From the front lines

Former Gilmore girl Esther Rand was in the Snowy Valleys last month, helping her parents as they cleaned up recent bushfire damage around her childhood home and started to rebuild. Now, the young nurse is working in the Emergency Department at a hospital in Sydney, dealing directly with COVID-19 patients. She had left nursing to start a new career, but has gone back to help with the pandemic. Here is her story.

Esther Rand after finishing 12 hour night shift at an Emergency Department in Sydney where contact with coronavirus is a daily reality.

Going to work in one of the largest and newest public hospitals in Australia, I walk past a queue of about 40 people waiting to be tested in the new “Fever Clinic”. What used to be a transit lounge – an area open to the outside where people wait for patient transport services – is now a clinic of emergency nurses in full personal protective equipment (PPE); a full-body plastic gown, gloves, an N95 mask, and goggles.

Spending 10 minutes in one of these gowns is tough. The non- breathable plastic material means sweat lines our scrubs, and we start to feel very uncomfortable very quickly. Spending hours on end in this outfit means the nurses working in these clinics are putting themselves and their families at risk exhausted, uncomfortable, and hungry.

During another record day of emergency presentations – over 500 in 24hrs – a colleague declined a lunch break after seeing the growing queue outside. She had her lunch at 5pm. Some people had been incredibly rude to her, angry they didn’t fit into the criteria of people we are testing, while others had been normal and civil. She wasn’t angry or upset. She just shook her head and said she was glad to be sitting down.

Being an emergency nurse means we are tough. We rarely becoming flustered, even when we are terrified. We know how to deal with patients having the worst days of their lives. We are used to being spat at, bitten, sworn at, and abused. We are used to seeing pools of blood, doing CPR on children and adults alike.

We know exactly what to do when a patient comes in to our bed space with conditions like sepsis, pain from endometriosis or an amputated finger, toe, or limb. We know what to do when a patient from a nursing home comes in unable to breathe with end-stage pneumonia or heart failure, or a child comes in blue with asthma.

We see all sorts of trauma.

We look after people with measles, meningococcal, HIV, and antibiotic-resistant strains of infections.

Research teams, very experienced nurses and consultant doctors run training programs and simulation sessions almost every day, making sure we are most up to date on how best to save lives. We impact many lives every day, and are good at what we do.

What we cannot do, however, is deal with hundreds of severe presentations at a time.

We can save lives, but only a certain amount. What Italy is experiencing is too many patients presenting at a time, and that is what we need to prevent. We need the community to participate in helping to reduce the amount of people needing emergency care at any one time.

What we are seeing now would resemble a bad flu season.

Patients present to the hospital with viral and respiratory symptoms – fevers, dry or wet coughs, difficulty breathing, chest pain, and sore throats. If they are well enough to go home, we send them home.

We may test patients if they meet criteria, and send them home to await results. If they are very unwell with their symptoms we isolate them, test them for flu A and B (the common strains of the flu) as well as COVID-19, treat their symptoms and make them as comfortable and stable as we can and wait for the results to come back.

These patients require a private room and will likely have a prolonged hospital stay as we await their results and their condition to be stable enough to return home without medical intervention – oxygen, breathing support, IV medication, etc. This can take days, if not weeks.

At times, lines of people wait outside Emergency Departments at Sydney Hospitals, but the busyness fluctuates. At other times, Esther said there may only be a few patients to see.

Ultimately, this will cause the hospitals to buckle under the demand, with hospitals going in to bed block and causing restricted movement for admitted patients moving from the emergency departments to wards. This will affect people’s lives and may experience a more lengthy hospital stay.

In a short time, we will see our wards – wards that are already usually full, pushed to capacity.

Nurses are feeling under-resourced and unsupported under mounting pressure.

Staff members who have any respiratory symptoms need to be tested, and isolate themselves from family and friends for 5 days as they await their own results. Staff are being sent home mid- shift if they develop symptoms throughout their day at work. This puts massively increased pressure on staff well enough to continue to work.

We are all in good spirits.

We have knots in our stomachs waiting for the brunt of this virus to hit us. What we’ve heard from other countries terrifies us. But people are kind, and we continue to dance in our PPE and make jokes about using masks as eye covers on night shift and blow up gloves as balloons for the paediatric patients.

We buy our colleagues boxes of pizzas when we have a night off to show them we’re thinking of them.

The night shift coffee cart that comes around to our hospital at 3am has started a GoFundMe page called “Buy them a Coffee”, where people donate money to buy doctors and nurses coffees whilst working throughout the night.

The feeling of “togetherness” is very much alive.

Stories of city people going to the country to raid supermarkets and people fighting over resources are rife, but small acts of kindness are everywhere.

Entire streets have come together to offer help, and community groups attempt to help where they can, whilst maintaining distances.

In my household of 2 nurses, neighbours offer food and meals and ask for shopping lists so they can help.

We are a kind country, and the insanity of few cannot douse out what we are made of and the values we hold.

In the busiest of shifts and the dead of night, where ambulances still pour through our doors, we take each patient as they come and care for them as best we can. No matter what.

All the projections look very scary, are only scenarios based on current statistics, and are subject to how well people take advice and self isolate.

Hopefully the forecasted scenarios will not happen, but that depends on how compliant the community is with health advice – the most important being to self isolate and maintain good hand hygiene. We can expect the first wave of the pandemic to last from 12 to 22 weeks.

As per reports from health professionals in other countries dealing with presentations of this virus, deterioration is common. It starts out as moderate respiratory failure, and over time deteriorates to requiring ventilation and breathing support. Very few scientific papers have been released with information on how this disease presents; however we know that recovery, if achieved, is a lengthy process, specifically in populations with complex healthcare requirements.

Reports from one doctor in Italy stated they had ongoing issues with staff becoming sick with the virus. Once staff become sick, others are needed to do overtime shifts, leading to a deterioration in staff health, and over time mortality spikes as patients aren’t able to be treated properly.

Australian Emergency Specialist David Green describes the current mood as though there is a “massive cyclone off the coast heading our way, and we are just starting to get our first drops of rain. We are as well prepared as we can be, and I think in 2-3 weeks we will be in Cat 5 cyclone territory,” whilst also urging everyone adopt heightened precautions.

Simpler times for Esther and Brooke at Ciderfest in Batlow, before fires and fears over coronavirus.

He says “many of us will get sick, all of us have heightened anxiety.

“There’s a very real risk of death working in this place.” He has urged everyone to take this situation extremely seriously, and to never be dismissive. “This is going to be one tough long ride,” he says.

There is one way we, as a community, can stop the rapid spread of this disease. We can stay home. We can listen to sound and reliable advice and updates. We can stay calm and support each other.

It is a strange feeling removing ourselves from our community, especially one that is so close-knit and supportive of one another. Some months ago, we came together to fight something that was threatening our safety and livelihoods. Now, once more, we do it all over again. Just this time a little further apart.