It’s been an extremely interesting couple of years being an ICU nurse.
We started off terrified because we’d heard healthcare workers in China were dying—like Dr Li, a 34-year-old medical eye specialist who first raised the alarm about a virus he had contracted from his patients.
We were also learning from the Italian experience. We could see television footage of Italian hospitals overrun with patients needing ventilation. And we could see all kinds of non-invasive and invasive ventilation being used to prevent patient deaths.
In one day, an Italian hospital in a regional town similar in size to my own had forty patients on ventilators. We knew we had about twenty ventilators, seven dialysis machines, four heart-lung bypass machines known as ECMOs (from extracorporeal membrane oxygenation) and seventeen staffed ICU beds. If this thing was going to get big, we were going to be seriously under-resourced.
With the overseas experience in mind, we made our preparations, working closely with government to make sure we had enough resources. I worked out how to split a ventilator and bought non-disposable PPE because the stories about PPE shortages coming out of America were so concerning. Then, armed with a snorkel, white overalls and crocs, I was ready to meet the COVID-19 beast head on!
Our COVID pod was a shemozzle in the first few days, so I said to my boss, because I have a background in infectious disease, ‘Just put me in there every day for the next two weeks and we’ll sort it out and it will be good, but we just need one consistent person to make sure we get the messaging right.’
We needed to sort the processes because it was busy, and it was hard work, but I knew if we could make it routine-driven, we could do it.
I may sound brave now, but I was scared. I was scared of getting COVID and dying. Remember the pictures of the Chinese nurses? The PPE they went into was next level—and they were working twenty-four hours a day—and I thought, ‘I don’t know if I’m that brave.’
I made sure my will was up to date. I found alternative accommodation so that if I became exposed, I wouldn’t take COVID home to the one-bathroom house I shared with my husband and teenage boys. I practised the decontamination measures I would need to follow so I could go home. And I waited to see how my work would be affected.
We cruised along for a while—a case here, a case there. We got to refine our PPE skills and learnt what this disease could do to the human body. Then we got our first Delta patient in July 2021.
Delta was a whole new beast.
When Delta came, we found we were admitting patients between day ten and day fourteen of their disease. People who had been booked to go home were ending up in ICU.
We see very sick people in ICU, but this was by far the sickest group of patients I had ever cared for. The normal length of stay in ICU is about three days. With Delta, the minimum length of stay became two weeks.
We had some patients stay for seventy, eighty and one hundred days. And that’s where the busyness came into it for us. We didn’t have one hundred patients at any one time, but we had patients who weren’t going anywhere.
That’s where Europe, Canada and America were running into trouble. They had so many patients at once and they couldn’t get them off the machines quickly enough.
We knew that if we could get a patient to last three weeks, they would live. That was the difference with COVID; you just had to wait it out, because lungs do repair, it just takes time.
But that’s what these other countries didn’t have. Because they were experiencing Delta before vaccinations, they didn’t have the time. It meant they had to make terrible decisions like: Do we take an elderly person off a ventilator because we have a thirty-eight-year-old father of four waiting for one?
Early on we had run these scenarios through our heads because we knew we had limited resources, but it didn’t get to that in Victoria. Because we used masks and lockdowns and waited till most people were vaccinated, we didn’t have to do anything awful.
I don’t think the public really ever grasped that, but I shall be forever grateful our government and chief health officer were strong enough to make such hard decisions.
After our first Delta patient, we cared for another eighty COVID patients. Every day, we’d get patients from Melbourne hospitals that were overrun. They were ambulanced in through the back door and up to us in ICU and usually by then they were so unwell on the ventilator that we would need to put them on the ECMO straight away.
COVID patients ventilate completely differently from people with pneumonia. With pneumonia patients, we struggle to get the air in. With COVID, the patients had this ‘air hunger’ that was quite different. We could get the air in, almost too easily, and that put them at risk of lung injury.
We learnt that to keep them safe we had to take the patients’ drive out of the equation completely. To do that, we had to sedate them so their body couldn’t do anything and put them on the ECMO. If we could get patients on the ECMO early, the ventilator wouldn’t do the extreme damage to their lungs.
Wearing full PPE made our work heavy, uncomfortable and hot. Most of our patients were big, one-hundred-and-twenty-kilo guys. When they are completely unconscious, they are like dead weights, so we needed eight to ten nurses to ‘prone’ them—to turn them onto their stomachs to improve their breathing and oxygenation.
Proning is not something we did much before COVID because we’ve got so many lines and tubes attached to our patients. But through COVID, we got really good at it, we saw how effective it was and we practised it a lot. It’s become one of those things that we just do now.
And we’ll continue to do everything we can to get people back to their loved ones, but please do me a favour—get your vaccinations and listen to scientific factual information. Facebook is not the place to get your health advice. Do a lap of this unit and then tell me you don’t want to get vaccinated!
We’ve looked after some of those guys from the big violent antivax rallies—and we still get the conspiracy theorists—people who can’t see what I see. In ICU we quickly learnt that with vaccination, you might still get COVID, and you’re still going to feel terrible, but you’re probably not going to end up in ICU, attached to everything, and potentially dying.
COVID in ICU is devastating.