After months of anticipation, fear and frenetic preparation, we were now deep inside the first significant COVID-19 wave of 2020. Any scepticism that COVID was an overstated concern had long been laid to rest.
Despite our best efforts, it was quickly apparent that there would be much to learn. Every day we were writing a new page in the rule book for tackling this one-in-a-hundred-years pandemic.
We were addicted to the daily published tally of the number of COVID-positive people in the community and the translation to hospital-admitted patients. Was the wave going up? Were we there yet? How much longer and how many more would need our care? It would be a long time before we ignored these numbers and lifted our gaze from the day-to-day grind of relentless pressure and suffocating PPE.
The emergency department was struggling to keep up with demand and more and more portable tents were being erected outside its front doors. It was now starting to resemble a farmers’ market, but with no casual wanderers or weekend vibe.
I was working within one of Melbourne’s tertiary public hospitals. As the numbers of patients climbed, we flipped ward after ward, converting them to COVID-only admissions to be quarantined and locked down in an isolated bubble. Our intensive care unit was doubled in size, with a satellite unit running from the theatre recovery area.
Each day, we were running a gauntlet—doing our best to manage the delicate balance created by increasing our COVID bed capacity at the expense of providing fewer and fewer options for people needing non-COVID care.
The COVID wards were generally eerily quiet, the usual buzz of activity and traffic long gone. The medical and allied health clinicians were reviewing and consulting on patients from a distance. Virtual ward rounds and consults allowed us to keep unnecessary traffic out of the high-risk COVID wards. Only those required to deliver care were permitted: the nursing team was a constant, always closest to patients and exposed every day to the highest level of risk.
Denying a family visiting rights to be with their loved ones is one of the toughest experiences served up by the pandemic. Seeing patients deteriorate and having heartbreaking discussions with family members was an emotional rollercoaster. These conversations happened all too frequently and occupied many hours. They filled all nurses with anguish. How could this be right? How would I respond and manage in the same circumstances as these poor families and patients? There was verbal abuse too, as many families struggled with denied access, believing that this restriction on their life and liberty was a step too far and one they could not bear.
We tried hard to connect families to their loved ones through various screens and virtual exchanges—but this was terribly inadequate. As nurses, we held countless hands and conveyed our apologies for what was an unfair and compounding set of circumstances. For those patients with significant needs who were approaching the end of their lives, visiting concessions were made and one or two family members were permitted to be by their side. In the early days of the pandemic, this was a difficult path to navigate as decisions often rested with those less connected to the raw human exchange we nurses could see happening at the point of care.
How do you manage a request from a COVID-positive wife, Maria (not her real name), to visit her dying COVID-positive husband, Joseph (not his real name), inseparable soulmates, married for sixty years? This was the first request of its kind for our health service and the first for the state of Victoria as we later discovered. It was time to speak up and advocate for what was clearly the right thing to do and bring this couple together to say goodbye to each other.
We set to work to map out a plan. We knew any plan would require the endorsement of our executive. We knew it would also need to find its way to the highest authority, the Victorian Chief Health Officer, for approval—this was the government-mandated requirement at the time.
But time was running out quickly for Joseph.
We made it our urgent priority to map every step of the process. This was not a visitor who we could bring through the front door or via the emergency department. Travelling to and from the in-patient ward carried risk. Every element and possible interaction with our staff or other patients had to be considered and challenged. Endless ‘what ifs’ were explored.
When we had finalised the plan, we presented it to our chief nurse and waited.
The team was briefed and ready to go. Our senior nursing coordinator volunteered to be the constant companion and guide for Maria, accepting the risk. They needed us, were trusting us, and we were called to act, adapt and above all care. The clock continued to tick, and Joseph held on.
The plan was simple.
Maria was to be driven to the hospital by her son Dominic (not his real name). They were to enter the underground carpark, call the direct number of the nursing coordinator and wait in the car. The nursing coordinator would meet them there and hand them their N95 face masks. Maria and Dominic were to follow the instructions for correctly donning the mask which we had already sent by video to Dominic’s phone. Once they had correctly donned their masks, they were allowed to exit the car. The nursing coordinator would then show them how to don a hairnet, gown and gloves. Once in full PPE—and touching nothing—they would follow their companion.
A service lift would be ready and waiting, secured for the sole purpose of this visit, with access locked to any other users. Upon arrival on the ward, they would enter Joseph’s room, where chairs would be waiting. They would be permitted to stay for thirty minutes but had to always maintain their PPE. We would execute the plan in reverse to exit the hospital, with Maria and Dominic only able to remove their PPE when securely back in their car.
Then all touch points in the patient’s room would be cleaned and the lift would be deep cleaned. Frequent PCR testing for our nursing coordinator would be followed up for the next fourteen days.
Finally, the call came—green to go!
We swung into action. Maria and Dominic arrived. Tears flowed freely from everyone. The plan went smoothly and after thirty minutes they reluctantly left. Joseph died a few hours later.
What an extraordinary gift we gave this family and this dying man. What an incredible team of nurses who were not content to deny their patient the opportunity to say goodbye.
What selfless sacrifices our nurses made, repeatedly, at a time when vaccinations were a dream on the horizon, air purifiers not considered seriously, and the validity of fit testing for N95 masks was still being argued.
On that day, we took pride in making a big difference, upholding dignity and humanity and doing what was right. It was a good day at a time when there were mostly dark days.
This was now our road map to ensure more families could access their loved ones. Human contact was possible, because the nursing team made it so.