COVID nurses putting their lives on the line for our sickest patients
As critically ill patient after patient arrived at hospital in the early weeks of June, Melbourne’s dedicated COVID-19 ward first filled, then burst at its seams. Here are the stories and pictures from the patients and staff inside.
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As critically ill patient after patient arrived in the early weeks of June, Melbourne’s dedicated COVID ward first filled, then burst at its seams.
The nightmare Royal Melbourne Hospital medics thought they had avoided in April suddenly re-emerged as a surging second wave.
Nine East, the hospitals’ highly-specialised infectious disease unit, began to overflow.
By July 12 the RMH had no choice than opening up more of its ninth floor as a “hot zone”, converting the neighbouring Nine West surgical ward into a second makeshift COVID unit.
Two days later the hospital opened a freshly built COVID emergency department for a flood of infectious respiratory patients.
Months of detailed planning everyone hoped had been needless now had to be enacted, seeing the RMH’s intensive care unit also expanded as the number of critically ill mounted.
As coronavirus’ second wave grew across Melbourne, so did the hospital which bears the city’s name.
But the biggest impact was on staff, such as infectious disease nurse Rosie Dickison.
“In the past three or four weeks I have seen more people die than I ever have in nursing,” Ms Dickison told the Sunday Herald Sun.
“We are having to do video calls with a nurse holding peoples’ hands with their family on the phone instead of the family being here.
“Doing that once is a horrible experience – but doing it over and over, it becomes cumulative.
“Sometimes I feel really guilty that I am the one that gets to spend that time with somebody instead of their family.”
When the Herald Sun first stepped into the Nine East late into Victoria’s first coronavirus wave on April 16, Ms Dickison was already front and centre of Victoria’s COVID-19 response.
Her 20-bed unit had become the state’s first dedicated COVID ward and bore the brunt of the 37 coronavirus patients admitted to the RMH during the initial wave.
That day there were six patients recovering in the specialist negative pressure rooms, as Ms Dickison and medical colleagues throughout the hospital breathed their own sighs of relief.
They had trained, planned and gathered equipment and new recruits for months, but were overjoyed the pandemic’s full force had not eventuated.
Ms Dickison was still in the middle of Victoria’s COVID response when the Sunday Herald Sun returned to the RMH hot zone on Thursday, but everything else had changed.
From the moment coronavirus swept through nearby public housing towers in Flemington and North Melbourne at the start of June dozens of extremely unwell patients began flooding into the RMH.
“That was a pretty dark time,” Ms Dickison said.
“It has been constant since then.”
In the past five weeks alone the RMH COVID wards have cared for 110 patients, while 26 have gone to ICU.
On Thursday there were just seven patients being treated in Nine East – the youngest is 16, the oldest is 79.
After seven weeks of spiralling patient numbers the empty rooms are “a dream” for Ms Dickison, though the pain is obvious when she thinks back over recent times and how some of the beds became vacant.
“We have been going up and down a lot because we have been discharging a lot of people and, also, have had deaths on the ward,” Ms Dickison said.
“I find it quite difficult to be involved when somebody is at the end of their life, especially because we aren’t able to have their family members in their holding their hand.”
In the “doffing” area, just metres inside the door of the neighbouring Nine West ward where PPE must be meticulously removed on exit, a collection of clear plastic bags is gathered.
Each is filled with carefully folded clothes.
They are the belongings of patients who have died in the ward over the past week.
Although they have been disinfected, the virus can still live on in material for seven days, so they must linger here long after their owners.
It is too painful to try to count the bags, but there are at least five.
Grace Tanner, 22, graduated from university last year before proudly joining the RMH as a surgical nurse.
Then COVID-19’s second wave hit Melbourne.
On July 14 Ms Tanner’s Nine West surgical ward was drafted in to became an expanded epicentre of Melbourne’s coronavirus response.
She is now only eight months into her nursing career, but has shared a lifetime of grief.
When the first COVID-19 patient arrived in her ward they were one of their own – an RMH emergency department colleague.
“From there they just rolled in and rolled in,” Ms Tanner said.
“It was hard. It was really hard.
“The anticipation of not knowing what was going to happen, how sick are they going to be — nobody has ever cared for a COVID patient before so it’s really hard.
“But we have adapted and we’ve done really well — and we were prepared.”
On Thursday the 24-bed Nine West has only eight patients and the medical staff are relieved.
In recent weeks the “overflow” unit has almost burst its own banks with up to 18 patients.
There are a mix of younger people who have caught COVID-19 in the community, others who were infected in aged care homes.
Some of the patients have dementia. Aggression and difficulty in social distancing are constant and very loud issues, occasionally needing three, four of five staff to help settle confused and highly infectious patients back into their beds.
Others appear asleep and, in some cases, nurses and doctors are making bedside phone calls to update patients’ loved ones on their condition.
But there are some things nobody can ever be prepared for.
“This has been really hard. Especially hard when we have had to step up and be with patients in their last moments, when their families can’t be,” Ms Tanner says, as tears drip on to her face mask.
“They can’t have visitors, even in the palliative process. So we’re sitting with them waiting for them to pass away.
“FaceTimeing family members to explain why a patient can’t breathe, why they look the way they do, things like … I can’t explain it … it’s awful.
“You take on a sense of their grief because they can’t be here and you can tell how awful that would be.”
When each patient comes into the ninth floor there is an in-depth conversation involving them and their family to spell out the “goals of care” best meeting their wishes and needs.
Medically, most of the treatment is focused on supporting patients to breathe as well as possible, just trying to get them through the worst of the virus by whatever means necessary until their own body can fight it off.
Many need oxygen to support their lungs, the most severe moving to the sixth floor Intensive Care Unit to be placed on a ventilator.
But for a few, particularly the aged, frailty means the breathing machines are not an option.
Sometimes the nurses best gift is simply to care for their patients as though they are their own family.
“We have to call family members to ask what music they like, so we can provide that for them and they have some kind of nicety to their death,” Ms Tanner said.
“The last sense to go is a persons’ hearing so it is important to give them music and phone calls to family so they can hear them.”
It’s not all doom and gloom, though.
In bed 15 on Nine West Kent Bloxham is short of breath, but still keen to chat.
The nurses have painted the 57-year-old’s fingernails brilliant colours and, despite the severity of his situation, his bright mood matches them.
Already battling a failing pancreas, chronic asthma and a fractured hip, Mr Bloxham was in Melbourne Health’s Royal Park campus when he caught COVID-19 and was transferred to the ninth floor three weeks ago needing oxygen to survive.
Now able to breath on his own, Mr Bloxham is desperately hoping to test negative to coronavirus so he can see his partner and their Ascot Vale home for the first time in seven weeks.
“I have lots of pain, it’s everywhere,” Mr Bloxham said.
“I have a terrible headache and all my joints ache.
“But the nurses here, I can’t praise them enough for their bravery and their compassion, their honest love of what they do and how they look after us.
“Particularly at night time, you look out there and they are like blue ghosts just gliding along.“
One of the biggest changes to the COVID wards occurred six weeks ago, when the entire units were classified as “hot zones”.
Unlike the first wave of the coronavirus, full PPE must now be worn at all times in North East and North West, not just in infected patients’ rooms.
It is relentless and painful for the medics to wear layers of latex and plastic all day but, with so many patients to now care for, the declaration means they no longer have to go through the long and often nervous “donning and doffing” process every time they enter a room.
Having seen so many of their own colleagues now suffer COVID-19, the fear of spreading the virus has driven many to sacrifice their own personal lives.
Several nurses working on Thursday have moved out of their homes to live in hotels so they can devote themselves fully to patients and colleagues, without risking their own loved ones.
For Ms Dickison, the devotion extends to growing closer to her patients than she could have imagined pre-COVID.
To try and lessen some of the impact of not having family, Ms Dickison does everything she can to find out her patients’ children’s names, their grandchildren’s names, who lives with who in their families and where everybody has come from – so they and their families know somebody care when they need it most.
“We are a pretty tight-knit team but it is obviously really emotionally draining,” Ms Dickison said.
“I feel like we are taking it in turns to be really upset and emotional, but you have to get on with it.
“As much as it can be very painful, I think this is a privilege.”
Through layers of plastic Laura Keily has hugged her patients as though they are her own family members, holding their hands as they take their final breath.
Tears fogging up her PPE has become an all too common issue for the 30-year-old nurse during the second COVID-19 wave.
She has felt the horror of her own breath failing too after contracting the illness.
Given the all-clear but still weak, Ms Keily on Friday stepped back into Royal Melbourne Hospital’s Nine West ward — the epicentre of Victoria’s COVID’19 battle — knowing how vital it is to be there for patients.
To families unable to be there for a final goodbye she is a saviour.
“They deserve all the care and support in the world,” Ms Keily said.
“I can’t tell you how many people I have hugged and cuddled like they are my own grandmother and cried.
“It is really hard crying under a mask and goggles that you are fogging up.”
Not only are the number and severity of patients unlike anything Ms Keily has experienced in her seven years on the infectious disease ward, they are also alone – aside from medical staff like her.
“(Normally) When patients come into hospital there is a conversation had and the families are present, they are understanding and they are there by the bedside holding their hands and telling you stories about the patient and giving you a sense of who they are.
“You feel privileged to be a part of it.
“But, in this (COVID-19), the patients are beyond petrified because all they hear in the world is ‘I am going to die and I can’t even see the nurses’ face underneath all of this’.”
Pressure began to mount on the dedicated COVID ward when coronavirus struck Flemington and North Melbourne public housing towers in the first days of July.
The influx of patients was like nothing Ms Keily and her colleagues had seen.
“We had so many young patients who were so unwell and from such an at-risk community,” she said.
“All day long patients were fine — then all of a sudden they can’t breathe, they have a fever, oxygen levels drop and then emergency teams come running.
“They are going to take them to ICU but then, the patient next door to them, the exact same thing happens.
“We had many days when concurrently we had that happening for four or five patients.
“The ICU would be saying ‘we only have two beds at the moment’ or ‘we only have enough staff to look after two of them, what are we going to do?’.”
On day six of an exhaustive stretch dealing with spiralling patient numbers, Ms Keily received a message from a colleague who had just tested positive herself.
Ms Keily said she began feeling achy, but put it down to constantly wearing PPE.
At work the next day the nurse underwent her own coronavirus test and was shocked when it came back positive.
Whisked away to a “Hotel for Heroes” Ms Keily was stuck in a room away from her partner Rohan and her cat Charlie — though she was not alone, having friends down the corridor to share the ordeal with on the phone.
“At the time it was very hard. Three of my colleagues were also in the hotel who tested positive over one weekend,” Ms Keily said.
“Knowing they were positive too meant it wasn’t anything we did wrong — if you are around something enough your risk increases no matter how careful you are.
“In the first seven days there were a few times I felt I wanted to call an ambulance. I was very short of breath and just so achy. Doing anything just made me feel like I had run a marathon.
“It was quite anxiety-producing because I have seen the worst.
“I know I am healthy and young, but we have lots of healthy and young patients.
“We have seen 30-year-olds — unfortunately even 30-year-old pregnant women — come to us.
“And we have healthcare workers as patients. We had an influx of healthcare workers just a week before I went off, so I was very anxious thinking ‘will I get to that level?’
“After day seven I still felt wiped out, but the breathing got better and I was able to shower and eat again.”
Cleared of coronavirus on August 3 Ms Keily was determined to return to work the very next day.
But, like so many of her patients, she has continued to suffer ongoing impacts that left her still too weak to work for most of last week.
On Friday she was back in the ward, determined to make a difference.
“I have colleagues who tested positive this week so we are short staffed and you want to be there helping everyone,” Ms Keily said.
“This is what I do, this is what I love to do and it is definitely not the time to be stepping away. I want to be there for my colleagues, my patients.
“In this time a lot of people feel like they are out of control and they can’t do anything to help — I can do something, I can have a bit of purpose.”
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