Extract from ABC News
Arriving for a shift in the intensive care unit at a Sydney hospital, Sarah* sees something that fills her with dread.
The road leading to the emergency department is full of ambulances waiting to discharge their patients.
"Seeing the ambulance bay full up, that scares me," she said.
The hospital's ICU unit, where Sarah works, is under extreme pressure.
Nurses usually looking after one patient in need of high care are now looking after two.
And the NSW government says the worst is yet to come.
Sarah says she's exhausted, and she knows the COVID trend line is not working in her favour.
"We know from previous COVID-19 experiences that with every day of high cases it will get worse one to two weeks down the track," she said.
"It's like knowing a foreboding and depressing future. That's daunting when I'm already tired.
"We are burnt out, tired and working in a system that is understaffed, under-resourced."
The ABC published a callout out last week, asking healthcare workers across the country to talk to us about their experience in the system.
Sarah was one of hundreds from all over Australia who got in touch.
Employment contracts mean most healthcare workers are unable to talk to the media. The ABC spoke to each person in this story on the condition their identities would not be revealed.
"I've seen full-grown men I work with just break down crying. That's a daily occurrence. We're already at the brink and I just don't know how 'opening up' is going to go. I'm so nervous about it. When will it end? It's just relentless". Belinda*, Sydney-based COVID ward nurse
"They say we’re coping now, but you only have to speak to the staff day to day, week to week, they’re suffering in silence. Just ask the ambos, ask the people in ICU, they will tell you we’re on the brink" - Greg*, 40-year veteran nurse, Victoria
"I've been called a 'COVID bitch' on my way home from work, people say to me: 'How do you sleep at night with your dirty COVID money?'. It's exhausting to hide part of yourself so that you can feel safe, even though you are helping keep people safe" Denise*, COVID vaccine nurse
Overstretched and understaffed
In NSW, the heaviest COVID-impacted health system in the country, Premier Gladys Berejiklian has acknowledged healthcare workers are feeling overwhelmed.
But she has repeatedly outlined her confidence in the health system, telling the people of New South Wales it "will cope".
Sarah recently stopped watching the daily press conferences.
"I understand they have to present hospitals as a safe place to go to," she said. "But I wish there was more acknowledgement of the pressures we are under."
The ICU she works in used to have one section set aside for COVID-19 patients, but now all Sarah does during her 12-hour shift is look after COVID-19 patients needing high care.
Among them are people whose lungs have been so badly affected by the virus, they have been sedated and a tube has been put down their throat so a machine can help them breathe.
"As soon as we take over their ventilation, we have to monitor that so closely, because they become helpless," she said.
Nurses also need to monitor their patients' medications and blood pressure, watch for deep-vein thrombosis and pressure sores, take care of their eyes and mouth, and manage drains supporting their bodily functions.
Now she is caring for two patients at once and is worried she is going to miss something.
"COVID has illuminated staff shortage issues and deficiencies in our service," she said.
'What about when it gets worse?'
Grace* is an intensive care nurse who has treated COVID-19 patients throughout the pandemic at a hospital in Melbourne.
She is worried about what's happening in NSW.
"We are feeling for the nurses going through what we went through," she said.
Like Sarah, hearing politicians say the hospital system's coping has made her angry.
"Other times I've laughed at how ludicrous it is," she said. "When I hear people say 'It's OK', then I ask, 'What about when it gets worse and it's not OK?'"
As she sees it, intensive care capacity is not simply about the number of ventilators, it's also about having enough nurses trained to look after patients who need them.
She said surge capacity meant health authorities could triple the number of ventilators, but they couldn't suddenly triple the number of specially trained ICU nurses.
Grace believed hospitals were still providing patients with safe care, just not excellent care.
But she worried that overcrowding in hospitals may lead to substandard care, making hospitals unsafe places for healthcare workers.
Last year more than 4,000 healthcare workers were infected with COVID, and a recent outbreak at Royal Melbourne Hospital infected several staff members and led to 450 hospital workers being furloughed.
Grace would like to see hospitals become safer places to work in, so that healthcare workers were no longer considered "heroes" for doing their job.
"If someone goes to work in a safe environment, they don't need applause because they are just doing their job.
"Everyone is afraid"
'Mistakes can happen, and do happen'
Emma* works on a specialised ward where she and her colleagues care for suspect COVID-19 patients at a large hospital in Melbourne.
She said the extra pressure they were under made felt like "the walls are closing in".
To accommodate the influx of COVID-19 patients, specialised wards were now taking in patients from other parts of the system.
For example, plastics nurses were now looking after cardiothoracic patients.
"Mistakes can happen, and do happen," Emma said.
She's been wearing PPE for so long she now has dents on her face that make it look like "I've been punched in the face".
Patiently looking after people while burning up in head-to-toe plastic PPE was a challenge, she said.
"Trying to keep your cool when there is literal sweat pouring off your face is a form of emotional labour I've not really had before," she said.
"We are getting the sickest of the sick and they require more skills, more TLC.
"Everybody is afraid.
"I'm worried [someone] will die because I missed a policy [update]. It's guilt-based fear."
'I couldn't be there for her'
Patients' end of life experience is something several healthcare workers who contacted us were concerned about.
"End of life care in ICU during COVID is really horrible," Grace said.
It's not just COVID-19 patients affected, but any patient whose life had ended in ICU during the pandemic.
And healthcare workers are carrying the burden of seeing them die without the comfort of family, or perhaps a priest, or the right pain relief.
"They cry, they get frustrated. It's not easy to see when there is something you should be able to provide that you can't," Emma said.
Providing compassion to people in the greatest need is why many nurses do the job, but according to many nurses the pandemic is making that virtually impossible.
Sarah was recently caring for a COVID-19 patient when it became clear there was nothing more they could do — she would soon die.
She removed all her tubes and monitors to allow her to pass away with dignity, but wanted to do one final thing for the woman who was about to end her life alone.
"I just wanted to hold her hand," Sarah said.
"But before she passed away I was called away and I couldn't be there for her."
* All the healthcare workers' names have been changed
Illustrations by Emma Machan
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