Monday, August 30, 2021
It’s 11am on day 35 of Sydney’s second full lockdown. Like clockwork, residents across Sydney flock to their television screens. NSW Premier, Gladys Berejiklian expresses, for the umpteenth time, the importance of staying at home. Like a teacher to an unsettled kindergarten class, she scolds those who are breaking the rules.
NSW Chief Health Officer, Dr Kerry Chant, with glasses lopsided and passion unwavering, answers unending medical questions from a flock of journalists. The daily televised event that for many has become the only constant in a timeless flurry of endless zoom calls, existential dread and sourdough starters.
Ms Berejiklian and Dr Chant step back from the podium and a new face steps forward. A tired face, with bloodshot eyes and a sense of urgency. The face of 38-year-old Joe Ibrahim. Standing behind a bouquet of microphones, his navy uniform starkly contrasts the pajama-donning Sydney-siders watching from their lounge rooms. A red patch with the words ‘Intensive Care Paramedic’ is stamped to his chest like a badge of honour- one very well deserved.
As he details the exhaustion that accompanies being a paramedic during a global pandemic, Joe pleads with NSW to roll up their sleeves. A reminder of the only way out of this waking nightmare.
Moments after his emotional plea, his speech floods social media feeds. Joe’s speech was a reminder that the COVID-19 numbers flashing on our daily news feeds represent real people. For me it was a reminder that while I sat safe at home avoiding the outside, thousands of professionals, like Joe, were putting their health and the health of their families on the line every day to tackle the highly infectious COVID-19 Delta variant.
HEALTHCARE WORKERS STEP UP TO THE PLATE
On June 26 2021, rising COVID-19 case numbers saw Greater Sydney enter what would become a 107 day lockdown. During that period, NSW Health recorded over 65,000 COVID-19 cases, 10,099 COVID-19-related hospitalisations and over 400 COVID-19-related deaths. These numbers put the NSW healthcare system under immense pressure. The Bureau of Health Information revealed that emergency departments in NSW were the busiest they have been in recorded history. While Sydney-siders adjusted to stay at home orders, front-line healthcare workers across the region went to work to keep us safe. Among them were Joe Ibrahim, Alisa Berberovic, Alex Mackay and Amanda Vlandis who were kind enough to share their stories from the health-care frontline with me.
Weeks after the press conference, I called Joe. He sat in his kitchen as we spoke over a video call. His charisma and kind nature was not lost through the poor web connection. In stark contrast to the last time I saw him standing behind the podium in uniform, Joe is wearing a black T-shirt. He sighs in reply when I ask, “how are you?” Joe is exhausted. As an acute care paramedic and a unit inspector, Joe hasn’t switched off for months. The unfolding COVID-19 emergency has consumed him. While many have the luxury of switching off the news of Sydney’s current reality, Joe can’t afford to do so.
“Even on my days off I can’t tune out,” Joe explains.
“If I do, I lose crucial information because everything is evolving so quickly. The information that is coming to us is thick and fast. So where normally we would work 12 hour shifts, four days on four days off, I found that I’m doing a lot more work through my days off so that recovery time in my personal life is lacking.”
Due to lockdown and the lack of his normal coping mechanisms Joe has found it difficult to process the stresses of his job.
“You speak to the trauma psychologists regularly, and they’re excellent. They’re really good to debrief with. But you’re still lacking something. For me it’s jumping on my motorbike, putting the helmet on and riding up the Pacific Highway with just me and nothing else to literally just go through everything and let it wash over you”.
The open road and the rumble of an engine as two tyres pummel the bitumen beneath. Trees and cars whizz past as wind licks a leather jacket, the speedometer jumping up the notches. 70, 80, 90 kilometres per hour, the speed is exhilarating. Inside the motorbike helmet is a comforting muffled silence allowing its owner to tune out of life for a moment and leave any worries behind. That motorbike is freedom.
At least it is for Joe. When things are tough or he needs a break, Joe will slip into his riding gear and slip out of reality for a while. It’s how he decompresses from the stress of his job and processes all the trauma that he witnesses.
But for the past few months, lockdown and the 5km travel rule has taken this escape away. Its absence is sorely noticed. Normally, the combination of psychological debriefs, grabbing a beer with friends and hitting the open road are what keep Joe sane and help him handle the immense stress of his every-day life. But with the latter two gone, coping is not easy.
“That de-stress component of the job is gone and it absolutely takes its toll,” Joe says.
Joe’s story is not unique.
Neatly framed by the Zoom window on my desktop, Alisa Berberovic sits in her apartment. She’s wearing navy scrubs with the words NSW health embroidered on her chest. It’s her day off, but she’s just returned from the hospital. Her image may not be clear but her dedication to her job is crystal.
At her graduation in 2019 Alisa would have laughed if you told her she would become a nurse unit manager less than three years into her career. To her surprise, the combination of an incredible work ethic and a global pandemic saw the 24 year-old rise the ranks and take over the management of a COVID-19 ward during the 2021 Sydney outbreak of the COVID-19 Delta variant.
“I was the only one who was fully vaccinated [at the time] and fit all the criteria …so I went in there,” she says.
It is day 100 of the Sydney lockdown as we speak. She has since stepped down from the role but managing one of the COVID-19 wards at Campbelltown Hospital for the past three months was overwhelming for Alisa. While stories of overloaded hospital systems and rising COVID-19 hospitalisations rolled across the news crawl daily, she witnessed it first hand. With cases rising exponentially and government guidelines changing quickly, she had to learn to think on her feet. Alisa had two weeks of management training before starting her role on the COVID-19 ward. During her training she had the opportunity to ask more experienced managers questions but in the COVID-19 ward she had to be part of the solution.
“In my two weeks of regular nurse unit management I could go to other people and ask them [if I didn’t understand something], and everyone knew all the answers.
“At one point, I was on three phone calls at once… It was really hard in the beginning, because I was the go-to person clinically, but I was also the go-to person management-wise.”
LITTLE TIME FOR SELF CARE
With constant policy changes and beds filling up with patients desperate for ventilation, moments for calm were obsolete. There was little time for Alisa to fill her own cup.
“I didn’t have time to think, ‘oh, I need a break’. I was so overwhelmed with everything that we had to do at work.
“So it’s not like I made the decision to put myself second, it was I just didn’t have time to think about myself at all.”
Provisional Psychologist Shannon Grassby explains that this high level of stress experienced by Alisa and many frontline healthcare workers is not healthy, especially when rest and self-care is neglected.
“[When we are in high stress situations] our body’s threat detection system is switched on via our sympathetic nervous system, which is colloquially referred to as our ‘fight/flight’ response. This system, monitored by the Hypothalamic Pituitary Adrenal (HPA) Axis, prepares us to deal with threats by causing physiological changes, switched on by cortisol and adrenaline, which will enable us to fight or run away from threat,” she says.
“This is an adaptive response and helps us to cope with stressful situations. However, exposure to high levels of cortisol for a prolonged period of time can cause changes to the HPA Axis, changes to neural circuitry and brain regions, can impact an individual’s ability to cope with stress and anxiety and may also contribute to the development of PTSD. In short, it can be very damaging.”
Thankfully for Alisa she believes that she has the mental fortitude to withstand this mental and emotional load.
“I think at least for me, my mental health is good enough to process [the stress of the job].”
Alisa is not alone, nurses throughout Sydney have selflessly put their needs aside for the wellbeing of the city, as they always do. Alisa says it’s in the nature of the job.
“As nurses we’re very good at putting ourselves second… I think even in our daily lives, generally, we always put ourselves second. And that’s both a good thing and a bad thing, I think.”
This desire to put others first is shared by Alex Mackay. He has been a nurse since 2010 and a paramedic since 2017. Between the two roles, Alex has seen his fair share of medical emergencies. But never did he expect to be a part of a task force against a global pandemic.
“No one ever thought about a pandemic,” Alex explains.
Unsurprisingly we are on a zoom call. It’s day 90 of Sydney’s 2021 lockdown as we speak and it is a welcome change to see a new face- albeit on my laptop screen.
Alex explains that when Sydney experienced the first outbreak of COVID-19 in March 2020, it was a shock. Both for himself and his colleagues. But not long after, the NSW and Federal government implemented restrictions and tightened borders keeping COVID-19 at bay and returning life to a semblance of normality. It was a different story with the outbreak of the COVID-19 Delta variant that hit Sydney in the middle of June 2021.
According to a statement released by the Australian Technical Advisory Group the new variant is harder to contain.
“The greater transmissibility of the Delta variant makes control of outbreaks using public health measures more difficult and increases the risk of seeding additional COVID-19 outbreaks.”
Alex says that the second outbreak changed everything.
“Day to day, things are very different. From the way we start a shift, to the way we have to always wear PPE whenever we’re around each other.”
Alex explains that, despite being vaccinated, the fear of the Delta variant has made responding to COVID-19 patients and suspected COVID-19 patients a source of anxiety.
“Tending to someone with COVID-19 seems to be psychologically so different.”
UNLIKE ANYTHING WE’VE SEEN
In the thick of the 2021 Sydney COVID-19 outbreak the NSW health system was under immense pressure and it was thousands of people like Joe who were keeping it afloat.
Throughout our call, Joe casually describes horrific scenes that he has witnessed throughout his career. There’s been tragic car crashes and victims of suicide. But when he speaks of this year’s COVID-19 outbreak, he can’t believe what he is seeing.
“It’s unlike anything we’ve ever seen before,” Joe says.
He recalls countless COVID-19 calls to which he has responded. Each time, it’s the same. Response units rushing to calls at all hours, strapping patients to ventilators and whisking them away in the middle of the night. Leaving distressed family members in their wake, as they battle with a virus that has taken its hold and is not giving in. Joe describes that, with the limited amount of medications available to patients with COVID-19, it’s like trying to breathe for them.
During his speech at the press conference, Joe reflected on one particular case that has stuck with him. He attended the home of a single mother and her teenage son. Gripped by the virus, this woman fought for breath as Joe and his team fought for her life. Her son, distraught, watched from the side.
“I think this is my fault,” the son said, “I think I have given my mum COVID.”
His words tumbled out and dropped to the floor like lead, according to Joe they left a sinking feeling among the paramedics.
“It stopped me in my tracks. It stopped my team in our tracks. And it absolutely broke our hearts”, said Joe.
Eyebrow’s furrowed, Joe seems to recoil as I mention this particular incident.
“There are very rare instances where we’d be time critically treating somebody and you would just stop but that’s certainly how it affected me on that day,” he says.
Amanda Vlandis is a newborn intensive care unit (NICU) nurse at Liverpool hospital and also a COVID-19 vaccination nurse. Between the two jobs, Amanda has been worked to the bone and is understandably exhausted. She kindly took some time out of her Wednesday evening and, in typical lockdown fashion, sits on her couch as we speak over zoom.
In the NICU ward that Amanda works in, COVID-19 protocols have meant that families cannot visit their premature babies.
“In the baby unit, we allow one parent per day, that’s all. So it’s not like they can send any of their family members and see the baby,” she says.
That one parent must also wear full PPE and if the mother wishes to breastfeed she must express her milk at home and send it into the ward.
“So these babies are not getting any face to face contact at all.”
In a hospital only 19 minutes away from Amanda’s, Alisa has stood at the bedside of many COVID-19 patients. While doing what she can to help, she has watched as they struggle for breath.
“It just looks like they’re drowning,” Alisa says, “and there’s nothing you can do to help them. You can see the terror in their eyes.
“The amount of people that have looked me in the eye and asked, ‘am I gonna die?’ I don’t know what to tell them.”
For Alisa, the hardest part was watching patients suffer alone.
“It was just so heartbreaking that their families couldn’t be there for them,” she says.
“If that was my family member, I’d want to be there holding their hand.”
When I ask her how she handles the emotional toll of these experiences, she shrugs, explaining that it simply comes with the territory of her job.
“I think we all have the capability, at least in nursing, to process death and dying … to hold someone’s hand because they don’t have anyone there.”
It’s hard to imagine this act of humanity performed through a plastic gown and gloves.
PERSONAL PROTECTIVE EQUIPMENT (PPE)
Imagine being wrapped in plastic from head to toe. A specialty-fitted mask gripping at your face, creasing the skin on your cheeks and digging into the bridge of your nose. Hair tucked inside a cap, beads of sweat drip across your goggles and settle into the fabric of your mask.
Then imagine wearing this for 10-12 hours straight while carrying a 120 kg patient down a flight of stairs or performing CPR on a dying patient. Imagine hot air circling inside a face mask, the stench of sweat settling inside gloves and gowns, the feeling of plastic stuck to sweaty limbs.
The thousands working on the frontline in Sydney don’t need to imagine this. They live it daily.
As Joe describes the PPE he has to wear, he recalls a time where he performed CPR on a patient in full PPE and reached a core body temperature of 39 degrees.
“[The PPE] really takes a toll,” he explains.
This toll is also felt by Amanda.
“I’m in PPE [at the NICU ward] for my entire 12 hour shift and it’s just exhausting.”
Amanda explains that she frequently experiences headaches at the end of her shifts due to a combination of the uncomfortable PPE and the inability to drink enough water. She points to a mark on her nose left by her N95 mask and jokes that it will stay with her as a constant reminder of the pandemic. After our call, she sends me a selfie that she took at work, she has a dressing on her nose and cheeks. She explains that her N95 mask has rubbed her nose red raw.
Alisa’s experience is similar.
“That gown is not breathable at all,” she says.
Alisa is required to wear her full PPE including a fitted mask during the entire duration of her shift, only able to take her mask off on her break.
“So between your breaks, you’re still going a couple of hours with just a mask on and you can’t have a drink. It was so restricting”.
Understanding the importance of self-protection, Alisa says it is simply another layer of stress.
“We have to think about ourselves, we have to make sure that we’re fully protected before we go in there and try to help other people”.
“But I think everyone felt so claustrophobic because you’re just covered head to toe, like you can’t tell who’s who. That was what I really struggled with”.
A FEAR OF PASSING IT ON
But it’s a struggle they have to put up with to protect themselves and those around them. Despite the layers and layers of PPE, frontline workers live in fear that they will bring the virus home to their loved ones.
“I don’t think the fear is so much catching it yourself. Because we’ve been vaccinated since the start of the year, or at least midway through the year. I think everyone’s fear is ‘what if we catch it and take it home to our family?’,” Alex explains.
Alex lives with his mum Helen and his partner Karl who is also a paramedic. Both working on the front line during the lockdown, the risk of infection in their household has been high.
“That’s been the scary thing, you know, we’re both paramedics, it’s like double the chance of bringing something home,” Alex says.
For Alex and Karl, this has meant maintaining a disciplined routine to keep themselves and Helen safe. On returning from work they will leave their boots at the door, take off their uniform and head straight into the shower. Alex says it’s the combination of little things that keep them at ease.
“It’s just an awareness. It’s those extra little precautions”.
Amanda has a similar routine. She keeps a bathrobe in her laundry before she leaves for work. When she comes home she immediately puts her work clothes in the washing machine, puts on her bathrobe and jumps in the shower.
She also keeps what she calls a ‘COVID box’ in her car filled with masks, sanitisers, goggles and wipes. A COVID-19 armoury if you will.
For Joe, this fear of bringing COVID-19 home to his family has been difficult. At work he is often at risk, be it from a threatening patient to just travelling in the ambulance, but to him it is just part of the job.
“We’re used to taking life threatening risks. To serve the community.”
But he is not used to taking these risks home.
“I’m not used to taking those risks back to my wife, I’m not used to taking those risks back to my two little kids. And that’s a challenge. It’s a real mental hurdle to try to think ‘how am I going to protect these little ones?’ and ‘how am I going to protect my wife?’
“I can do the stuff that everyone says is heroic, but it’s not heroic, it’s my job. I can do the life threatening stuff to respond to the community outside, it’s harder bringing it home.”
When Joe gets home from a long day at work his two boys run to greet him at the door. The only thing they want to do is give their dad a hug. Joe sees their eager smiles as he walks through the door but he must reject their welcome and make a beeline for the shower.
“The first couple of times that it happened, the disappointment on their faces was heart-breaking”, Joe says.
But now his boys have come to understand, Joe explains.
“They know it’s just so that I don’t make them sick”.
Joe acknowledges that his job comes with sacrifices that his family needs to adjust to.
But according to Joe, they handle it like pros. He smiles as he speaks about his wife and kids. There is a twinkle in his eye that reveals just how much love he has for them.
“They’re really pretty tough.”
One month into the Sydney lockdown, after several weeks of working on the roads as a paramedic, Alex received a call from an old boss. She was desperate for nurses to work in the vaccination centres. The statewide push for vaccinations was beginning as NSW officials began to abandon hopes of returning to COVID-zero. Operation vaccinate became the only real answer to the virus and the only way out of lockdown. Within days, Alex had swapped out the keys to his ambulance for a syringe, and stepped into the NSW vaccination task force.
With thousands of locked-down Sydney-siders choosing to do their bit, Alex, Amanda and thousands of nurses helped put jabs in arms and played their part in the race to vaccinate.
During Sydney’s second lockdown, the daily vaccination rate in NSW continued to exceed 100,000 doses. COVID-Live data reveals that the highest day of vaccinations was September 16 with a recorded 158,344 doses administered.
Working in a team that was thrown together, in a facility that was built overnight, the job is very different to his paramedics work. But with eager individuals rolling up their sleeves to do their bit, Alex says it’s exciting.
“When you stop and think about it and you look at the people coming through the doors you think this is amazing. This is a part of history, really, because hopefully, none of us will ever have to do this again in our careers. And I expect it will be the biggest thing and the most significant thing I do personally in my career. So the atmosphere is generally very positive.”
While lockdown has spirits down, Alex is uplifted to see the community spirit that the state emergency has bred.
“It’s amazing to see what people are capable of when people get that shared goal, and they’re all working towards the same thing, it’s been a really exciting thing to be a part of.”
Amanda tells me that when she vaccinates she comes across three types of people. First there are those who express their anger at vaccination mandates. Then there are the begrudged who don’t want it but know they must have it. And finally there are those who skip up to Amanda’s chair, excited to be a part of the cause.
Despite the varying patients she experiences, Amanda is happy to help make a difference.
“I feel really proud of the work that we’ve done and I feel really proud of the teams that I work with,” she says.
At the time of writing the Sydney lockdown is over. NSW reached the 70% double vaccination target (for people aged 16 and over) on Wednesday October 6 and a swathe of restrictions eased for those vaccinated on the 11th of October. A day that Sydney-siders were calling ‘freedom day’. Within a week NSW hit the 80% double-dose milestone allowing restrictions to ease further on October 18 and the vaccination rate continues to rise. Regional travel is soon to be granted to vaccinated Sydneysiders on November 1 and restrictions are to be eased for all people in NSW, including the unvaccinated, on December 1.
A couple weeks after ‘freedom day’, I picked up the phone to Joe.
The exhaustion in his voice from the last time we spoke had faded.
As soon as the lockdown ended, Joe drove to his mum’s place to give her a hug. He then grabbed a beer with a mate and finally hit the road on his bike. The relief was immediate.
“I got home and I could physically feel the relief,” he said. “I got a great night’s sleep that night. There was no anxiety and it just felt like the world is good again.
“You don’t realise how much of a role those coping mechanisms play in your life.”
According to Joe the once palpable tension among his colleagues has dissipated. While there is still a long battle with COVID-19 he is relieved that the last few months are behind him.
“Don’t get me wrong, emergency care is always going to be confronting and it’s always going to be challenging. But COVID-19 was the most difficult challenge I’ve ever seen in my whole career and likewise [for] my team and now that we’re two weeks post lockdown, and job numbers are not ridiculous as they were before, everyone’s taking a step back and can breathe a sigh of relief.”