Two years on and not forgotten

1 February 2013

It is two years since the first quake victim was carried into Christchurch Hospital’s emergency department – a young girl scooped up by a stranger from the rubble. FIONA CASSIE talks to ED nurse researcher SANDY RICHARDSON about her personal research project collecting more than 90 stories from staff working in ED on 22 February 2011 – and why after the heroic phase comes the flat.

Sandy Richardson says people talk about a cloud of dust rising from the city and drifting towards the hospital. Emerging from the dust came the victims – first the youngest carried in arms, then on top of police cars, on planks, and in the back of utes.

“These are things we just don’t see. That doesn’t happen in New Zealand or the civilized western world. This is third world stuff.”

For nurses, much of their training– particularly for ED nurses – is about preparing for the worst case scenario, says Richardson.

“Nobody wants it to happen, but if you can’t be part of it, you feel you’ve somehow missed an opportunity to contribute because that’s what you’ve been trained for all that time.

“That certainly came through in the stories of those (off-duty) people who went to quite desperate efforts to actually get into the ED. Or those who made it in and were told ‘actually we’ve got enough staff, go home and come back later’. But they’d say ‘No, I will just stay in case there is something I can do’.”

Staff also converged on the ED from every area of the hospital: consultants, nurses, social workers, orderlies, managers, radiologists, Māori health workers. If they weren’t immediately required elsewhere, they wanted to help at the hub of the country’s worst disaster in nearly 80 years.

“Nobody had egos … people were just coming in and doing what was necessary.”

Tales to be told

Richardson as a researcher and a nurse decided she could not let those experiences go unrecorded and those contributions unrecognised.

“It’s almost like a defining moment in life, an opportunity to be able to contribute in that way.”

Without waiting for funding, she put word out and started to record the stories of the people who worked in the department that day (not forgetting the off-duty ED staff, gridlocked on their way in, who ending up volunteering at makeshift emergency centres outside GP surgeries).

She has ended up with more than 90 stories in all. A founding member of RHISE (Researching the Health Impact of Seismic Events), a group formed to ensure a Canterbury focus to researching its own disaster, she is involved with a number of research projects, but this is the most personal as she, too, is part of the story.

Working a short distance down the road that day, in her other role at the University of Otago, she arrived at the ED within minutes of those first victims arriving and didn’t leave until about seven hours later when the constant wave of patients finally reached a lull.

“I think maybe one of the reasons people felt okay talking to me about it was because I had been here. I suppose depending on your theoretical perspective, it would be more appropriate to use someone who was neutral, but I actually think there was a good argument for using people who are involved and have got that understanding … it was sometimes just recognising what wasn’t spoken.”

Richardson has since received funding from the Emergency Care Foundation, had the interviews transcribed, and aims to publish them as a book.

She is also discussing with Dr Kathy Peri – a nurse leader and researcher who worked intimately with older and vulnerable people post-quake – in writing a second book on the broader health sector experiences and the hard-won practical lessons learnt on responding to a disaster.

“I think they are both very valuable ways of dealing with it because there is so much to learn and there is so much we can share with other people.”

Meanwhile Richardson has had her first journal article from the project accepted for publication by ital**International Nursing Review. The article is drawn from anonymous excerpts from the nursing interviews.

Evocative tales

“To be honest I’ve actually had to put them (the interviews) to one side (since) as I couldn’t deal with all of them immediately because it is very evocative stuff.”

Such “evocative stuff” includes the orderly who talks about seeing a driver ferrying victims to the ED himself with a visibly badly broken arm; the nurse recalling taking a head injury patient down a corridor by the light of her cellphone wondering how she was going to check their pupil dilation in the pitch black; and another recalling a trail of bloody footprints snaking through ED.

At the same time, the staff were dealing with their own trauma of working through aftershock after aftershock, and with phones overloaded, not knowing how many casualties would arrive and whether their own family, friends, and homes were safe.

While most Christchurch workers in high rise buildings were evacuated and sent home, hospital staff worked under collapsed ceiling panels, no lifts, a partially collapsed ambulance bay, and a generator that failed several times plunging ED, radiology, and ICU into darkness.

“Honestly, when you saw the waiting room, you sort of thought, “God, is anything else going to fall down?” And to be honest I was going around reassuring the patients that this is the safest place to be. But was I telling myself a lie? You know what I mean?” (ED nurse after the ED waiting room ceiling collapsed)

Richardson says from across the spectrum of professions she had people describing being absolutely terrified, bursting into tears, or being swamped with indecision. She says there was also no way to estimate the level of trauma people experienced. Some of the usually ‘strong’ froze and others surprised themselves with their resilience.

One of the tasks Richardson took on with a colleague that day was looking after the deceased victims in the observation ward. Most of those killed by the quake didn’t make it to hospital, but poignantly, those that did were nearly all young.

“Certainly it’s a very devastating thing as many of the nurses would look at the people coming in – and they were young people by and large – and saw people their own age or someone who looked like a brother or someone they could relate to. So that was very hard. I think everyone was dreading they would come across someone they knew.”

That night Richardson walked for almost two hours to her home, which is in a valley a whisker from the epicenter. Her teacher husband was preparing to settle in for the night at school to tend the last of the children waiting to be collected by parents.

She was escorted the last of the way to her trashed but still standing home by her son who had biked over from Riccarton to check his mum was okay. Then her daughter came and whisked her away to her flat where a hot shower was a possibility.

The new normal – just papering over the cracks?

It was the beginning of the new normal.

Two years on, the abnormal is still the norm for Christchurch nurses. Aftershocks are rarer but the after-affects carry on. Richardson started the New Year doing the Cantabrian shuffle – madly seeking short-term accommodation on short notice and packing up their cracked home so repairs can be made. Others are still caught in the Canterbury Catch-22 bouncing back and forth between EQC, insurers, and builders that stop them from moving on.

All are used to traffic cones, random road closures, and a mostly hollow shell of a central city. Many health facilities are still in rebuild and repair mode, with Canterbury District Health Board facing building projects for years to come. Some nurses now also face the loss of their child’s school.

People still laugh, love, and carry on, but Richardson says she would like the chance to re-interview as many people as possible to see where they are now compared with back then.

“I think we’ve maybe got past that heroic phase when everybody pulls together, we’re all part of a team, and ‘isn’t it great we’ve survived and gone forward’. Now we’re at the really flat stage of ‘yeah we’re still here, and it’s still here, it hasn’t gone away and things aren’t better’.

“People can look like everything is going fine and you just ask them a particular question. It’s a different question for every person, and sometimes a whole lot of stuff starts spilling out again.

“So I don’t know whether we’re just papering over the cracks or we’ve actually fixed the foundation … it’s hard to know.”

QUAKE INJURY STATS

• In the first 24 hours after the February 22 quake 6659 injured people sought treatment for quake-related injuries.

• 365 patients attended Christchurch Hospital ED (142 admitted), Pegasus • Health 24-Hour Surgery saw 373 patients, Southern Cross Hospital 94 patients, and Princess Margaret Hospital 50 patients.

• 5578 patients were seen by other primary care facilities.

• 182 quake victims died in first 24 hours: 175 people died in the community and seven died in hospital. Two further elderly patients died of their injuries several weeks later.

*source: Ardagh M, Richardson S et al, The Lancet, 2012