Introduction by Croakey: Across New South Wales this week, nurses marched with signs expressing their exhaustion, frustration and distress. “We are not coping”, “More nurses, less hearses” and “safe staffing saves lives” read some of the placards.
The summer wave of Omicron has left a mark that won’t be forgotten quickly by many working in health services and systems. While some deal with the weight through collective action, others turn to creative forms of expression.
The story below, by emergency medicine specialist Dr Clare Skinner, is fiction, but clearly reflects the reality of the pressures on emergency departments in recent months, as well as the opportunities for moments of connection.
Clare Skinner writes:
Sometimes, just when I think I’m finished with emergency medicine, it throws me a moment. Some shifts, it throws me two.
The evening had started badly. We were three doctors down and the nursing roster was even tighter, relying on favours and overtime. Several beds were closed. A ward clerk tested positive and was promptly sent home.
Nothing was going smoothly. With the department partitioned into ‘hot’, ‘warm’ and ‘cold’ zones, every patient streamed and tested according to COVID risk, the team was stretched paper thin. Emergency medicine, even on a ‘quiet’ day, is an extreme sport – the cognitive equivalent of spinning plates. That night, like so many others, there was too much to do – patients to see, ECGs to review, notes to write. A folder under the desk bulged with printouts of the latest health department guidelines. Monitors beeped, babies cried, and phones rang out. I struggled to keep the plates in the air.
She saw me first. ‘Doctor Clare?’
I finished swabbing her son’s nose, sanitised my hands, then turned around to see her properly. The intern, hunched over a computer-on-wheels at the end of the bed, stopped typing.
The woman sitting in front of me was in her thirties. Her hair was smooth, her body compact. She had the bearing of a dancer. Her eyes, precisely made-up, revealed only the slightest trace of our shared history. Her boy, four-years-old, sniffled and coughed on her lap.
‘You don’t recognise me,’ she said. ‘I almost didn’t recognise you.’
‘It’s the masks,’ I said. ‘They keep us safe, but they make things more difficult.’
She reached out. Her wrist was sinewy. The tips of her fingernails were painted white. I squeezed her hand and thought about a shift in another emergency department, many years before. A younger version of me had sat shoulder-to-shoulder, on a thin, hard, hospital bed, with a teenaged version of her. Plastic curtains became a protective forcefield, separating us from her friends, her sister – her world. We hadn’t talked much while I examined her, drew her blood, then carefully cleaned her face and hair. That night, there had been a lot to feel, not so much to say.
I still had the card she had sent in a box, somewhere under the house. ‘To the best intern in the universe!’ it read. A lot of life had happened to us both since then. A lot of corners turned.
‘I look different,’ she said. ‘I know I do. I finally got my shit together. I’ve changed.’
‘I’ve changed too,’ I said. I gestured around the department. ‘We’ve all changed. Everything has changed.’
‘You helped me feel safe,’ she said. ‘Do you remember?’ And at that exact moment, I realised that I had forgotten. Human stories, human feelings, human touch. This is why.
‘I remember,’ I promised her. ‘You’ve helped me too.’
The plates kept spinning. ‘Category two in the triage area,’ the voice on the intercom announced. ‘Major trauma in the resuscitation bay.’ A husband, shouting at the front desk. ‘Let me in, you bastards – I need to see my wife.’ A distressed daughter, weeping as we negotiated her mother’s treatment plan over the phone. A woman curled up on a stretcher, transferred for hospital admission because of an outbreak among the carers who usually tended to her at home. A man in cuffs, accompanied by two police officers, pacing the corridor with an unlit cigarette in his mouth and a surgical mask dangling from one ear. Everybody waiting – for a bed, or a chair, or a decision. Just waiting.
‘What’s up with you?’ asked Bec, the in-charge nurse. ‘You’re not your usual cheerful self.’
I wasn’t. I was hot, tired, and cranky. Two years into the pandemic, twenty years of working in an increasingly overloaded system, and my goodwill had evaporated. My face was itchy, my ears hurt, and my mouth was dry.
The discomfort was more than physical, it reached deep into my psyche. It was all the sleepless nights wondering what lay ahead. All the worries. The intrusive thoughts that I wasn’t enough. The nagging feeling that I had missed something important, that I had done something wrong.
All those patients, seen quickly, too superficially, their emotional needs pushed aside as we shifted to a transactional, more linear, style of medicine. It is nearly impossible to work out what is really wrong with someone during a consultation carried out entirely in the waiting room.
The interns and residents, left to fend for themselves too often, with bedside teaching curtailed by roster gaps, and changes in role, and practice, forced by increasing presentations and strict infection control – how would these experiences shape the doctors they would become?
All that time spent at work, or thinking about the hospital, when I should have been more present for my partner and kids. Trying to navigate the social minefield of pandemic etiquette – how I longed to eat in a restaurant with friends, but could I risk catching the virus and letting the team down?
My escalating anxiety as I watched plastic overflow from the bins – all those masks, all those gowns. The environmental costs of the pandemic were too enormous to contemplate.
Survivor guilt. How to reconcile the knowledge that no matter how stressful, no matter how difficult, people, communities, colleagues – all around the world – were experiencing far, far worse? All those families with loved ones missing. Millions of lives lost. The incomprehensible suffering. I was changed, but I was still here.
It was the uncertainty. The injustice of it all. The politics. The anger. Not enough to go around. Too much to put into words.
‘I’m thinking about starting a podcast’, I said. I looked Bec square in the eye. ‘I’m going to call it Perimenopausal in PPE.’
‘You need a break,’ she said. ‘Hand me your phone.’
The night air felt like freedom. I gulped down two glasses of water and splashed a third on my forehead. I took a slow, deep breath.
You’ve tried hard, I told myself. None of this is your fault.
The ambulance bay was eerily quiet. Two nurses, Mitch and Lucy, sat at opposite ends of a worn-out sofa, which we had moved outside when the tea-room closed. They sipped instant coffee and foraged from a box of Cadbury Favourites, a thank you gift from a local mothers’ group. Laksmi, a paramedic, leaned against the back of an ambulance, stretching her legs as she scrolled through Facebook and ate her Lean Cuisine. Another doctor, Rubi, stood on the grass across the driveway. She was singing softly in Tagalog, wishing her children sweet dreams over the phone.
I slumped into a camping chair and looked around. I saw faces that were blistered and bruised. Limbs so heavy they almost melted into the hot asphalt. Solemn eyes that were beyond tired. In the distance, sirens wailed. The setting sun glowed – the city was in self-imposed lockdown, but the sky was determined to put on a show.
Suddenly, lightning crackled. The change had arrived. Rain began to fall. Big, heavy drops splashing all around. The sign outside the church lit up as the sky went dark – John 11:35. Jesus wept.
‘Have a chockie,’ Mitch said. He threw the box into the air and a dozen chocolates in shiny wrappers scattered out across the wet ground.
We laughed out loud as we sat there, eating wet, sweet, sticky chocolates. Smiling, laughing, together in the rain.
I remember. This is why.
Through sliding doors, I heard the low hum of people talking, the static of the ambulance radio, and shoes clapping on hard ground. A trolley rumbled past, small wheels on concrete making the sound of thunder. I drank my tea and stared at the purple ribbon between the land and the sky.
Afterword
The people and events described in this story are fictional. They are based on a composite of my own experiences and experiences related to me by colleagues of working in Emergency Departments during the Sydney Omicron COVID wave in summer 2021-2022.
I acknowledge the extraordinary efforts of everyone who has contributed to the pandemic response – healthcare workers in community and hospital settings, many of whom have worked beyond their usual scope of practice, essential workers in other industries, and everybody who has observed stringent public health restrictions. Thank you.
See Croakey’s archive of stories on the emergency departments and care.
