11 Dec 2020
Covid restrictions have brought a new dimension to the challenges of working in an eating disorders service, says Eating Disorders Dietitian Lucy Gardner.
Even before Covid, a typical day working in an acute eating disorder setting can involve the unexpected. Just before lockdown, we had to ask Estates to remove a kettlebell weight hidden and chained to the nearby bike rack that had suddenly appeared – we suspected one of our patients had put it there to over-exercise whilst on ground leave.
Covid has provided different challenges and yet speedily paved the way for thinking and working more creatively.
But the following offers a glimpse of life in lockdown for an eating disorder dietitian on the frontline.
Arrive on the unit. Use hand gel as I enter reception before donning my face mask. Glug a cup of tea down quickly before anyone else arrives in the office as face masks and drinking are rather incompatible. Check in with the ward. The fridge containing all our milk has broken and one of our new patients has a nut allergy and the cake rotation that day contains nuts. Usual issues that present an extra dimension during Covid.
Join Microsoft Teams on my iPad in a therapy room on my own. Handover is now on Teams. However there is ample room in the building currently as all the therapists are working from home. Reminder by someone to unmute my iPad. We all start talking at once and are reminded to take it in turns. Teams is effective but it does require more concentration and does make me realise how our actual real-life team are like a well-oiled machine when we all sit and work together in the same room.
Nutrition group. Patients sit spaced apart whilst I do the session with them in my mask, gown and gloves. Then on to individual patient consultations. Try and project voice more during all of this as face mask seems to muffle my voice.
Team meeting around reintroducing food preparation and assessment sessions for patients. This has temporarily stopped, partly due to us having to spend the first weeks of lockdown switching over our entire catering system and food delivery. We are now back on track, having changed some of the suppliers, probably permanently. Our normal Tesco deliveries may be a thing of the past and we need to be mindful of a possible Covid part two. A lack of delivery slots and a limit on food items is not conducive to getting our patients better.
Eat a free frontliner’s sandwich provided by the Trust. Must remember not to choose the cheese and onion one though as I then have distinctive cheese and onion breath inside my mask afterwards! Try and remember to drink whilst mask is off.
Ring one of our day patients who we are trying to manage remotely. She has emailed me her weight and her electronic food diary (we normally use paper copies but have mastered tables on her iPhone). Answer her many questions. Chat about the Anorexics and Bulimics Anonymous online support she is also using. She sends me details which I then forward on to our Community team. There is a live mealtime support group ABA offer each evening which may be of some benefit to some of our patients in the community struggling at the moment and may help us manage the transition of our patients back to the community moving forwards.
Back to Microsoft Teams. Have learnt in the past week I can use this to contact people outside the Trust. This is a revelation! Have online appointment providing CBT-e to one of our Community patients. Good to eyeball her and see that she seems to be doing okay and has not lost weight. Phone the John Radcliffe. One of our Community patients is medically unstable and has just been admitted to intensive care. The JR dietitians have asked for advice around a meal plan.
Microsoft Teams and my iPad again to give supervision remotely to a dietetic colleague. Discuss the extended scope of practice she is hoping to do. End the day feeling inspired by my amazing colleague.
Remove mask, wash hands, leave the unit and take a deep breath of fresh air. Smother face in cream to ease the irritation from the face masks. Take the dog for a walk to clear my head having eventually persuaded one of my kids to join me and that it is a replacement for his P.E lesson that day. Some things just don’t change even during lockdown!
Dietitian , Cotswold House