclophosphamide, doxorubicin, vincristine and prednisolone) chemotherapy, I was moved into isolation. I kept a record of my feelings while I was in the dark room.

'I have been in isolation for five days now. Today is a bank holiday for NHS staff but not for many other professions and as a consequence I have had no visitors today. As I write, I have not spoken to anyone, apart from monosyllables with staff, for 10 hours.

'It's a long day when you are woken for antibiotics at 6 am. I have missed my coffee and my newspaper today as no one has bothered to come into my room. I am starting to think I am a bit sad, perhaps even getting paranoid. Maybe I am not worth talking to.

'I have no television, although I can hear them playing in both the rooms next to me. The radio is monotonous and I wish I could play music that I like. I have just finished the last of my books and I ache with boredom and inactivity.

'I sit and think for a while and recall that isolation is used as a form of torture. No wonder I am feeling strange. I console myself that many other patients, like me, have used a commode in the comer of the room and stood naked at the sink to wash with no privacy. There is no lock on the door or sign to say please do not enter. It reminds me of dodgy campsites in France with 'holes in the ground' and rows of showers - this makes me smile.

'I have to eat cooked food, as I do not have a single detectable neutrophil in my blood. I was presented with one shrivelled jacket potato and one dehydrated fish cake for lunch. Lee, a kind young male nursing auxiliary, brought me some tomato ketchup to enhance the flavour, but as I squeezed it out of the sachet, viscous clear fluid emerged. I laughed and put the lid back on the meal. I am used to healthy eating and miss my salads, fruit, steak, chicken and vegetables. However, I helped to write the policy which stipulates that home-produced and 'takeaway' food should not be brought into the hospital because of the risk of gastrointestinal infection - so I can't complain.

'Perhaps I should run away to the hospital shop, in an act of rebellion. I am so abjectly bored and I really can't see why I'm not allowed to leave the room. There is no positive-pressure-filtered-20-air-changes-per-hour ventilation system in this room, so why shouldn't I go into the garden outside? A registrar told me that it would be extremely stupid to do that and when I asked for evidence, she became defensive. I'll respect the registrar's wishes and I will not to defect to the shop, although I know it is illogical.

'Alone with my thoughts, my mind wanders. What if I get upset about losing my hair? We are going to have a family get-together for that - cut the remnants off, shave to a number one, while drinking a glass of wine. But what if I don't have the courage to get through chemotherapy and then regret it and die? I really need someone to talk to. I am usually a positive and happy person.

'The turmoil suddenly ends. A microbiologist I work with has come to see me. Bliss, she is talking to me and it is lovely. I tell her about my sensory deprivation and she helps me out. She pops out and returns with the Times, my new work laptop computer and notes for me to write a report. She has also brought me some wine gums, as my mouth was sore.

'As I have been single for 12 years and like my own company, I thought that isolation would not concern me. However, I now understand that it is not so much about being on your own; it is the lack of control over your life and the need for physical movement and stimulation that are so distressing. In isolation I am restricted, bored and frustrated and I want to talk to someone. After all, human beings are social animals.'

Nine months on

It's now nine months since I wrote about the isolation room and I am in temporary remission from my cancer. I struggled through seven CHOP chemotherapy episodes, all on the due date, having survived near-death a few times. Losing my hair didn't bother me at all. I injected myself with lenograstim, became somewhat psychotic on steroids after the first set of chemotherapy, had about 15 blood transfusions, and focused on trying to stay alive. It took all the willpower I had.

Through the rounds of chemotherapy, I had another two days in the isolation room. Days spent in that room are a time for reflection and resolution. In my experience, events that I have perceived to be bad have always turned around to produce something good. Perhaps those days in isolation gave me resolve and courage. In fact, with hindsight, I am sure they did. I am extremely grateful to be alive. I am back at work, which I love, and will soon be married to my partner of 10 years.

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