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Hygiene Fidelity

Read Thursday, 12 Sep 2019

CB Mako remembers the cleanest room in the cleanest ward of the Royal Children’s Hospital.

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In a reflexive action, you sprinkle your floorboards with clear, water-like liquid. There’s a sticky spill of pancake syrup under the table. This is how you clean the mess your kids made during weekend breakfast. You have bottles of this substance around your house. Two in the open living space, one in each bedroom, one in the bathroom. There’s even a travel-size container in your bag. The label reads ’70 per cent Isopropyl’; your version of a hand-sanitiser. It has also become your floor-sanitiser, surface-sanitiser, and toy-sanitiser. 

A week earlier, while you were wiping the floorboards with this same substance, your friend asked you what you were doing. You rarely have friends over at your house. What if your friend is unwell? Or has a teensy-tiny cold? Or – with an audible gasp – a phlegmy cough? 

But this is how you clean almost everything now. It’s your routine since your child completed chemotherapy seven years ago. 

It is December 2011. You are at the new Royal Children’s Hospital in Parkville, Melbourne. You and your child are among the first patients in the state-of-the-art facility. And in the Kookaburra Ward – also known as the cancer ward – you and your child are among the first occupants of the ‘isolation room’.  

In this room, you would spend Christmas, New Year, and Easter. It’s a pressurised, airtight room, separating you and your child from the rest of the patients in the ward. Like a glass bubble, you see the world outside flow past you. You’d wave to Santa Claus and the Easter Bunny from inside sealed glass doors. 

The isolation room is different from the rest of the cancer ward’s rooms. First, its location is closest to the reception desk and the meeting-lounge room. Second, it is the only room with a separate entrance – a narrow holding bay; an anteroom, with a floor-to-ceiling window – where you prepare before entering the isolation room itself. There is a hands-free sink, a soap dispenser, two laundry baskets and a rack with three boxes of sanitised gloves in small, medium, and large sizes. There is also a long shelf where food trays are left by the catering staff during mealtimes. And stacks of clean linen and paper towels. 

Everyone who enters the isolation room needs to wear several sterile, sanitised, and clean items. It’s akin, in some ways, to prepping for surgery. The oncology nurses explain the multi-step procedure. First, you must wash your hands – no, scrub your hands – thoroughly. With a generous amount of liquid soap, you wash your wrists, palms, the backs of your hands and fingers – you also check your fingernails. Afterwards, you dry your hands completely. Then you put on the face mask, covering your mouth and nose. There is also a surgical gown, which you ditch at the laundry basket when you leave the isolation room. All this preparation because your child has contracted an insidious, contagious bug in her gut. 

They say the room has its own HVAC – Heating, Ventilation and Air-conditioning system – separate from the rest of the ward. Does this mean that the isolation room is climate-controlled, and pumps purified air?

It is 2019. At home, you pull out a plastic crate from one of your children’s rooms. It sits on top of several plastic crates of toys and children’s books. But this crate is slightly smaller than the others and the lid is purple, lavender – unlike the other plain, cloudy crates. You brace yourself as you lift it up and place it on the floor.

You stare at it. Hard. You haven’t looked at the contents in years; not since your child acquired the necessary toileting skills through the help of an expert occupational therapist.   

A thick layer of dust covers the lid. Automatically, you wipe the dust with your handy home antiseptic and microfibre wipe.

You unclasp the lid and peer inside the box. Everything looks clean; untouched by dust and years. Soon, you are brought back to 2011, seven years ago, when all these items were vital – literal survival necessities – and you never, ever ran out of any of them.

You tip the contents on to the carpeted floor. A box of medium-sized, bright blue surgical gloves. A fistful of individual nappy disposal bags. And an unopened bag of sterile cotton balls. There is also a stack of neatly folded ‘blueys’ – that’s what the nurses called them, and that’s what the Royal Children’s Hospital’s Equipment Distribution Centre called them – when you bought them in bulk. The original box is somewhere, half-full of the remaining disposable underpads. 

What you don’t see among the items on the floor is the specific handwash you used back then. It’s a handwash specific to the cancer ward. But you remember the colour: a unique shade of greenish-blue. And you remember the name and can still spell it correctly: Chlorhexidine. It was an antimicrobial procedural handwash. At the hospital, when you’d go down to Level Basement Two, down to the Equipment Distribution Centre, you would add a note to your order: ‘it’s the one used in the cancer ward’. And the staff would know straight away what you meant. 

Three days before Christmas in 2018, you and your eight-year-old child re-visit the cancer ward; a spur-of-the-moment decision. Your child just finished a medical check-up in one of the hospital’s specialist clinics. You wonder if your child remembers. You do. The sanitised smell, the long corridors; they yank out the memories deeply buried. Later, much later, when you get home, you will cry as memories come to the fore, seeping out of you as though from an open wound. You remember vines of plastic tubes, entwined from your child’s chest and nose to the multi-coloured bags of intravenous fluid, plasma, blood, and platelets.

Walking slowly, you point your child’s gaze to the red tinsel garlands on the ceiling. The hospital volunteers really went all out, over-the-top with the Christmas decorations. Back in 2011, the medical staff were still getting accustomed to the new hospital, and decorations were minimal.

You take a picture of your child standing outside the isolation room. Seven years ago, your child could barely stand. At 18 months of age, the toddler you held in your arms didn’t have time to learn to walk before the cancer struck, and chemotherapy started. 

You remember a photo of your child lying face down, wearing a disposable nappy with a red-and-white Christmas motif.  

On Christmas Day in 2011, chunks of ice fall from the sky; a freak weather event you witness through sealed, double-glazed windows from the isolation room. Green manicured lawn becomes a blanket of winter wonderland in the middle of summer. Back inside the cleanest room in the cancer ward, there is a distinct hissing and clicking sound, followed by a heavy thud. These are the sounds that let you know that the room is airtight. Would there be a beeping sound if the room wasn’t air-tight? You feel like your ears are going to pop. Eventually, you acclimatise. They say the room has its own HVAC – Heating, Ventilation and Air-conditioning system – separate from the rest of the ward. Does this mean that the isolation room is climate-controlled, and pumps purified air? You try to understand the purpose of the design of the room. You try to understand what you are seeing and hearing. 

But all you want is to go out. You feel claustrophobic. When they allow you a bit of respite, you take your three-wheeled cargo bike, parked in a secured area within the hospital grounds, and you ride away.

On freshly painted bicycle lanes, you head to the nearby cafes, and breathe a different kind of air which fills your lungs. Your heart works faster; pumps your blood faster. This is its own kind of cleansing. You feel invigorated, refreshed after a slow ride, up and down the roads of North Melbourne.

Then, once you return to the cancer ward, you immediately take a shower in the sterile en-suite bathroom. 

Once again, you’re all clean – inside the cleanest room of the cancer ward.

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Acknowledgment of Country

The Wheeler Centre acknowledges the Wurundjeri Woi Wurrung people of the Kulin Nation as the traditional owners of the land on which we work. We pay our respects to the people of the Kulin Nation and all Aboriginal and Torres Strait Islander Elders, past and present.