The University of Notre Dame Australia (UNDA) alumna Carla Sabatini shares her experience of spending most of the early COVID-19 pandemic in the Intensive Care Unit (ICU) at Sir Charles Gairdner Hospital (SCGH).
At the best of times, working in the ICU requires a strict attention to detail and the ability to walk the line between life and death, COVID-19 shifted existence in this tenuous purgatory to the next gear, and made that thinnest of lines a precarious tightrope walk.
Few people would have seen the sometimes-brutal effects of COVID-19. We may have heard or read about it, how ventilators are keeping people alive for example, but there’s more to keeping a patient alive than popping a ventilation tube in their mouth.
If you were unfortunate enough to catch the virus and ended up in ICU, they give you medicine to paralyse you. They push a breathing tube down your throat.
To stave off the nightmarish reality of being paralysed and awake, a selection of sedatives keep you just beneath the thin veneer of consciousness. However, these medications drastically lower your blood pressure, meaning further medication is required to normalise the pressure so your vital organs don’t fail.
You’re already sedated, paralysed, and ventilated, and then food and waste must be considered.
More tubes into your stomach and bladder. All these tubes and entry points to your wasting body open hundreds of opportunities for infection to set in, and the cocktail of medicine plays havoc on your heart rate. This is the reality of life on the COVID ward, nurses hurrying around, keeping the proverbial plates spinning and trying not to let any fall and smash. No wonder nursing is one of the most stressful vocations.
But for a person who sees death and disease up close daily, Carla is surprisingly relaxed and full of smiles as she sits in Fremantle sipping a coffee. Her work schedule is a strange pattern of shifts of various lengths and times, a concept that is alien to the routine of a “9 to 5” worker, and this morning is one of her few free mornings in the week.
“I graduated in 2014,” Carla says as she reels off the steps she took on her journey to ICU, “then went straight to my graduate programme at SCGH, did six months in surgical, six months in medical, and then you get to choose between the two placements where you want to work.”
Carla moved into surgical. She explains that one of her driving motivations for getting into medicine was getting to see patients improve and get better. Medical, she says, is too long-term for her.
This move marked a transition to the fast-paced world of constant patient monitoring and the ever-present risk of sudden declines. And it was here that Carla developed her ability to carefully detach herself from the emotional reality of her workplace, a reality most people avoid at all costs.
“Some people say that ICU nurses can be quite detached and emotionally raw, but I think you need to be like that to cope with it all. Otherwise you get too emotionally involved and you go home and can’t wind down. Then you get burnt out.”
None of which is to say she doesn’t care. In fact, the empathy she exudes makes it difficult to imagine her detaching herself on the ward. When she talks about medicine, it is always from the point of view of a dedicated healthcare worker who just wants to help people. Even when racing back from Canada at the start of the pandemic, she was thinking about getting back to work.
With more and more reports emerging and offering various theories on what symptoms the virus caused and how transmissible it is, Carla thought about the ventilators at SCGH and how the previously adequate 25 machines could cope with what was looking to be a substantial influx of critical patients.
“There’s only 100 ventilators in the entire state. I wouldn’t like to be in a situation where there are more patients who need this intensive care than we have the necessary equipment.”
Carla didn’t waste any time getting back into work once she landed in Perth. In the space of just a few days, she went from gathering in mountain lodges in puffy down jackets and gloves, to pulling on personal protective equipment and entering the hot zone of the COVID-19 ward.
Fortunately, WA held back the rising tide of active cases, meaning it never got to the stage of having to choose which patients got to breathe, and which patients were resigned to end-of-life measures and desperate prayers from loved ones.
But as written about recently, the stress and anxiety that can come for those in positions like Carla’s is considerable. We may be past the first wave, but with the threat of a second wave just over the horizon, nursing students and nurses like Carla are facing the potential re-entry to the world of the COVID-19 ward, and may continue to go through the motions over the coming years.
“We may never have a fully effective vaccine for it,” Carla says, “It might end up being like the flu and come in waves after winter. If there is a vaccine it could be like getting a flu jab each year.”
“Now that everyone knows about the importance of distancing and hygiene, hopefully it won’t take off, but then saying that, it is contagious. If you can pass it to other people whilst you’re asymptomatic, then there’s no real chance of defining it.”
For nursing students reading this or speaking to nurses on the front line, the looming threat of COVID-19 is a source of constant concern. Carla knows this – and having been in the profession for several years now, has some advice for those about to enter the world of nursing.
“UNDA offers a lot of practical experience, which helps when applying for jobs. You can learn everything you want from books, but as soon as you step in front of a patient, everything changes.
“It’s valuable having lecturers who are working in the field too, to have clinical professionals teaching something means it must be important so it’s worth listening to.
“The programme also exposes you to different areas so you can broaden your horizons and decide where you want to work. I know some of my friends have gone up to Darwin to do remote Aboriginal nursing. People are in mental health nursing, community nursing and so on.
“On the coping side of things, get yourself into a good routine, and have a good support group that you can talk to and debrief with, because you don’t want to be carrying around these stories just by yourself. You need to have an outlet. Make the most of your practice as well. Get to know contacts, because they’ll help you get a job at the end.”
Aside from remaining on the frontline against future health emergencies, Carla has various ideas of where she would like to get to next in terms of her career.
“There are lots of unique roles in ICU. I’m just a floor nurse at the moment, but you can do resources, equipment, staff development nurse, area manager. I enjoy teaching so I may go into staff development. I know some girls at work do tutoring, so that might be in my future.”