A chaplain’s experience of the Nightingale hospital

A chaplain’s experience of the Nightingale hospital

A conversation with Fr James Mackay, parish priest of Our Lady of Walsingham, Royal Docks. Fr James served at the Nightingale Hospital in the Docklands area of the city, perhaps better known as the ExCel Centre. Throughout the course of our interview he explained what it was like on the frontline in those really tough, early months of the pandemic.

The voice from the chaplain’s chair

A fascinating chat with a priest from the East London, Fr James Mackay, parish priest of Our Lady of Walsingham, Royal Docks. Fr James is a genuine East Londoner, who served at the Nightingale Hospital in the Docklands area of the city, perhaps better known as the ExCel Centre. Throughout the course of our interview he explained what it was like on the frontline in those really tough, early months of the pandemic.

Fr James was interviewed for the Art of Dying Well podcast, episode 19: Lockdown, loss and pandemic trauma.

Q. Fr James, accompanying individuals and caring for people, certainly in hospital, has taken rather a different turn with COVID-19 – which is new and has been a shock for us all. I know that you helped set up a 24-7 chaplaincy system at the Nightingale Hospital in East London. Known as the ExCel Centre to those of us who know the area well, it’s a building on an industrial scale, so let’s begin perhaps by giving us your first impressions of the Nightingale Hospital, and how you felt caring for people in that context?

A. “I’d been to the ExCel many times, it’s on my doorstep, but when I walked in it for the first time, having got the call from the Bishop to go in, it felt eerie to go in there because it didn’t have the hustle and bustle of people going to shows or whatever is usually going on in there… Instead everything was geared now towards one purpose, and then to go into one of the exhibition rooms – which are huge – and see the whole thing being turned over to what is effectively a massive set of wards with just rows of beds. Industrial is a good term to use really, because that’s what it felt like.

“It was empty, it was cavernous and there that was that sense of foreboding, of imminent crisis, but with nothing actually having started yet. That changed as you went up a few floors and you met some of the staff and personnel who were getting ready, and as it started to fill up with nurses, with volunteers, and all sorts of different departments running down the concourse of the ExCel, it felt much more – I wouldn’t say like a hospital – but like a place of work, where everyone shared a common purpose, but that definite initial impression was quite intimidating.”

Q. Now I guess if you felt that way, I’m trying to project how it might’ve felt to a patient suffering with their breathing, anxious, worried about what might happen to them, entering that space, unaccompanied. Apart from the medics, who are doing a phenomenal job, did the patients who could speak to you, communicate that sense of foreboding and the fact that they felt isolated from the very start?

A. “This is the thing… I can’t be one hundred percent sure, but my experience was that I never met a patient who was conscious, they were all brought in in a certain state of illness, they were unconscious and intubated. There were patients, who when they were brought off of the intubation, were put into another section, another part of the ward so that they wouldn’t be exposed and they could recover quietly, and I can only imagine what it was like for them, but I didn’t get to interact with those people.

“There was one moment, I chuckled a bit at my own silliness, I’m visiting a patient whose family have requested anointing, and as I’m finishing I look over to a patient who has come off the tubes, he looks groggy, a bit bewildered. He’s still coming to and I’ve got a full face mask on so he can only see my eyes, and I look towards him and try to give a friendly smile and he just looks at me like a weirdo, because obviously he can’t see my mouth, all he’s seeing is a guy staring at him for a period of time with crunched eyes. And I thought to myself he’s woken up in this place with the ceiling going up however long, it’s basically like a factory, what must this be like for him? Having gone unconscious in a hospital – maybe in an intimate space in a ward – having said goodbye to his or her family, to wake up in this huge building, I can’t even begin to imagine it.

“That said, the family liaison team, which is a team of nurses basically, was in constant contact with family and with the patients, who were able to communicate, and were excellent at reassuring everyone, particularly families, that their loved ones were being taken care of, giving them constant updates, and also – and this is from what I was told second-hand – with those patients who regained consciousness constantly giving them information and informing them about their family’s concern.”

Q. It sounds to me like that family liaison team was quite crucial to the chaplaincy effort, having that link between family members and loved ones, who must’ve been desperate to be at the bedside, but obviously knowing that was unlikely to be possible?

A. “To us it was excellent. I would say it was unique, because I’ve visited many hospitals obviously in my pastoral ministry, and that kind of relative-to-patient connection, you don’t observe it so much. Normally you go into hospital as a priest, family are often by the bedside, so the contact has already happened, and then you can be face-to-face with them and give them whatever support they need. But here that’s not possible, there was a big gap because families couldn’t be at the bedside whenever they wanted, or during visiting hours, so the family liaison team’s role and their presence was much more frontline so-to-speak, and I just found them excellent in communicating, in contacting me and whatever chaplains were in. We built a great relationship with them, and through them good relationships with the families of people who were on the wards, because particularly at this time, they needed to know someone was at the bedside, and that someone was nearly always the priest, or of another religion, the imam or the rabbi. So family liaison really invested themselves because they could see how important we were as, obviously a spiritual presence, but also as a sign of hope and connection of relationship.

“We developed an excellent relationship with family liaison, I’m still chatting with a couple of them now on various different areas of commonality, I’ve got nothing but high praise for them and the nurses, it was mainly nurses who volunteered in this role; their constant updating of families, then their contact with us was excellent.”

Q. I’m very struck by what you said about when people are intubated and are unconscious, fighting for their lives sadly, vs those that are recovering and need to be in a slightly different place. How did you cope with that not just as a priest, but as a human being, having the one side where you’re looking at people who may be dying and the other side, where there’s the joy of recovery, that juxtaposition, that sort of light and dark, must’ve been very hard to handle for you?

A. “Yes, I mean the experience on the wards is one of the most intense pastoral experiences I’ve ever had, because I’m on the bleep for the local university hospital, and normally I get a call, and I say ‘Name? Ward? Yes, I’ll be there’. I go in, I visit the patient, and in and out and you’re there 20 minutes max, unless there’s a deeper conversation to be had. One visit to the ward on the Nightingale could be a 3 hour job because you’re getting the call, you’re going in, you’re getting dressed in all the PPE, then there’s the visit itself, and then the exit. If you’ve got a family member with you, add another hour onto that because they have to go through the whole same thing, you meet them beforehand, you sit with them as the family liaison take them through all the procedures, and then afterwards also you’re with them as well.

“And then when you’re there, the main concourse of the ward I was on, it’s just unconscious people and the sound of machines… Doctors and nurses all fully masked, almost constantly attentive to each patient because they really are struggling to keep them alive, and to get them in the best position to give them the best chance, so it is very intense.

“It’s encouraging to see so many people at their job but at the same time it feels quite oppressive and not just that, the face masks that you wear for protection make it very hard to breathe yourself – so they almost create a certain sympathy – I’m deep-breathing through this mask and I’m thinking, gosh this patient is going through this all the time.

“And the longest I think I was just on the ward itself was 3 hours, and I just wanted to rip the mask off, and I was thinking, there are doctors and nurses here who are wearing this thing for how many hours…? Seven, eight, nine hours at a time, not able take it off. Emotionally, mentally, spiritually that must take its toll. I’d get to the end of a shift with maybe two or three callouts, and so I’d been on the ward a number of times and I’d just be exhausted and wondering why I’m so exhausted at the end of a day, and I’d think well of course it’s not just the physical thing you’re going through. It’s psychological, it’s emotional, all those things rolled into one. It did take its toll.”

Q. Yes, I’m not surprised. But when death is such a reality it does then make me think about those really painful situations such as having to say goodbye to a loved one, maybe on an iPad or Zoom, if one is conscious enough to talk at that point. Or you then communicating to someone, a family member or a relative, or a friend or a close person, that something of this nature is happening and that this is goodbye. How difficult is it to do that job through an iPad or through Zoom or whatever, because it seems like you’re having to make the impersonal, relatable and personal?

A. “Well I should say that the Nightingale really stood out early on, and I’m only going on what I heard from other hospitals, in that we were able to get relatives close to their loved ones if they were close to death. If their prognosis was bad, then family were contacted and told, and one family member could be at their bedside and I would accompany them, where I would give the anointing and pray with them, and that was unusual at the time I think for other hospitals, and I think they’ve since developed it.

“So bringing in the iPads or the online access wasn’t such an emergency because the Nightingale just seemed to be very attuned to getting the family members on the ward when needed. So what would often happen would be family groups would come down and they would elect one person, perhaps the wife, to go in and represent them. Then later on we got in iPads and what-not, and I never personally used one but I know the imams did, and it was very powerful because basically you’d have a device by the bedside and family members could “talk through it, or play some prayers that the dying person would be familiar with.

“It’s not the same, like anything over a screen, I think as we’re finding now, everyone was loving Zoom at the start of lockdown, but now we’re all fed up, we just want to see people don’t we? But they were the best we could do, and by all accounts a very moving moment for people to be with their loved one if they so choose. But it was also very distressing I think, they’re not in a state where you can interact with them, they’re unconscious, and often looking quite worse for wear, so it wasn’t unusual for families to decline the Zoom offer, and just send one person in as we offered them, a chance to be with them. And if the person was able to be aware of their loved one’s presence, to reassure them of that, but then also to report back to the family that the person wasn’t alone when they died.”

Q. And in that sense, were you ever a part of what comes next? Speaking to those family members who maybe couldn’t have been at the bedside, there’s a trauma in that as well isn’t there? This is a massive national and global trauma really. Did you have a part to play in helping family members communicate that to other family members? And then of course there’s the funeral side of things that’s obviously very severely restricted. I’m sure you’ve experienced that as a priest as well?

A. “Yes, I’ve celebrated a couple of funerals in lockdown, and it’s the worst, it’s really horrible, and I’m not even a family member… it’s not great.”

Q. What would you say was is worst thing about that?

A. “I think, limited numbers is one thing, not being able to hold… the people who are grieving, people who’ve lost spouses after decades, your natural inclination is to touch them on the shoulder, for family members to hug one another, and they’re not allowed to do it. And you just go after the funeral, there’s no reception afterward, you just leave. It’s not nice at all, I know there are opportunities to view the funeral service over a screen but if I was being honest, I’d probably take up that option. I feel really sad for people who have lost a loved one in terms of the funeral during this time.

“On the plus side, it is possible, when you’re preaching, you feel like the homily is much more important, because you’re the one who can personalise it as much as possible, and speak in to what everyone’s feeling there because you’re feeling it with them, the distance, the reduced capacity to grieve in a fully human way which involves other people and touch and closeness and intimacy.

“So to be able to speak into that feels like a very important ministry, and that goes for ministry over the phone, for example, when you are talking to family members, to let them know that someone was close, that they were touched.

“There was this regulation that everything would have to be done with cotton buds when it came to anointing but frankly when I said this to doctors and nurses on the wards they said: ‘No, place a thumb on his head, it’s no problem because you’re wearing gloves anyway’.

“And it was very important to know that their loved one was touched – even if they couldn’t feel it – it was important for the family to know that, so there was a kind of vicariousness to what I was able to do there as well, and to report it back, that during this time your loved was not alone, and to whatever degree there was a degree of intimacy in the contact, that was very important to families.”

Q. As human beings perhaps we take the fact that we’re relational, the fact that we like to hug, be tactile for granted, on the whole we certainly need connection, and long and crave for connection. Do you think because we’re being forced to face these realities at the moment – certainly more acutely in March, April May… Do you think there’ll be a generational almost post-traumatic stress situation where we’re all going to have to try and help each other over this?

A. “I really do. I think we’ll look back on the pandemic as the opening chapter to a long story, that’s my feeling. How we get over this is – emotionally, psychologically and spiritually – is probably more important than how we get through this current pandemic. It’s going to have a massive effect, it’s going to take a long time for us to get over these emotions which, to use the term, have been locked down, been allowed to build up. It’s going to take real pastoral sensitivity and care and patience; the capacity to bear people’s feelings.”

Q. It reminds me of something you said a month or two back actually, in one of the interviews you did, when you pointed out quite rightly and poignantly, that love is stronger than death and love wins the victory over death. And you also said, which I found very powerful, this is why I was ordained a priest, and it makes me think, and I certainly take your point about the post-pandemic times, but maybe what you saw, and what you experienced in terms of kindness and particularly in terms of working together, maybe we all need to work together, societally, to recover from this properly?

A. “I do, I think we need to provide space for each other just to be in… One thing that we can all agree is that we’re all going through this together and there’s nobody that’s not been affected, and for those of us who can, to provide a space around a person to just allow them to be, and to accept as valid whatever feelings come out it. As a priest, I’ve been sensing the call to do this more and more, to lead not with direction, but with compassion and with open arms.”

Read more about dealing with bereavement and grief.

Read more about coping with loss and trauma during the time of the pandemic.

Fr James was interviewed for the Art of Dying Well podcast, episode 19: Lockdown, loss and pandemic trauma.

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