Behind the scenes at The Alfred’s ICU: Untold stories from the heart of the hospital
It’s home to some of the sickest patients in the state — but behind the scenes, the The Alfred’s ICU is full of life. Follow as the Herald Sun spends a day with the staff dedicating their every strength to those who need it most.
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It’s home to some of the sickest patients in the state, a beacon of hope on a family’s worst day.
But for a place where tomorrow can feel more like a prayer than a promise, life is all around us.
It’s the excited pitter-patter of paws as a beloved dog is reunited with their owner for a last goodbye in the courtyard outside.
It’s the glimpse of daylight through the glass wall that overlooks the park, a moment of sun for patients in need of a new view.
It’s the photos and cards that surround the beds, and the prayer for nurses, lovingly taped to the wall by a grateful mother.
It’s the sound of AC/DC, played in a patient’s room for hours on end, because it’s their favourite band.
And it’s the hundreds of staff members — the beating heart throughout sixty years of the Alfred Hospital’s intensive care unit — who turn up day after day to care for Victorians.
On the day the Herald Sun visited, there were 61 patients in ICU.
It was still dark outside as the day shift — 25 doctors and 90 nurses — gathered for a briefing, where leaders ran through key safety updates and informed them seven patients were admitted overnight.
ICU acting director Dr Maurice Le Guen said that once would have been considered a busy night.
“But it’s no longer a rarity,” he said.
“We admit about 3800 patients, including 800-900 trauma patients, a year.”
The hospital opened an overflow ICU on another floor during Covid, but Dr Le Guen said it’s still here.
“We couldn’t shut it,” he said.
But despite the demand — and gravity — of their work, there was an unexpected calmness as the day in ICU unfolded, a controlled chaos within the flurry of activity.
Nurses worked against the steady soundtrack of machines breathing for patients who cannot, as medical teams, each including several doctors and a pharmacist, move from room to room.
Most of the patients were so unwell they need one-to-one care from a dedicated nurse 24/7.
Clinical nurse specialist Penny Howard said after spending an entire 12-hour shift with a patient, they can pick up on small, but important, changes.
“I can say ‘I know you’re standing here right now and he looks really fine, but he wasn’t fine ten minutes ago and … everybody is happy to listen,” she said.
Intensivist Dr Brooke Riley was leading one of the medical teams, speaking to the nurses and calling other specialties — doctors from cardiology to trauma weigh in on ICU patients care — as they reviewed each patient.
She said if a patient’s care only falls under one specialty, about 30 clinicians will be involved in their care but — for patients with multiple, different injuries — this number can quickly grow.
“It’s a rollercoaster everyday,” she said.
“We want the best for our patients and when it’s not going to be that, it can be really hard to have those conversations.
“Then you walk to the room next door where the patient is getting ready to be discharged to the ward and everyone is celebrating.”
As the ward rounds continued, a team of three to four specially trained nurses was in a room down the hall, preparing to care for a patient with significant burns.
They would spend up to four hours carefully changing the patient’s dressings, an intense process that other hospitals perform in a surgical theatre and which must be repeated every few days.
For ICU Nurse Unit Manager Annabelle Maclure, teamwork like this drives the unit.
She said after a challenging day — the rising levels of violence towards staff, particularly nurses, keeps her up at night — it was the “amazing” team that kept her going.
“Sometimes it is really hard … but we just keep coming back because it’s all within us, this innate need to care for people,” she said.
She said most people didn’t realise how many allied health staff worked in ICU, from nutritionists and physiotherapists to social workers and psychologists.
“There’s so many little things that each of these specialists do that add into everything else that the doctors and nurses are doing,” she said.
“Our team amazes me with all the things that they do every single day.
“They push the boundaries and they try and do the best they can for patients.”
And they really do push the boundaries for patients, no matter where they are.
The hospital specialises in ECMO — a last-resort, complex form of life support that essentially acts as a patient’s heart and lungs, and requires a number of specially trained staff.
Dr Le Guen said, early last year, a team flew to Darwin overnight to place a patient on ECMO.
“We got there at midnight, put the patient on at 2am in the morning,” he said.
“We got about 2.5 hours of sleep and then got ready … to bring them back here.”
He said after a couple of cases, they began exploring whether they could train hospital staff in Darwin to initiate ECMO.
It was a success, and on the morning the Herald Sun visited The Alfred, a patient from Darwin — placed on ECMO by local hospital staff and then flown to the Melbourne — has been admitted overnight.
Dr Le Guen said some patients needed care that pushed “the absolute limit” of what’s medically possible, and their stories stuck with him.
He pointed to the pandemic, when the team managed to successfully treat dozens of patients others thought were beyond saving in what was a “very distressing” time for healthcare.
Dr Le Guen said Covid patients were kept on ECMO for far longer than had ever been done before at the Alfred, and they spent 100, 150 or even 200 days in ICU.
“Some of those patients have walked out, gone home and are living their life,” he said.
“I think we feel [they] maybe wouldn’t have survived anywhere else if they hadn’t been in Melbourne, Australia at that particular time.”
Another patient the team is unlikely to forget is Mona Schwalger, 31, who fell through a skylight shaft and onto a timber post — which impaled him — while on a roof at a work site last month.
The freak accident damaged his left lung and shattered his chest, sternum and several ribs, and he was rushed to The Alfred and into surgery.
His wife Alanna Schwalger, 30, said he spent nine days in an induced coma in the ICU.
“One of the doctors, he said to Mona’s brother and I, ‘I’m going to tell you straight out how it is’,” she said.
“‘It’s as if he’s walking along a cliff’s edge, he can fall either side at any moment, but we will do everything that we can to make sure he stays on track.”
And to the delight of everyone — that’s exactly what the team did — and Mr Schwalger is now back home and walking.
He said it was a “miracle” he’s still here.
“I’m just so grateful to them for keeping me alive,” he said.
“We’d only been married one year and I could have been gone.”
Ms Schwalger said the entire ICU team were “absolutely incredible”, from the ward support staff who always said hello to the dedicated nurses at the bedside 24/7.
“They were an amazing support, not just looking after Mona but looking after the family and friends,” she said.
“They really took the time to get to know Mona, to get to know all of us.”
She said she kept a list of everyone involved in Mona’s care, but it quickly grew to over 50 people.
“I couldn’t wait for Mona to wake up to introduce him to all the people that had taken care of him for almost two weeks,” she said.
Of course, the reality of ICU is some stories don’t end like this and, while most patients do survive, some will wake to life-altering injuries or take their final breath on the ward.
But, in many ways, this is when the team does some of their most life-changing work.
Ms Maclure said they once spent days organising a beach trip to give a dying patient on a ventilator one last look at the ocean.
“There’s this gorgeous picture of them sitting on the pier on the beach,” she said.
“She’s staring out at the water with her family and her dog around her.”
In another case, a patient from the country was able to take their last breath in a courtyard outdoors, surrounded by family and the nature they loved.
“All he could see was the trees and leaves above him,” she said.
“That was one of those moments where you go, this is why we do this.”
Dr Le Guen recalled the time the team pulled together to help a critically ill woman marry the love of her life, organising a small ceremony at the hospital.
“Everyone was crying,” he said.
And behind every grand gesture, there’s a thousand more that go unspoken between staff, but which the families hold on to forever.
Ms Howard said, during end-of-life care, the family is her patient and her job is to empower them and listen.
“A lot of people at the end of their family member’s life just want to talk about them being alive, so you spend a lot of time just listening to people,” she said.
“You’re taking on their sadness.
“You’re lending your strength to them.”
Dr Le Guen said the emotional toll of the job made it even more important to focus on the good they do, and celebrate all the patients they have helped.
One of those lives is Kaylene Roberts, 77, who was recovering in the ICU after undergoing complex, open-heart surgery.
The operation was a huge success and the Albury Grandma said the team were “wonderful”.
“I’ve got eight grandchildren and six grandchildren and I want to see them grow up a bit more,” she said.
“I thought I’m not ready to go yet, I’ve got to see this out a bit longer.
“You couldn’t get better staff.”
The sentiment is shared by the patient next door, Mildura father-of-two Gary James Pearce, who was flown to the Alfred with multiple injuries after he was run over by a car a week ago.
But when the Herald Sun met him, he was joking with his nurse – laughing they preferred him when he was knocked out because now he won’t stop talking.
He said the kindness shown by everyone was difficult to put into words.
“They’re the best people, honestly fantastic. Every single one of them,” he said.
“I’ve got two beautiful boys. They wouldn’t have their dad if it wasn’t for all these people.
“They saved my life.”
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