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.
