A frontline nurse’s gripping story

A frontline nurse’s gripping story

When Melbourne was plunged into rounds of lockdowns during the first months of the global coronavirus pandemic, two friends answered the call to join the frontline as nurses.

After spending years as a family violence educator and sexual health nurse, Simone Sheridan put her hand up to retrain and work as an ICU nurse.

Over countless phone conversations with her friend Alisa Wild, Simone shared the exhaustion, confusion, tears and surprising moments as she faced the greatest health crisis her city had ever seen.

Then Alisa wrote it all down to form the newly-released book, The Care Factor.

A celebration of friendship and nursing in the time of social distancing, The Care Factor has been praised for its ‘behind the scenes’ view into nursing and health care during the COVID-19 pandemic. 

Here, we present an excerpt from their gripping tale. 

Chapter 1

‘Like preparing for a war’

The Crisis Respondent

It’s  20  March  and  I’m  in  a  doom  spiral, fear- scrolling and heartbroken. There are twenty-eight new cases of Covid-19 in Victoria. Yesterday 2700 passengers disembarked from the Ruby Princess cruise ship into Sydney. It’s time to keep my three- year-old home from childcare.

I’ve been working from home for years, setting up and packing up my laptop from the kitchen table each day. I think of this house as mine alone. Those hours when Jono is at work and Jack’s at childcare, the stretching peace of tea and silence and room for my brain to work; they are what keep me sane.

I’m about to give them up. 

I’m supposed to be writing a children’s book but I can’t focus. I’m afraid.

Instead, I call my friend in Sydney whose grandmother is dying in aged care. Limits on visitors seem to shrink each day. She’s from a big Greek family and everything feels wrong about her Yiayia being alone for a second. There should be cousins and great-grandchildren and love all around her for these final days. My friend manages to get permission for her children to come in for a ten-minute visit to say goodbye. With her own full-time work, the domestic load, and the children in her face, she sounds like she doesn’t have time to grieve.

I call my single friend who is just back from an overseas work trip. She’s in quarantine at home alone – facing lockdown as soon as her quarantine time ends. She’s been sharing articles about skin- hunger and loneliness. I bite back my envy of her space, my longing to be alone. And I listen to her sadness.

I call my friend who is helping to care for her bedridden father. He has a slow, debilitating terminal illness. Someone needs to wake with him several times a night to help with toileting because his bladder is shot. My friend is living several nights a week at their house, trying to share the load, dressing in cobbled-together homemade PPE when she does the shopping.

I call my friend who’s living on Centrelink with two kids and training to be a nurse. I check that she’s got the tech she needs for remote learning.

I call my friend whose work as a touring theatre performer  stopped overnight to find out how she’s planning to manage financially.

I call my friend who’s a high school teacher. He is spending the entire school holidays planning how to deliver distance learning.

I feel like they are all superheroes. I feel like I am part of a great network of carers who are holding up the world and I hope my phone calls lighten the burden. I realise that the phrase, ‘Love makes the world go around’ isn’t actually about the nice feeling I have in my chest sometimes.

It’s talking about the hard, endless, soft, sleepless, exhausting labour of caring for our people.

That labour just got a whole lot harder. 

I call Simone.

I make my first recorded call to talk about how she’s feeling as the lockdowns roll in. Wu Han, Seoul, California, New Zealand … and now us. I’ve been listening to ICU nurses in New York talking about their days. The danger. The deaths. The lack of PPE. I want to know exactly what’s happening here in the hospitals near me.

I asked her how she came to decide.

‘I guess I felt: I’m up for this. I’ve got ICU experience. I’m fit and healthy and I’ve got good support. So, I’m going to give it a go. For me, there wasn’t  a  question.  Sure,  there’s  a  part  of  me  that would love to just bury my head in the sand but…’

But people need her help. At the first ICU orientation session, the message Sim heard was, ‘We need you. Please come and do whatever you can. If you only come in for two hours to relieve tea breaks, at least that’s something.’

She is part of a huge cohort of nurses returning to ICU from other places – education, project management, retirement or maternity leave.

Sim will be stepping back a little from her other role: training health professionals to recognise and respond to signs of family violence in their patients. ‘The thing is,’ she tells me, ‘all the face-to-face training I was doing has ceased. We can’t have people in a room together. No-one’s got time. It’s not the priority right now.’

She’s obviously conflicted about this.

‘We know from data around bushfires and other crises that we’re going to end up with an escalation in family violence incidents. Isolation at home will just make it …’ She breaks off. ‘It’s really hard for a lot of people. Really fucking hard.’

She explains that, on top of increasing incidences, the family violence services have to find ways to operate with social distancing. ‘Social workers are having to figure out what they can do online, from their homes. The refuges are asking questions like, can they take people who’ve been in hospital, or might they be a risk to other people in the refuge?’

I feel the issues expand in front of me. Of people living in crisis accommodation, of children in state care, of prisoners. How are we, as a society, going to keep people safe?

‘So, I’m hearing all this info about family violence and my emails are full of it and my job is to make sure hospital staff have an eye open for it. But you can imagine the barrage of information going through hospitals at the moment. People are trying to filter what they need to know from pages of writing. They just don’t have time for it. I wrote one email about the increases in family violence we’re expecting. I probably went over it 20 million times trying to make it as succinct and easy to read as I could.’

Her frustration levels are high. This is not surprising, when all she can do is send emails people might not read.

‘I don’t have the ability to talk to people about all the details. All I can do is flag it and make sure they know where to look for resources.’

She’ll keep working at that for now. But she’s also getting ready for something very different. She had her first training in ICU yesterday.

‘It was, quite hilariously, the most welcoming experience I’ve ever had there.’

She pauses to explain. ‘Background: ICUs can be snobbish places in the sense that you have to meet certain criteria to work there. They’re very strict about it. If you haven’t worked there for a while, they will only take you back under specific conditions – so you can receive support and training.’

It makes sense to me. This is about life and death. You need to get it right.

‘But  we  just  don’t  have  the  ability  to  run  ICUs with the number of staff this pandemic will require. Things are changing fast and we need to think outside the box. Suddenly it feels like ICU is rolling out the red carpet. They’re just having to say, “We want you. We want all of you.”’

It’s been five years since Sim worked regularly in an ICU and when she did it was at a smaller, more specialised unit. She’s never worked in a big trauma ICU like at the Royal Melbourne Hospital. I ask her how she’s feeling about it.

‘I’m incredibly nervous. You can imagine that there are a lot of machines. And there are a lot of things to remember. There’s a lot of immediate recall of  what  to  do  at  each  point  that  really  isn’t  fresh for me.’ Her voice rises. ‘And there was a woman in my  group  yesterday  who  hasn’t  worked  in  ICU  for eighteen years!’

On the recording of our conversation, you can hear me gasp, ‘Eighteen years! The tech must have really changed for people like her.’

Sim equivocates. ‘Yeah, but interestingly, a lot of the principles haven’t. Bodies are still the same.

Blood pressures are still controlled in the same way. The tech has changed for sure, but some of it’s become more intuitive.’ She laughs. ‘You know, like how using an iPhone is actually easier than using an old Nokia.’

Sim explains the way ICUs are run. If a patient is on a ventilator, they have a nurse dedicated solely to them, who does not leave the bedside. The machines control how many breaths they take, the volume of air with each breath and the concentration of oxygen they receive. Medications are delivered by pumps to control blood pressure and heart rate. The nurse is always there, monitoring the machines and adapting settings and dosages in response to changes in the patient’s vital signs.

‘I stupidly started the day by reading stories from nurses living the nightmare that is ICU in London right now.’ Her voice rises with incredulity. ‘I read they only have one ICU nurse to six patients.’ I can feel the tension rolling down the phone.

Royal Melbourne usually has thirty-two ICU beds and they’re looking to open ninety-nine in preparation for the pandemic. ‘So, if we are going to ninety-nine beds, then we need to triple the number of staff, and there’s just not that many ICU nurses. Even with all of us coming back from retirement and out of projects, there’s a gap. So, they’re also training up  a  cohort  of  nurses  who haven’t worked in ICU before; they’re calling them Fast Track nurses.’

She says they’re not just training. They’re also ‘untraining’.

‘They always talk about danger to self. Don’t go in if there’s a danger to you. But nurses are inherently bad at that. If someone suddenly pulls out a breathing tube or is bleeding everywhere, we tend to go straightin. We should wear gloves, of course, but in that moment, we often just do what we can to save that person’s life – then deal with ourselves later.’

They’ve been training in how to put on Covid PPE. They have to pay attention to exactly how they handle the mask and breathe strongly to test if they have a seal. The mask is tight-fitting and takes time to get it on. It takes time to get it right.

‘If I look into a room and someone’s arresting, I can’t rush in and save that person’s life. I have to diligently put my mask on and focus on myself first. It’s actually going to be really hard.’

But Sim’s trainer told them, ‘Look, the thing is, how many other people won’t make it if we lose one ICU nurse for fourteen days? Even if you’re not sick, you’ll have to isolate and that has an impact on how many people we could actually save.’

‘Yeah, that was just huge.’ She laughs her disbelief. She explains that the ‘pods’ of the intensive care unit will be divided to stop the spread of infection. ‘Initially, they’ll put Covid patients into the isolation rooms, but there are only eight. Once the isolation rooms are full, then they’ll go into Pod A and B which can be locked into Pandemic Mode. And then, of course, there will still be all the patients in ICU  who  don’t  have  Covid  –  so  they’ll  be  in  the other pods.

‘And then just … we don’t know what will happen. But that’s the initial plan.’

I’m worried about older nurses coming out of retirement, back onto the wards and being put in the way of infection. I’m worried about the fresh new mothers who had months of maternity leave planned and are suddenly, instead, stepping back into a risk- filled workplace. I’m afraid of our hospital system being overwhelmed. My sister lives in London and works for the National Health Service. Just days ago, she was telling me about clearing entire mental health hospitals to make way for palliative care wards. Wards for the Covid patients over sixty who they won’t be ventilating. Who will quite probably die.

I’m scared for my parents who are far away in New South Wales. Sim’s parents are even further, in Western Australia.

But we don’t talk about our families.

It’s easier to focus on the details of the organisation and planning underway. It feels both compelling and reassuring.

‘They’re trying to work out an estimate as to when we expect to see patients at the hospital. When we expect to be flooded. And the interesting thing is, they don’t think it will peak for us until late April.’

The hospital was planning to roll out a new system of electronic medical records in April but they’ve slammed the brakes on that. They don’t want to be training hundreds of staff how to operate a whole different record-keeping system in the middle of a global pandemic. They’ll do it in July, when hopefully the peak will be over.

‘We’re going into a period now of potentially four weeks of not much happening from a hospital perspective. So, we have this amazing benefit of time to prepare in a way that Italy didn’t. And the UK didn’t. Those countries were flooded with ICU needs before they had time to think what was happening.

‘Whereas we don’t have any patients with Covid at the moment at Royal Melbourne, so we’re in total preparation mode. Teams are being formed. People are being brought on. Recruitment is happening.’

Sim pauses and slows. ‘It’s weird. It’s like preparing for a war, but the war’s not here yet.’

This is an extract from The Care Factor, the story of one incredible nurse who chose to join the frontline combating an unprecedented global health crisis (Hardie Grant Publishing Australia), out now.