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Gabi—Registered Nurse
Emergency department
Metropolitan Melbourne

January 2022. The Omicron variant. Working in the emergency department. Reflecting back, I think that’s when I lost my empathy, although I didn’t know it at the time.

There had been a lot of empathy, discomfort and hard work before then.

Patients and visitors would ask me, ‘How do you wear these N95 face masks?’ after they’d put one on for approximately two seconds. And I always said with a half-smile, ‘You just get used to them.’ But I’d think, ‘Mate, try wearing one for eighteen-plus hours!’

I still remember that first shift back in 2020 when I wore an N95. My first thought was how uncomfortable it was, but the next thought was that it had to stay on. I needed to do my job and that required me to forget my comfort. I was doing it for the patients who come through our emergency department doors: for the elderly patients from nursing homes with multiple comorbidities; for the chemo patients in the middle of chemotherapy. I was doing it for my colleagues who needed me to stay well and rock up to each shift; and for my family who I didn’t want to make ill. I wore that N95 and added a face shield, gown and gloves.

As a small, young female I am lucky I rarely sweat. That was until COVID. That first shift I wore full PPE the whole time. It was a night shift and I didn’t have time to stop until 4am. I was in shock how sweaty I was when doffing. That was the first time I used the only two words I feel adequately describe what wearing full PPE for a whole shift is like: Sweat City.

The Delta wave brought the worst of COVID. Fewer patients were vaccinated and those who got COVID were sicker. I was studying for my postgraduate qualification that year and I owe all my first intubations—placing tubes into a patient’s windpipe to aid their breathing—to COVID patients. The youngest was twenty-eight years old.

But the patient I remember best was an elderly patient who was relatively independent, unvaccinated and had caught COVID. I nursed her alone in one of our negative-pressure resuscitation cubicles. The level of oxygen in her blood was low and she was confused and agitated, even on maximum oxygen flow. I asked the doctors if we could try her on a ventilation machine, but there were no high dependency or intensive care beds available—none in the state! She went to the ward with high-flow oxygen and we tried to prone her—place her on her stomach to improve her breathing—but because she was confused, she kept rolling back. She died five days later. Although I know it’s complicated, I can’t help feeling that I sent her there to die. She was the first of many elderly patients I sent to the ward like this.

When January 2022 arrived, Omicron reared its head and our emergency department staffing took a hit. On average we were down more than ten nurses per shift. I felt as if I was set up to fail. At each shift, I tried to care for all the COVID patients packed into the ‘respiratory zone’, a shipping container out the front of the department. These patients weren’t critically sick, but they still needed care.

Sometimes, I think about how ruthless we had to be triaging patients. I learnt to triage through ‘a baptism by fire’. There were never any beds; most people had to sit or stand in that waiting room. Only if we truly thought the patient absolutely needed it did we send them to resuscitation where they received intense support to breathe. I learnt to trust all my knowledge and gut instincts and to know who to prioritise.

In undergraduate studies, they used to say that patients remembered best the nurses who brought them a warm blanket or the cup of tea they had asked for. We had no time to look after the mildly sick patients, let alone bring someone a blanket—and we’d probably run out anyway.

What I learned was probably at the cost of my empathy. When you’re that overwhelmed with a large triage line or a waiting room queue, you can’t continue empathising with every single patient—you just can’t.

Throughout the pandemic, after long shifts, I would come home and my husband would ask, ‘How was your day, love?’ I sometimes unloaded with the crazy pandemic stories that we all knew as healthcare workers. But many times, I’d just give him a half-smile, exhausted and drained of empathy, and say, ‘It was Sweat City.’ I knew he couldn’t really understand where we came from and how we got to this point.

Only my colleagues will know the feelings and experiences we all felt and faced. Call it a shared experience, pandemic bonding or trauma bonding, we all went through something more significant than I think we realised at the time.