In 1988, as awareness of the AIDS epidemic grew in North America, people affected were dying quickly, in large numbers and alone. While in hospital, they were isolated from everyone, even caregivers. Meal trays were left outside the room where patients could not access them. Nurses, physicians and others were so afraid of “catching” the dreaded “gay” disease that they protected themselves and left patients alone, often leaving them to die without a single soul around.
It was in this context that Dan Chisholm, a young RN working at St. Michael’s Hospital in Toronto, heard of Casey House, the first freestanding hospice in Canada, for people with HIV/AIDS, and decided to join their team shortly after Casey House opened its doors in March 1988. Dan needed to go where clients would be treated like human beings and be cared for in their final hours and days. He became one of the nurses who greeted clients with HIV/AIDS with a hug instead of a hazmat suit, which at the time was the preferred form of health care protection. Dan was an active member of the inter-professional staff team who strove to create an atmosphere where people with HIV/AIDS found acceptance, support and hands-on care; where clients and their chosen family could relax and feel welcome no matter the circumstances; where dying was a peaceful experience rather than a lonely one.
Death was the only outcome in the early days of HIV/AIDs care. Clients were admitted to Casey House for one or two days, or for just a few hours prior to their death. Often clients were alone, shunned by families and society; a blur of stigma and fear. This intensive caring would also take its toll on the clinical staff; it was not uncommon in these early years for Casey House staff to support hundreds of young vibrant men who were dying. However, Dan felt he was making a difference, not only to the clients, but also to their partners and other members of the community.
If you talk to Dan, he will tell you how well he remembers the first client who recovered enough to walk out of Casey House. The introduction of ARV’s (anti retro viral medications for treating the HIV virus) were making a difference. This was a new phenomenon for staff. Now they not only had to assist clients who were palliative to die with dignity but also had to help people live with the disease. This required a different type of nursing. There were now additional issues for both the client and his clinical team. Dan, already an excellent palliative nurse now had to learn how to support individuals living with HIV as a chronic illness, to manage the systemic and often debilitating components of having a severely depressed immune system. Dan had to pursue knowledge in what the disease process was doing to the body. He learned about the new medications and how they were affecting clients, how difficult it really was to live with HIV, the impacts of aging with HIV and what the long-term exposure to treatments meant to assist recovery whilst causing significant side effects.
As more and more clients were living with HIV new populations of those infected with the virus were emerging. Mental health and substance use were prominent issues for the majority of clients Dan was now seeing at Casey House. Once again, Dan had to enhance and build his skill set. Dan, an excellent palliative and then medical surgical nurse mastered the skills and became an excellent mental health and substance use nurse. As the team around these HIV clients changed, Dan also modified his knowledge, skills and abilities to become a nurse who truly demonstrates the definition of the words ‘holistic care’ as he integrated bio –psycho-social concepts into his practice.
Today Casey House is no longer a hospice, but a stand-alone HIV/AIDS hospital. W e recently moved into a new state-of-the-art building, with a new day health program, a new electronic health record and an ever-changing inpatient environment in which Dan is nursing. On any given day, Dan can be found delivering a wide variety of care: providing palliative care in one room, dealing with chest tubes on a client transferred from an acute care hospital’s ICU in another, or supporting someone who is homeless, alone and trying to find other ways of coping with their trauma than by their current substance use. Dan has to adapt daily from client to client. Dan is a nurse who embraces change; learning and growing as clients needs have shifted. Dan mentors new staff, students and his peers so they too can move with the changes we all face in health care. In his role as permanent charge nurse, which he has occupied for over a decade, Dan is the constant, the knower, the facilitator, the mentor, the supporter and most importantly the example of nursing at its finest.
Dan is celebrating his 30th year at Casey House and his commitment to the clients we serve is truly remarkable. Dan is retiring in June 2018. Looking back on his time at Casey House, his nursing career and his spirit in continuing to provide high quality, effective care it is easy to celebrate Dan and his contributions. Although Dan started out his career as one of many working in a large major hospital in Toronto, he has dedicated his career to a small organization, serving some of our most vulnerable citizens. He has made a difference in many lives at Casey House. In a climate of fear, Dan and his colleagues were not only brave, but also driven by compassion for those who were otherwise marginalized. Dan has remained committed to this population despite phenomenal change over the past three decades. Change can be difficult for many people, but Dan has adapted by expanding his knowledge, abilities and skills to make a difference. Dan is a NURSE who leads by example; caring in the face of the unknown, committed to those he serves He has assisted countless individuals to live with their HIV/AIDS diagnosis, through the peaks and valleys of their health care journey, and ultimately honouring their lives by caring for them as they died. Any nurse can only hope to have accomplished so much and affected so many throughout their career. Dan is a true nursing hero.
Nominated by:Kathryn van der Horden and Karen de Prinse.