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“I know what you are doing” the man screamed at me through the security glass panes at the front of the office. He was a big guy with rage in his eyes and a had finger pointing aggressively at me. Two of my co-workers fled the office while I tried to calmly speak to him. “I have seen the movies” he continued.

This is going to be interesting, I thought to myself.

With a heightened emphasis in his voice the continued yelling “You are going to steal his kidneys and sell them on the market”. He wasn’t joking, and as much as I wanted to laugh this off I had to deal this with the utmost consideration. I’d been in the job two weeks at this stage and frankly wasn’t entire sure how I could progress this.

I knew that working in a tertiary ICU was going to be an interesting and challenging experience when I accepted the job offer. I had been seeking such when I applied to work there, and when they offered me 6 days a fortnight I dropped enough hours at my other job to snap up this opportunity. Working in a major tertiary ICU is something that looks great on your CV, and was never likely to do my career any harm.

I’ve become used to these high emotion environments, having worked in many departments where others have said ‘oh, I feel it is too hard for me to work there’. You’ve got to keep a calm head, collaborate, and understand the limits of how much of your own emotions you can put into the job. Something I usually managed well,  but was about to be tested to its limits.

The Royal Melbourne Hospital ICU is a top tier tertiary facility. A year before I started working there it received a 33 or so million dollar upgrade. It’s a sprawling ward that’s patient and visitor space is spread across an entire floor of the building, with several other spaces taken up on floors below for other utilities. It is an ICU built to support the life of the most dire and critical of patients, and even has been designed to handle the worst of infectious diseases in safe isolation. It is stacked with technology and contemporary design practices, with a team constantly review what is or is not working and move quickly to rectify it – sometimes gutting and rebuilding entire rooms no matter how new they are.

I even found myself in one of the hospital’s videos, where I introduce the Donate Life program.  I feel quite strongly about organ donations I was happy to be involved. Speaking of which, please sign on as an organ donor. You can’t take those bits with you when you die, but they sure can help others.

You can sign up here in Australia.

Here in the USA

Here in the UK

The ICU is an environment that is depicted often in fiction, and while there’s certainly plenty of drama there’s many important elements that are often down-played in these stories at the expense of honesty while capturing some kind of high-action visceral experience. In television you often see a flurry of activity around a patient while doctors (and sometimes nurses) are seen as stressed in order to convey the drama. At some stage a doctor will pop out and talk to a wordless, silent family who for some reason are standing in the middle of a room, huddled together. Their shock and anxiety compressed to a brief moment just to add to the drama and remind you that they have loved ones.

In reality a patient’s deterioration can be as dramatic, however handling a family can become just as complex as the care the patient is receiving. This became a key part of my job over the years, and it is something that’s hard work. Patient’s rarely fall apart so dramatically, rather they do so over a number of hours. As they do stressed families build up around the environment and become more than just the television depicted man, woman and a child. Phones run hot, and while nurses and some doctors concentrate on observing, deciding and responding, families and friends can fall apart even faster. The multi-cultural nature of the city of Melbourne adds a further element to this, as there’s diverse social expectations that influence how people can and will respond.

One of the ICU rooms waiting for a patient to be moved into it, equipment pendulums ready to be loaded with life-sustaining and monitoring hardware. The view is over Melbourne University. 

Bourke Street Tragedy.

January 20, 2017. 1:30pm

One of the managers in the unit received a call from his wife about gunshots in the CBD (downtown). Whispers rushed around the unit as we googled to find news of what was happening. Soon hospital executives rushed into the unit, along with numerous medical professionals.

A code brown was called (in Au: large catastrophic event outside the hospital). All the patients that were waiting to be moved to other units that afternoon as they were well enough were rushed off the floor as we vacated as much space as possible. Just as the unit was becoming busy my shift ended, so I asked my manager if they needed me to stay. She said no, they should have enough oncoming staff but she’d call me if they needed. So with that I walked out the door still unsure of what was happening.

On the street below tow-trucks were yanking illegally parked cars off the street to make way for ambulances and police swarmed the the entrance of the emergency department, stoping camera crews from coming inside. I felt the cameras on me as I exited through the emergency department entrance and as I pushed through the crowd. I could hear helicopters buzzing overhead and sirens in the distance.

Not far from where I was a man had decided in a fit of drug induced rage to drive though the busiest mall in Melbourne and run down as many people as he could. A child and two adults died at the scene. by the next morning a 3 month old that had gone under the car passed, as did another man. In all 20 people were left injured or dead in his wake.

 

The front entrance to the RMH emergency department. 

When I came in to work the next morning the mood of the unit was low. We received patient’s from the tragedy, and it felt like the massacre had been continued on in our unit. These weren’t people recovering from the trauma after the event, at the time these were people still dying from it. 

One of the people hit spent months in our unit.  I often would walk past their room as they silently lay there with machines pumping the life back into them. Their families visited daily, looking like ghosts from the ongoing shock and trauma. Outside the media circus kept going for just as long, and we had to be careful who we talked to about the patients in our care. Even here I won’t say anything that identifies them, no matter how small – such as their gender. Their privacy is important. 

Many months later I found myself standing in front of the hospital again. The media circus now faded and the tragedy slowly going to the back of everyone’s minds. But there, on the street, I ran into that patients and spoke to them for a while. They weren’t of interest to the public anymore, well, in a for the time being. There they were just another person on the footpath. But as we spoke they pushed their shirt aside to show me some of the scars on their body. It was a tragedy that moved a city, and no one around us knew the person I was speaking to had gone through such horror. The moment felt surreal while people peacefully passed us.

The event brought many in the iCU to feel personally involved in the tragedy. With every trial and every media appearance of the culprit, the mood in the unit would dip or rise. After spending so long caring for them and their family, it’s natural to do so. 

On December 21, 2017 I hopped on a tram about 4:30 in the afternoon. While travelling down Elizxabeth street in the CBD at 4:41 approaching Bourke street, the tram ground to a sudden grinding halt well away from and tram stop. We waited a few minutes with the doors firmly shut before being ordered off the tram by the driver, then spilled out.

I stepped out onto the road to find Elizabeth street filled with people. Police cars raced past. Minutes later fire-trucks blocked access to the streets to centre of the city. I pulled out my phone and called a co-worker at the ICU. “Are we on code brown yet?”

“No” she replied. “Why?”

An ambulance raced past me. 

“I reckon you’re about to.”

Minutes later they messaged my phone saying “We’ve just gone code brown.” A driver a hundred or so meters up the road from my tram had decided to drive through a group of pedestrians crossing the road at the end of that street. 

Stretched Too Thin, Too Far. 

Working between two hospitals isn’t easy, and working between two roles that had cultures and systems that were in many ways complete opposites of the other, is personally very taxing. But I had, or believed I had everything in place to do this. I had Stress coping mechanisms and activities that helped me deal with stress (fixing typewriters) along with experience in working within this kind of environment and pressure. I was sure I was going to be okay.

The roster between the two hospitals was hard, with hours jumping around like a roller-coaster on a calendar and I did my best to manage the impact. But then some things happened at my other job that increased the strain on me dramatically. The workload started to inflate and become exhausting. My sleep was broken because of my inconsistent hours and it all started to feel hard. With some other major events occurring in my life I found myself struggling to maintain my work/life balance.

Soon the balance started to teeter the wrong way. I didn’t take time to read. I stopped working on my typewriters and the joy of writing and creating. My work-life started to consume much of my life.

As I planned to head to Queensland in 2017 for the wedding, I learned that a good friend was unwell. She had cancer. When I heard what kind, I felt a little piece of me get torn out as I knew we weren’t going to have her for much longer. Later in the year I saw a photo of her, withered and tired. I hadn’t seen her all year as she withdrew, and week later she passed.

I threw myself harder into my work. It felt important. The ICU looks after the patients from Melbourne’s major Cancer hospital – which just happens to be located directly across the road and is visible from the ICU.

Before the year was out another close friend was diagnosed with cancer.

Towards the middle of 2018 I found I had withdrawn from almost everything that gave me joy. My social life, writing had all ceased. I had a growing collection of typewriters I had acquired that needed repair, but whatever I started I stopped.

That second friend took off to Queensland at the end of a chemo course to take a nice break in the sun. While there she started to feel a strange pain. Then she stopped making sense in text messages, only to go silent. Days later we learned she was to be evacuated back to Melbourne. I feared her ending up in the ICU where I worked.

I crossed a stress boundary then. I walked around the ICU one night and every patient I passed was her. I saw them as her. I felt my heart breaking, thinking of her in every one of those beds. I fled to the front office and didn’t go back into the ward that night, worried that I would experience the same sense again. I never did though. But my coping limits had been exceeded.

She was in the hospital across the road. Her room was visible from my ICU. I came in with Jane and another friend to visit her as soon as the doctors and family said it was appropriate. We arrived to find a person that couldn’t have known we were there. As I looked at her and saw her conditions, due to my experience in oncology, I knew exactly how this was going to play out, and the time-frame it would. But I lied to those in my company after we left, saying maybe she had a week, and let’s hope things could improve – stressing that I didn’t think they would. Around the same time that I said that to them she died. When we found out the next morning of her passing I wasn’t shocked, but couldn’t help but play through my mind what the likely last minutes of her life were like.

You can’t help it working in that environment. Switching off your intimate knowledge of the process isn’t possible.

The morning view out of one of the ICU room’s windows at dawn.  

After her funeral I started to work on coming to terms with what was happening in my life. While dealing with my own grief I had a moment to reflect on the damage that I had incurred emotionally and psychologically during the last year. So I started to take steps to move back from that. But at the same time pressures at my other job began really ramping up.

I booked a trip to New Zealand to see some family, and started making some adjustments to my life to start getting back on track. I booked an even bigger trip for the next year to Japan, and spent the rest of 2018 feeling excited about my next upcoming adventures. I started to feel myself again. But the pressures from my other job didn’t ease, and I was left with a difficult decision before I went to New Zealand. Either take on additional paid hours of my job and deal with the workload, or continue to resolve the workload in the hours I currently worked. I opted to take the paid hours, even though it led me to work at times 14 days in a row, with only a one-day break between. 

While I felt I was improving psychologically, I knew this wasn’t sustainable. By the time I left for Japan I had started pursuing positions with more consistent stable hours – even though I would earn less. A day after I returned I had an interview for a position in a facility I had long been seeking to work for. They offered me work at 8 days a fortnight and accepted. Leaving me to decide if I should quit both my jobs, or  quit one and reduce my hours at one. I chose the latter, and pondered for a couple of days which way I would go. Eventually I decided to leave the ICU and drop my hours to nearly nothing at the other job. It was an extraordinarily hard decision to make.

I pulled out a Corona 3 typewriter and wrote to farewell letters to my co-workers. This has become a tradition for me whenever I leave a job. It was hard and emotional writing, but it felt good to be back behind the typewriter again writing letters. 

I would work at the ICU again in a heartbeat. Although I left my role there, it wasn’t because it was the harder of the two jobs or I disliked it. I was always supported by an inspirational management and co-worker team. But I’ve learned that if I work there again I’d best do so as my one and only job. Working two positions simply stretched me too thin, too far and left me with no room to move when things in my life went wrong.