An anonymous intensive care unit doctor at a major hospital in metropolitan Melbourne explains the crisis unfolding in hospitals as Omicron cases and deaths surge across Victoria.
During the first wave of the pandemic, there was a huge focus on workers. I can promise you, though, that nothing happened in those first few months. Now, across the past five months, things have been really fucked — but the focus on workers has moved on.
This is the busiest it’s ever been.
We’re experiencing a huge staffing shortage. I get texts probably 10 times a day from [the workforce department] from all other units, whether it be emergency or general medicine, begging for us to take extra shifts at $150 an hour. Because there’s just not enough staff, especially in the emergency department.
With Omicron, people are not getting as sick, but many still come to the hospital and require supplemental oxygen. The hospital has had to change the nurse staffing ratio from one-to-four to one-to-six or even one-to-eight because of nursing shortages. The doctors in the wards are getting absolutely smashed. People aren’t getting the care they usually get.
The ICU has extra beds, but we just don’t have the staff to man them. If someone comes into the ICU with COVID-19, they’re invariably intubated, which means they’ve got a breathing tube and you need a highly trained critical care nurse to know how to manage that. The ICU is one-to-one nursing, so one nurse to every ventilated patient. But nurses have been quitting or catching COVID. If we’ve only got five nurses, we only have five beds available.
If there are people who need a bed, we have to send them out through Adult Retrieval Victoria, which is basically an ICU on wheels. In November we were sending patients to other hospitals three or four times a week because we just didn’t have capacity.
The nursing shortage is partly due to border closures, but it’s mostly due to burnout. I know doctors who have quit the profession; I know lots of doctors who have broken their contracts early because they have another contract starting but they want a few months off before they take the new job.
We need more funding to train nurses in critical care and hire doctors — because we have the space, and people need beds. Funding extra staff would reduce burnout, especially among the nurses because they’re always getting called to take extra shifts, with the nurse charge begging them to come in.
In the ICU, we’ve also had to deny a few patients — in one instance, there was a 50-year-old unvaccinated person with COVID getting the bed as opposed to a 75-year old triple-vaccinated person. I’ve seen people die because they haven’t gone to ICU.
We’re absolutely pissed off when this happens. We provide the same level of care [to the vaccinated and unvaccinated] but we’re bitter about it.
Some deaths are more difficult than others. I’m pretty realistic about it — some people are older and have multiple comorbidities so their deaths are not unexpected, but it can be tough dealing with families who struggle to understand medical interventions.
Sometimes there are language barriers or socioeconomic status that makes talking about vaccinations or palliative care difficult, but for others, you just can’t get through to them — they want their family members to stay on machines forever, even when we’ve reached maximum therapy. Their organs are crumbling and they’re staying alive because a lot of modern medicines are a miracle, but people forget that part of human nature is to die.
This is only the start of it, once the pandemic health demand starts to subside there will be a tsunami of delayed health problems with greater complexity requiring more care. This will come with increased pressure from hospital administrations demanding ‘greater throughput’ in response to pressure from Governments.
But, hey, suck it up, it is all about the economy.
Apparently.
Thank you very much for this candid essay Doctor. I have read similar pieces here at Crikey and at The Guardian. I squirm with embarrassment for some reason when I read articles written by overworked and overwrought medical professionals. I feel ashamed to belong to a society that does this to some of our finest and dedicated professionals.
None of the problems that you describe seem to be of any consequence to our business leaders whose only consideration is loss of profit.
I am well aware too that the health system has like, education and umpteen other areas, been run as a business by ‘bean-counting’ accountants and ‘managers’, so the situation before the onset of COVID was bad enough. There will be no end to this egregious state of affairs without a complete revolution in our thinking at the social, economic, cultural and political levels..
The models didn’t plan on Scummo and the NSW Dumbicron, Perrottet going completely stupid. And they knew. It was plain to see. The deaths of the elderly have been blamed on them, not the complete scum who are responsible for their deaths.
Whilst I applaud your dedication and commitment to the health of those in need, along with the frankness of your article including the difficulties you face daily, especially since the pandemic began….. I’m afraid, for me personally, you lost me completely in your closing paragraphs.
It’s bad enough that the LNP State and Federal governments and their health officials – and, the fawning media spew forth their daily lines of….”but, X, Y, Z despite being double/triple/single vaccinated, also had multiple pre-existing conditions/multiple comorbidities”.
In other words, who cares? They were all apparently past their Use-by or Best-before dates ….or worse, “in Palliative care” or in , “Aged Care” …you know…knocking on heaven’s door, right?
Wrong! On every level as far as I’m concerned.
Who appointed everyone else Judge and Jury in the allowance of life and death during this pandemic?
On the one hand, doctors report to GA or Nine, Seven, Ten, ABC, SBS, Crikey that all lives are sacred ….you know the line I’m referring to? “Just because the person is unvaccinated, doesn’t mean he/she/they shouldn’t receive appropriate medical intervention during the pandemic”!
Then, there’s the other which you yourself allude to – and one which Morrison and his cohort are suddenly (though the Pandemic is now in its third year) “in trouble” with the media and the rest of the country for saying (for the millionth time) – about age, comorbidities, blah blah….and which has received much well-deserved scrutiny over the past week or so, regarding Aged Care facilities.
My question is , how does a doctor or nurse choose whose life they will save in the circumstances you mention – especially without knowledge of the life lived by that particular person with “multiple comorbidities” or over a certain age?
Why is there assumptions made by not only the medical profession, but media and those on social media that anyone past a certain age, doesn’t matter, whether they’re vaccinated or not?
Yet an un-vaccinated person, who may have deliberately chosen their path, because they’re younger, is saved by medical intervention, or given preferential treatment in an ICU ward?
I shall be upfront here and candidly state that I’m almost 65, am double vaccinated, waiting for a particular Booster recommended by my GP (in a small regional area) due to drastic side-effects from the first two doses.
I also, to quote one of my Specialists and my GP, have “multiple comorbidities”.
My 12yo Grandson calls me, “the youngest Grandma and the most fun – not like most, or actually all, of the grandmothers my friends have got”.
He tells me I’m not young in age, but that I’m “fun to be around” and, “you always have a go at stuff even if you aren’t well”…and, “that’s what I love most about you”.
My grandson is also aware that if I got sick with Covid, choices at a hospital would inevitably be made by whoever was attending – and invariably not in my favour. He has watched News stories since the pandemic began and the topic has been discussed with his mates at school ever since the media highlighted what was happening in Italy and the US in the beginning.
Having just begun High School, my Grandson is still at a loss to understand how these spur-of-the-moment decisions can be made – without input from families who know and love a family member.
I have no answers for him, apart from – It is what it is and that, we don’t have the staff, hospitals, politicians with hearts to value people of all ages, let alone those of a certain age with “multiple comorbidities”.
I remember at the start of the pandemic there was talk in the US of developing a framework for deciding, in these sorts of cases, who gets ventilated and who misses out. Is this the kind of thing you’re suggesting? Obviously, age and health status would be factors, but others could be included as well. I guess it’d be very hard to get societal agreement on the exact formula, since people often prefer to avoid such topics, but whatever was ‘decided’ could be made public, in the interests of transparency.
I’m not sure I agree, however, that age and health status shouldn’t be mentioned when discussing covid deaths. Surely this is important information for both ‘sides’ (‘vulnerable’ and ‘non-vulnerable’ to use a simplified dichotomy), to be able to assess their personal risk and the risk of those around them.
Very well said, Marcia. Totally with you. I’m a handful of years older and completely fed up with hearing the “co-morbidities” excuse. Who doesn’t have co-morbidities at our age? This could be a VERY slippery slope.
Triage is the essence of all emergency treatment – the criteria is mutable, depending on the available resources.