On call: A day in the life of two Brussels hospital workers

Catherine Heijmans does double duty as a haematologist and oncologist working with children. Dividing her time between the Queen Fabiola Children’s University Hospital in Brussels and Jolimont Hospital in La Louvière, she found time to talk to us about caring for children with cancer.

What does your speciality involve?
Haematology concerns all problems with blood, while oncology is the study of cancer. As the most frequent tumour in children is leukaemia, and this is a blood tumour, paediatricians working with children with cancer are usually both haematologists and oncologists. Most of what I do is haematology, but I also have to know about solid tumours and brain tumours and so on, because the patients I see in the hospital in Wallonia have all kinds of tumours.

Why do you work in two hospitals?
Fifteen years ago, everyone had to go to a university hospital such as Brussels, Leuven or Ghent to get treatment. For patients who live in Wallonia, this is difficult, especially since often they don’t need chemotherapy or other serious treatments, just a check-up or a transfusion. For these things, it’s better if they can go to a hospital near their home. With this in mind, we developed a partnership to bring the best practices of the big university hospitals closer to families living outside major cities. Now the doctors who treat them in larger hospitals can care for them locally. This is easier on the whole family and makes people more confident that they will be OK, even if they’re not being treated in a university hospital.

What’s the best part of your job?
The most rewarding part is that we know our patients very well because we treat them over a long period of time. We don’t just care for sick children, we follow them until they’re at least 18, even if they were treated when they were two or four. Very often they’ll come back to tell us they’ve finished university or won an award. That’s really nice.

How is treating children different from treating adults?
In general, I think children are more honest than adults. If they don’t want you, they’ll tell you very quickly, and if they’re OK with you, they’ll let you know. Children are also different in that when they’re sick, the things that matter most for them are one, I don’t want to be in pain and two, I don’t want my mum going away. If they’re comfortable and they’re with their families, they’ll play in the ward because they feel OK. It’s more difficult with adolescents as they think more about what’s going to happen next week, and the physical effects of treatment, like losing hair, are harder for them.

What are the most important qualities in your job?
It’s a balance between intellectual, scientific work and being very close to people. First of all, you have to like learning. You have to have some intellectual abilities and be interested in medical and scientific knowledge. Being quiet and calm are important. You have to manage parents who are sometimes in a great deal of emotional distress and you have to be calm with the children; if you’re stressed, they’ll feel it and won’t react well. You have to be a good communicator. If you don’t explain well to the nurse what they have to do, they won’t be able to do it. The parents, too, have to understand what the disease is. Patients need special food, they can’t use buses or trains without some precautions; you have to be sure parents understand that. That’s why I talk a lot!

What do you wish that patients and parents knew?
That they can discuss everything with the doctor. Nowadays everyone looks everything up on the internet. You say a difficult word, like thrombocytopenia, and they’ll search for it. But they don’t always understand everything and sometimes people think they can’t ask their doctor about it. You can bring up everything with your doctor; it’s very important to discuss things. It’s the same for alternative therapies; understanding that there’s a difference between scientifically approved therapies and therapies that are not evidence-based medicine. Patients have to be very careful, because the mixing of medications can have bad effects. But just because we wear a white coat doesn’t mean we can’t hear about other therapies. Probably a part of the cure comes from the mind, so it’s important to feel good and be confident with anything you do. We are open to discussion.

In the 25 years you’ve been practising, how has your discipline changed?
Some children with leukaemia are now treated for a week or two in hospital and the rest of the time at home, with very few or no side effects. When working with children, we want them at home as much as possible. For leukaemia, it’s important to realise that we have very good results. Some 80 to 90% of patients will achieve permanent remission. We’ve had these good rates for the last 15 to 20 years and while the treatments haven’t changed much, what has changed is the way we give them. What we try to do now for the more common diseases is to use less aggressive treatments. We’re confident we can cure it, so we scale back the treatments to have minimal side effects. Today, it’s not
only the cure that’s important, but a cure while maintaining a good state of health.

How do you deal with the difficulties of your job?
One way to deal with it is to make a clear split between work and home. It’s helpful if you have a stable life at home. I spend time with my husband, and I have three children, two in university and one in high school. I jog and play tennis, I like to read books – not medical books – and I have a normal life like everyone else. I think it’s important to keep a barrier between yourself and the patients. Not everyone does this but, for example, I never attend funerals. I know it would be very difficult for me. If one of my patients dies I always call the parents and propose seeing them again, but I don’t visit their homes. Finally, I think it’s important to share work with colleagues when there’s a difficult case. We all come together for a debriefing a week or a month after – us, the hospital, home nurses, the social workers, the GP – and everyone talks about their emotions as well as the medical details.

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Cameroon native Boris Tiambou arrived in Belgium eight years ago to study nursing. For the last two years, the 31-year-old has worked in the emergency care department of Erasmus Hospital in Anderlecht, which treats more than 40,000 patients a year. He tells us what life is like on the frontline of public healthcare.

Is there such a thing as a typical day in emergency care?
At Erasmus, emergency care is divided into three parts and I work in all three. In the first, we care for the more acute cases, people who have a problem but will return home afterwards. Then there are more serious cases that need to be admitted to hospital directly. The third part is temporary hospitalisation, where we need to keep patients a little longer for observation or to do more tests, but not necessarily fully admit them. It’s hard to say what a typical day is: regular tasks are taking blood, giving infusions, accompanying patients for tests and setting up electrocardiograms to monitor heart function. No day goes by without doing those things. Other than that, it changes all the time. On top of this, once in a while I have on-call duty. This is on a rota system; if a big accident or catastrophe occurs, you come in to help. Last week some workers were intoxicated by a product and we needed to call in extra help. But it could also be a train
accident or a fire.

What makes a good emergency nurse?
You need to have a global vision of any patient who arrives. This makes the difference between caring for someone based on your assumptions and caring for the person who is sitting in front of you. It also means taking into account both the symptoms and the circumstances that present themselves and proceeding from there. Symptoms can be present for many reasons. Stomach pain can be constipation or indigestion, but it can also be something more serious. So you need to be attentive, look at the context and listen to the patient’s history to determine what needs to be done. You don’t want to send someone off to do invasive or expensive scans and tests if you can glean what’s going on by asking questions. Beyond that, you need to be efficient and to be able to work fast. But working fast doesn’t mean going quickly and being careless. It means being able to perceive and react to the circumstances quickly.

What attracted you to nursing?
I always wanted to work in healthcare. I like to help people and nursing is a good profession to satisfy that need. When I arrived in Belgium, I was accepted on a nursing course, which I really enjoyed. After three years of studies, I began to work in cardiology in Ghent, but I soon realised it wasn’t for me. It was the same routine every day – medications, notes, bed baths... I’m someone who likes to do many things at once and to mix things up. So I returned to school to specialise in emergency care. In my job, there are plenty of different things to do: surgery cases, medical cases, paediatric cases etc. It changes all the time and I like this variety.

What’s the best part of your job?
What’s nice is that just because you’re in one place when you start your shift, it doesn’t mean you’ll be there all day. When I arrive, I know I’m there for eight hours but that it can be in any part of the service. So maybe I’ll start out providing the first line of care to people who come in – it’s a nice job because you’re kind of the boss as you decide who goes where. But then I’ll move around to other parts, such as working with admitted patients or helping in the trauma rooms.

Are there public misconceptions about emergency care?
In general, people think emergency means fast, so they think that when they arrive they’ll be immediately checked in and seen. But that’s often not the case. Sometimes they come in and have to wait up to four hours, and not everyone understands why this happens. We see everyone – surgical, medical, paediatric cases – and some people are more critical than others. The doctor is obliged to see the most critical patients first, so they get seen ahead of people who are waiting. But this isn’t clear for everyone in the waiting room and they ask why it’s called urgent care if they have to wait and wait. The best way to avoid this is to contact your GP first. Of course there are things that you absolutely need to come to urgent care for, but many people come in for things that their regular doctor could have addressed.

Is the healthcare system in Belgium very different to that in Cameroon?
It’s not that easy to compare the two because they’re very different. It’s not the same system; in Cameroon you have to pay before you’re treated. The chances are that if you’re in hospital in Cameroon, it’s not for an illness that’s common in Belgium. Here we see a lot of cancer and cardiovascular disease. In Cameroon they’re lucky to not have so many of those cases, but care is more expensive. And for the moment they also have other, more basic problems with care that we don’t have here.

What do you have to study to become an emergency nurse?
You need a specialisation in intensive care and emergency medicine. Before this, you have to have completed three years of general nursing studies and then a year of specialisation. I also did traineeships in Flanders, Wallonia, Marseilles and Cameroon. At the end of your specialisation you can work in either resuscitation or emergency care, or both. In some hospitals the same staff do resuscitation and emergency care, but where I work it’s split, so I only work in emergency care, though I have previously worked in resuscitation.

This article first appeared in the Bulletin Newcomer Autumn 2015