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From doctors and nurses to cleaners and pharmacists, hospital staff are the true heroes behind Australia’s successful response to the coronavirus pandemic. Those on the frontline at St Vincent’s tell their stories.
Danielle Austin, 41
Incident response and disaster manager
Danielle Austin, a nurse seconded to the aged-care facility, Newmarch House: “The touching thing was none of the COVID-affected residents died alone. The nurses did absolutely everything they could in their daily care.”Credit:Kate Geraghty
I was seconded to Newmarch House to provide clinical support during its COVID outbreak. It’s incredibly challenging for an aged-care home to suddenly have to turn into a healthcare facility with so many unwell people. The touching thing was none of the COVID-affected residents died alone. Whether they died at 2am or 2pm, there was always someone with them; I held hands with people as they took their last breath.
It wasn’t the closure their families wanted, but the nurses did absolutely everything they could in their daily care. Seeing them made me incredibly proud to be a nurse.
Midori Fukushima, 29
Clinical nurse specialist, operating theatres
Clinical nurse specialist Midori Fukushima: “We don’t know what’s around the corner, but I’m ready to play my part if we come across another surge.”Credit:Kate Geraghty
It was tense and anxiety-inducing. I was one of the nurses who was upskilled to become an ICU nurse in order to look after a ventilated patient. Fortunately, in the end we never saw that anticipated influx of critically ill patients. But I’m proud that I stepped up in such an uncertain time. I guess we don’t know what’s around the corner, but I’m ready to play my part if we come across another surge.
Dr Paul Preisz, 61
Medical director of the emergency department (ED)
Head of St Vincent’s Hospital Emergency Department, Dr Paul Preisz: “I’ll be telling my grandkids about COVID. We’ll be saying, ‘We were there; we were the ones who had to make the decisions.’”Credit:Kate Geraghty
The ED is a factory of the sick and maimed. We get about 60,000 patients through the door a year. We have a team of roughly 200 people to deal with it, from medical to nursing and clerical. COVID was a new disease, which meant it was hard to get good information in the early stages. the nasal swabs we were doing took a day or two to get results, so we bought a piece of equipment that provided results within an hour, which allowed us to make better decisions about who needed isolation and who didn’t. It was expensive – $30,000, and each test cost $100 – but it was worth it.
We also used our negative-pressure rooms, which are really important with infectious diseases. In a normal room, air circulates around and goes out into other areas. A negative-pressure room is sealed off. The air is sucked through a filtration system where viral particles and airborne toxins are captured. It means no air leaks out but also that the air inside is constantly cleaned.
The hospital used to have three negative-pressure rooms, but they were demolished in recent renovations. Fortunately, we’d built two new ones just months before COVID. We went to some lengths to not make the rooms frightening; we made them look just like a private room, with their own bathrooms. But COVID patients who went in there weren’t well enough to get up to walk around anyway. Some were unconscious.
I’ll be telling my grandkids about COVID. We’ll be saying, “We were there; we were the ones who had to make the decisions.” I also tell my trainees, “The decisions we make today aren’t just critical for the patient now; they’re things you’ll be relating to your trainees, adding to the whole body of knowledge in the future.”
Dr Priya Nair, 52
Director of ICU
Director of ICU, Dr Priya Nair: “My concern was that if I hadn’t done enough personally, I would have been putting everyone at risk.” Credit:Kate Geraghty
I was on holiday in Portugal when COVID really hit. I got back to Sydney on March 2 and had to hit the ground running. We have 32 intensive-care beds across the public and private hospitals here, but we had to be ready to get, say, 30 admissions in one night. One of the first things we did was go around with the engineers and convert all these different areas into little satellite ICUs. In the end, we found another 40 beds. It was great to see how quickly the team rallied to make that happen.
It was non-stop. There was so much to think about that I found it hard to sleep. Mainly my concern was that if I hadn’t done enough personally, I would have been putting everyone at risk.
Pandemic training was held daily for all staff treating suspected or positive COVID patients.Credit:Kate Geraghty
One of the particular issues was when you put a breathing tube into a COVID patient. That’s the time the health-care worker is most likely to get COVID, because it’s an AGP, or aerosol-generating procedure. Another difficult area was how to manage patients on a ventilator, and to turn them on their tummies, for “prone ventilation”, which allows the blood and oxygen to mix more efficiently and to drain secretions.
One patient I especially remember. He and his wife were in their 60s. They’d both tested positive, but she never needed to get admitted. For the first two weeks of his time in ICU, his wife couldn’t leave home to come and see him because she was self-isolating. So we spent a lot of time organising for them to FaceTime on an iPad. There were moments when it was touch-and-go for him, and we always had it in the back of our minds that the last time they might see each other would be on FaceTime. It was a matter of preparing her for that to happen. He ended up spending seven weeks in ICU, but he survived.
Todd McEwan, 53
Director of acute care services
Director of Acute Care Services, Todd McEwan: “COVID isn’t like a plane crash or a fire. It’s much more agile; it keeps going and moving.”Credit:Louie Douvis
I’ve been at St Vinnies for just over three years. My job is to run all the acute services, from the emergency department to ICU to the wards and surgery, and manage them on budget and on time. We have about 400 beds and 5500 staff – doctors, nurses, orderlies, allied health, all that. So it’s a logistics game, basically.
The first COVID case we saw – our index case – turned up at about 7pm on a Friday night in early March. It was a 79-year-old man who lived locally but had just come back from overseas. We were under-prepared at that point – it was that early stage where probably nobody had seen a presentation. The man sat in the ambulance bay for two hours, so he probably provided a level of cross-contamination. So then I lost staff, because I had to isolate them. You think, “How did we miss this?” Then it was like, “Okay, shit’s happening, and it’s real.”
Within two days, we’d set up a special COVID fever clinic. To get a room, we kicked out our pathology unit on the ground floor, and moved that upstairs. We then had to secure our supply chains to source enough kit: swabs, gowns, gloves, masks, face shields, hair covers and shoe covers, scrubs, bins, handwash. Soon we had 250 to 280 patients a day turning up at the front door to get tested, frightened, frenetic. We had nurses to do the swabbing, but not enough.
On day one we had three staff swabbing; on day two we had eight, then we had 12 to 14 people – just swabbing. We also had clerical staff to capture the information. We didn’t have enough clerical staff, either, so we trained up some other people from around the hospital to be able to do that. In total we had 20 people running the clinic, which was functional 24 hours a day. At the same time, we also had to get the emergency operations centre up and running. We did that in two days.
COVID isn’t like a plane crash or a fire. It’s much more agile; it keeps going and moving. There was so much uncertainty that we used too much PPE [personal protective equipment] upfront, so we had to balance that over time to make sure we were able to keep going.
The other part of my role is just being present. I’d go through all the wards and the ICU and into theatres, the cafe, everywhere, and take feedback on what we could do differently, how people are feeling, asking if they have the kit they need to do their job.
I’m from Newcastle [a two-hour drive from Sydney]: I have a wife and a daughter there. Normally on the weekend I’d go home, swim and relax. But during that early COVID period, I was working from 6am to 8pm, and also on weekends and I was on call, so I stayed in Sydney. Until late May I hadn’t seen my wife or daughter since early March. I was so excited [to see them], because I missed them dearly.
Niki Mastello, 41
Nurse unit manager
Nursing Unit Manager Niki Mastello: “I’d never worked so hard. Everyone did. We just didn’t want Italy to happen here.”Credit:Kate Geraghty
I’ve been an Emergency Department nurse for 16 years. I love the action, the adrenalin. That’s the core of me, being an emergency nurse. When COVID-19 hit, lots of people started turning up to get tested so we set up an area at the front of the hospital as a pre-triage system to make an initial assessment of their symptoms.
I worked on that front-of-house pre-triage system when it was first set up around mid-March. It was incredibly busy. There was a queue 30 to 50 people long coming through all day. People were anxious, which made them angry. We had people trying to exaggerate their symptoms. When we said, “You’re not going to be able to be swabbed because you don’t fit the criteria,” they would suddenly start coughing really badly. One day a taxi driver pulled up, got out of the car and demanded I give him a mask. At that stage I was giving out 200 masks a day to patients coming to the hospital, so I said I couldn’t, and he started screaming and swearing at me.
We usually have 16 nurses in ED. We didn’t have to radically increase that because the number of people who’d normally show up completely dropped off. I think people thought they had a risk of getting COVID, so they stayed away. Of course, there were still things like cardiac arrests and drug overdoses. And that’s where COVID became this unknown entity: if someone came into ED with a drug overdose, we didn’t know if they had COVID or not. That sense of the unknown and the constant changes made the whole thing a pressure cooker, a boiling point. There were short tempers and lots of tears. ED nurses are good at getting our feelings across. We’re very upfront. There’s no point keeping it internalised; it only makes it worse. But we try not to do it in front of patients.
At one stage, our emergency response team came out with new ALS [advanced life support] guidelines regarding COVID. It said we couldn’t perform CPR on patients unless we wore an N95 mask, a full gown and visor. But donning that takes time, and your gut reaction is to go to the patient and save them, so that was very confronting.
I have two daughters, six and eight. My husband lost his job – he’s an airport refueller – so it was easy for him to look after them. But I’d never worked so hard. Everyone did. It was the biggest team effort I’ve seen in my time in nursing. We just didn’t want Italy to happen here. Still, part of the nurse in me is excited we’ve gone through this. It’s a once-in-100-year event. I’ll never see it again.
Dr Gail Matthews, 52
Head of infectious diseases
Gail Matthews, head of Infectious Diseases at St Vincent’s: “We were all learning as we went along, and there were always new questions and new problems, things that we hadn’t thought of.” Credit:Louie Douvis
COVID came very quickly. The area around St Vincent’s had a high number of infections with the Bondi backpackers and outbreaks linked to a couple of weddings. I began getting text messages throughout the day notifying me of the number of new cases. When someone tested positive, I or one of my infectious disease consultants would call them. Most already suspected they had it. They had a lot of questions about what it meant for them.
We had a daily briefing in the emergency operations centre with the heads of departments and other key people to make sure everyone was on the same page. It got pretty intense because we were all learning as we went along, and there were always new questions and new problems, things that we hadn’t thought of. We were being bombarded with so much information all the time – new modelling, public health stats, reports of new drugs – and it was sometimes contradictory. So part of my job was to synthesise all that information, then feed it back to people who needed it to make decisions.
Practising chest compressions on a training dummy called Corey Virus.Credit:Kate Geraghty
This was a new virus: we hadn’t studied it before. So I read everything I could find, then re-read it, and started to build a picture that way. It’s like a jigsaw: you start putting the easiest bits in first, then each time new information comes in, you add that. Sometimes you get a bit of information and you think it fits but you’re wrong, so you go back a step. In our lab, we looked at 17 other respiratory pathogens at the same time as COVID. Interestingly we saw rates of all of them fall because of better hand hygiene and social distancing.
At one stage, every thought I had was about COVID. Every single dream I had involved COVID; our response to it, setting up testing clinics, this and that. The lockdown has been hard for people, but there have also been positives about it, like being at home with your family, just taking a breather. I have two teenage girls, and I feel I’ve been cheated out of that. We’ve only had more craziness in our lives, which were already fairly crazy to begin with.
COVID is more than just a virus. It will be an inflection point in time. As an infectious diseases physician, I’ve been concerned about the anti-vaxxer movement and the general lack of trust in science. But [Australia has warded off COVID] because the politicians have listened to the experts. I think the community has seen the good that comes when you take the politics out of a crisis and let the experts shape the response. And that needs to happen in other areas, like climate change, just as it needs to happen in health.
Dr Mark Benzimra, 44
COVID respiratory response team
Respiratory physician Dr Mark Benzimra: “I was getting phone calls 24 hours a day, from the ED, from the wards and other departments. I was having nights where I didn’t sleep at all.”Credit:Kate Geraghty
I first heard of COVID in late January, when it was still a small cluster of infections in China. I thought maybe it would be something like SARS. By March we were seeing what was happening in Italy, which was horrific. I have friends who work in intensive care in Italy and they were messaging me about how they were being overwhelmed by patients who were dying in corridors, and how they were having to restrict resources to patients on the basis of who they were going to offer intensive care to. That was so scary, it focused everyone’s mind. We didn’t want to have to ration resources like that here.
I volunteered to be part of the COVID respiratory response team because I was relatively younger, and therefore at less risk. It was a team of seven. We were either at the hospital or on call. When you were on call, it was for 24 hours, so I was getting phone calls 24 hours a day, from the ED, from the wards and other departments. I was having nights where I didn’t sleep at all.
One of the things I noticed early on was the inequality in the system. One of the key questions about whether someone with COVID could go home was whether they could look after themselves and self-isolate. But we had vulnerable patients – homeless people, those with mental health or drug and alcohol problems – who had a cough and fever but no way of safely self-isolating, or no home to go to, so we had to look after them on the ward in single rooms. It was good to see how the hospital made it a priority to take care of those people’s needs.
Jack Hung, 42
Cleaning supervisor Jack Hung would say to his staff: “You are not just a cleaner. You are doing something great. You are part of the whole system of care.”Credit:Louie Douvis
I’ve been at St Vincent’s for three years now. I manage 100 staff – 60 on the morning shift and 38 in the afternoon. The hospital has 10 levels, so cleaning it is a massive job. We have to clean all the clinical areas, back office, operating theatres, toilets, public areas. Anything that has a physical form and a hard surface and falls under the legal jurisdiction of the hospital, we clean it: walls, tables, chairs, windows, doors, medical equipment. Everything has to be cleaned on top and underneath, every nook and cranny, because viruses hide everywhere.
It’s exhausting; you never stop moving. Now with COVID, we have to wear PPE [personal protective equipment] – goggles, gloves, hair nets and a full body suit. It’s like working in a sauna. It takes 45 minutes to clean one patient’s room, and by the time you finish you’re covered in sweat. After each room, all that PPE gear is disposed of, because you touch everything in the room and so if you went into another room, it could be a disaster. Each staff member can do 12 to 16 patient rooms a day, but after three or four they’re totally dehydrated. I usually bring a change of clothes to work, but the other day I forgot and I had to drive home in soaking wet underwear, which was so uncomfortable.
COVID also means cleaning on demand: if there is someone in emergency and they need to be transferred quickly, or if they are moving someone in ICU to a room to make space for a more critical patient, you have to clean that room and get it ready, right then. Normally, most of the cleaning staff would leave by 10pm. With COVID, we have at least one person stay overnight, just to clean the ED.
A big part of my job is walking around. I do an average 12 to 13 kilometres a day, supervising staff: I sneak up behind them to observe them and make sure they’re not hurting themselves and doing a proper job. I walk so much that I get a new pair of shoes every three months. My legs are so fit, but I don’t go to the gym. My girlfriend is like, “Jesus, you need to do some work on your upper body!”
No one knew what COVID was at first. We didn’t know how it killed people. My staff would ask me a thousand questions a day. A lot of my time has been spent educating them. Once they built the knowledge in their heads about it they felt better; they would then tell their families and their neighbours and educate them.
Still, we had to be careful. Some of our staff are in their 60s and 70s, and some of them are smokers or they have heart issues. We talked to them to see if they were comfortable to keep working. A couple of them took time off. But mostly, they were quite willing to keep working. They saw that they were making a contribution in a really crucial time. Let’s be honest: a cleaner in the social scale is the bottom of the ladder. Before COVID, some of my staff would say, “I’m just a cleaner.” That’s how they saw themselves. So I’d say to them: “No! You’re not just a cleaner. You are doing something great. You are part of the whole system of care. And for that system to work, everyone has to pull together.” They came to see that even though they weren’t doctors directly treating
patients, they were making a huge contribution.
Lili Carlos, 40
Heart and lung transplant pharmacist
Heart and lung transplant pharmacist Lili Carlos: “I was doing 12-hour days, six days a week. Luckily my husband works from home, and he has been a huge support.”Credit:Louie Douvis
I’m the pharmacist for heart and lung transplants and for the ICU. I’ve worked here for 10 years. We dispense the patients’ medications for their hospital stay and for their discharge and we teach them about their medication and what they have to do with them. Transplant medicine and intensive care is really specialised: some of the patients are on 20 to 30 different medications, so it can be pretty overwhelming. But it’s important. It’s keeping them alive.
When COVID came, we saw a huge increase in our workload. We were trying to keep our patients safe by doing more reviews by Telehealth, to keep them away from the hospital as much as possible. But that meant the volume of medications we had to mail out to patients grew immensely. We were doing about 100 more mail-outs than usual every week.
A COVID patient in his 50s, transferred from a quarantine hotel to receive care.Credit:Kate Geraghty
Our pharmacy, which is normally on level three, deals with a lot of transplant patients, who can be immunocompromised. These patients would normally come in to see their doctors, get their prescriptions, then come to us to get the medications. The COVID fever clinic was set up right opposite our pharmacy, a couple of metres away. Suddenly we had people queuing up waiting to get tested for COVID, walking straight past us. We didn’t want our transplant patients potentially being exposed to that, so we set up a little pop-up pharmacy on level four. We had to do that in two days. The hospital then came up with this plan to move all the heart and lung patients across to the private hospital next door so we had to do all this background work to make sure that could happen. The pressure was so intense: I was doing 12-hour days, six days a week. Luckily my husband works from home, and he has been a huge support.
Meanwhile, the transplant unit was still doing transplants, and patients were still coming in with other problems, so we still had to keep that service going.
Generally, I wasn’t worried for myself about catching the virus. I just didn’t want to get it and give it to anyone else, especially our transplant patients. Also, I’m young. Then I got a message that a colleague I used to work with in the UK got the virus and passed away. He was only 45. He was a pharmacy tech I worked with in London. He died in the ICU of the hospital that we used to work in together, so you just never know.
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