The Care Factor 9781743587461

Citation preview

This book was written on the lands of the Wurundjeri people, whose sovereignty was never ceded and whose struggle for justice continues daily. We would like to pay our respects to their Elders, past, present and emerging; to the Indigenous healers who have cared for this country and its people since time immemorial; and to all Aboriginal people and Torres Strait Islanders on whose lands we live, work and care.

To the carers – whose work, hours and expertise so often goes unseen and unacknowledged.

This book began as immediate memories told to Ailsa by Sim in recorded conversations in the days following the events they depict. Some people in this story have had their identities obscured by changing their gender, diagnosis, occupation or other identifying features. Other people gave consent to be named and appear as themselves. Some are actually two people magically squished into one for the sake of clarity and simplicity. The whole book is told from the perspective of our friendship – which is just one window of millions into the events of the pandemic in Melbourne. Everything in this story happened. This book touches on stories of trauma, sexual violence, domestic abuse and Covid deaths. If these topics are difficult for you, go gently.

Contents

Cover Page Title Page Introduction – The Skill We Need Now 1 Crisis Respondent 2 Sexual Health Nurse 3 Cancer Nurse 4 ICU Nurse in Training 5 Family Violence Worker 6 Ward Clerk 7 ICU Nurse 8 Nurse Educator 9 Quarantine Caller 10 Pool Nurse 11 Covid Nurse Conclusion – The Friend Acknowledgements Background Reading Resources for those in Australia Copyright Page

Introduction

The Skill We Need Now

‘THERE ARE GOING to be so many half-naked nurses on front porches!’ Sim laughs. ‘How else are we supposed to take off our infected clothes after we leave the hospital but before we step into our houses?’ Simone is going through the nitty-gritty of how her days look now: the pathway from her front door to her laundry; how she’ll keep her girlfriend, Emily, and their housemates safe from infection; how she’s going to stay hydrated throughout her shifts. ‘They’re getting us to wear the masks all the time so we don’t waste them.’ These masks aren’t designed to be simply pushed aside and then returned to position. Once they’ve touched other parts of the face, they’re considered contaminated and need to be disposed of. ‘At one point I left the room, did my hand hygiene, took my gown off, cleaned my hands again, grabbed my water bottle and undid the lid. It wasn’t until I’d almost pushed it into the mask that I remembered I couldn’t drink. Not for another two hours.’ I breathe out quietly on the other end of the phone, aware that my friend is at the very beginning of this journey. Thinking of the hard work that lies ahead for her, where a few hours without water will probably be the least of it. Sim has put up her hand to retrain for ICU in response to the global pandemic. In other parts of the world hospital corridors are full of patients who don’t fit in the wards. They’re sending the elderly home without treatment, they’re talking about turning ice-skating rinks into temporary morgues. My social media feed shows cities applauding their medical staff from a million balconies. There are memes about how the disaster movies got it wrong: turns out we don’t need to know how to shoot aliens or barricade our homes from zombies. The skill we need is how to care for a sick human body. My friend has this skill. I don’t. My skill is to listen. Sim is the kind of person who really likes talking. She goes into intimate, gory detail about her work. She explores her emotional reactions and checks my thinking about her relationships. She treats each new patient, each colleague, with a deep, humane respect. She texts me her griefs and terrors in the middle of the night. She’s constantly analysing her work through a queer feminist lens, and I’m admiring of, and sometimes utterly exhausted by, her drive towards integrity. I want to write her story. ‘Do you trust me?’ I ask. ‘I’m not going to ask you to read anything now. Not until it’s all over. But later? I won’t publish anything you’re not happy with.’ ‘Yes, yes!’ she says. And then: ‘This feels like such a privilege. Like, why would you do this for me? There are people whose work is so much more important than mine.’ It’s true, there are people doing bigger-picture organising work, or whose faces might be even closer to the trauma of this thing. But I disagree that their work is more important. Also … ‘But I don’t have this relationship with them,’ I say. Her voice changes. Grows stronger. ‘I know,’ she says.

CHAPTER 1

Crisis Respondent

IT’S 20 MARCH and I’m in a doom spiral, fear-scrolling and heartbroken. There are twenty-eight new cases

of Covid-19 in Victoria. Yesterday 2700 passengers disembarked from the Ruby Princess cruise ship into Sydney. My sister just called from London to ask me to keep my three-year-old home from childcare. It’s time. I’ve been working from home for years, setting up and packing up my laptop from the kitchen table each day. I think of this house as mine alone. Those hours when Jono is at work and Jack’s at childcare, the stretching peace of tea and silence and room for my brain to work – they are what keep me sane. I’m about to give them up. I’m supposed to be writing a children’s book but I can’t focus. I’m afraid. Instead, I call my friend in Sydney whose grandmother is dying in aged care. Limits on visitors keep shrinking. She’s from a big Greek family and everything feels wrong about her Yiayia being alone for a second. There should be cousins and great-grandchildren and love all around her for these final days. My friend manages to get permission for her children to come in for a ten-minute visit to say goodbye. With her own full-time work, the domestic load, and the children in her face, she sounds like she doesn’t have time to grieve. I call my single friend who is just back from an overseas work trip. She’s in quarantine at home alone – facing lockdown as soon as her quarantine time ends. She’s been sharing articles about skin hunger and loneliness. I bite back my envy of her space, my longing to be alone. I listen to her sadness. And within minutes she has turned the conversation around to ask me how I’m coping. I call my friend who is helping to care for her bedridden father. He has a slow, debilitating terminal illness. Someone needs to wake with him several times a night because his bladder is shot. My friend is living a few nights a week at her parents’ house, trying to share the load, dressing in cobbled-together homemade PPE when she does the shopping. I call my friend who’s living on Centrelink with two kids and training to be a nurse. I check that she’s got the tech she needs for remote learning. I call my friend whose work as a touring theatre performer stopped overnight to find out how she’s planning to manage financially. I call my friend who’s a high school teacher. He is spending the entire school holidays planning how to deliver distance learning. I feel like they are all superheroes. I feel like I am part of a great network of carers who are holding up the world and I hope my phone calls lighten the burden. I realise that the phrase ‘love makes the world go around’ isn’t actually about the nice feeling I have in my chest sometimes. It’s talking about the hard, endless, soft, sleepless, exhausting labour of caring for our people. That labour just got a whole lot harder. I call Simone. I make my first recorded call to talk about how she’s feeling as the lockdowns roll in. Wuhan, Seoul, California, New Zealand … and now us. I’ve been listening to ICU nurses in New York talking about their days. The danger. The deaths. The lack of PPE. I want to know exactly what’s happening in the hospitals here. I ask her how she came to decide to retrain for ICU. ‘I guess I felt: I’m up for this. I’ve got ICU experience. I’m fit and healthy and I’ve got good support. So I’m going to give it a go. For me, there wasn’t a question. Sure, there’s a part of me that would love to just bury my head in the sand but …’ But people need her help. At the first ICU orientation session, the message Sim heard was, ‘We need you. Please come and do whatever you can. If you only come in for two hours to relieve tea breaks, at least that’s something.’ She is part of a huge cohort of nurses returning to ICU from other places – education, project management, retirement or maternity leave. Sim will be stepping back a little from her other main role: training health professionals to recognise and respond to signs of family violence in their patients. ‘The thing is,’ she tells me, ‘all the face-to-face training I was doing has ceased. We can’t have people in a room together. No-one’s got time. It’s not the priority right now.’ She’s obviously conflicted about this. ‘We know from data around bushfires and other crises that we’re going to end up with an escalation in family violence incidents. Isolation at home will just make it …’ She breaks off. ‘It’s really hard for a lot of

people. Really fucking hard.’ She explains that, on top of increasing incidences, the family violence services have to find ways to operate with social distancing. ‘Social workers are having to figure out what they can do online, from their homes. The refuges are asking questions like, can they take people who’ve been in hospital, or might they be a risk to other people in the refuge?’ I feel the issues expand in front of me. Of people living in crisis accommodation, of children in state care, of prisoners. How are we, as a society, going to keep people safe? ‘So I’m hearing all this info about family violence and my emails are full of it and my job is to make sure hospital staff have an eye open for it. But you can imagine the barrage of information going through hospitals at the moment. People are trying to filter what they need to know from pages of writing. They just don’t have time for it. I wrote one email about the increases in family violence we’re expecting. I probably went over it twenty million times trying to make it as succinct and easy to read as I could.’ Her frustration levels are high. This is not surprising, when she’s sending emails she knows people might not read. ‘I don’t have the ability to talk to people about all the details. All I can do is flag it and make sure they know where to look for resources.’ She’ll keep working at that for now. But she’s also getting ready for something very different. She had her first training in ICU yesterday. ‘It was, quite hilariously, the most welcoming experience I’ve ever had there.’ She pauses to explain. ‘Background: ICUs can be snobbish places in the sense that you have to meet certain criteria to work there. They’re very strict about it. If you haven’t worked there for a while, they will only take you back under specific conditions – so you can receive support and training.’ It makes sense to me. This is about life and death. You need to get it right. ‘But we just don’t have the ability to run ICUs with the number of staff this pandemic will require. Things are changing fast and we need to think outside the box. Suddenly it feels like ICU is rolling out the red carpet. They’re just having to say, “We want you. We want all of you.”’ It’s been five years since Sim worked regularly in an ICU and when she did it was at a smaller, more specialised unit. She’s never worked in a big trauma ICU like at the Royal Melbourne Hospital. I ask her how she’s feeling about it. ‘I’m incredibly nervous. You can imagine that there are a lot of machines. And there are a lot of things to remember. There’s a lot of immediate recall of what to do at each point that really isn’t fresh for me.’ Her voice rises. ‘And there was a woman in my group yesterday who hasn’t worked in ICU for eighteen years!’ On the recording of our conversation, you can hear me gasp. ‘Eighteen years! The tech must have really changed for people like her.’ Sim equivocates. ‘Yeah, but interestingly, a lot of the principles haven’t. Bodies are still the same. Blood pressures are still controlled in the same way. The tech has changed for sure, but some of it’s become more intuitive.’ She laughs. ‘You know, like how using an iPhone is actually easier than using an old Nokia.’ Sim explains the way ICUs are run. If a patient is on a ventilator, they have a nurse dedicated solely to them, who does not leave the bedside. The machines control how many breaths they take, the volume of air with each breath and the concentration of oxygen they receive. Medications are delivered by pumps to control blood pressure and heart rate. The nurse is always there, monitoring the machines and adapting settings and dosages in response to changes in the patient’s vital signs. ‘I stupidly started the day by reading stories from nurses living the nightmare that is ICU in London right now.’ Her voice rises with incredulity. ‘They only have one ICU nurse to six patients.’ I can feel the tension rolling down the phone. Royal Melbourne usually has thirty-two ICU beds and they’re looking to open ninety-nine in preparation for the pandemic. ‘So, if we are going to ninety-nine beds, then we need to triple the number of staff, and there’s just not that many ICU nurses. Even with all of us coming back from retirement and out of projects, there’s a gap. So they’re also training up a cohort of nurses who haven’t worked in ICU before; they’re calling them Fast Track nurses.’ She says they’re not just training. They’re also ‘untraining’. ‘They always talk about danger to self. Don’t go in if there’s a danger to you. But nurses are inherently bad at that. If someone suddenly pulls out a breathing tube or is bleeding everywhere, we tend to go straight in. We should wear gloves, of course, but in that moment, we often just do what we can to save that person’s life – then deal with ourselves later.’ They’ve been training in how to put on Covid PPE. They have to pay attention to exactly how they handle the mask and breathe strongly to test if they have a seal. The mask is tight-fitting and it takes time to get it on. It takes time to get it right. ‘If I look into a room and someone’s arresting, I can’t rush in and save that person’s life. I have to diligently put my mask on and focus on myself first. It’s actually going to be really hard.’ But Sim’s trainer told them, ‘Look, the thing is, how many other people won’t make it if we lose one ICU nurse for fourteen days? Even if you’re not sick, you’ll have to isolate and that has an impact on how many people we could actually save.’ ‘Yeah, that was just huge,’ Sim reflects, and laughs her disbelief. She explains that the ‘pods’ of the intensive care unit will be divided to stop the spread of infection. ‘Initially, they’ll put Covid patients into the isolation rooms, but there are only eight. Once the isolation

rooms are full, then they’ll go into Pod A and B which can be locked into Pandemic Mode. And then, of course, there will still be all the patients in ICU who don’t have Covid – so they’ll be in the other pods. ‘And then just … we don’t know what will happen. But that’s the initial plan.’ I’m worried about older nurses coming out of retirement, back onto the wards and being put in the way of infection. I’m worried about the fresh new mothers who had months of maternity leave planned and are suddenly, instead, stepping back into a risk-filled workplace. I’m afraid of our hospital system being overwhelmed. My sister in London works for the National Health Service. Just days ago, she was telling me about clearing entire mental health hospitals to make way for palliative care wards. Wards for the Covid patients over sixty who they won’t be ventilating. Who will quite probably die. I’m scared for my parents who are far away in New South Wales. Sim’s parents are even further, in Western Australia. But we don’t talk about our families. It’s easier to focus on the details of the organisation and planning underway. It feels both compelling and reassuring. ‘They’re trying to work out an estimate as to when we expect to see patients at the hospital. When we expect to be flooded. And the interesting thing is, they don’t think it will peak for us until late April.’ The hospital was planning to roll out a new system of electronic medical records in April but they’ve slammed the brakes on that. They don’t want to be teaching hundreds of staff how to operate a whole different record-keeping system in the middle of a global pandemic. They’ll do it in July, when hopefully the peak will be over. ‘We’re going into a period now of potentially four weeks of not much happening from a hospital perspective. So we have this amazing benefit of time to prepare in a way that Italy didn’t. And the UK didn’t. Those countries were flooded with ICU needs before they had time to think what was happening. ‘Whereas we don’t have any patients with Covid at the moment at Royal Melbourne, so we’re in total preparation mode. Teams are being formed. People are being brought on. Recruitment is happening.’ Sim pauses and slows. ‘It’s weird. It’s like preparing for a war, but the war’s not here yet.’

CHAPTER 2

Sexual Health Nurse

‘HI, I’M SIMONE from the Sexual Health Service,’ she said. Then she paused to wait for the interpreter.

While retraining for ICU and doing what she can in her family violence role, Sim is also still working at the Austin Hospital one day a week as a sexual health nurse consultant. Things are different now because of Covid. Previously, these consults were conducted face to face, but now Sim has to work over the phone. All the nuances of facial expression and body language are no longer available to her. For this session she had the added complication of an interpreter. ‘I’m calling because your doctor referred you to our service.’ Pause for the interpreter. ‘We see people who are experiencing sexual problems after their illness or injury.’ Her patient was an older man who’d had his prostate removed. ‘He is worried,’ Ronnie, the interpreter, explained, ‘because when he climaxes, it doesn’t feel the same as it used to. Nothing comes out.’ Ronnie was also older and both men’s voices sounded similar over the phone. Ronnie spoke English with a strong accent, so Sim had to focus just to hear when he switched languages. Sim explained that no, a dry climax is normal for someone who’s had a radical prostatectomy. They can orgasm but no longer ejaculate. Some partners of people who’ve had their prostate removed see this as a plus: one mess they no longer have to deal with. Sim has been trained to work with interpreters. She keeps her information clear, uses short sentences and lets the interpreter translate before moving on. But each time her patient spoke it was in long rambling paragraphs. Ronnie responded to the patient to clarify things and there was some discussion before he eventually came back to Simone with a brief reply. Sim knew there was a whole lot more conversation going on between the two men than Ronnie was interpreting but she found it hard to read the situation. Should she ask Ronnie to elaborate? Or trust that she didn’t need to hear all the additional things her patient said? In a consulting room she would be able to read body language and get more of a sense of her patient’s response. On the phone she had far less to go on. This patient should have had it explained to him that he would no longer ejaculate. He’d had preoperative and postoperative appointments with his doctor, and erections had been discussed, ‘but not very much’. Maybe he missed the information – with the interpreter and so much to communicate. Maybe his health professionals didn’t tell him. They were midway through the assessment part of the consultation and Sim had spent about half an hour trying to find out his concerns and how his body was functioning. They began talking about his erections. He explained that he’d been taking Viagra, but his erections weren’t as hard as they used to be. Then there was a click. The interpreter was gone. ‘Ronnie?’ Sim asked. ‘Ronnie?’ Nothing. Into the silence her patient said, ‘Ah. No. Inter-pre-ter.’ Sim told him, ‘Okay, I’ll call you back.’ And hung up, not knowing whether he understood. She called the interpreting agency who couldn’t get the interpreter on the phone. He was just gone. They gave her another interpreter, a woman this time. Sim and her patient had to launch back into a conversation where Sim was asking him to describe the details of his erections. As her patient continued to talk, she had a wave of gratitude for his tolerance and openness to having this conversation. Sim asked, ‘Would you like me to talk about the options for erections?’ ‘Yes,’ he said. She said she could talk more about pumps or injections to make his erection harder. ‘And I could also talk about using your body in other ways, stepping away from penetration and thinking about what else you could do sexually. Which of those would you like me to talk more about?’ ‘I would like more information about the last one,’ he said. Sim isn’t a trained counsellor. She’s a nurse whose job (on these days) is to talk about sexual function. But the role requires a lot of sensitivity and a willingness to ask and talk about things people often find difficult to discuss. She didn’t want to assume anything about his knowledge. Perhaps he was already an incredible, diverse lover, adept with his hands and his mouth. But perhaps his only experience was

penetrative sex. She began to talk about mutual massages and intimate games. ‘Ah yes,’ he responded. ‘I’m familiar with some of these. I like this idea.’ Sim wanted to get a better understanding of what was worrying him about his lack of ejaculate. Looking at his age, she thought it probably wasn’t a fertility issue. But she couldn’t be sure. He explained that, in his culture and in his family, they believe that if you don’t ejaculate, it causes cancer. His operation was last year and since then he’d been terrified the lack of ejaculate meant his cancer was coming back. Sim talked him through the anatomy of his operation. That the glands that produce the seminal fluid had been removed, and tubes that carry semen had been cut, which means there shouldn’t be any fluid when he ejaculated. As he listened and responded she could hear the relief in his voice. ‘Thank you,’ he said. ‘That’s been very helpful. Thank you.’ After Sim tells me the story she says, ‘I’m really sad he didn’t get that answered earlier. He should have known before his operation last year and he’s been sitting on that anxiety for months. It’s weird in the middle of a pandemic, where we’re trying to manage staffing and this scary new virus and then caring for really unwell people in ICU. In the middle of all that, someone’s really worried their cancer’s coming back because he can’t ejaculate.’ I can hear the smile in her voice as she says, ‘In some ways it was really awesome for me, to talk with that gentle man about a problem that was so solvable.’ Sometimes Sim and I don’t talk about work, we just hang out on the phone together. ‘I miss you,’ I say. ‘I miss you. I was thinking about that secure feeling of holding your hands as I tuck upside-down or when your hands are wrapped around my arms when I lunge into arm-to-arm.’ Sim and I were in each other’s orbits for years, in the quick-hello-hug-phase of warm acquaintance. We eventually formed our friendship in our acro-balance class – a class that Sim’s girlfriend, Emily, teaches. We came to acro as adults, so we know what it’s like to feel clunky and heavy and ridiculous while trying something new. We know what it’s like to fall in a laughing pile on the floor together, or to achieve a thing that an hour ago felt impossible. We’ve iced each other’s injuries and squealed at videos of ourselves succeeding. We’re in our forties. I returned to acro when my baby, Jack, was three months old. Milk leaking through my sports bra, my pelvic floor managing lifts but certainly not star-jumps. Obsessively checking my phone to be sure Jack was safe and that Jono, my partner, was coping without me. They were fine. I was a ball of nerves – and Sim was the person I whispered my anxieties to while we stretched. Sim used to arrive at acro in astonishing leggings – printed with luminescent jellyfish or shimmering peacock feathers, or a haunted house with bats. People exclaimed over them and she would smile widely, ‘I know! Aren’t they great!’ But she’s not the kind of person to simply enjoy the admiration and envy of the class. Within a fortnight, she had been hunting through online sales, and before our warm-up she tipped a bundle of leggings on the floor to give away. Galaxies, cloud bursts, reefs of fish – she handed them out. Some days, more than half the class would arrive in leggings Sim had found for them. But she kept the crowning glory to herself. Her long legs shone in a rich dark gold that reminded me of Tutankhamen. When I came closer, I realised the image on the print was maggots. Hundreds of golden maggots. Now the acro class has closed its doors. We aren’t allowed that close to each other anymore. Acro is a touchpoint for how Sim and I talk about learning and trust and relationships. Through acro, we’ve built a reciprocal confidence in each other’s strength and ability to communicate. We judge the risk of each new trick together, anticipate, encourage, and then attempt. We entrust our bodies to one another. I wonder if one reason it’s easy for me to do this is because people entrust their bodies to Sim every day. It’s her job – to care for their bodies. Over her next few shifts in the sexual health service, Sim talked with a woman in her twenties who was in rehab after a traumatic spinal cord injury. ‘I don’t want to just lay there like a doll,’ she said to Sim. They workshopped the possibilities for different positions and how she might experience pleasure herself. Sim talked with a woman in her sixties who had bowel cancer surgery. She was worried about resuming sex with her scars and how to manage her stoma, and was nervous about pain. Sim called a man about sexual difficulties related to a chronic health condition but, after forty minutes of conversation, learnt that he’d been caring for a bedridden ex-boyfriend for years without support. She connected him with carer supports and LGBTQIA+ groups and encouraged him to talk to his GP about NDIS. Sim could have just talked him through physical sexual health information, but she didn’t. She could see that his sexual health depended on him making changes in his home life and support base. She called a couple who were feeling lost and guilty about a new lack of regular sexual intimacy now that one of them was moving towards end-of-life care. ‘There’s no way they would pay to see a sex therapist,’ she says about this couple. ‘I find that in this sexual health nurse role, I’m often an intermediary. I have the credibility of working at the hospital but I’m not a psychologist or a counsellor. I’m “just a nurse”. It means people feel safe with me, I think.’ For some people, it’s far easier to see a health professional about their ‘body’ than it is to seek psychological help around issues that are deeply personal and close to their hearts. The word ‘nurse’

implies practicality and trusted medical solutions – but some people come to Sim when medical doctors can’t fix their problems. She unpacks their feelings and steers them towards mental health services. ‘When I got this job, I didn’t realise how much of a gateway I’d be for people,’ she says. She sees people whose beta-blockers or tricyclic antidepressants impact their libido. She sees people whose spinal injuries have impaired the complex nerves that trigger vaginal lubrication. People whose pelvic surgery or radiotherapy might impact sexual function in any number of ways. And this is only the beginning of the list. Part of this role is also to educate other health professionals in talking about sexual health with their patients. This is not automatically covered at university. Often health professionals think someone else is doing that job: ‘Oh, I’m sure the doctors are having that conversation’ or ‘the social workers are onto that’ or ‘that’s the OT’s job’. Sim wants them to know that it’s all of their jobs. She’s also clear that it’s really important we aren’t just having these conversations with the young and able-bodied. Sim asks her colleagues to consider who they think they don’t need to talk with about sexual function. What assumptions do we make about a woman who is eighty and single? Or a man in a wheelchair without much control of his arms or voice? Why do we think we don’t need to talk to them about their sexual health? And what health issues do we miss when we don’t talk about it? The medical profession, historically, has dehumanised people by desexualising them, or disregarding sexual function as a health issue. The chronically ill, the disabled and the elderly are often mistaken for no longer being sexual. This can lead to significant omissions in health care. Sometimes we forget that we’ve already had a pandemic in our lifetime. Because HIV was first considered in the West to be a ‘gay disease’, it was allowed to spread devastatingly far before, medically and politically, people stepped up to fight it. People didn’t want to ask the physiological questions of exactly how it was spreading. Most of the medical profession weren’t talking with their patients in an open, unbiased, human way about sex. And that killed us. Healthcare professionals having the capacity and skills to talk about sexual function is good for public health. It’s good for everyone. But sometimes nurses have a reason not to talk with their patients about sex. One day in 2018, when Sim was training a group of health professionals in how to talk about sexual function with their patients, a younger nurse put up her hand. ‘What if a patient wants to talk about sex – but in a way that makes you feel really uncomfortable?’ she asked. The nurse looked vulnerable and nervous. It raised a red flag for Sim. It sounded … familiar. She asked the group if anyone else had had an experience of patients talking or behaving in a sexual way that made them feel uncomfortable. Out of a group of thirty, mostly women, almost everyone raised their hand. Sim talked to me about it after our acro class that week. In acro, Sim flies over my head or twists in a series of arcing bends over my upraised feet. I can lift her high in my hands and take the weight of her as she stands soft-footed on my shoulders. I trust that she trusts me. I noticed our reciprocal trust at a whole new level the day she began to tell me the stories of being sexually harassed by her patients. As she spoke about the man who growled sexual obscenities at her again and again from his bed, I realised that what she was saying was both horrible and completely unsurprising. She was a young grad nurse and had gone back and back to his bedside to care for him that night. She went home feeling awful, but never thought of it as sexual harassment. Every time she goes past that ward she still, years later, remembers that man and feels sick in the pit of her stomach. Sim’s younger cousin, also a nurse, had been sexually assaulted by a patient, and then had her complaint dismissed by her superiors. Sim told me about one of her students whose patient had grabbed her and pushed his body up against her in the shower. There were others. In each story a nurse carried on centring her patient’s care, making sure he was safe and that her job was done – and often kept working until the end of their shift before making a complaint or report. In each story, someone dismissed the validity of the nurse’s feelings. Sim, who couldn’t fight for herself when she was a grad nurse, had a fire in her belly and an overwhelming protective instinct to fight for her students and junior colleagues. She listened, helped them file complaints and emailed their superiors herself. Now that she had her ear open, more nurses kept telling her their stories. I suggested that we pitch a co-written piece for an anthology of Australian #MeToo stories. Sim wrote and I edited. Then she talked, I wrote and she edited. One Saturday night we ate ice-creams on the footpath on Smith Street while she looked over the final pages. ‘I think it’s done,’ she said. ‘Is it done?’ ‘It’s done.’ I sent it off. It was accepted. As part of the book’s publicity, an extract of our piece was published online and there was a flurry of responses. At first they were from other nurses contacting Sim to tell their stories. It shattered my confidence in myself as a worker.

I think we all have similar stories which we’ve fobbed off. I’ve found it awful that we just continue on and ignore it. It’s a very violating and helpless and disappointing feeling. I didn’t report them. Raise this issue in any nursing tea-room and the stories will erupt. Mentioned this article at lunch yesterday and there was not a nurse in the room (we were all female) without multiple stories. The Director of Nursing at the Royal Melbourne Hospital sent the article to all her unit managers, asking them to read it. The CEO of the Australian College of Nursing arranged a conference call with us from Canberra. She’d read our piece that morning and she wanted to get a team together to write a position statement now. Would Simone co-chair the committee? The Director of Nursing at the Austin invited Sim to speak at what they call a Grand Round – a monthly formal educational meeting for nurses. Sim stood up in front of a packed auditorium of health professionals to talk about sexual harassment of nurses by patients. She sent me the video. On the screen Sim stands tall and her straight grey fringe shimmers silver in the lights. She’s quick and I barely notice she’s moving, but one moment she’s at the far left of the stage, throwing her smile to the back of the room, and the next she’s at the front, talking with someone who’s answered a question, bringing everyone in. She asks a hundred people: ‘How do you think you would respond to that behaviour? Not how should you. How would you?’ They answer her with their vulnerabilities, their hopes and their mistakes. Somehow, she’s having an intimate conversation about how much she wanted to protect her cousin with a huge auditorium of people. ‘Who here has googled nurse costumes?’ she asks. The groan that rises from that roomful of nurses tells me everything. Sim carefully talks everyone through the legal definition of sexual harassment. Then she puts up an interactive survey slide. ‘Have you ever experienced or observed sexual harassment behaviours from patients or consumers in your workplace?’ As people log on to their phones to answer, the results go up on the slide. The ‘yes’ column shoots up and hovers at around 86 per cent. Since Sim started looking, it has become very clear that nurses are being sexually harassed in all our hospitals. Is it because nurses are so often women? (In Australia, 90 per cent of the nursing workforce are women.) Is it because nurses perform tasks that are both intimate and menial? Is it because they are seen as being there to serve? Is it because, in a hospital bed, people might feel disempowered, and this is a way for them to assert their power? Sim has trawled the research on this, and there is no clear answer. She pulls up a graphic showing the pyramid of gendered violence. At the top are the murdered women. Further below sit sexual harassment and verbal abuse. ‘So we might feel, when we are being harassed, that we’re tough enough to handle it,’ Sim says. ‘But when we speak up for ourselves, we are actually standing up against the murder of women.’ After the Grand Round, the Director of Nursing at the Austin asked Sim to be part of a new sexual safety working group. She wanted to know who was reporting sexual harassment and how, who was staying silent and why? What were the gaps in their workplace policies and procedures that were letting nurses down? As Sim began to do her sexual health nursing consults from home to reduce the risk of Covid infection, she was also preparing for the sexual safety working group. In the times between sexual health consults, she pulled together snapshots of articles she’d found about harassment of nurses by patients and did a gap analysis of the hospital reporting procedures. In one consult, she called a man who, until recently, did physical work with his body. In April he had a forklift accident resulting in multiple pelvic fractures and other long-term injuries to the lower half of his body. As the first and then second waves of Covid hit, he’d been living in a regional rehab unit. All the other patients on the rehab ward with him were elderly or had dementia. He hadn’t seen friends or family for four weeks because that’s how long it had been since hospitals stopped visitors entirely. ‘No-one else here even knows what coronavirus is,’ he said to Sim when they spoke. Restrictions were ramping up and he was facing at least another six weeks with no visitors. He told Sim that he was married.‘But she’s only forty-nine. She’s in her prime,’ he said. They’d been together for twenty-five years and used to have sex two or three times a week and he said it was really important to both of them. It was the thing that kept them connected. ‘She didn’t choose this,’ he said to Sim. ‘Maybe I need to tell her to go find another sexual partner because clearly I’m no use to her in that way anymore.’ Sim responded carefully. ‘Well, that’s definitely one option, but what do you think she’d say if you said that to her?’ ‘Oh, she’d hit me,’ he replied, with a little laugh. He wanted to talk about options for erections, so Sim talked him through different medications and pumps and vibration; the benefits and issues of each. Then they talked about exploring other sexual options. He said that using fingers and hands is something that he has done. He knows his partner values this, not just penetrative intercourse.

But it was going to be a long time before they saw each other again. Sim told generalised stories of people who, as a result of prostate cancer, spinal cord injury or other illnesses, have lost the ability to have an erection, but not lost the ability to have a satisfying sexual relationship. Sim talked about the idea of ‘keeping the pilot light burning’. It’s something she heard at a conference about sexuality and cancer. Sometimes, in the thick of an illness, sexuality is turned all the way down. You’re not flaring up the heater at the moment, but it’s good to think about what you can do to keep that pilot light burning. What are the connections you can have that are still okay right now, physical or emotional – those small intimacies? He was doubtful. ‘I’m not going to see her for six weeks. We’ve only got, you know, a phone and screen. There’s nothing we can do.’ ‘Well, maybe we can workshop some options.’ ‘Are you talking about sexting?’ he said, sounding startled. ‘Well, that’s one option,’ Sim said lightly and they both laughed. They wouldn’t be the only couple connecting this way for the first time since Covid hit. ‘Or you might just send her a memory of something. It doesn’t have to be about sex, it could be about anything, but an intimate moment that you shared together and what you remember about it, how you remember it feeling.’ As they talked more, he started thinking about a gift he could buy her and send with his love. He and his wife hadn’t really had a conversation about sex since his accident. He was deep in his grief about it, but he thought she had just been really worried about him getting home and logistics and how they were going to manage. Now, suddenly, he had an opportunity to talk. ‘But,’ he said eventually, ‘it’s just that, as a man, you have this feeling that you just have to conquer. And if you’re not a breadwinner and you can’t bring money home to the family, and you don’t have that sexual prowess in bed, then what are you?’ Sim was slightly taken aback, but she also liked that he was being honest and self-aware. And neither of them was in a rush. She didn’t have another appointment. He was in a rehab unit with strangers and no visitors. They talked and talked. In the end he answered questions like, what does it mean to be a man? And where do we get these messages about why men have to conquer? What is masculinity? Why are there words like ‘virile’ and ‘potent’? After she tells me about the consult, Sim sighs. ‘At the end of it, I felt like we’d done something good together. It’s such a hard story and such a sad story, but I really noticed the scope of my knowledge and the way we built a connection. It was a worthwhile thing in amongst this Covid pandemic. If I’d decided that talking about sexual function wasn’t important right now, I would have missed that moment.’

CHAPTER 3

Cancer Nurse

‘SIM, HAVE YOU got a moment? Can you just go and take that patient’s cannula out? She’s been in radiation pre-planning all day and she seems a bit flat.’ ‘Okay.’ Sim found herself in front of Asha, a young woman in her late twenties who had just been diagnosed with metastatic melanoma. ‘How are you doing?’ Sim asked, getting organised to remove the cannula. Asha didn’t look up, didn’t make eye contact. Her voice was heavy and dull. ‘I just need to get out of here,’ she said. It was the start of April, early in the first pandemic lockdowns in Australia. Sim was doing one of her occasional casual shifts in radiotherapy – an outpatient unit at Peter MacCallum Cancer Institute. Peter Mac, as it’s known by almost anyone who’s heard of it, is the cancer hospital that sits across Grattan Street from the Royal Melbourne Hospital. There’s a wide, windowed walkway high over the street which runs between the two hospitals. Patients and staff used to move easily between the two. With the arrival of Covid, however, there are new rules and the skyway is far quieter. Sim first came to Peter Mac as an agency nurse. After her grad year, she worked backfilling shifts in private and public hospitals across Melbourne. In a lot of places nobody even bothered to ask her name and she felt a bit like she was just a faceless worker, there to get a job done. At Peter Mac, people made an effort to get to know her. ‘I felt like I was a person there. I felt like Simone.’ She was ambivalent about many of the other hospitals but she loved Peter Mac. ‘How an organisation treats the people who seem to matter the least says a lot to me,’ she explains. When Peter Mac offered a course, training nurses to care for high-dependency patients, Sim leapt at it. People say Peter Mac is like a country hospital in the city. It has a small number of staff compared with somewhere like Royal Melbourne, which takes on 120 new grad nurses a year. Many Peter Mac patients come in regularly for weeks and weeks. Everyone gets to know each other. When Sim arrives for her casual shifts, the receptionist calls, ‘Simone! I haven’t seen you in ages!’ Sim has been saying hi to the same people in medical imaging and Jimmy the cleaner for ten years now. Peter Mac is where she first became a nurse educator and many of her students stayed on there. She laughs that now she sometimes has to ask them questions, and takes pride in the fact that, in a small way, she was part of assembling the current team. Even when she left her role as an educator there for the role at Royal Melbourne, she has never left her home at Peter Mac – she’s always stayed on their casual roster. One of Sim’s dear friends, Josh, manages the radiotherapy department. He’s a sweet man with a soft brown beard. In 2011, Sim was the clinical teacher for groups of students on placement at Peter Mac. The students would be allocated to the wards, each with a different buddy nurse, and Sim roved between them, checking in and doing specific tasks with them. Josh was one of the nurses on the wards who buddied with her students. Sim couldn’t help noticing how great he was at it. All the nurses were excellent clinical nurses and most were also good with students but there were some who found teaching stressful or exasperating. Josh was one of those beautiful nurses who really cared about his students. When Sim checked in with Josh to get a sense of how his students were going, he always had time to go into detail with her. At the end of every day, the students came down to the meeting room and Sim would facilitate an educational debrief session. She always heard from Josh’s students about what an amazing day they’d had and how much they’d learned. I can hear the smile in Sim’s voice when she tells me about him. ‘I was just like, You’re amazing, how lovely are you?!’ When there was an opening for a second clinical teacher, Josh applied and Sim cheered him on. Josh got the job and later become the radiotherapy department manager. Last year he took on an additional role, similar to Sim, educating nurses about family violence. Sim and Josh have a lot to talk about, professionally. For years, since Sim moved to the Royal Melbourne Hospital, she’s crossed back over the road for weekly coffees, hugs and debriefs with her colleague-turned-friend. Now they can’t hug. They can’t even meet up and sit over coffees. But they get to see each other when Sim has a shift at Peter Mac. Some days, Sim works there as a radiotherapy outpatient nurse. Outpatients don’t have a bed in the hospital. Instead they travel to the hospital regularly for radiation treatment over several weeks. At the

start and end of their treatment, and for every week in between, patients have an appointment with the radiotherapy outpatient nurse. It’s different to a bedside nursing role and Sim loves it. As part of the nursing team, she checks patients’ hydration and oral intake. Sometimes people’s skin starts to break down and needs dressing. People get nauseated and tired and Sim talks with them about managing fatigue. She talks with people about sexual function and how it is impacted by cancer and its treatments. She talks with people about intimacy and their relationships. When somebody is severely unwell, she is part of admitting them to hospital. But Covid has changed how Peter Mac operates. They need to reduce the number of patient contacts and the amount of people walking the corridors. The hospital is full of immuno-compromised patients – everyone feels particularly protective. They have to be. But it comes at a cost to the face-to-face time patients have with nurses to talk through their care. At the end of a shift, Josh found Sim and two other nurses who were doing their regular organising of equipment before they left for the day. ‘I need to talk with you about rationalising our nursing appointments,’ he said. ‘I’m trying to catch up with everyone about it this week.’ Sim felt the room grow heavy. Josh asked if there were groups of patients they could safely cut back to just one appointment at the start of their radiotherapy and one at the end? Or make the appointments at a patient’s request instead of them being routine. Josh could see the pain on the nurses’ faces. ‘Okay,’ he nodded, ‘but if you had to, which tumour streams would you start with?’ The other two nurses were permanent staff on the radiotherapy unit, and although Josh included her, Sim deferred to the others as they talked it through. It wasn’t only the number of appointments – they also had to limit the length of time. At a patient’s first radiotherapy nurse appointment, before their treatment starts, the nurse’s role is to talk them through the side effects and the symptoms. The doctors will have given this information already, but briefly. The nurses can take more time to step their patients through. This is what it might feel like. This is what it will look like. This is what to look out for. This is what you can do about it. They don’t want to be in a hurry. It’s about you taking the time to absorb what you need to know right now. And if your brain is feeling overloaded with all the information, we’ll catch up next week, and we’ll go through anything you need. Those appointments might take forty-five minutes or an hour, and that’s been okay. Until Covid. Josh and his team had to reduce radiotherapy nurse appointments to under fifteen minutes. Sim was with Asha in the trolley bay. It’s a kind of waiting zone where patients sit or lie in a row of big reclining chairs waiting for treatment or resting afterwards. But patients aren’t simply waiting – nurses might take bloods here or attach a heart monitor or insert someone’s feeding tube. Two or three nurses share the workload and patients are often coming and going. Radiotherapy is in the basement. The walls need to be concrete, two metres thick, to prevent scatter radiation harming people nearby. There is no natural light in the room, but the trolley bay is filled with luscious greenery. Plant after plant in big pots with glossy, spreading leaves is rotated into this room each week, and then out again to somewhere they can catch some sunshine. It’s a gentle surprise for people who arrive there, at what is possibly the darkest time of their life. Asha pushed herself to her feet. ‘I just need to get out of here,’ she said to Sim. ‘I just need to go home and have a shower and I don’t want to think about this anymore.’ Asha had spent her morning in the hospital in appointments about the kind of cancer treatment she would have. She had just come out of radiation pre-planning. This involves lying on a hard table in a scanner while radiation therapists take an image that will be used to plan precisely where radiation will be delivered. It’s very technical and can be an unpleasant and isolating experience at the best of times. Because of Covid restrictions, Asha had been attending appointments on her own, without a family member or friend. Sim started to ask a question about how Asha was feeling. ‘No, I don’t want to talk about it.’ Sim was worried that something had happened. As Sim walked Asha out to the lift, she tried asking, ‘Is there anything in particular that’s upset you today? In addition to all the stuff going on, have you had any tricky interactions with people here?’ ‘Oh, it’s just everything. I just can’t cope with it. I just need to get out of here.’ Sim didn’t want Asha going home feeling hopeless and alone. As they reached the lift, Sim said, ‘There are going to be a lot of people looking out for you and you probably haven’t met those people today. The people you met today are working on treatment, but there are going to be so many people who will be here to support you and go through everything with you.’ Asha looked up at Sim and made eye contact for the first time. She said, ‘Thank you. That’s good to know,’ and stepped into the lift. As Asha left, Sim’s heart was hurting. It’s always going to be a horrible time getting a cancer diagnosis – but this? Sim flagged on the system for the team to keep an eye out for Asha’s mental health. For someone to check if support could be provided by phone.

She calls me afterwards, feeling torn. Knowing it’s important to reduce infection risks, but desperately sad about how it might impact patients. ‘You know what?’ she says. ‘I have actually been wanting to give more for my entire career. For my entire career, I’ve wanted to give people more time. I feel like the healthcare system has been on a trajectory of figuring out how to give more emotional support and now … now, when people are more scared, we have to …’ She breaks off. A friend calls me at 6.30 in the morning. She’s miscarrying. Can I come and look after her four-year-old while she goes into hospital? I wake up Jono and tell him what’s happening. I run down to the car in my ugg boots. I am hugging my crying friend in her dawn-lit kitchen. We haven’t touched each other for weeks. Her child is a warm, wriggling lump on my lap; we are reading stories while we wait. ‘Will you tell some people for me?’ my friend asks, later that day. ‘Of course.’ I am thrown into connection with seven women I barely know. We organise meals and care packages. It’s something I do in the evenings when I might otherwise do things ‘for myself’. It takes hours of my time and it’s not easy. But there’s a rich and painful sweetness to it that’s far more nourishing than a bath or television. We think together about cultural silences and grief and how to give our friend what she needs, though we are physically separate. I feel like we are the cushion sitting beneath the work done by our friend’s healthcare team. We are doing our best to be a landing place. Jack and I cycle up to Emily and Sim’s to borrow a pair of hula hoops. Em brings them out to the gate. She won’t need her full class set for a long time. I hang the hoops over my shoulder and we cycle home along the train-line, stopping for diggers and cranes, for lavender and a big ginger cat. We take the hoops out into the park in a rare moment of winter sun. ‘How were the hula hoops?’ Sim asks the next time she calls. I laugh. ‘So I thought we’d have this big, physical running-around play with them. But of course he laid them both neatly on the grass and said, “That is your home and this is my home. You have to sit in your home, and I have to sit in mine. We are both sick with pandemic sickness.”’ I know that play is how he processes, but I never imagined this is what he would be processing. Nor that he would be so specific and articulate about what he was experiencing. It’s been weeks since he played with another child and my chest aches. We are deep into the second wave and Sim has another shift at Peter Mac. This should be a day off from her work at Royal Melbourne but Sim goes where she sees the need and she’s working ten days straight. Staff infections at Royal Melbourne have shot up in the last few weeks. Every day now there’s a bulletin announcing how many more patients are in intensive care and how many patients are in the wards, how many staff have tested positive. Sim says being at Peter Mac feels like working beside a bushfire. ‘There’s a feeling of being on edge,’ she tells me. ‘It feels like we’re standing on Grattan Street thinking, Do you think we’re going be safe here? Will the winds change and take this somewhere else? Or will they blow this way?’ Because it’s a specialist cancer hospital, suspected Covid patients are being kept out of Peter Mac; instead, they’re being treated across the road. It’s working. There’s been no Covid at Peter Mac so far. For this shift, Sim was on the Peter Mac high acuity team – which is like a roving ICU. Peter Mac used to have a small intensive care unit on-site. It’s where Sim completed her postgraduate qualifications, trained as an ICU nurse and worked for eight years. But in 2016, when the new Peter Mac building opened, it was agreed they would use the bigger Royal Melbourne ICU across the road. Now Peter Mac has a high acuity team that works throughout the hospital. The team consists of doctors and nurses with a background in intensive care and anaesthetics. Members of the high acuity team are on site 24/7 and work together to visit the sickest patients to see if there’s anything they can offer from an intensive care perspective. Any time there’s an emergency call in the hospital, if a patient is deteriorating or arresting, the high acuity team’s phones beep and they hurry to coordinate the response. If a patient needs to be moved into an ICU bed or needs a specialist service not provided at Peter Mac, like coronary care, the high acuity team manages the process of moving them across to the Royal Melbourne Hospital. Sim’s role as a nurse in that team is to be the link between them and the nurses on the wards. She talks with the nurses, hears their concerns and escalates if necessary. She works closely with the doctors to be part of any logistical coordination. She’s been on their back-up list for years, since she took up her permanent role in education at the Royal Melbourne. When their regular high acuity nurses have sick leave or are furloughed, Sim gets a call. This has been happening a whole lot more since Covid. Sim had just finished the morning round with two doctors, Wilson and Jeremy, when their phones buzzed with an emergency call. A patient was having trouble breathing in a ward two floors below When they arrived, the nurses were suctioning the patient’s tracheostomy – a breathing tube inserted

through an incision in the patient’s neck. His oxygen levels were dropping. There were already at least ten other people in the room. Lots of sputum came out of the suction device in a rush. ‘Sputum plug?’ someone suggested. As Sim and the two doctors reached the bedside, the patient began to breathe more easily. His oxygen levels lifted. Tension in the ward dropped. There was a quiet rattle behind them. Someone had called for a chest x-ray and a radiographer had arrived, pushing the mobile chest x-ray machine. As he tried to navigate between the staff members gathered around the patient, the radiographer joked, ‘Everyone out of the way, Asian driver coming through!’ Sim glanced over at Jeremy and Wilson, both of whom were Australian-born of Asian descent. Wilson caught her gaze and they raised their eyebrows. Emergency over, they headed back to the sixth floor. The high acuity team office is a small, windowless room with a computer in each corner and various pieces of medical equipment against the walls: the transport ventilator and defib; the anaesthetics trolley, like a tallboy on wheels with tubes hanging off it. It was the beginning of a twelve-hour shift together. Sim wasn’t sure about starting this conversation. She was a white person wanting to check in with Asian people about racism. They were both cis men and doctors, which historically put them above her in the hospital hierarchy, though they saw themselves as a team. If the conversation went badly, they would still have to work together for the day. ‘Hey,’ Sim asked. ‘How did you feel about that Asian driver comment?’ Wilson’s first response was, ‘I guess he’s Asian, so he gets to say it.’ Some days in this role they have to run from emergency to emergency. But on this day, there was a pause. They were gathered in the office, available to be called at any second, but with time to sit with their coffees and take a breath. There were no emergency calls for a while and Wilson and Jeremy were both ready to talk. ‘I don’t know … is it different, somebody saying something like that in a professional setting, in a bigger group?’ Jeremy asked. ‘There would have been twenty people there once we turned up.’ Sim talked about how wrong the stereotype was. ‘Because, I mean, the drivers in cities like Hanoi are actually pretty incredible.’ One of the doctors suggested the bad Asian driver stereotype wasn’t because of drivers like that. It was because of Asian women in particular suburbs in their big four-wheel drives. ‘Oh,’ Sim laughed, ‘now we’re talking about women drivers.’ Sim brought up a study she’d been reading for her family violence training on how unconscious bias translates into behaviour. ‘I’d never understood the impact of it. When I was a more junior nurse, I wouldn’t have thought twice about making an apologetic comment about women drivers. I’ve said that so many times when I’ve been awkward, pushing a wheelchair or a bed: Sorry, ooops! Women drivers, hey?’ But a comment like that might entrench the idea that it’s okay to mistreat women drivers. Or Asian drivers. Or nurses. Sim felt this could be a moment to talk about nurses who’d been sexually harassed by their patients. Jeremy was nodding. ‘I’ve seen it happen,’ he said. ‘I shouted at a patient who did that once.’ ‘Really?’ Sim asked. Jeremy seemed so gentle. ‘I can’t imagine you shouting at anyone.’ He said he’d heard the patient’s comments to the nurse and then watched him grab at her while both her hands were busy. ‘I don’t know what came over me; I just felt like I had to protect her … I shouted that he wouldn’t be welcome here if he treated nurses like that.’ ‘Last year I co-wrote an article about patients sexually harassing nurses,’ Sim said. Wilson pulled out his phone and looked up at her. ‘What do I search for?’ In the article a doctor in a similar position to Wilson was dismissive and unsupportive of a nurse after she was sexually harassed. Sim reminded herself to breathe as both men leaned into their phones, reading what she’d written. The sound of clatter and conversation from the nearby nurses’ tea-room drifted in. The article describes an issue so omnipresent for Sim in her workplace and yet, until recently, rarely articulated to her male colleagues. An article that begins and ends with her own vulnerable emotions. And here they were, interested, reading, and then ready to engage with her. After that, the three of them fell into feeling more relaxed together. They worked well throughout the day and there was a lot of banter and chat. It was coming to the end of the shift and they were all looking forward to going home when their phones buzzed again. Somebody had spiked a fever and was short of breath. A very regular occurrence in a cancer hospital. But also, classic Covid symptoms. They hurried from their office, up lifts, down long corridors to the ward. ‘Could this be it?’ Wilson asked. ‘Could this be Peter Mac’s patient zero?’ Outside the room there was a flurry. Through the glass, Sim could see two nurses inside a double room with two patients. ‘We need to limit who goes in there.’ Jeremy, who agreed to go in, looked at the PPE available and said, ‘I need an N95 mask.’ They were all already in surgical masks, which cover the nose and mouth and stop droplets, but plenty of unfiltered air can creep in around the edges. An N95 mask forms a close seal on the face and filters airborne particles much more efficiently. They are designed to protect the wearer. ‘No,’ the nurse-in-charge said, ‘I don’t think you have to wear an N95 mask if it’s just suspected.’

At that point, N95 masks hadn’t been directed for this situation but Jeremy was firm. ‘No, I work in other organisations and I want an N95 mask for this.’ The patient’s oxygen was dropping. ‘Okay, okay,’ the nurse agreed and hurried away to get one. Sim then watched through the window as Jeremy, N95 mask in place, went in and worked over the sick woman beside the nurses who were already with her. They had all been trained in donning and doffing Covid PPE but it was all still very fresh. And now they were in an emergency. People were stumbling through the steps. ‘We need to get her out of that double room and isolate her from other patients.’ ‘There are no single rooms available to put her in,’ the nurse-in-charge said. ‘We need to move someone else out of one.’ Two nurses hurried off to move someone out of their single room. After forty minutes of working beside Jeremy, one of the nurses came out, also now wearing a round N95 mask, like an industrial painter. She was flustered and hot and breathing heavily. As she stepped out the door she gasped, ‘I can’t, I can’t do it. I need to get this thing off!’ She reached up to her face with her gloved hands and pulled off the mask. Those gloves should have come off first, then her hands washed before they went anywhere near her face. But it happened too quickly for Sim to say anything. That’s how easy this is, Sim thought. That’s how it happens. Oncology nurses are really good at dealing with these sorts of emergencies. They don’t generally panic because people are experienced and well trained in their responses. But with the addition of new Covidsafe PPE and the fear of infection from the patient, people were easily rattled. The nurse washed her hands. Her face had a thick red mark over her nose and around her cheekbones and she still didn’t have her breath back. Her eyes were wide and stressed. How do I have that conversation? Sim thought. I’m sure she’s had the training, but she really needs to know. She didn’t want to jump straight in with a criticism when the nurse was still looking so vulnerable. She watched quietly as the nurse went for a quick break. When she returned, Sim found a moment to say, ‘Oh, it’s so hard, isn’t it, with the PPE and those masks are just awful …’ ‘I know!’ the nurse said. ‘I don’t even know what I did, I just know that I had to get my mask off.’ ‘Yeah,’ Sim said, trying to be gentle. ‘I think you might have, you know, used your gloves to do that.’ ‘Oh God, I did, of course,’ the nurse said. ‘I think … I think I’m going to go and wash my face. Ugh. I don’t know what else I touched.’ Sim said to me afterwards, ‘I feel like I’ve just seen how a whole ward could be furloughed. How many nurses have been into this person’s room? Plus, the patient next to her and whoever has been in to see that patient. In the time I was there, there were maybe six nurses in and out and around. And then, if you look at who was on the morning shift and who was on the day before. It would have been a lot of people. And that’s … that’s how it happens.’ But it didn’t happen. Not to that ward. I GET TO SEE YOU TODAY!! Sim messaged Josh. Beardy-face emoji with his mind blown. Beardy-face emoji with love-heart eyes. It was well into the second wave of lockdowns and they hadn’t seen each other for weeks. Sim had been working intensely on her other jobs, all of which were dialled up because of Covid. But Peter Mac was also short on regular staff and had put out another call for a replacement high acuity nurse. It could have been a day off for Sim, but she hated leaving them short-staffed and in some ways this job was so different to the others that it felt like a break to her. Also, she loved the excuse to catch a moment with Josh. Sim ate breakfast in the quiet of 5.30 am. After fifteen years of early mornings, she’s well-practiced at keeping the clatter down for her housemates. She was back on the high acuity team with Wilson again. ‘Simone!’ Wilson said, recognising her immediately though it had been at least a month since their only other shift together. ‘This is Simone,’ Wilson introduced her to Jess, another doctor. ‘She’s also a sexual health nurse at the Austin. She wrote this great article …’ Sim wasn’t used to being remembered by doctors she’d only worked with once before, let alone in this enthusiastic detail. Maybe he’s just got an amazing memory, she thought. There weren’t many patients to visit that morning and after they had done their rounds, Laurence, the consultant and their superior, bought them all coffee. He talked about how his children were thriving on the one-on-one attention from his wife during remote learning. He showed videos of their elaborate creative productions. At 9.30 am their phones buzzed with an emergency call down in the basement at radiotherapy – Josh’s department. Wilson and Simone hurried down the thirteen floors to find two doctors, two nurses and Josh with a woman in her late sixties. Sim and Josh made quick hello eye contact and then focused on their patient, Moira. She was sitting in a chair in a little waiting area. Elbows on knees, face grey, portable oxygen going in through her nose. She was breathing at thirty-six breaths a minute – far too fast. One of the nearby doctors had Moira’s son on the phone, letting him know about the incident. The other gave Sim and Wilson the information they needed. ‘She’s a newly diagnosed lung cancer patient, history

of smoking and alcohol use, diabetes.’ Moira had laid down flat on the CT table to go into the scanner and immediately become short of breath, so they helped her up and made the emergency call. In between rapid breaths, in her light Scottish accent, Moira managed to say that she’d actually been feeling like this since Monday. It was now Wednesday. To even enter the hospital for this appointment, she would have scanned a QR code and answered some Covid-screening questions on her phone. One of these was, ‘Do you have any new respiratory symptoms?’ How did you get in here? Sim thought. But of course, a lung cancer patient is often short of breath. Wilson asked, ‘When did you last have a Covid swab?’ She’d had a Covid swab last week and it was negative. She probably wasn’t high risk but she did have new respiratory symptoms and was sitting in a semi-public waiting area. Up until this point, there had been at least six people who’d had fairly close contact with her, wearing surgical masks but not full Covid PPE. ‘Is someone getting this on the resus narrator?’ Wilson asked. Resus narrator is the part of the medical record system where they document an emergency call. ‘The computer isn’t loading,’ replied the nurse, Justine, who was one of Sim’s former students. Now permanent staff at Peter Mac, Justine is someone Sim trusts implicitly in an emergency like this. She’s also the person who cares for the trolley bay jungle, taking plants home each week to give them sunshine and bringing others back in to fill their place. Sim hovered behind Justine. ‘Try shutting it down and turning it on again?’ Nothing. Justine ran to get paper forms and a pen. They were in an open-plan area where several patients were coming and going, monitored by more staff. ‘Look, I think we need to get her into an isolation room,’ Sim said. Wilson agreed. There were no isolation rooms available and it took some logistics to get one organised. Sim and Josh had a moment to smile at each other behind their masks and say a hurried, ‘It’s good to see you,’ before racing on with their work. When they eventually found an isolation room, it was actually the paediatric radiotherapy recovery room, repurposed since Covid. Children have a general anaesthetic every time they have radiotherapy because a child can’t be expected to stay still enough for the treatment. Afterwards they need somewhere to rest and recover from the anaesthetic. This was that room. The walls were covered with pictures of elephants and tigers and Disney characters. There wasn’t much room around the bed and everything was brightly coloured. Moira talked to the team between fast, huffing breaths. Apparently on Monday she ‘took a bit of a turn’ but then seemed to be okay and she decided to just wait and come in today as planned. She couldn’t really describe the ‘turn’. Initial monitoring showed her blood pressure and oxygen levels weren’t too bad. Her ankles were swollen and they were worried about fluid retention so they gave her a strong diuretic. They sent blood for testing and ordered a chest x-ray. The x-ray came back showing Moira’s heart was enlarged so Wilson decided to order an ECG – a picture of the electrical activity of her heart. Moira felt a bit better and her respiratory rate had improved slightly. She was sitting up and asking for water. Sim called the bed manager to organise her a bed on the ward so she could be admitted and investigated. It began to look straightforward. ‘Do we stand the emergency call down?’ Sim asked Wilson. ‘Yeah, I reckon we probably could. Let’s just check this ECG.’ But when the ECG came through, Wilson shook his head. There were significant changes. ‘When you had this turn,’ Wilson asked Moira, ‘did you have any chest pain?’ ‘Oh yes, (huff) I did. I had this (huff) kind of (huff) pressing (huff) in the centre (huff) of my chest.’ Suddenly this meant they could be dealing with a heart attack. Sim rushed to organise her some chewable aspirin. They needed to get her across to the Royal Melbourne, to get specialist cardiac intervention. Sim called Moira’s son back to let him know his mother might need to be transferred to the emergency department. ‘Will I be able to visit her there?’ the son asked. ‘No,’ Sim had to say. ‘No, I’m so sorry. I don’t think you will.’ While Sim was talking with the son, Wilson rang across the road and got the busy cardiologist on the phone. Yes, the cardiologist agreed that Moira should come across to emergency. ‘But on Sunday she was fine!’ the son kept saying to Sim. ‘On Sunday she was walking the dog!’ He was worried and full of questions and Sim handed the phone over to Wilson to take him through what they knew so far. In the past, Sim would wheel patients across the road in a wheelchair between the hospitals. Now admissions to emergency needed to come by ambulance with lights and sirens. Wilson had to call triple zero and organise an ambulance. As they waited for the ambulance, Sim felt each second like its own version of forever. But somehow the hours had flown since the original emergency call. It was the middle of the day. Moira’s blood results

came back. ‘Wait a sec,’ Wilson said, checking the results. ‘Look at this, her troponin levels are normal.’ A troponin rise is one of the criteria for diagnosing a heart attack. The new information meant they needed to rethink Moira’s diagnosis. There must have been something else causing those changes on her ECG. ‘Okay,’ Wilson decided. ‘If it’s not a heart attack we can’t send her to emergency now. We need to keep her here and try to diagnose what’s going on.’ Wilson rang back triple zero to cancel the ambulance. He was still on the phone as the paramedics came around the corner dressed in full PPE, looking like bulky plastic medical astronauts. Sim tapped on Wilson’s shoulder. ‘Ah, just look behind you.’ She was worried the paramedics would be annoyed that they’d wasted their time. Wilson stepped up. ‘I’m so sorry. We thought we were admitting a patient with a heart attack but it turns out she hasn’t had a heart attack so … I’m sorry.’ ‘Oh no, don’t apologise,’ one of the paramedics waved it off. ‘Best pickup we’ve had all day,’ the other one joked. They spacewalked out. Sim had to call Moira’s son back to explain the change in plan. She took a moment to think about what she was going to say. ‘It’s looking like your mother hasn’t had a heart attack after all.’ He sounded relieved. ‘Oh, thanks for letting me know.’ She talked him through their decision-making process and reassured him that he would be kept in the loop. She hung up and turned back to Wilson who was looking through the rest of Moira’s blood results. Laurence, their superior, arrived to help, but was somewhat frazzled. Since he’d bought them coffee, he couldn’t find his credit card. ‘It’s not anywhere I’ve been,’ he said. He shook the distraction from his mind and leaned in to focus on the bloods. They were bad. Moira was in complete renal failure, her liver was struggling, the pH in her blood was acidotic, certain dangerous electrolytes in her blood were quite high, and one inflammatory marker was hundreds of times the normal limit. ‘These are the kind of blood results you normally see on a patient who is intubated in ICU after an arrest,’ Wilson said. Laurence nodded agreement and patted his pockets as he thought through possible diagnoses. ‘Maybe we can see if someone can go and speak with security about your credit card?’ Sim suggested. Then their phones buzzed. They had a second emergency call. ‘I’ll stay here with Moira,’ Laurence said. ‘You two take this one.’ It was another patient with shortness of breath and chest pain. ‘What is going on today?’ Sim murmured to Wilson. This patient was a man in his seventies who was there for a specialised cancer treatment, a particular type of immunotherapy he could only have at a very high-tech hospital like Peter Mac. He was sitting in a chemotherapy chair but they hadn’t started treatment because of his new symptoms. The chest pain and shortness of breath meant he needed to be admitted to the hospital to stay overnight. He wasn’t happy about it. ‘There is no way I’m going to be admitted to a Melbourne public hospital.’ He demanded to be taken to his regular private hospital immediately. Simone and Wilson listened as the patient’s oncologist explained why that was difficult. ‘I know your preferences. I really understand and I want to respect that. But I’m just, I’m struggling with the logistics of how to get you there.’ ‘My sister is going to drive me,’ the man declared. ‘I don’t think your sister has the provision for oxygen in the car,’ his doctor explained. ‘I don’t care.’ If he’d been well enough, Sim thought he might have stomped his foot. His doctor remained soothing and reasonable. ‘The thing is, you could become very unwell at any moment.’ ‘I will not stay here in this public hospital.’ The circle of people around him, all of whom had chosen to work in a public hospital, shared a quiet moment of eye contact. ‘I refuse to allow you to admit me here,’ he announced. Peter Mac is the top cancer hospital in the southern hemisphere. This man was sitting facing a fulllength window overlooking the Docklands and Port Phillip Bay. There was nowhere better in Australia to manage his specific health issues. Another doctor came in and pulled the patient’s oncologist aside. She murmured, ‘If you ring the private hospital, they’ll be happy to pay for transport to come and pick the patient up.’ The patient was well enough that Sim and Wilson could leave his oncologist to work out how to get him to his preferred hospital and return to the situation with Moira in radiotherapy. An echocardiogram had found fluid around Moira’s heart which they suspected might be because her cancer had metastasised. Her oncologist had come down to talk with the team. He was a big man and he used forceful gestures when he spoke. ‘Yes, she needs specialist intervention, probably in ICU,’ the oncologist agreed. ‘But when you hand her over, tell them that her cancer is curable. We want to go all guns blazing and—’ Wilson interrupted the oncologist. ‘Ahh …? You’re bleeding.’

The oncologist had cut the back of his gesticulating hand. He wiped it off but more blood sprang back. He covered it and kept talking. ‘We want to go hard and pull out all the stops. Make sure they know it’s curable,’ he repeated. He looked a little uncomfortable, not being able to wave his hands around anymore. You know what? Sim thought. One thing I can actually do right now is find this guy a bandaid. She went looking in Josh’s storeroom and found Josh. ‘I need a bandaid for Mr Talks-with-his-hands,’ she said. ‘How are you? It’s so good to see you,’ Josh said, finding her what she needed, eyes smiling. ‘Oh, I just want to give you a hug!’ she said, before they rushed off in their separate directions. Sim sidled up to the oncologist who was still talking and slipped him the bandaid before returning to stand by Wilson. They were looking at how bad Moira’s kidney function was, and Sim suddenly remembered that she hadn’t asked the nurse if the patient had passed urine since they gave her a diuretic. She went back into the room where Justine was still with Moira. ‘Justine,’ Sim asked, ‘has she used the pan?’ ‘No, she hasn’t. She hasn’t actually passed urine since a tiny bit at seven this morning.’ It was getting towards 1 pm. Josh, who was nearby, said he would go for the bladder scanner. The bladder scanner is a small ultrasound that needs to be pointed in the exact direction under the pubic bone to measure the amount of fluid. ‘I can’t … see … it,’ Justine said, pushing the scanner against Moira’s lower abdomen. ‘Do you want to take a look?’ she asked Josh. Josh searched. And searched. And searched. ‘There!’ It was very small. He took the measurements. ‘Sixteen ml.’ This meant Moira was in anuric renal failure – she wasn’t producing any urine at all. It meant her body couldn’t expel toxic wastes or balance chemicals like potassium and phosphate in her blood. Untreated, it could be fatal. ‘Can I have something to eat,’ Moira asked cheerfully, ‘and a drink?’ They had to say no. She might need treatment that would require her to have an empty stomach. It was now 2 pm and Sim was feeling dazed. She hadn’t eaten herself since 5.30 am. She hadn’t drunk water in hours. As Josh brought the bladder scanner out of the room, he caught her eye. ‘Sim, I’ve got some crackers and cheese for the patients in the cupboard at the end, but they’re actually to keep us alive when we need it. Get some crackers and cheese and go into my office and eat them. Now.’ Sim and Wilson had to wait with Moira in the radiotherapy department until ICU across the road was ready to admit her. Unlike the emergency department, ICU was still accepting patients from Peter Mac directly, no need for an ambulance in this case. To walk her across the skyway, they had to take the defibrillator and all the emergency equipment they might need should she arrest on the way over. Usually this would travel on the patient’s bed. But because Moira was a suspected Covid risk, if they transported the equipment on the bed, someone would have to clean it all afterwards. Instead, Wilson and Sim carried the equipment seperately in a heavy bag and a fluoro pink backpack. Justine stayed by Moira’s bed, which was being pushed by a clinical assistant. They handed Moira over to a waiting ICU nurse and lugged their equipment back across the road. Wilson and Sim finally reached their office at 4.35 pm and slumped down in their chairs. Laurence, who had found his credit card and was feeling much better, leant comfortably on a desk. ‘I’ve been thinking, there is probably one explanation for why all of these problems are happening. It’s very unlikely but it would account for most of what’s going on.’ They all knew what he meant – a Covid diagnosis. They talked through who had been wearing what PPE at which points. ‘You know, there’s a chance we’ll all be furloughed after this.’ Sim calls me that night to tell me about her day. It’s like she needs a valve release on all that tension because there are times when she giggles unstoppably: when she subtly slid a bandaid to the gesticulating oncologist; when the patient was having a tantrum. ‘I refuse to suffer the indignity of being admitted to a public hospital’ – Sim recalls it like Elizabeth Bennet mocking Lady Catherine. We both howl with laughter. When she explains about needing an actual ambulance to take Moira across the road, I gasp. ‘No, stop it, it can’t be real!’ ‘It’s real!’ she says. ‘So then Wilson called triple zero.’ ‘He called triple zero?’ I squeak. ‘No!’ It was a busy, difficult day. Most of it might just as easily have happened without a pandemic in the mix. But Covid shadowed every second of what they did. The consistent levels of vigilance required, the constant muffling and blinkering and sweating under layers of PPE, the barriers to human contact. These are ongoing stressors on Sim’s system. She grows serious again when she talks about the risk of being a Covid contact. ‘Oh, I really don’t want to have to spend two weeks in quarantine right now,’ she says. Then she sighs. ‘You know, I think the

hardest thing about the day was not hugging Josh.’ But despite the barriers, Sim is still making human contact. Laughter in the face of difficulty. Acknowledgement in the moments of disrespect. A hurried ‘I miss you’ in a hallway. These things get her through her days. Wilson texts her the next day to let her know that Moira has had emergency surgery to open the sac around her heart to drain the fluid. She’s now in ICU, in an induced coma and on a ventilator. In other countries right now, medical teams are triaging which patients get to use their limited supply of ventilators. Here we are lucky. ‘We did well,’ Wilson says. Moira’s Covid swab came back negative.

CHAPTER 4

ICU Nurse in Training

IT’S EARLY IN the first Australia-wide lockdowns, and Sim has just had her first supernumerary shift in ICU

– which means she’s been working alongside a buddy nurse who’s more experienced in the unit. I’m under the doona with my phone on speaker, listening. Eyes closed. Bra on the floor. With Jack asleep and Jono clattering the last of the dishes, this feels like the first moment I’ve had to breathe all day. I’m tired with a sore throat and a cough. Although it’s mild and I don’t meet the current criteria for testing, I’ve been waking up at two in the morning convinced I have Covid and having to talk myself down from the terror. Sim is taking herself for a walk around her neighbourhood. I picture her out in the cold night air after her day of work. I try to tell her she doesn’t have to talk to me now. Maybe she should just rest and be with her girlfriend. ‘Oh, but I’ve been waiting to talk with you,’ she says. ‘It’s not a chore.’ ‘So, ICU …?’ I prompt. ‘Yeah,’ she says, the word ending on a tense up-note. She laughs roughly. ‘There was a moment where I walked onto the unit and saw a nurse educator I knew. She looked me up and down and went, “Oh God,” in this tone that said, THIS is what we’ve come to.’ ‘I’m so sorry, Sim.’ Sim is making this sacrifice, stepping up to this dangerous job, and this is how she’s treated? But then, I imagine the educator must have fear sitting behind her contempt. I feel a wave of empathy for her and all the other health professionals who are preparing for the tsunami. Sim laughs. ‘I think she was trying to be funny. I thought, Yeah, this IS what we’ve come to. And the nurse I was buddied with for the day was ridiculously lovely. I was really honest with her right from the start. I said, “Look, I haven’t even revised. I thought I’d come in today and see what I remember, and what I don’t.”’ Sim’s previous ICU experience, in the small oncology intensive care unit at Peter Mac, was extremely specialised. She’s an exceptional cancer ICU nurse. But this is a much bigger unit, with many more beds, and a huge range of illnesses and injuries. She’s never worked on this particular unit, with this diversity of patients, and it all feels a little bit like starting at a new school where you don’t know where anything is. ‘We had a handover on this super-complex patient. He had necrotising fasciitis around his eyelids as well as a head injury.’ She starts reciting the backstory. ‘Chronic alcohol use. Found comatose by his neighbour in the backyard. Had potentially been there for days, we’re not sure. But the dog had been licking his face trying to wake him up. And they think the dog’s tongue had bacteria on it. They had to cut out his eyelids and all around his eye and put grafts on. Like a panda. ‘In the scheme of how unwell ICU patients can be, he was pretty moderate – you can get a lot sicker – but for me, it felt overwhelming. ‘At the start of the shift, there’s a kind of choreographed dance that takes you through a whole lot of checks. You work your way around the bedside and check everything’s plugged into the right sockets and everything’s working right and has been labelled correctly. I remember being able to do this dance without thinking about it. Now, the whole time I’m thinking, Oh God, that’s in it too! I forgot that bit. My brain was on overdrive trying to remember. ‘There’s a lot of …’ she starts, and then I can feel her shrugging. ‘There’s just a lot.’ She sounds exhausted. ‘I’d forgotten how physically heavy it is, even though we’re not actually lifting patients. We took this man to CT today. There were five of us and I had to hold his breathing tube. So obviously my job was to not let the tube come out. Which means as we were going around corners and getting in and out of lifts, I was doing all this contortion with my body just to keep his tube in place. ‘There’s a priority list and him breathing is higher than my comfort. I noticed how much that happens throughout the day. I kept finding I’d put myself into an awkward position and I couldn’t readjust. I just had to stay in position and move with him and negotiate my body to fit what was needed.’ They’re teaching all the ICU nurses about ‘proning’ – that is, nursing a patient who’s lying on their front rather than their back. Results in other countries who’ve had Covid for longer seem to show better survival rates. It changes a whole series of things about the way someone is cared for and Sim has to learn them step by step. She talks about trying to manage social distancing in the tea-room. About how to fit a mask properly. About trying to stay hydrated. Amongst it all, there’s still that heavy sense of anticipation. ‘One of the nurses today told me he also works for the CFA. And he was saying this feels a little bit like

when you’re on the strike team during a bushfire summer. It’s Monday and you know you’re looking at a catastrophic fire day Thursday. You’ve had the report: the weather is gonna get really bad. And you just don’t know whether it’s going to take out heaps of national park or a whole lot of homes. He said this feels the same. What’s it gonna look like?’ Sim says she’s setting up a WhatsApp group for all of us who want to know the details of what her ICU days are like. Do I want to be a part of it? Of course I do. I hear her gate creaking as she arrives home and heads for her back door. She asks about my sore throat and checks I’m definitely not feverish. I tell her I’m fine, it’s just a cough, and to go and cuddle her girlfriend. I turn off my recording equipment and lie in the dark for a while before pushing myself out of bed to check how chaotic our home is after a day of three-year-old play and two adults trying to work. We spend an entire Sunday working together to move Jono’s office into our little two-bedroom apartment, turning half of one of the rooms into a study. ‘Are you going to count this towards your work hours?’ I ask Jono. He snorts his ‘no’. He talks about his salary. It’s bigger than the rest of his team’s and it includes working this kind of overtime. I don’t say, But when your job takes time away from your family work, it’s effectively taking time away from ME. Because I benefit from that salary. Because people in his team are getting paid less than him. Because my work has had this house to itself for years, so why shouldn’t Jono’s work share the house for a while now? Because Jono’s job as an environmental campaigner always seems so urgent and virtuous, I feel selfish asking for anything more. But I feel like I’m being squeezed. Because now, if Jono can’t or won’t give me something, there’s nobody else to give it. ‘Are you expecting your team to set up their home offices in their work hours?’ I check. I’m thinking about the women in his team, the parents home-schooling. I feel a sudden duty of care for the people he manages. If I cheerfully make this work, without questioning it, in our house, does it set expectations for how his team members manage? I send him an article about our workplaces requisitioning our homes because it articulates things I can’t say. I hope he reads it. Early in lockdown, I feel like I’ve retreated to a cosy bubble. We do a weekly meal plan for the first time in our lives and Jono goes down to the Vic Market once a week to do the shopping. There’s a lot I am grateful for. But I still can’t work on my children’s novel. In any time I do have, I’m a sea of blankness and fear. I can’t put down my phone. I can’t write fiction. I start transcribing my conversations with Sim. There’s something about her being so close to what I’m afraid of that enables me to concentrate. Listening to our voices and typing out our conversation holds me to my desk. The soft click and tap of my keys. It’s a strange moment of peace. The next time she calls, she tells me she and her housemates have also been rearranging furniture. They are four housemates living in a three-bedroom house, with a small shed converted into a studio where Em and Sim usually keep their extra clothes and a spare futon. Now their workplaces are moving in with them. Sim needs an office for her sexual health consults and some of her family violence work and she needs a quiet bed where she can sleep off her nightshifts. Em is studying and running the occasional online workshop. Their housemates are a schoolteacher and a manager and both are suddenly taking their work online. Everybody needs space. I don’t know why it surprises me that people without kids would also be feeling squeezed. I suppose I had mum-tunnel-vision. Em and Sim are going to turn their back studio into an office and/or day-sleep space, but right now there are piles of books and clothes on the floor, furniture in the hallways, and Sim doesn’t know where anything is. She leaves Em sorting through books and heads out into the evening to pace the streets and talk with me. ‘How was your second shift at ICU?’ She says her buddy nurse was ‘an utter darling’ and that today was ‘quite … quite lovely’. The patient they were caring for had recently had major heart surgery and became badly unwell. She was in ICU on a lot of drugs for blood pressure and heart rate. The nurse handing over said, ‘Look, she’s really flat. Her family are worried about her. They think she’s lost the will to live.’ She was shut down. She hadn’t smiled. She refused to have a wash. Sim thought, I’m going to have twelve hours with this person. How can I make a connection with her? Part of what Sim does each shift, each interaction, is try to read the situation emotionally and work out what her patient needs. Do they just need her to do her job professionally and then step back? Or will it be useful for Sim to build more of a human connection? As she checked her patient’s record, she put her first little feelers out. ‘January,’ she said, smiling, checking the woman’s face. ‘My birthday’s in January too.’ Sim had to keep a close eye on one drug because it was controlling how hard her patient’s heart was pumping, but medically there was not a lot more she needed to do. So she and the buddy nurse took their time giving the patient a gentle wash and moisturise. They gave her a foot rub and washed her hair using a shampoo cap. The conversation turned to the January bushfires. ‘Yeah, I tried to turn forty in January,’ Sim explained,

‘and all my birthday plans were thrown out the window.’ Sim and Em had booked an Airbnb for twenty of us in the Victorian Alps. We were going to go bushwalking, have a spa day, set up picnic rugs and cushions amongst the snow gums and read for hours. I remember her calling to cancel. I’d already had to abandon going home to my family in New South Wales over New Year’s. I remember the horror of the fires closing in on Mallacoota. My parents holding fast and sending me photos of the dark red smoke over Bega. That was when I first downloaded the Vic Emergency app. Now that same app dings pandemic warnings at me every few days. Were the fires really only January? Sim’s patient was recovering slightly throughout the day. They were able to slowly wean her off the medications. Her breathing and bloods improved, and Sim was on a mission to get to know her a little. ‘I was talking to her about how active she was before all this happened. When you see an older person who’s sick in bed and they look so frail and vulnerable and fragile, it’s really hard to imagine them being active.’ Sim knows that if you understand what someone is like when they are at their most physically strong and active, you know them better as a person. You probably make a better nurse. When Em’s mum had a stroke last year and was recovering in hospital, the physio tentatively asked her about walking. ‘How do you go with walking to your letterbox?’ In the weeks before the stroke, she’d been bushwalking kilometres a day. This kind of information changes people’s concept of what recovery looks like. ‘I used to go ballroom dancing. With my husband,’ the woman said. ‘Really?!’ Sim was pleased. ‘I did ballroom dancing for years and years.’ I can just imagine her: chin high, face glowing with the pleasure of it as ostentatious skirts swirl around her calves. So they talked about the dances they loved and tried to remember different tunes. Sim spent her tea break looking up ballroom dance songs on her phone and came back in to play them to her patient. For the first time, she smiled. ‘That’s the one.’ Right at the end of the day, when Sim was leaving, her patient grabbed her hand. ‘You make sure you have a good fortieth at some point.’ It was a night-duty shift. Sim’s ICU buddy nurse was great at her job but she didn’t seem interested in training Sim. Anja was silent and brusque, performing the tasks quickly while Sim watched and tried to take notes and remember everything. Sim felt envious, watching Anja’s easy proficiency. She remembered what it felt like to be so smooth and experienced at a patient’s bedside and knew she wasn’t right now. There’s a hierarchy of career progression in ICU and Sim felt as though she was somewhere to the side of that ladder. Her diverse experience and knowledge elsewhere didn’t even rate here. She felt that Anja’s coldness was about her and she had to work hard for Anja to be okay with her presence. Sim tried cheerful chatter. She got out of Anja’s way as they cared for their unconscious patient: checking the machines, administering medications. ‘I live with my parents,’ Anja responded to Sim’s question. ‘Just moved back in. My mum has dementia.’ Gradually, Sim learned her story. Anja’s mum was deteriorating slowly. Until recently, they’d had respite carers in and out of the house and Anja’s sister came down regularly from Sydney to help. Now Anja and her father were caring for her mother alone. Sim started to see Anja’s brusqueness as grief and worry. It seemed she was concerned about her father’s ability to cope. And she was exhausted. Her mother had been up and distressed several times in the previous night. Anja would be caring for her as soon as she got home. Anja began to open up about her parents and how she managed to work and care for them and the struggle to get additional help with the lockdown restrictions. Sim listened, asked questions and listened some more. She didn’t learn very much about ICU that night. She cycled home in the early light feeling like she hadn’t been very clinically useful, as though that shift hadn’t brought her any closer to being able to care for a Covid patient. When she calls me to debrief, she tumbles through the details of her changing responses to Anja and what she learned about her colleague over the shift. But then she says, ‘I felt a bit bad that I spent the night “chatting”, when it was meant to be a work learning experience. I had a moment of thinking I should be talking to people who will be doing the super-cool high-level stuff. I feel like I’m lurking around ICU and helping mop up.’ ‘Yeah, except that that’s not true,’ I respond emphatically. I’m fascinated by her work and how she thinks about it. The details of the technical, high-level nursing are interesting, but I’m just as interested in the human relationships of care. In how we care for the carers. I think of Anja and the thousands of others who are struggling with their own personal griefs; their family griefs and logistics; the daily, exhausting work of caring for small children and elderly parents, dialled up to breaking point by the pandemic. These people who are still turning up to our hospitals to care for our sick. I’m afraid that calling them heroes somehow hides the fact that they need caring for in return. Sim’s neighbours have clubbed together to give her a massive bunch of flowers and someone else sends her luxurious hand-creams. She feels like she doesn’t quite deserve it. She hasn’t yet seen a Covid patient and she doesn’t feel ready. I’ve been trying to tell Sim that I’m sure she’s going to be an excellent ICU nurse when she has to care for a patient alone. But she’s been watching the experts up close and she can tell she’s not at their standard. She guesses she will be caring for the patients with the lowest needs while the longer-term ICU career nurses take the reins on the complex Covid patients.

‘I think there’s a level of excitement for some of the ICU nurses who are going to be challenged to care for patients who are really sick. They’re really good at their job. They thrive on that challenge of optimising ventilation and working on the fly, and they’re really smart. They’re excited about working on a project where the rules aren’t entirely mapped out. And they’re learning as they go. What kind of pressures are working well in people’s lungs? What positioning? It’s a chance to be really good at your job at a very important time.’ Over the next few weeks in May restrictions ease in Melbourne. It’s starting to seem like the worst might be over and we’re all feeling less afraid. Sim is still training in ICU and I’m continuing to record our conversations. I’m really interested in her learning processes. She says watching an experienced nurse making an assessment, taking in all that information at a glance, is like watching acro coaches demonstrate a trick you don’t recognise. ‘You know,’ she says, ‘the first time you see the trick it’s like a blur of, Oh that’s pretty.’ I laugh, because I’m always the one in class who gasps and cheers the demonstration and then immediately says, ‘Wait, can you do it again? I forgot to watch.’ Learning to see the exact timing of when a foot is flexed or pointed, the specific angle of a lift, is as much a skill as the trick itself. ‘I felt like I had blinkers on, and I could only look at one part of the picture at a time. And I could tell my buddy nurse was taking the whole thing in at a glance. That’s what I have to learn, so I can care for patients alone.’ I ask how she’s feeling about Covid and she says it’s strange because we’re all being so careful about keeping our distance outside the hospital. ‘The funny thing is, once I’ve had my temperature scan and am in the hospital, I spend so much time right next to people. You can’t turn someone in bed without being right next to them. You can’t check your medications without standing beside a drug chart together. ‘Even with our changerooms – I don’t even know how many nurses start at the same time, but it feels like at least thirty or forty. Everyone’s got to get into this tiny little locker-room. Put their stuff away in a locker. And then we have a communal tea-room. It’s difficult to maintain even half a metre distance from each other.’ She had sweet days. One day she cared for a man whose wife had saved his life, administering CPR while on the phone to the ambulance. All with a frightened five-year-old by her side. When the man woke up, Sim held the phone by his cheek as he cried and told his wife he loved her. She had harder days. ‘My buddy nurse suggested I watch a Covid patient be intubated to get familiar with the process, but the nurse in charge was so stressed. She was just like, “No, no, no, no, there has to be no-one extra round here at the moment. This is not okay.” She was heavily pointing her finger up and down.’ One nightshift, Simone sat beside a man whose neck wouldn’t stop bleeding after a tracheostomy. His daughter called from quarantine in a hotel nearby but she couldn’t come in and visit. He was about the same age as Sim’s father in Western Australia and she didn’t want to think of her own family in the same situation. Her father in need of critical care. Herself in a Perth quarantine hotel. So she turned her mind towards the person in front of her. Focused on her work, wiping away blood for hours in the darkness. She laughs on the phone to me afterwards.‘Honestly, if you weren’t used to this work, you’d think it was a scene from a horror movie,’ she says. She sat with the family of a woman who had a catastrophic brain bleed. Doctors said there was ‘no hope’ but the woman was not actually brain dead. There were decisions to be made about organ donation and turning off machines. It’s such a strange intangible thing, the line between life and death, Sim texts. She’s stopped her bike on her way home from the hospital to message me. I need to talk about the lump in my throat. I’m here for her tears. I can respond immediately because Jack is in childcare again and I have the luxury of time to care for others. A few days later, Jack turns four and we celebrate in the park with his cousins and grandparents. Three dogs, three kites and strawberry ice-cream despite an Arctic breeze. The grown-ups don’t touch each other but everyone hugs the kids. As the low winter sun makes the grass glow a sharp bright green, I have a lump in my own throat – the tears of relief that my child was able to have this party, of hope that the crisis here in my hometown is over. I think maybe I won’t write a book about a nurse in a Covid pandemic after all.

CHAPTER 5

Family Violence Worker

IT’S THE SIXTH of June. Victoria’s first day of zero new cases since March.

That night I’m having dinner at Sim’s; it’s the first time I’ve had dinner at a friend’s house in seven weeks. Keeping a distance feels so much harder now that Sim and Em are right here, smiling on their doorstep as I lock up my bike. I’m suddenly desperate to throw my arms around them. I don’t let myself – I’m flying to a funeral in New South Wales tomorrow and I want to keep this visit as safe as I can. It hurts, though. Not hugging makes my skin ache. But there are curries and pappadums and Tim Tams and giggles. I lie on their loungeroom rug and let my shoulders, hunched from anxious hours curled around my phone, ease slowly open onto the floor. Em and Sim do the kitchen dance, piling food onto the table in beautiful mismatched dishes. I ask how people’s days were and quickly there’s a kind of sad fury in the room. Em and Sim have been to the Black Lives Matter protest. Their housemate went to Northlands shopping centre to buy shoes. The differences were stark. Sim says, ‘The protests were so respectful. Everyone was trying really hard to give each other space. I don’t think …’ she glances at Em, ‘I don’t think I saw a single person without a mask.’ Em shakes her head, slowly. ‘I don’t think I did either.’ Sim continues, ‘And there were people passing out hand sanitiser everywhere.’ Their housemate steps in. ‘But Northlands was a shit-show. It was like nobody there thought coronavirus existed.’ All of us in Sim’s kitchen understand that the public vitriol against Black Lives Matter protests is part of how racism operates in Australia. The hypocrisy: that crowds of people in shopping centres not socially distancing, just a few kilometres away from the rally-site, don’t get any public mention. We agree that standing up against racism is an essential service. We agree with the handheld signs that say: Racism is a pandemic. We are also all white women. In various ways we hold positions of power. As Sim talks about her work in family violence alongside social workers, police and child protection, I can see how closely her profession sits to those who have, and still do, systematically oppress Indigenous people and people of colour. The present histories of the Stolen Generations and deaths in custody resonate in my mind beside the stories Sim tells. I start recording. Phone on the table between us. Me crunching the last of the pappadums. Sim’s ICU shifts have reduced. She’s back to her main job before Covid: family violence training. In March she imagined she would be barely doing this role by now. She tells a story about a male health professional, in a powerful role, saying to one of her colleagues, ‘Yeah, but like, really? It’s one woman a week who’s killed by this, come on.’ ‘As in, it’s not a big deal?’ I ask flatly. And somehow, I wonder for a second if he’s right. What if it’s not a big deal? Some days all it takes is one relayed comment for my perspective to veer and I distrust myself. What if I’m wrong and I didn’t understand the situation properly? What if that man is right to be dismissive? Sim is appropriately scathing. ‘Oh, yeah. Not a big deal. But you know, you compare it to cancer and heart disease. People might just see the death statistic and not see the rest of the iceberg and … just what are the fucking costs?’ Emily interrupts. ‘So there’s the one woman a week killed …’ ‘It was triple in March,’ Sim says. ‘Okay, but what is the prevalence rate?’ Emily asks. ‘Of intimate partner violence?’ Sim says. ‘One in four.’ My throat hurts because I must have heard this before. But I feel the statistic all over again. One in four women experience domestic abuse. Emily is on a roll now. ‘Yeah, one in four. I mean, if it were a disease and there were one in four people suffering from this condition, this chronic stress that leads to all these other healthcare issues: hypertension, miscarriage, digestive problems, substance abuse. I mean, we know it’s the greatest risk to …?’ She glances at Sim. Sim takes up the baton. ‘Intimate partner violence is the greatest risk to women’s health when they’re aged twenty-five to forty-four. So in this age group, compared with smoking or driving or cycling down Sydney Road, or whatever you do that might be considered dangerous, having a partner is actually more risky.’ I am struck by this because up until I was eight months pregnant, I regularly cycled the last block of

Sydney Road between my house and the supermarket. Walking hurt and was exhausting. Cycling the footpath, apart from being illegal, had also drawn shouts from random older men. So I would ride between the parked cars and busy traffic to get our groceries. But I got in trouble for that too. One of my friends told me I shouldn’t. She looked down at my belly and said, ‘You’re too precious for that.’ I think of all the women who are too precious to be with a man who hurts them. I think of the times people looked askance at me for riding my bike, for walking alone at night. And nobody, but nobody, said, ‘Are you sure you want to date a guy? You know there’s a high risk he will abuse you?’ Sim is still talking. ‘And then, after forty-four, family violence is still a huge risk factor for women. It’s just that things like cancer and smoking catch up with you.’ We talk about costs. We look it up and quickly find a figure on an Australian government website. It is estimated that violence against women and children cost the country $22 billion in 2015–16. I can’t help thinking about the opportunity cost that sits on top of that. What have we, as a culture, lost because women must give so much of their energy to simply surviving? What research was never done, what laws weren’t made, what films weren’t created because a woman couldn’t work; was forced instead to spend her day protecting herself and her children from violence? Sim starts telling stories from her work. Yesterday, part of her role in the family violence team was to answer a phone. It’s a number that the social workers and other healthcare workers in the hospital can call to talk through family violence cases. Usually, a senior social worker answers it. But she works part time. In fact, the whole team works part time. Often on Fridays Sim might be the only one at work, answering the phone alone. She’s not there to solve the complex problems, but to talk people through the hospital policies and let them know about specific services. She has handled some tricky calls. One woman who had been in ICU for several weeks disclosed to social workers in ICU that her husband was abusive and would regularly ‘belt’ her (the woman’s words). ‘But that’s what happens in families, isn’t it?’ the woman said, tired and stoic. ‘It’s no different to other people. We all have to cope with things …’ Over her time in hospital her medical team discovered she had motor neurone disease and would need ongoing care. They also found she had a mild cognitive impairment, which is not uncommon in family violence survivors. Neck and head injuries account for almost two-thirds of hospitalisations of women due to partner assault. The neuropsychologist declared the patient not competent to make her own medical decisions. This meant she needed a medical power of attorney. The woman wanted to give this power to her husband. Nobody on the ward knew what to do in this situation, and it was Sim who answered the phone call asking, ‘What do we do? And who can we talk to about this?’ What are the risks to her if he finds out the hospital has stepped in? What happens when she goes home and he’s her carer? She has been really explicit and clear about how violently he treats her. But also, she says that’s her life. She’s resigned to it. I’m thinking about the tension in our society between our duty of care and allowing people agency. The harm that has been done by those who did not take action when they saw violence. The harm that has been done by those taking action on behalf of those they perceived as helpless. There aren’t simple answers. I do know we need to trust that women know best how to keep themselves safe. But as a society we need a whole lot more resources and support structures in place to enable that. Sim explains to us her next steps in the hospital bureaucracy. It appears there’s a way forward, but probably neither of us will ever know what happens to this woman. ‘And then I got the call about the two young men on the same ward …’ The seventeen- and twenty-year-old had been in a traumatic motorbike accident together and were now being treated by the same staff. One young man disclosed to a nurse that they were in a relationship. His partner had been abusive. He was distraught. I imagine him, waiting for a moment when his partner couldn’t hear. Finding a staff member he could trust to speak with. Facing shame and grief and fear, all while his body is recovering from injuries that have him bedridden in hospital. The nurse told the social worker, and for her, this disclosure changed how she could work with the young men. In this situation, the victim/survivor and abuser cannot see the same professional. The social worker can’t be the judge and the jury. They can’t advocate for both. But she was getting pressure from her team leader to do the work. ‘You’re the social worker of that ward,’ she was told. ‘Just do the job.’ So she rang the hospital’s family safety phone and spoke with Sim. ‘This is not okay, is it?’ she asked. ‘Can I get back-up from the family violence team? Can you speak to my manager and say this shouldn’t happen?’ Telling me the story, Sim says simply, ‘I could do that. It’s in the hospital policy.’ I’m struck by the great, intricate, rolling bureaucracy of it. The number of managers and staff who don’t know what policies and resources are in place – because there are probably too many to learn. The number of people and policies impacting how these young men are treated. The push and pull of different personalities in this hierarchy and the different degrees to which policies enable them to help keep people safe. Sim tells me about a family violence perpetrator in the hospital at the moment. He’s under police guard

after breaking an intervention order. Sim was called because a nurse wanted to check if the patient’s expartner (and victim) was okay. I nod. It makes sense that services are checking in on her. But after leading me through a complex maze of conversations she had, Sim explains, ‘We’re his healthcare team and contacting her would actually be breaking the conditions of the IVO.’ I think of women who receive hundreds of abusive text messages a day from their exes – and the trauma of not being able to avoid contact. I think of the women who are afraid for their abusive partner’s safety each time he regularly threatens self-harm. The fear triggered by those threats is part of how he exerts control. For a woman who has carefully built up barriers to being contacted, to being made responsible for their ex’s wellbeing, I imagine that a call from his healthcare team could be the opposite of useful. But an IVO takes the guesswork out of what may or may not be good for her. It’s a legal direction the hospital has to follow. ‘And then I had a call from a more junior social worker …’ The social worker was caring for a woman who’d been found at the bottom of the stairs in a pool of blood. She’d been brought into hospital and was now recovering on the ward. The woman, Tamara, said she’d tripped over their cat and fallen down the stairs. Her story was corroborated by her husband. But there was an anonymous tip-off. Someone called the hospital and said, ‘Do you have Tamara in your care? Can I speak to the nurse? You need to know what is going on in the house. I’m really worried.’ The junior social worker tried to bring up family violence with Tamara, but she didn’t want to talk about it. Tamara was ‘quite well-to-do’ says Sim. I imagine an upper-class woman giving a polite but icy rebuttal to the young worker at her bedside. Where the power sits in this kind of situation is complex and shifts from moment to moment. The social worker still wanted to be able to offer Tamara resources but wasn’t sure how best to broach the subject again. So she called Sim. This time Sim’s job was to listen and be a sounding-board and a coach for the social worker as she workshopped her next conversation. How to respect Tamara’s autonomy while trying one more time to offer her resources. Eventually, under the guise of ‘if anyone you know might need them’, Tamara took down a helpline number and stored it discreetly in her phone. I think about the time and effort it took just to give a phone number to one woman, who may or may not have been a victim/survivor. Did Sim and the social worker make any difference in Tamara’s life? How many cases go unaddressed because this amount of effort is more than many busy health professionals can make for a single patient? I think about secrecy and shame. The sense that this is a problem that must be managed alone. Whether Tamara is a victim/survivor or not, the shame and stigma around family violence made it a sensitive task to even approach her. The social worker needed to use subtle intricacies of tone and body language throughout the conversation. The skills of listening and communicating with each individual require great sensitivity and expertise. Such expertise is deeply undervalued by our culture. Perhaps because we can’t easily measure these skills. Or perhaps because traditionally they sit in the realm of ‘women’s work’ and are therefore not actually valued as ‘work’ at all. A few days ago, Jack pooed in the bath. As he was climbing out, he stepped in the poo and trod it all over the tiles. I soaped his feet and dried him down and washed the bath and the floor and got some clothes on him and cuddled him. He said, ‘Please don’t tell Dad.’ I wanted to say something like, Dad and I are a team and we don’t keep secrets. But I also felt protective of this little person who I thought might be feeling ashamed. I cuddled him on my lap and said, ‘Do you know what the feeling “shame” is? Have you heard that word?’ ‘No.’ ‘It’s when you feel so bad and yucky about something that you don’t want anybody else to find out about it.’ His small face was so clear. ‘That’s the word I was feeling.’ I smiled at him. ‘Do you know something cool about shame? Do you know that if you find someone who you know loves you, and you know they’ll be kind to you, and you tell them about it, it can make the shame feeling not so bad?’ After a little bit more cuddling I said, ‘Would you like to go and tell Dad about it yourself? I’ll stay really close to you.’ Jack nodded and held my hand as we headed into the kitchen where Jono was cooking dinner. Listening to Sim, I hope, hope, hope that this little person who I am teaching to bring his shame to the people who love him will have the skills to keep himself safe. Safe from people who might use his shame to keep him silent if they hurt him. Safe from becoming someone whose shame twists them so hard they hurt other people. Sim spoke to a social worker on the trauma ward who called the family violence phone because she was worried about a patient who was a known perpetrator. He was a younger man, a refugee fleeing a traumatic past who had spent years in detention and now had a diagnosed mental illness. He had been violent to his family and they had taken out an IVO against him. He’d been living alone and supporting himself for a while. But he was in hospital for a new injury requiring surgery and it would take at least a few weeks to

recover. He couldn’t care for himself or work or pay rent and the hospital had nowhere to discharge him to. The social worker was hunting down all the avenues for support, trying to find ways to assist him to get back on his feet as quickly as possible. Sim and the social worker went through all the options for resources they could think of and ended up passing it on to Caroline, Sim’s manager. ‘Yes,’ Sim says, ‘it’s true, he’s been violent with his family. He’s a perpetrator. But the situation is so complex.’ There are layers and nuances of power and Sim is deeply conscious of moving through those layers as she works. Medical establishments have a long history of dehumanising patients: men have locked away non-compliant wives in ‘insane asylums’; people of colour have been used as non-consenting test subjects; people with disabilities have been tortured and sterilised; trans and gender-diverse people have been denied, degraded and refused treatment. In Behrouz Boochani’s No Friend but the Mountains, Australian nurses in detention centres wield power, cold and manipulative. Our institutions reflect our society. Nurses are and have been agents of oppression. At the same time, they care for us. It’s a paradox I’ve been sitting with for a long time. My mother was a nurse. She was a middle-class white woman who held power over others, but who also felt powerless. The first time I remember seeing her cry was because of a doctor being unkind. I was four years old, looking up at her as she cried in her bedroom doorway one evening after work. I thought she was being funny. ‘But are you pretending?’ I thought grown-ups only cried when they were playing. I remember her face as she laughed through her tears and shook her head. ‘No, no. I’m really crying.’ Even now, when I ask about the power dynamics of that job, my mum has a gut reaction and shivers dramatically. ‘Ugh. They were awful, those doctors. Awful.’ She backs up slightly and talks about how the system trained them away from compassion. I know she saw patients dealt with in a way that made her deeply uncomfortable: mental health patients, brand-new mothers. She was complicit. She was part of a strict hierarchical system and there were times she felt she could make no difference to how people were treated. She also worked for change. As a midwife in the ’70s she worked with her colleagues to fight for the empowerment of midwives and of birthing women, and this work had a direct impact on how babies are birthed in the UK now. Sim tells me about small changes she has made to advocate for particular groups of people in her workplace. For one of the first family violence training sessions she ran, a half-hour in-service session, she looked at the training package she’d been given. She thought it could better address violence in same-sex and gender-diverse relationships. Sim tweaked the training. She added some inclusive language. She made sure she emphasised, ‘This can happen to anyone.’ A grad nurse in her early twenties approached Sim afterwards. Gemma wanted to say thanks for including same-sex relationships. While she was at university Gemma’s girlfriend had been abusive. They had shared a house and it reached the point where Gemma went to the police and took out an intervention order. But she wasn’t sure she would be taken seriously. ‘I was worried the police would look at me and say, “Oh, two women? You’re saying that your girlfriend is hurting you?”’ While Gemma was on placement studying to be a nurse, she was going home to violence. She kept her secrets well, as so many victim/survivors do, and she lost most of her friends over the relationship. Gemma learned how to care for people with all kinds of diseases, injuries and a raft of mental illnesses, but looking back over her nursing degree, she didn’t remember a single lesson on family violence. She wanted Sim to know how important her session was. She wanted everyone to know about the prevalence of domestic abuse. Sim checked in with Gemma later. ‘Is there anything you think I could do differently in the training? Do better?’ No. Gemma didn’t have any suggestions. She said, ‘Yes, it was a little bit triggering. But at the same time, it was really validating. I felt as though I was with someone who understands.’ The atmosphere of Sim’s training sessions has shifted since Covid. It’s so much harder to read body language on a screen. There’s not an easy way for someone to hang back afterwards and approach Sim. In June she ran a session where some staff were sitting in a room with her, socially distanced, while others were on her computer screen. ‘They were doctors from the trauma team. They know they’re likely to experience increasing family violence because of Covid so they asked us to come and talk to them.’ Her tone makes it clear that this is unusual. ‘They were quite stressed, and their questions were around, How much social work support will we have around this? Will we know that we can access a social worker? If we call this number, will we get someone?’ The doctors know the social workers are already stretched. What’s going to happen as the problem increases? Will there be an increase in services? At that point Sim didn’t know. Sim sighs. ‘It’s hard at the moment because we don’t have those answers. And we don’t have those resources. So we can’t just say, Yes. We’re gonna be fine. You can get a social worker whenever you need one.

‘One of the trauma coordinators was saying they have a frustratingly small amount of social work support there anyway. They’re often pushed to get people out of beds and home, even though they can see that there are problems. ‘My teaching is so much about being able to read a room and assess people’s level of engagement. The doctors could give us forty-five minutes or an hour before handover time. As soon as the discussion became more nuanced, I could feel the room saying, But I don’t have the space for this right now. ‘So I try to work out a few key things they need right now.’ She pinches the air. ‘Is this enough?’ Then she opens her arms wide. ‘As opposed to having a full and nuanced understanding of things?’ ‘It’s like triage, huh?’ I say. ‘Very much like that. I guess the thing with family violence is there’s not a one-size-fits-all perfect answer. In many ways, people feel like they’re getting a lot of confusing information. They just want something simple that makes sense.’ Sim had an hour, which couldn’t possibly lead to all the doctors in front of her taking perfect action. ‘But there were some women up the back who were doing lots of head nodding, nonverbals of: Yes, I’m here. I’m listening. Maybe they were showing how familiar they were with the situations I described. It felt worthwhile. It feels like there’s an increased attention because they know it’s going to get worse. Which is awful, but I guess it’s one of those factors that drives learning, isn’t it?’ ‘And in July you’re running your first full day of training. Face to face?’ I ask. ‘I hope so.’ She crosses her fingers. But by July, Melbourne would enter a second lockdown. Sim would be running the training day from her little office in their studio.

CHAPTER 6

Ward Clerk

IN MARCH, THE final year of Emily’s osteopathy course was put on hold; the last part of the course was

mostly clinical practice sessions, which couldn’t operate under Covid restrictions. Emily’s regular casual work as a circus coach dried up. Suddenly Em was looking at complete unemployment. Em runs our acro class with bright energy. When she points her toes and reaches her arms high over her head, each finger stretching for the ceiling, she has a clarity of movement, a decision she makes with each muscle, that echoes her verbal instructions. She organises warm-ups that make us laugh, bring us into relationship with each other. She understands that acro is about trust as much as it’s about physical skill. Like Sim, she knows how to bring people together. Outside the class though, Em is quieter, more reserved. Sometimes, when Sim talks on Em’s behalf, I wonder if perhaps, given a little more room, Em would prefer to speak for herself. But Em’s silence seems to come from a strong and centred place. When she sees that things are off-kilter, Em speaks her mind. She speaks kindly and surely, with a certainty, not that she is right, but that it’s right to have a conversation. I love this about her. When I imagine Sim and Em, they are snuggled shoulder to shoulder, wearing layers of merino, with hand-crocheted scarves, fingerless gloves and cups of tea. They are cosy and close. Like any couple, they have times of push and pull, where one needs space and the other needs attention, or one is broken and low while the other has no energy left to give. But those aren’t the times that define them. From where I am, I see a whole lot of safety and sweetness. They are generous with each other. Em wants quiet hours in the garden and the silence that allows her endless daydreams. She laughs that if it wasn’t for Sim, she wouldn’t see anyone for weeks at a time. She’s grateful to be tugged out into the world. In March, the week after Em suddenly became unemployed, Sim heard that the Royal Melbourne Hospital had put out a call for ward clerks. Em applied. If you’re a patient arriving at the emergency department, the first person you see is the ward clerk. They take your name and your Medicare card number. They ask if you have any allergies and get you on the hospital system. They are not nurses. They are not medically trained. The Royal Melbourne Hospital was opening a second emergency department, the Respiratory Emergency Department, or the RED Zone. They would need a lot of extra staff at that front desk. Sim called me with a smile in her voice to say that the hospital now had the most interesting group of ward clerks ever. It was full of entertainers, theatre production crew and her circus-coach girlfriend. Em had a job. One of Sim’s friends sent her a selfie with two new ward clerks. At first Sim didn’t recognise them or understand why her friend had sent the photo. It turned out they were two members of Hi-5, the kids’ band, slightly less recognisable without their rainbow of clothes and beribboned high pigtails. There was something beautiful about Melbourne’s arts workers stepping into the frontline to help in a crisis. There was also something tragic about it. My feed was full of theatre-makers, comedians and musicians who were watching their world crumble. That world, of live performance and the community around it, was where Sim and I met. It’s a place we feel we belong. One of my favourite photos of Sim is backgrounded by a red velvet curtain. She is onstage in a row of women in styled black wigs and small black dresses. It’s a moment before an acro routine. The warm lights accentuate biceps and calves and their faces are full of laughter. They are mostly queer women, taking joyous pride in the strength of their bodies. When Sim moved to Melbourne from Perth, she wasn’t out to the people she worked with and there were times she felt the nurses’ tea-room conversations had little to do with her. When she found the queer carnie corner of Melbourne, Sim found a home. She met Em and got to know her when they performed in a show together. She took long service leave to operate sound for her friend’s theatre productions and built her work roster around acro training. When their friends performed in Fringe or Comedy Festival shows, Sim and Em were out night after night, often three shows in a single evening with different groups of friends – seeking out the circus, the cabaret, the queer comedians, the women storytellers. Cycling the midnight streets home to Brunswick. Many of our artist friends teach casually to supplement their income – in jobs that have also suddenly collapsed. Many of them don’t qualify for Jobkeeper and they take themselves off to the Centrelink queues. They post pictures of the lines. They talk about the hours they are spending on the phone, in rising fear and frustration. Sim is worried about our friends who work in the theatre. She also feels immense gratitude to them. In a way, she feels she owes them the life she has now. She calls me with an idea. ‘What if I set up a sort of

health-professionals-adopt-a-theatre-worker thing,’ she suggests. ‘I know lots and lots of nurses. We could all give a portion of our income to artists who can’t work at the moment.’ ‘Oh Sim …’ I say. She hurries on. ‘I just feel like I’m going to be getting so much extra work at this time and I don’t want to profit from it.’ ‘Sim, that’s very … very generous.’ My voice cracks a little at the thought of her working herself into the ground, putting herself at risk, and thinking she should give the money away. ‘But there’s going to be so many more people than the theatre-workers whose jobs disappear. And … I wouldn’t want to ask other nurses to give up their pay.’ When I get off the phone, I imagine those bright Hi-5 faces being the first thing people see when they arrive at emergency and it makes me want to cry. When we next talk about Em being a ward clerk, Sim has moved on to being concerned about Em’s safety. Her voice is fast and worried as she says, ‘I remembered that awful video of the people in emergency, the ones who throw stuff through the window at staff. Remember that? That’s the front desk she’s at. And when I asked if they’d been put through the training in dealing with violent patients,’ her tone rises almost to a squeak, ‘she told me that she knows where the emergency button is!’ Em is only meant to be rostered for two days a week, but somehow, she’s managed to get four night duties in a row. She spends long nights at that desk. Nights of boredom followed by intense adrenaline. Nights managing fear and facing violence. In one night, someone arrived who had been stabbed, someone came off their bike and wasn’t found for hours. Someone else stacked their bike while really high on something. Em couldn’t get any information from him because he’d smashed his face and damaged his windpipe. He was in front of her in a collar of blood with blood bubbling out of his mouth and dripping down his front. Ambulances arrived from traffic accidents and cardiac arrests. Someone had been stabbed with a fork. A woman in furious distress requested a cab charge home. Em couldn’t give it to her. The woman broke down and began to shout at Em and her female co-worker, ‘I hope you get RAPED. I hope you all get RAPED.’ One day a man arrived who was having what Em thought might be a psychotic episode. He was hallucinating and needy but also very sweet and trying hard to pull himself together. He was there because he wanted help. He came back and back to their desk to ask questions. ‘How long ago did I come up last?’ ‘When … when was I speaking to you before?’ ‘What’s happened since then?’ Emily thought he was terrified and that she and her colleague were the people he could come to for human contact and reassurance. The next time he came up to the desk he asked, ‘What have you been doing?’ Emily’s colleague responded professionally, focused on protecting the privacy of the patient information on her screen. ‘Well, I can’t tell you that. It’s confidential.’ She could have responded in a chatty way. Oh, my job is to take notes, I make sure that we’ve got everything here up to date. So, yeah, I’m just working away on the computer. But she didn’t. It wasn’t something she’d been told to do. Em could see the man getting more and more stressed. He was twitching and upset and his voice was rising. Em suddenly realised there were five security guards with their arms crossed looming next to him. He wasn’t aggressive. He wasn’t threatening anyone. But his sense of being out of control was spiralling and the arrival of the security guards added to the tension in the room. As he left with the security guards, she wondered whether he could have managed to keep calmer if he’d been given just a bit more empathy. As I listen to Em’s story, I find myself feeling sorry for the patient and annoyed with the ward clerk for not being sweet and chatty with him. But there’s sexism in the expectation that women in public-facing jobs will naturally take on the task of de-escalating. De-escalation is a skill many women have had to learn in order to survive so it can be something society expects us to do ‘naturally’. It is also a professional skill that can be taught as part of workplace training. Em has gone through a similar emotional process to me. From feeling uncomfortable about how the man was treated, to wondering if it was the best option under the circumstances. She suggests that maybe the patient being taken somewhere quieter was a good thing. The waiting room was clearly a challenging place for him and maybe this way he was treated sooner. Occasionally the security guards pop in to the registration area and check in with Em about people: ‘Was that person aggressive towards you? Do we need to watch out for this one?’ A man arrived convinced someone had pissed in his coffee. He was upset and feeling queasy. He demanded that Em test his coffee for urine and report it to the police. Em explained that they couldn’t test his coffee there and suggested he report it to the police himself. He refused. He got angry, hovering in the waiting room clutching his coffee cup. The police brought someone in and he sat in a cubicle near the registration area, periodically bellowing in rage. A couple arrived and the man refused the mask he was asked to put on. He refused to tell the nurse why he came to emergency. He grew angrier when people asked him not to wander all over the waiting room without a mask. His wife began filming and demanding that he get treated, but still he wouldn’t tell the nurses what the problem was. He held a piece of paper in front of his face and came right up to the gap in the Perspex near Em shouting, ‘Will this do? Is this enough of a mask for you?’ His wife was

threatening to post her video to shame them all about the terrible care he was receiving. The waiting room was filled with looming security guards, standing around with their arms crossed, and eventually the couple left. Someone tells Em about a friend who had been working as a ward clerk for much longer than them. A patient she was registering got angry, smashed a glass bottle and lunged at her over the counter. A security guard threw himself across the room to intercept that lunge so fast that she wasn’t even touched by the glass. ‘I’ve actually never seen them manhandle anyone,’ Em says. ‘Not to say they never do, but they mostly stick to looming. I guess occasionally they have intense “bodyguard” moments where they have to react super-fast, after spending the hour before just sitting.’ For both the ward clerks and the security team there are long hours of waiting. Patients and their families are waiting too – long, quiet, boring hours. Followed by high-stress moments. When the ambulances arrive, Em must get their patients onto the system in a hurry. Sometimes it’s easy. Other times the person is arresting and Em needs to get the details in now. If there’s medication that needs to be charted to the patient, the patient must have an identity on the system. Sometimes staff know that the patient is coming in so they’ve pre-ordered drugs to that particular patient. But if the patient in front of Em isn’t matched to that record yet, she has seconds to add data, flick between tabs and enable the rest of the team to do their work: saving a patient’s life. An ambulance pulled up with someone who’d had a heart attack. As they came through the door, the triage nurse said to Em, ‘This person is about to arrest. You need to get them in now.’ But Em didn’t have enough details to clearly identify the patient on the system. It was offering her three different people with the same name and she couldn’t confirm which was the man in front of her. Her heart was racing as she stared at the screen. She said, ‘Do I just start a whole new entry or do I …?’ The triage nurse held up her hand. ‘You need to get them in the system. Now. Do what you need to do.’ Em’s so new to the job. She’s just learning the systems. She got it done, but how much did the few seconds of delay cost? She comes home wired, with the events of the shift turning over and over in her mind. A more experienced ward clerk – a friendly woman, loud-voiced with smiling eyes – spends a shift supporting Em through the ambulance transfers, making sure she feels clear about all the steps. But learning all the processes for specific circumstances takes time. How to enter someone into the system who doesn’t have a fixed address, the different codes for Medicare and private health insurance, what to do differently with a Traffic Accident Commission case. Em has come straight out of her masters of osteopathy, interrupted in her fifth year of study: anatomy, pharmacology, biomechanics, clinical skills. And this is yet another thing she has to learn. ‘It was this big lot of information that I had to remember, but I couldn’t see a logical way of connecting the memories. I really needed to know it and it was stressful not knowing it. But, in a way, it didn’t feel as important as remembering the osteopathy information, because osteopathy is my career and my big final exams could be back on at any moment. It felt like it was a big task in competing memory space.’ The more I listen to Em and Sim, the more I have a sense of the different kinds of information they hold in their minds, and the many truncated stories they carry home from work. They catch snippets of people’s lives, often in the most intense moments. But there’s no resolution. They don’t get to find out how the story ends. I wonder what it’s like for them to carry around so much not knowing. During one shift there was a man in the waiting room whose wife was having a baby. He couldn’t go in to be with her until his Covid test came back. A team of people rushed the test and it was returned within hours. A doctor ran out to Em and handed her a piece of paper. ‘When this guy comes back in, call my number immediately because I’ve got his test results. He’s negative, we’re gonna let him through.’ The PPE is more heavy-duty now. Em is covered in plastic, with a duckbill face-mask and a face-shield she has to wipe with disinfectant each time she has a break. It gets more and more smeared as the night goes on. Now, because the emergency entry is part of the RED Zone where there could be Covid-positive people, a whole slew of hospital staff are no longer allowed through. They are used to entering here, and arrive with their lanyards and tap the security card reader by Em’s desk. The doors won’t let them in. ‘My lanyard’s not working,’ she hears over and over again, and has to explain that they need to find a new way into their workplace. She is a gatekeeper. People come in, often intensely stressed by their medical emergency, and Em has to respond with bureaucracy – details the hospital really needs, but that don’t feel relevant to a person bleeding or in pain. They want to explain what’s happened to them and have their injury looked at. They want to feel like their pain is being taken seriously. But Em needs to take mundane information, and the quicker she gets it, the quicker they can see the triage nurse. She has to say no. No to the Covid-positive woman who wants to visit her son. No to the father of the young woman who was attacked last night because his daughter already has a visitor. No, she doesn’t know the answer to the next question because she is a tiny, tiny cog in an enormous machine and her job is just this: this computer, her patients’ details, this drop-down box. She wants to give everyone the answers they need, but it’s impossible for her to know all the answers. It hurts. Not immediately meeting people’s needs makes her feel insufficient. But there are times she knows exactly what to do.

A woman making little huffing, gasping noises was wheeled through the door in a wheelchair. She came up to the registration desk, handed Em her Medicare card and pulled her mask down from her face. Her lips were huge swollen sausages. Em jumped to her feet and ran to the triage desk. ‘Anaphylaxis!’ she called. The two triage nurses ran across, took one look at the woman and whisked her straight into a resus room. Within seconds she had been administered adrenaline. When Em went to return the woman’s Medicare card and get the rest of her registration details, she was looking dramatically better, and talking in full sentences. They chatted and laughed. ‘My airway only stopped working as I rolled in the emergency door,’ she said. Another day a nurse, arriving for their shift, discovered a woman lying bleeding in the ambulance bay with a stab wound. There was a sudden flurry by Em’s desk as nurses, doctors and security guards prepared to race outside. They were worried about what was out there. Where was she when she was stabbed? Would they too be attacked? Em learned that hospital staff insurance doesn’t cover them when they’re in the ambulance bay – that’s the zone of ambulance officers. But right then, there were no ambulance officers present. Eventually, they brought her in safely and treated her. Later, they checked security footage which showed her alone, bleeding, walking into the bay and lying down. She claimed the wounds were self-inflicted. But who had dropped her off? Knowing the answers and the reasons, the backstory and what happens next, is not Em’s job. She doesn’t clean wounds or diagnose illness. She enters people’s details. She sits, ready for the next patient, through the long nights. Part of a huge interconnected web of people who work, day in and day out, to save our lives. The sharehouse kitchen often holds a friendly housemate or two. At the end of Em’s shift, someone is there and ready to ask, ‘How was work?’ Sometimes it’s exactly what she needs – this chance to debrief with people who love her, to tell the day’s stories. Other times when she first arrives home, she wants to be by herself. She wants to shower in peace and then work in the garden or cook in a quiet kitchen. One day a woman brings her mum in to emergency and then waits in the waiting room all night long. She’s patient and quiet. Em barely notices when the woman ducks out for food. When the woman comes back, she’s carrying a huge box of donuts which she gives to the emergency department staff to share. ‘Thank you,’ the woman says. ‘Thank you for your work.’

CHAPTER 7

ICU Nurse

SIM CALLS ME in tears. She’s just had her first shift working in ICU without a buddy. She felt overwhelmed.

She couldn’t find what she needed when she needed it and she couldn’t get help from other staff when she tried. Medically, her patient should have been easy to care for. Debra was in ICU after emergency surgery following a spontaneous brain bleed. She had a huge staple-line down one side of her head. Debra was funny. She refused to open her eyes but she quickly learned Sim’s name and recognised the sound of her voice. ‘Simone!’ she called. ‘Yes?’ ‘I need to wee!’ ‘Remember you have a catheter that’s draining your wee into it? Here, if you open your eyes, I’ll show you.’ Five minutes later a doctor came in and introduced herself. Debra responded, ‘My wee is in a bag. That’s awkward.’ Simone helped Debra to call her husband and was in the room for a sweet ‘I love you’ and ‘Tell Andi I love him’. Then Debra asked about Graham. After listening for a moment Debra said loudly, ‘Graham’s a TWAT!’ Sim almost giggled. She found out later that Graham was a Jack Russell who had been tearing up the toilet paper again. But Debra didn’t want to be in hospital. Didn’t want to be attached to all those lines. By the time Sim arrived, Debra had already pulled out her urinary catheter with her toes. That would hurt. A catheter has a retention balloon which is inflated inside the bladder to hold it in place and Debra pulled that lump out through her urethra. Debra had a nasogastric tube delivering food and medicine to her stomach. She hated it. She twisted and turned on the bed, tangling herself in lines. Sim shifted her back to a position that she hoped would be more comfortable, but Debra wasn’t having it. She slid and squirmed until she was horizontal across the bed with her feet hanging out one side and Sim reaching awkwardly over, trying to save various lines from being dislodged. There was an emergency with the patient next door. Everyone was busy and there was nobody nearby for Sim to ask all her questions about the storeroom and where things were. She messaged Josh in her tea break. It’s not been hard clinically, thank God. But I’ll be very, very glad to see the 1 pm nurse turn up. God Josh. I just feel really incompetent. Oh, Sim, Josh responded seconds later. You are one of the most intimidatingly competent people I have ever met. Later, in a moment when Sim was busy, Debra had her hand to her nose in a flash and pulled out her nasogastric tube. ‘Oh no!’ Sim said. ‘Do you know what just happened?’ – hoping perhaps it was an accident. ‘Yep,’ Debra said. ‘I pulled it out.’ The nasogastric tube was the only way Debra could get medication and food and it was directed that she had to have one. Sim, with another nurse, had to reinsert it – a hard enough task when a patient is willing and physically compliant. Debra was neither. She refused to sit. She refused to tilt her head at the right angle. She shouted and cried and wriggled away. Now Sim cries on the phone as she tells me the story. ‘She was throwing her head from side to side and protesting,’ Sim says. ‘She wasn’t doing anything we asked, she wasn’t doing any of it. And so, it started to go down the wrong way, she was coughing and spluttering. We took it out but her heart rate went up and then she started getting chest pain and I felt terrible. The nurse helping me felt terrible. It felt like assault.’ I sit in silence, listening. If someone doesn’t want a tube stuck up their nose and you force it inside them, is it assault? What if that tube makes a significant and long-term difference to their survival? Who makes these decisions? And what are the impacts on those who carry them out? What are the impacts on the person being treated? And if there were more resources in the room, more people, more love, more understanding, more explanation, more time, could it be done in a way that didn’t feel like assault? Could we, as a society, value care work enough to give it that time? From zero new cases in a day at the start of June to numbers in their twenties and then thirties. There are

still no cases linked to Melbourne’s Black Lives Matter protests (though the media continue to ask). There are, however, several cases linked to people shopping at Northlands. On 29 June, Victoria announces seventy-five new cases and local hotspots are declared. Both Sim and I live within two kilometres of the West Brunswick border, with close friends on the other side. One of them, a casual cleaner, abruptly loses his job. The company doesn’t want people from hotspots working for them. I’m afraid of living in a city with arbitrary borders cutting across it. As the demographics of the lockdown suburbs become clear, so does the impact of long-term inequality in this country. It’s yet another example of how the cracks in our society are made more obvious by the pandemic. On 4 July, Sim and I go for our first walk together in a long time. We walk in Gilpin Park, looking over at the West Brunswick border. It’s breezy and chilly and the place is full of children and dogs and bikes. We are allowed to walk together. On the other side of Pearson Street, people are not. Sim is feeling nervous. Emily had three people from the same family arrive at the emergency department via ambulance. All different ages. All Covid-positive and deteriorating. ‘It was a snapshot view of how bad it might be,’ Sim says. ‘How many of us it might affect.’ The Royal Melbourne Hospital has also started training all the staff in how to use their new electronic medical record (EMR) – the one they shelved earlier in the year because of Covid. They want it to happen now, despite the rising Covid cases. ‘So I had to sit in this computer room for eight hours, learning how to completely change the flow in which I work,’ Sim tells me. ‘Like, just everything. Every little thing that I normally do is going to be different. Because the way we have to document it and the way we engage with the new system is quite different. It even feels like a different cognitive process.’ I can tell it feels like an extra weight on top of having to relearn skills and procedures to keep her ICU patients safe. Not to mention the work she’s doing for the big family violence training day she’s been planning for months, which is now definitely running remotely. On top of everything else, a staff member at the Royal Melbourne Hospital has tested positive. Sim tells me it’s made her notice how complacent she and her colleagues have become in the workplace. ‘I think everyone had kind of slipped a bit around social distancing at the coffee line, or in the tearoom,’ she says, ‘because it all felt a little bit farcical after a while. The thing is, I stood next to someone an hour ago while we turned a patient and changed the sheets. Then why do I have to stand apart from them when we buy a coffee?’ So far, Sim has been very firm about keeping distances. Of my friends, I would have put her at the more cautious end of the scale. But this isn’t sounding so cautious. ‘The office where our family violence team is based is in Business Intelligence so there are lots of people working at computers. And even though the premier said to keep working from home, people have been slowly creeping back in. It’s probably still fine in terms of distancing. But it’s gone from no-one to ten. ‘But anyway,’ Sim continues, ‘once this nurse was diagnosed, we had a staff forum about it. Having a staff member test positive has given a big impetus to push us to remember all of those precautionary measures.’ When I get home from our walk that day, I read the news. The government is putting nine public housing towers into hard lockdown with no notice. No-one is allowed to leave the building for any reason except to go into hotel quarantine. There’s a huge police presence. The idea of mothers with small children, of teenagers used to freedom, of big families cooped up in small apartments unable to go anywhere is bad enough. The police presence in a community of people who have already been through trauma, and who have been targeted by police, seems like an appalling decision. I start wearing my mask to the supermarket and to pick up Jack from childcare – where I’m the only person with a mask and Jack finds it disconcerting. He wants to pull it off my face and see me like he’s used to. I want to get us out of this room full of other people and home as quickly as possible. But I also hate my mask. Sim and I are avid listeners of the Guilty Feminist podcast and we sometimes play ‘I’m a feminist but …’ One evening, I call her from my balcony to say, ‘I’m a feminist and am in full support of mask-wearing. But I freaking HATE how much more obvious my wrinkles are when I’m wearing my mask.’ It makes Sim laugh. ‘OMG, I know!’ she squeals. ‘You put the mask on and all that’s left are wrinkles! Eye wrinkles and neck wrinkles.’ We laugh together. I know my eye-lines tell the story of how much smiling I’ve done in my life. I firmly believe that the way we collate the ideas of youth and beauty in women is deeply destructive. I know that the beauty industry wastes obscene amounts of women’s precious money and time and is a huge distraction from other fun we could be having. Nonetheless, I say to Sim, ‘I’m a feminist but there must be YouTube tutorials on how to mitigate the wrinkle-emphasising effect of masks. I’m definitely going searching for them.’ A few days later I read reports that the Royal Melbourne Hospital outbreak has worsened. There were Covid-positive staff at an EMR training session. They’re shortening the training time but pushing on with rolling out the new system. I’m afraid for Sim but I don’t want to scare her or add anything extra to her plate so I don’t send her the link. Also, I’m not really thinking straight because they’re going to close the childcare centres and I can feel the anticipation of the weeks ahead like a weight on my chest.

I’m daunted by the prospect of long days with just me and Jack. I’m daunted by the prospect of trying to work while Jono and Jack are rattling around in the house. I feel like the only thing that made work possible last lockdown was their regular hours-long bike rides. We took it in turns to take Jack out, spending days rambling over Royal Park, around Princes Park, through the cemetery, cycling along the Moonee Ponds Creek to Pascoe Vale or down to Docklands, to Southern Cross. Standing in the wind on the La Trobe Street Bridge, watching the trains come and go. I’m in support of lockdown. But the idea of six weeks with only an hour a day outside sends me into a spiral. We cannot just be in our apartment. When they said, ‘You’re only allowed to leave the house for an hour a day,’ did they really mean us? Did they really mean parents with rambunctious children who live in small apartments? Do they really want us to stay in these three little rooms, both trying to work, while Jack leaps off couches and throws things at the windows? But I recognise that I’m not special. I don’t deserve special treatment. I shut myself down and it takes me a while to realise that I’m still allowed my grief and fear. I turn to strategising about how to make the hours fair between Jono and me. I’m burning with preparatory defensiveness, afraid of not having time to work. This new lockdown will mean it’s just the two of us. Just Jono and I holding our little world together. We can’t go for help anywhere else. If I need time and he can’t give it, I don’t get time. I can so easily imagine myself saying to Jono, ‘Well, you earn more than me, and at this stage my income is far less reliable than yours, so I’ll look after Jack. It’s okay.’ It feels like someone is closing a dark sack around a small bright thing in my chest. Walking around Princes Park with two friends in my earbuds, I tell them I often want to offer Jono more of my time towards domestic things because his work seems more urgent than mine. ‘I don’t really have deadlines. I don’t have meetings I have to turn up to. It’s easier for me to do some extra childcare pickups. His job is to stop the world from burning and I’m just a dilettante lady-author who writes children’s stories,’ I laugh. I’m mocking my feelings. ‘Oh no, no, no, no!’ they tell me. They remind me of the difference my children’s books make in kids’ lives. How my powerful little-girl characters, full of curiosity and strength, have inspired girls they know to try new challenges. As they talk, I am suddenly looking at all the ways the patriarchy has held back little humans from being their whole selves – and the destruction this has wreaked. ‘And you know what?’ one says. ‘Your deadlines are SO overdue.’ I’m swallowing tears. ‘I guess my book was due a hundred years ago,’ I say. We all laugh. I hold my friends’ belief in my head as I prepare for the conversation about how Jono and I will divide our time. As soon as he arrives home from dropping off Jack, I say, ‘I’m not okay. I’m really scared this lockdown is going to be unfair between us.’ Jono is quiet. He hugs me but I can see the stress on his face. He manages a team of twenty-five people. He’s thinking about each individual and their circumstances and how to support them in working from home. They are modelling and re-modelling their organisational budget each month as new data comes in. I can almost see the sweat on his forehead. Over the weekend we put Jack in front of the TV and retreat to the bedroom with our diaries. Jono looks grim and exhausted and my heart hurts for him. I want to say, ‘It’s okay. Don’t worry about it. You don’t have to think about this. I’ll manage.’ But he does have to think about it. This is the place, this space between Jono’s stress and my own self-sacrificing empathy, where I have to step up for myself. We meticulously divide the hours between 7.30 am and 9.30 pm and schedule in time for each of us to go for a run every second day. We count up the exact hours each of us gets in the office while the other is in the loungeroom with Jack. We plan who will be in charge of cooking and bedtime and dishes each evening. We plan exactly when we’re going to do a weekly meal plan together. We leave Sundays unscheduled. It’s a huge relief to me. There’s no room here for me to loosely end up picking up the domestic slack. I text Sim a picture of our hilarious family schedule and she starts checking it before making a time to talk. The fact that she’s taking time to be aware of my schedule on top of everything else she’s doing makes me want to cry. Calling Sim and transcribing our conversations makes me feel productive when I can’t create anything else. It keeps me away from the news cycle and close to my friend. There’s a young woman pregnant with twins on a ventilator in the ICU. Amy and her partner, Michael, both had coronavirus. They both thought they were being really cautious and after long conversations with contact tracers they still have no idea where they caught it. Michael had only minor symptoms and recovered. At home Amy grew worse and worse. She had a fever. She was struggling to breathe. Her symptoms got so bad that the hospital had to send an ambulance to admit her to ICU. By that night they had decided to sedate her and put her on a ventilator. Amy has been on a ventilator for days now and Sim sends me crying emojis. It’s as if every patient is a grief for her. How does she hold it all?

One of her nurse educators, Fran, checked in with her as she worked at a patient’s bedside. Fran reminds Sim of her aunties in Western Australia who she loves. She’s warm and reassuring and Sim feels like she can ask her the ‘silly’ questions. ‘Going okay, Simone?’ ‘I’m still having to think twice about everything,’ Sim said. ‘It’s not second nature.’ Fran said she really trusts Sim and the other nurses who’ve come back into ICU after time away. ‘We’re finding that you know when to escalate. You don’t wait. You know when to ask for help and that’s the most important thing.’ Sim has talked a bit about feeling incompetent while she was retraining for this job. ‘It’s because I remember how good I used to be,’ she says. This time, part of her competence is her awareness of what she doesn’t know. It’s 8 in the morning and I’ve already been at my desk for an hour while Jono does the morning routine with Jack. In these windows of time when the study door is closed, I pick up the transcriptions from my conversations with Sim and start turning them into something comprehensible. Sim texts me. Emily is asleep after a hard nightshift in emergency and Sim needs someone to talk to. She’s discussed the restrictions with her family and they’ve all agreed it’s unlikely she’ll get home to Western Australia before Christmas. Suddenly my phone dings with pictures and videos of her siblings’ children, her ‘nibblings’, as she calls them. The youngest has turned from a tiny little armful into a tottering dancer since they last saw each other. ‘They’re getting so big!’ she cries. Sim usually goes home several times a year. In March they spent two weeks in a beach cabin south of Perth together. Sim and Em took turns to hold the baby and splashed in the ocean with the older children. They spent long hours with Sim’s parents and her sister, reading and walking and chatting. The first Covid cases had already arrived in Australia and they knew something was happening. But it didn’t feel real. It didn’t feel like it would impact them. Now they message each other over and over again, saying, ‘I’m so glad we had that time in March.’ Sim tries to re-imagine that airport goodbye; what would it have been like if they’d known what was coming? ‘I don’t think I could have done it,’ she says. ‘I’ve always known that if something happens, I can just go back there. It might be expensive and I might have to take some days off work but it’s always been possible. And I think this is the first time in fifteen years that I can’t just go home. ‘But I’ve been trying not to think about it. Sometimes I literally imagine putting the feeling of missing them away in a box. It’s easier just to think about my work.’ They’ve closed the border to New South Wales too. It’s a public health measure I’ve been hoping for for days. My family are just on the other side of the border. My parents are in their seventies and a tourist in Merimbula was found to be positive last week. I wanted that border closed and I wanted my family protected. But as I read the news, my skin rushes with heat and then chills. There’s an army between me and my family now. Sim’s family have been separated by strict borders for months already. She’s been so silent about it until now and I can’t believe I haven’t noticed. ‘Also,’ Sim says, ‘I had an ICU shift where I felt so sad about how little we were able to do. In April, my patient was living at home and doing fine and now she can barely lift her arms out of the bed.’ The patient was fifty-five and mostly quite well before she had a heart attack. They gave her bypass surgery, meaning they took blood vessels from her arm and leg and grafted them into her heart. It should have given her life back but instead she deteriorated. She went to rehab for months and months and just got worse. It’s unusual that someone of her age and condition who has this type of surgery wouldn’t have a good recovery. The medical team wasn’t able to pin down what was going on. Her kidneys failed. She was malnourished and her muscles were wasting away. In ICU she wasn’t receiving any high-tech therapies, her blood pressure and heart rate weren’t triggering alarm levels. It didn’t seem like there was much ICU could do. During Sim’s shift she was discharged out of ICU to the ward. Sim feels conflicted. ‘The criteria for being in ICU are particularly around what ICU is providing – all of these high-tech specialised therapies. But another thing ICU provides is one-on-one nursing. ‘I remember years ago when I first started in ICU, there was an ICU consultant who was talking to us about a study. There are all these amazing, high-tech interventions available to people in ICU. But the thing that was found to have the most profound effect in terms of recovery and survival and quality of life was the one-on-one nursing care. It was having someone at the bedside to notice those subtle changes and respond in that moment, and just be there with that person. Sitting with them while they eat, caring for their skin, noticing their mood and all those close monitoring things that you do.’ Moving the patient out of ICU meant they needed to call her daughter, who hadn’t seen her mother for weeks because of the hospital not receiving visitors. The doctor refused to use the hospital video-call system. ‘That thing’s a nightmare,’ he said. ‘I don’t understand why they don’t just let us use Zoom.’ Instead they used a regular phone and spoke on a three-way call with an interpreter. So many layers through which to communicate. Sim stayed in the room while the doctor spoke to the woman’s daughter. They were moving her out of ICU, the doctor told the daughter slowly, and then waited for the

interpreter. If she had another heart attack, they wouldn’t try to resuscitate her, the doctor explained. The doctor stayed on the phone to the patient’s daughter for thirty-five minutes. Explaining. Answering questions. My heart has felt a bit closed over, but telling you this made it clearer why, Sim texts me after we talk. And crying is better than the ugh bleh hopeless feeling. Darling, yes, I text back, you cry. The flat feeling is so often un-cried tears. Sim ran back inside the house. It was before dawn and she’d forgotten her change of clothes for after her shift in the ICU. She crept into the room where Emily was still sleeping and rustled through their wardrobe, shoving a few things into her bag. Once she was on her bike, lights flashing, cycling into the cold dark, she realised she didn’t have her gloves on and had to stop again. By then she felt like she was running late so she pedalled fast. Down beside the train-line and onto Royal Parade, breathing hard, telling herself she hadn’t had a proper cardio workout recently and it was good for her. She hit the unit with twelve minutes before she needed to be at the allocation area, which is not a lot of time. She scrambled her hair into her headscarf and made sure she had her goggles, ID badge and mask on and pushed her bag into a locker. The locker door was jammed. She pulled her bag out. Found another locker that worked and strode towards the main allocation area, long floors and corridors away. She looked up and checked where she would be working. Pod B. They had her on Pod B – one of the pods that was considered ‘hot’ and contained Covid patients. She arrived at the Pod B flight deck, an elevated area with all the rooms around it in a rectangle. Everyone else was already there. She wasn’t late, just right on time, which is late for Sim. ‘Oh, you must be Simone,’ someone said. ‘We saw your name and we’re all like, who is Simone? No-one knows who Simone is!’ As a nurse educator, Sim has met a lot of nurses and usually doesn’t go a day without seeing someone she knows. Of all these nurses standing in this pod none of the faces was familiar. She was struck by the sheer number of people in this department. There was a traffic-light system with a dot next to each patient. Green meant they were cleared, yellow meant they were waiting for clearance and red indicated Covid-positive. She looked up at the room allocations and saw her patient had a red dot. Usually, she also has ‘FT’ printed next to her name: ‘Simone FT’. She gets grouped in with the Fast Track nurses who used to work on the wards and were trained up in a hurry in March. Those nurses usually get extra support and lower acuity patients. But today she didn’t have an FT next to her name. For a moment Sim thought, Where’s my FT? Why does my patient have a red dot? I don’t get the red dot patients! What is happening? Sim met the night nurse for handover outside the patient’s window. Inside, he was dozing while the ventilator breathed for him. The night nurse pulled up the patient’s medical record at a computer. ‘This is my first Covid patient,’ Sim said as they clicked through the record together. ‘Oh, you’ll be fine,’ the night nurse said and spent lots of time going through everything with Sim. As the other nurse left, Sim realised she still had questions that might sound stupid but that getting answers now would mean she could start quicker. Is there a stethoscope in the room? Or do I take mine in? Is the computer in the room considered part of his environment or do I take my gown off to use that computer? The manager of the unit walked past while Sim was donning PPE. ‘Good to see you back here,’ she said and took the time to answer Sim’s questions. She smiled reassuringly and Sim walked into the patient’s room feeling like a trusted member of the team. That night Sim calls me. She is snuggled up in bed, her phone on speaker and a cup of tea between her hands. ‘There’s an Emily here too,’ she says. ‘Hello Emily!’ ‘I thought, rather than telling the story lots of times, she could just be here.’ Sim tells us about her patient. The machines, the medications, the ventilator. ‘Were you scared?’ Em asks. Sim was nervous when she first saw that red dot, and as she established herself at his bedside. But throughout the day it sounds like she fell into the rhythm of doing the work and being with her patient. ‘It’s a lot,’ she says. ‘The PPE is a lot. My head hurt by the end of the day from wearing the face-shields that kind of squeezed my brain and my nose was sore and I was thirsty and that’s one day, you know? I can see the point of giving me that patient and giving someone else a break, just from all that additional PPE.’ ICU nursing can be high adrenaline and high pressure – organising a patient for transport to surgery or for scans or responding to a deteriorating condition. Communicating closely with medical teams who have to rush in and out. But it’s not all like that. Sim talks about some rare days back when she was an ICU nurse at Peter Mac. ‘There is something beautiful about those situations with someone who is unconscious, being able to give them a really caring and slow wash in bed, knowing that you’re optimising their chances of recovery by doing all the things to prevent complications. Knowing that you’re achieving good things with their body, for their health. ‘I remember some lovely days making subtle changes to my patient’s ventilation, or their medication, but also managing to keep them clean and dry and their skin intact and taking time over things like eye

care and mouth care. I feel a real pride in that.’ For a while at Peter Mac, Sim cared for a younger man, in his forties, who was a patient there for months and months. He’d had a stem-cell transplant and was on a ventilator and was very sick. He was a Buddhist and he liked listening to chanting, so his partner brought in some CDs. Once she left, another staff member said, ‘Someone turn the chanting off! I mean, he can’t hear it, he’s unconscious.’ But on her shifts caring for him, Sim pulled the curtains around his bed, put on the CD and spent more than an hour giving him a hot towel bath as they listened to the chanting. She filled a bowl with towels and face-washers and covered them with just enough hot water that they were damp but not dripping. She steamed and cleaned him and gave him a complete moisturise and massage. ‘I remember being able to take my time caring. It felt like such an honour to have this person in this vulnerable state, and being able to treat their body as though it was the most precious thing.’ She remembers his partner arriving one day and standing by the curtain. Her sense of surprised gratitude at the peaceful scene. But those times are clear memories for Sim because they didn’t happen very often. ‘It isn’t the everyday,’ she says. ‘It never was the everyday.’ It’s definitely not what her days look like now.

CHAPTER 8

Nurse Educator

ON 15 JULY, Sim tells me the Royal Melbourne Hospital has forty-three Covid-positive patients. Twelve staff

are now Covid-positive. Sixty-four staff are furloughed for being close contacts. Masks are worn by staff at all times, except when eating. It’s scary and it’s going to get worse. The online family violence training Sim has been working towards is scheduled for 23 July. As Melbourne closes its doors and the Royal Melbourne Hospital outbreak worsens, Sim’s training day is going ahead. She’s working late into the evening pre-recording some sessions, practising the tech, developing new ideas for making interactive sessions work once they’re online. As a trainer, Sim is brilliant on her feet; in front of a group of humans she can make eye contact and read subtle body language. But now that everyone will be on a little screen, she feels like it’s going to be tricky. Doing a full day of this training is new for Sim. Running it online is new. The stakes feel high. Not the least because what Sim really wants to achieve is so much bigger than what’s possible, given the time and resources she has. Sim is waking in a panic in the mornings, remembering additional work she needs to do, getting her head around a new government framework that helps different agencies – police, health, education, homeless services, the children’s court – to work together to recognise and manage family violence risks. The information she gives in her session needs to include the participants’ legal responsibilities as laid out by the government, but it also needs to be Royal Melbourne Hospital specific. It needs to be nursing specific. And as well as gathering and synthesising knowledge, she’s looking at how best to engage people. How best to teach. ‘It’s way bigger than eight hours. I have so much content and every point I want to make has a rabbit hole I could get lost in. I thought, Okay, I want to talk about unconscious bias. So I’ve read a lot about unconscious bias. I found videos about it. And I’ve found images that depict it and interactive activities to help people think about it. I could do a day-long session now on unconscious bias. ‘But I can’t, I’ve got maybe a moment to touch on it. And maybe I shouldn’t have bothered. I should have just said, Hey, we have unconscious bias. Let’s be aware of that. Click. Move on. Because that’s the kind of time I have available.’ Piling on lots of extra information won’t help the people she’s teaching. ‘I know I have to get it down to the main things I want them to take away. I keep coming back to my goal: to generate a feeling of caring about the issue and empowering them to know where to look for information.’ One of my friends sends me a text: I never had the guts to say aloud, ‘Alex was my pandemic.’ All of this actual pandemic is easy in comparison. It’s been a thought every time someone asks me how I am. It gives me a sense of responsibility to know more. To understand this shadow pandemic that for people like my friend has been so much worse than the impacts of Covid itself. Tentatively, I ask Sim if I might come to her family violence training session – since it’s now being conducted online. I’m tentative because I don’t want her to spend a precious minute of her time considering whether I should come. I don’t want her to have to ask her manager or spend any extra emotional energy figuring out how to be kind when she tells me no. I know this creates work for her. But she and her manager agree that I can join them. Two days before the session, Sim is eleven days into working fourteen days straight. She’s in tears about her schedule document: a two-page table with hyperlinks that breaks down how the day will run. She’s about to email it to the participants but she feels like it’s a mess and not good enough to send. ‘I know, I know it’s just that I haven’t had enough sleep and I’m probably crying about other things,’ she says between sob-laughs. Emily gently agrees that yes, she probably is crying about other things. But she helps Sim to edit the document anyway and encourages her to go to bed, where she cries some more. In the morning Sim is bright, testing her video presentation mode with me while Em rigs a plant in the background. Their back-studio office is neat and sunny and Em is standing on a chair, trying to hang the plant so its foliage drapes across the corner behind Sim’s head. Sim smiles and flicks between screens. I’m coming to recognise that she, like many of us, has the emotional strength to bring easy warmth into a room, to be kind and sweet and funny even when she’s exhausted, anxious and has spent the previous night crying. It’s a skill I have drawn on myself: in the mornings when Jack has been awake for hours in the night and

I just want to cry and sleep and rage and eat a whole block of chocolate; when I’ve cleaned Weet-Bix off the floor while he clung to my back, yanking on my hair and I haven’t showered because there hasn’t been a second. In the times I’ve managed to squint through my exhaustion and find a genuine part of myself that can meet Jack in a moment of imaginative play so we can both be meerkats in a rocket ship for two minutes. Most parents are mining this skill for all it’s worth every day. It’s a human skill. One that often goes unrecognised because part of the skill is that it looks easy and fun and ‘natural’. The nurses arrive on my screen and Sim greets them one by one. Many of them look cosy in loungerooms and kitchens. There are dogs and couches and hoodies and coffee cups. ‘Oh, it’s so good to see faces,’ says one. ‘It’s nice to be working but not wearing a mask,’ says another. We go around and introduce ourselves with our pronouns. Everyone here is a woman except the sweetseeming guy from HR. After an Acknowledgement of Country, Sim kicks off with a list of ways people might look after themselves throughout the day. Turn off your camera if you need to. In the breaks go for a short walk, have a stretch or watch baby animals on YouTube. A few people chuckle while others nod. Sim has to be sensitive to the fact that anyone at the session might also be a victim/survivor of family violence. In her book See What You Made Me Do, Jess Hill calls it ‘the Underground’. An often-invisible violence going on all around us. A 2018 survey of female healthcare workers in Australia showed that 45 per cent had experienced family violence – a higher level than in the general population. Anecdotally, Sim’s experience bears this out. It’s been rare for Sim to run a family violence training session without someone wanting to tell her their story afterwards. A student nurse came up after one of the first family violence sessions Sim ran to share her story. She’d been trapped in her house with her child – only allowed out if her husband was beside her. She’d spotted a flyer about a local family violence service at the maternal child health nurse but hadn’t considered it safe to take it home. Later, out walking with her husband, she recognised the name of the service on a building sign. She picked up her child and literally ran for their door. She lived in a refuge and started again with nothing. When Sim met her, she was completing her nursing training as a single mum and was keen to support other victims/survivors. That’s a very clean, brief version of a messy, difficult story and I think Sim chooses to tell me about it because there’s an easy dramatic turning point. It often takes long months or years and a lot of strategising for women to leave abusive relationships. It takes practice. So Sim is careful with her workshop participants. ‘They’re self-selecting to come to this training, so they often have an … interest,’ she said to me earlier. Now, on my screen, Sim says gently to the group, ‘We’re here. Just message me or Caroline if you need to leave for any reason.’ Caroline, Sim’s manager, is one of the few people whose screen background is a neat wall and who has dressed for the day with a professional-looking scarf and jacket. She shares statistics from a recent survey showing the gaps in training for the Royal Melbourne Hospital. She explains that only 35 per cent of staff had any information about family violence included in their degree. If they gained further knowledge down the track, much of it was self-taught. A high proportion of the staff didn’t feel confident addressing family violence issues. Sim talks us through what family violence is: behaviour towards a family member that is physically or sexually abusive; emotionally or psychologically abusive; economically abusive; threatening or coercive or dominating. She stresses that it is behaviour that causes fear. It is a pattern of coercive control that one person exercises over another in order to dominate them, that compels them to behave in a way that they do not choose. There’s a long list of specific behaviours: threats to harm children, pets or loved ones; using force to cause fear; stalking and harassment; threats of suicide or self-harm; restricted access to money; social isolation; monitoring; constant criticism; intimidation. On the government risk assessment checklist, some of these have a star against them. Evidence indicates these behaviours show that someone is at increased risk of being murdered by their partner or ex-partner. Choking is one of these. Now that I know this, I can’t watch another drama where a man holds a woman up against a wall by her throat without thinking, That’s a strong indicator he might kill you. Another is stalking: consistent calling, texting and following is significantly associated with attempted murder. Another red flag is assaulting someone while they’re pregnant. One of the participants interjects to ask if people are screened for risk of family violence during prenatal appointments. Yes, Caroline says. They are now. I don’t think I was screened before Jack was born. Jono came to almost all our prenatal appointments and then our maternal child health visits. We tried to schedule them so we could attend together because we believe that Jack’s health is as much Jono’s responsibility as mine. I particularly wanted Jono there in the months after Jack was born because I felt very raw and fragile. Managing prams and baby capsules and bags of nappies and my slowly recovering leaky body as well as a crying baby felt just at the edge of my capacity. When I look back now, we gave our maternal child health nurse very little opportunity to screen us for risks of family violence. She needed to get me alone.

But I remember when she finally did, when Jack was still a tiny baby. She’d looked sideways at me and said something like, ‘He doesn’t hurt you, does he?’ in a tone that indicated she knew he didn’t. She just needed to tick the box on her screen. I remember feeling amused and slightly annoyed at what a bad job she’d done of it. I didn’t imagine I would have disclosed to her if Jono was hurting me. But he wasn’t, so I don’t actually know how I would have felt. I did feel sorry for her and grateful that she’d tried. Grateful there was some kind of system in place to check on me, however flawed. Sim sends everyone off for a five-minute break and I send her a quick message telling her how awesome she is. I feel a bit all over the ship! she responds. And then very quickly, Shop! I keep seeing your face and it’s really reassuring, she adds. When we are back together Sim talks about gender and family violence. I know she gets nervous about facing the #NotAllMen brigade. But this is not that audience. She flicks up a slide with some stats and people nod. Of Australians who killed their intimate partner, 81.6 per cent were male. Sim gently approaches the complexities around people who experience higher rates of family violence: women living in rural and remote Australia, women with disabilities, migrant and refugee women, younger women, Aboriginal women – who are thirty-five times more likely to be hospitalised by family violence than any other women, more often at the hands of white men. She stresses, ‘This can happen to anyone. It might be happening in any household. We need to be able to sit mutually with the two truths: that certain societal factors put people in a more vulnerable position and that family violence happens everywhere.’ She talks about the barriers to people disclosing and seeking help: shame, a history of not being believed, protecting themselves by protecting their perpetrator. These barriers are high enough for educated cis white women. People with a disability might also be dependent on their perpetrator for care. People in same-sex relationships and gender diverse people know they might face discrimination while seeking help. Aboriginal people might have a well-founded reluctance to involve police, with the long histories of deaths in custody and police violence against their communities. There have been cases of Aboriginal women in family violence situations calling for help from the police and ending up in prison themselves for unpaid fines – and worse: their children being left with the perpetrator, with horrific outcomes. When Sim touches on the reasons for Aboriginal women not to call the police, I think of a wonderful piece by Eugenia Flynn, ‘This place’. In it, Flynn opens up the layers and layers of how racism and sexism are interwoven in Australia – and the ways Indigenous women stand against them, stand together. There’s poetry and a powerful tenderness in her tone as she addresses violence over and over again. Turning it around, examining it from different angles and returning to the love and strength of the women around her. I want these nurses to read the whole thing. I think how important it is that people working in family violence understand the strengths of whoever they’re working with, and their own privileges. Sim steps us through the idea of intersectionality – that people face multiple and different forms of discrimination and that these are often present and active at the same time. That we can’t dismantle sexism without dismantling other forms of oppression. As Sim talks, I squint at the screen, trying to get a sense of how everyone is going with this. Intersectionality is such a commonly used term in my circles, and I wonder how many of the nurses are familiar with it. It’s time for an activity. We each fold a piece of paper in half and open it out again. ‘This line here,’ Sim says, ‘is a line of power. I want you to think about all your identities, all the things that have shaped who you are, and decide whether that identity puts you above or below the line of power.’ I feel like I know this already. I know. I’m white, cisgender, female, hetero-presenting, partnered. I know where my identities sit on this piece of paper. But I pull myself into the activity anyway and write the words above the line. Below the line. And then I think, Mother. Where does mother sit? Does it sit below the line? Statistically, being a mother means I’m providing society with years of free labour. My employment chances got slimmer the second my bump started showing. Or do I sit above the line? Because at forty-two, women who are not mothers barely see themselves reflected in popular culture and are almost entirely invisible. The fact of their non-motherhood is used to publicly disparage them. Either way, our bodies and our fertility history are considered public property and our choices are judged hard and judged often. Yesterday, in just one day of lockdown, by 2 pm I’d been a baby dinosaur, a plant being eaten by a baby dinosaur, a mummy dinosaur cuddling a baby dinosaur. I pretended to be on a piece of pasta being eaten by my child, on a piece of broccoli being eaten by my child, pretended to be going down his oesophagus and landing plop! in his stomach. I’d sent a few emails, done a promo post for my forthcoming book, written 500 words, pretended I was in a snowstorm while having packing baubles dumped on my head several times, scooped the packing baubles back into the box as many times. I refused to buy a treat online for Jack. Refused to let Jack do typing on my computer. Refused to read four different stories RIGHT NOW. Refused to pretend to be a poo. Refused to be a ghost, refused to be a shark. Had a long conversation about the fact that grown-ups sometimes get tired from pretending games. Unstacked the dishwasher, planned how I’m going to manage cooking dinner. Set up Jack to do

watercolour pencils thinking he might do it quietly. Instead, every few seconds, as demanded, I said I liked the ocean he drew, I liked the sun he drew, I liked the sky he drew, I liked the fish he drew. I’m tired. As the pandemic dials up the inequalities in society, shows us how we are failing each other, I am even more poignantly aware of my own cosy safety. At least I have a house. At least I actually have time to play with my child. At least I have a vocation I can work at from home (even if the pay is notably intermittent). At least I can leave my child at home and go for a run. At least I’m not living with a partner who tries to control or hurt me. At least there are these five seconds of sun shining on my eyelids while I hold a hot cup of tea. On my screen, Sim tells us how the pandemic is impacting women. Women are depleting their superannuation at a higher rate than men when withdrawing emergency funds. Women are more likely to be underemployed as a result of Covid. Women are shouldering a bigger burden of unpaid labour at home. Women make up 80 per cent of the healthcare force and at the same time are taking on greater caring roles for children and families. Women are experiencing higher levels of depression, anxiety and stress than men. And, as predicted, family violence has intensified. It’s hard to survey people who might be living in a situation where the very action of taking the survey might put them at risk, whose digital life might be under close surveillance. But a survey was hidden in a series of other surveys about products going to market. It had a quick-exit button and other safety measures and 15,000 Australian women responded. More than half the women who experienced coercive control reported that it began or escalated during the pandemic. Obviously, this escalation is huge for children too. Healthcare professionals have been seeing this firsthand, as children home from school accompany their parents to medical appointments. Sim talks about a father who came in for an operation and brought his adolescent daughter. In the preadmission clinic, the nurse noticed how disrespectfully he was talking to his daughter and how fearful she seemed. When the father went to get a urine sample, the nurse managed to check in with the girl and she disclosed that yes, she was scared of him. She spends all her time in her room colouring in because it doesn’t feel safe in the rest of the house. She says she can’t actually look at him because he’ll yell at her. When he went in for the operation, he told her to head home on public transport. But their pet was in the car in the hospital carpark. She didn’t have a public transport card. The nurse took the pet to Lort Smith Animal Hospital for the day so they could have a better chat with the girl and organise for her to see a social worker. The nurse contacted Sim’s manager, Caroline, who met with the nurse and they worked together to put a child protection notification in. But because it wasn’t a physical abuse or a sexual abuse situation, child protection recommended the girl go home without an immediate intervention. An older brother came to pick her up from the hospital. In the end that nurse spent the entire day with her and working on the child protection notification. ‘Prior to this family violence training project starting at Royal Melbourne, I don’t know that that would have happened,’ Sim says. ‘People are noticing and doing something about it. Or feeling like they can. Because I worry that the nurse would have noticed the girl’s fear, but not known that they could do anything.’ Sim goes through a bunch of the signs nurses might notice: physical issues like injuries and bruising, chronic pelvic pain, chronic headaches and chronic back pain. Psychological signs like depression, insomnia, eating disorders. And more subtle signs like their partner constantly speaking for them, a fear of being touched, anxiety about upsetting their partner, or an inability to access money. ‘Obviously,’ Sim says, ‘all of these could be for any number of reasons. Obviously, we don’t want to be making assumptions. So we need to ask. Overwhelmingly, the research shows that people are not offended to be asked.’ Sim once had a patient who sat on the edge of her seat during a conversation. As they talked, the woman’s phone buzzed with messages over and over again. She kept checking them, her fingers twitching, eyes darting back to her phone while she spoke. She couldn’t focus on what Sim was asking. ‘I’m sorry,’ the woman said. ‘It’s my husband.’ At that time, Sim hadn’t done any training in family violence. She didn’t know what to ask the woman, or how to ask, or what she would do next if the woman began talking about abuse. Sim didn’t know if it was her place to ask. She thought she should be pushing on with the original purpose of the conversation. She ignored the feeling in her gut that something was wrong. She still thinks about that moment and wishes she’d been able to approach it differently. Sim explains that a direct question lets people know that health professionals have the capacity to respond. ‘As nurses we’re used to asking people about personal things like their bowel movements,’ she says, smiling crookedly. I can hear years of experience in her voice as she says, ‘And that felt pretty awkward at first.’ The nurses laugh in recognition. ‘But we’re used to it now, right?’ People nod. There’s a process: making sure the conversation is private, that the patient isn’t nauseous or in pain, their partner is not in the room. It’s all about making sure the patient feels safe, respected and in control. But we’ve stopped paying them the false respect of not asking. Another nurse, Sanaya, tells a story. She was caring for a patient on the ward whose husband became angry and started shouting at the health professionals. He pushed over equipment. Sanaya called

security. The hospital went through a whole process around managing this man’s behaviour in the hospital and keeping staff safe around the patient’s bed. But, Sanaya says, nobody thought about the patient’s ongoing safety after she was discharged. Nobody followed up with her about how things were at home. Renae, a junior nurse, begins to talk and is very quickly in tears. One of her patients was a victim of intimate partner violence. Renae listened to her patient and offered resources. She did what she thought she could. But several weeks later, Renae saw her patient’s name plastered on the front page of newspapers. She’d been murdered by the man she was afraid of. Renae is now in floods of tears. ‘I’m sorry,’ she says. ‘I didn’t mean to cry. I just … I didn’t realise it was so raw.’ It doesn’t matter how good they are at listening. Or how many resources they can point their patients towards. These nurses can’t save their patients from violence. The older nurses gather around Renae in the comments, full of support and absolution. You did what you could, of course you feel this way. Sometimes you just can’t fix it.

CHAPTER 9

Quarantine Caller

THE ROYAL MELBOURNE Hospital healthcare-worker outbreak is spiking along with Victoria’s increasing

daily case numbers. They’re taking in Covid patients from multiple aged care centres. By late July the hospital estimates they are looking after around 40 per cent of Australia’s Covid inpatients. Whole wards of staff at the hospital have been furloughed because of a single positive case. People have been called and told they’re a close Covid contact and sent home to quarantine, with some basic medical information and the date that they will be ‘clear’. They are neurosurgeons and cleaners, agency nurses and physiotherapists. Anyone working at the hospital, who became a contact while at the hospital, goes on a list, and that list is sent to a hastily gathered team under a senior nurse called Karrie. The Director of Nursing says, ‘Please just keep them safe, Karrie. Do whatever is necessary to make sure they’re okay.’ In the beginning, it’s not exactly clear how to do that. They figure it out on the fly. The weekend this new Staff Health Monitoring team is formed, Sim is asked to join them. Sim can do this because ICU patients haven’t increased exponentially so their need for her there is less urgent – and the Staff Health Monitoring team wants a nurse with education experience. It’s work she can do from home, in the studio office. Their job is to provide information, support and friendly conversation on the other end of a phone. Being a close contact of a confirmed case often means people are stressed and anxious. They’re worried about their health, their families, about how they’re going to manage quarantine. Karrie’s team makes sure people have someone checking in with them, that they know about support lines they can access and what they can do if things start to change or if they become unwell. The team is also making sure people know the current information about quarantine requirements and about testing dates. ‘But we have to remember they’re our colleagues. Not our patients,’ Sim explains. The Staff Health Monitoring team is like a bridge between Infection Prevention and the staff. They are making hundreds of calls. ‘I looked at the list,’ Sim says, ‘and there were so many familiar names.’ She sounds choked, sad, worried. ‘It grew rapidly at the end of this week because a couple of patients tested positive on a ward where they weren’t using eye protection yet because that directive has only just come into place. And so, I spent a day pretty much calling an entire ward of staff. They’re all in quarantine.’ The spread has escalated incredibly fast and, despite the months of preparation, in this particular way the hospital wasn’t ready. The infection prevention, the contact tracing – so many individual people are doing their best, but they’re developing systems as the need arises. Things have fallen through the cracks. Sim is suddenly on the receiving end of a lot of people’s anger and fear. Someone she calls is devastated and furious because they’d been in contact with an infected staff member but weren’t initially told. They found out accidentally by word-of-mouth and were utterly shocked. ‘Why did no-one call me?’ they ask. ‘Why? It’s really not good enough.’ ‘I know,’ Sim responds. ‘It’s not. It’s really, really not.’ One woman is a ball of fury because Sim says the hospital doesn’t recommend leaving the house to exercise. The health department is still saying the opposite – that people who are quarantining can go outside to exercise. This woman usually runs seven kilometres every day and there’s something awful to her about being told she can’t. ‘At the end of the day, we’re not police,’ Sim says. ‘We can’t stop you, but I need to tell you that it’s not what the hospital recommends.’ Sim hears the anger and stays on the phone. She asks what exercise means to this woman. Why is it important? They spend time talking through a home exercise program using chairs and body weight. As Sim gets off the phone, she thinks maybe the woman is resigned to staying inside. Everyone has been offered a hotel room, but they can also elect to quarantine at home. If they do that in a house with others, they have to stay in their room, have meals delivered to their door and ideally have their own bathroom. If there’s a shared bathroom, they have to wear a mask and wipe down all surfaces when they are finished. Infection-prevention measures that are second nature at work suddenly seem less clear when people are in their homes. Sim calls a doctor sharing a flat with another doctor. While her housemate is out working for twelve hours at a time, she’s wearing a mask to quickly reheat meals in the kitchen and bring them back to her bedroom.

‘Great,’ says Sim, ‘and do you wipe down the freezer and microwave door-handles afterwards?’ There’s a pause on the other end of the line before the doctor says, ‘Oh gosh, I didn’t even think about that.’ Sim is talking through these kinds of questions in call after call. No, having an air-purifier doesn’t mean it’s okay to share the couch with your partner. No, if you have decided to quarantine in a bubble with your family, they can’t leave the house either. I wonder if the health department is calling other people who are quarantining. The premier has been announcing the numbers of people found to be not at home during quarantine. Surely having someone kind and sensitive call them each day and listen while they talk through their worries would be far more useful than sending the army out to check on them? Sim is suddenly helping to solve a whole raft of logistical issues. Someone in quarantine needs medication for their pet and has nobody to ask to deliver it. Someone in Wallan needs to feed his horse which is agisted ten kilometres away from his house. One of the physios quarantining in a hotel is an elite athlete and wants his cross-trainer dropped off. Sim doesn’t solve these problems, although she wants to – her first urge is to get in her car and fix them all. Instead, she listens and workshops ideas until it sounds like they have a solution that fits within quarantine regulations. One young pharmacist dislocated his shoulder a day before being diagnosed with Covid, and isolating in his sharehouse was unworkable. His boyfriend joined him in a hotel, assisting him with dressing and daily tasks. But then the boyfriend tested positive, which meant that once the pharmacist was clear, there was nobody to drive him home. Also, there were questions about the boyfriend’s hotel bill because he wasn’t staff. Sim talked with Karrie and they spent several hours working through the logistics in order for them both to stay in the hotel. People were often worried about pay coming out of their holiday or sick leave and Sim was able to reassure most of them about their special Covid leave entitlements. But some of the people she was calling weren’t on the hospital payroll: students, agency nurses, cleaners employed through external cleaning agencies. One agency nurse had just come out of two weeks’ quarantine from being a contact in a different hospital. Her first day out she worked at the Royal Melbourne and came in contact with someone else who was positive. Now she was back in isolation for another fortnight. ‘Oh, that’s too much!’ Sim said. ‘It really, really is. I live alone and it’s just …’ She was emotionally exhausted. And she wanted to work. As an agency nurse, her job was totally casualised. She didn’t have an employer paying her special Covid leave. She was entitled to the $1500 government pay but Sim couldn’t talk her through that process, just point her to the department website. What Sim could do was mark her down to receive another welfare call tomorrow. A friendly voice on the phone. A cleaner was worried because their manager told them their pay during quarantine would come out of their sick leave. They didn’t have much sick leave left. ‘It might have been said accidentally,’ suggested Sim. ‘It definitely should be Covid special leave.’ I’m worried about cleaners being mistreated by their managers and I’m glad they’re included in the welfare calls. I’m worried about the agency staff moving from workplace to workplace. Surely this becomes a far greater infection risk? Surely, as people die in their thousands in America, someone here looked at the impacts of casual staff moving from hospital to hospital and said, Maybe we should try not to do that? But Sim was working across several hospitals too. ‘What if they told me I could only work at one hospital?’ she says. ‘I’d suddenly have only half a job! And the way the staffing is structured, we’d lose a huge amount of availability and skillsets.’ As hundreds of Sim’s colleagues test positive I’m suddenly acutely conscious of what ‘bodies on the frontline’ really means. They have literally walked into this danger in order to care on our behalf, while we wait in our homes. Sim is exhausted. She’s talking with me about the viral load. It looks as though healthcare workers are getting significantly more ill and are potentially at greater risk of dying because of increased exposure to the virus. ‘People are saying maybe it’s from caring for people in that space day in, day out and getting just double-inoculated with it,’ she says. She’s realising that maybe she was initially afraid for the wrong reasons. ‘I think I was scared of having to learn the ICU stuff so fast and the pressure of that environment. Being able to care for my patients properly and not make mistakes. I don’t know that I felt scared for my life. And maybe I should have been. ‘People kept saying, Look, if you’re not older, you’re not immuno-compromised, you’re probably okay. And chances are you get a mild version of it. But it’s becoming clearer and clearer that it’s a really strange and scary disease. We don’t know the long-term effects. And even for the people who are asymptomatic, we don’t know how it might impact their organs years down the track. And this virus is doing really weird things to some people in terms of hearts and brains and blood vessels. They just don’t know what those long-term impacts are, which is … scary.’ Sim has worked ten days straight and hasn’t had a proper break for weeks. ‘If I worked at a single hospital, they’d never let me do this many shifts in a row,’ she tells me. ‘But I work at three. And I just keep seeing more gaps I could fill.’ After a week of calls, the Staff Health Monitoring team manager, Karrie, takes a weekend off and Sim

finds herself leading the team because she’s already the most experienced person in the room. More and more staff are being furloughed and added to the list each day. The hospital wasn’t prepared to manage staff welfare with this many people in quarantine and they are scrambling to handle the data. Sim is on the phone again, telling me she’s not good enough at spreadsheets to do this. ‘I don’t know about data management!’ she says. ‘I don’t know about IT. Surely there’s someone better for this job? Surely there’s someone from Business Intelligence or something?’ I try to tell her she’s excellent but she interrupts me to describe how they’re working. ‘We’ve got this enormous spreadsheet and we’re emailing it back and forth between our team and Infection Prevention. Ugh! The columns go all the way from A to Z and then start again at AA, AB, AC. It just goes on and on. I have to freeze literally fifty columns just so I can see what I need to see.’ At the end of the day, after everyone on the team finishes making calls, Sim is left cutting and pasting into the master spreadsheet, painstakingly combing through and checking for errors. Someone is designing a data management tool, but it’s not built yet. In the meantime, Sim works into the night so they can be ready to make calls the next day. She tells me her friends and family keep messaging her to check how she’s going and she can’t respond. ‘I just text their names to Emily and then Emily writes to them for me, saying I’m so glad to hear from them but I can’t write back at the moment.’ ‘Lucky you have an Emily,’ I say, and I can hear the smile in her voice as she says, ‘Yes! I am lucky.’ We plan to talk at 8 pm on a Sunday evening, once she’s finished making calls, but Sim bails at the last minute. ‘One of the unit managers just contacted me about a staff member in a family violence situation.’ Sim isn’t meant to be the go-to person for staff family violence issues; her role is around patients. Adrian should technically be calling someone in People and Culture. But he did a training session for managers where Sim spoke. ‘And of course,’ Sim says, ‘what people remember is how you made them feel. They remember your face more than what you said. So his first thought was to contact me.’ One of his staff members had asked for family violence leave. She was leaving her abusive partner, taking three children, and she needed a few days to sort out her accommodation and settle her family in the new place. She couldn’t come to her next shifts. Adrian remembered Sim’s training. Listen and believe the person, reinforce that it’s not their fault, find out if they currently feel safe and offer them support. Adrian approved the family violence leave which, for the sake of confidentiality, shows as personal leave in the system. He made sure his staff member was connected to a social worker. But he wanted to check with Sim if he had done everything right. Did he say the right thing? Was there anything else he could do to support her? He had never been in this situation before and he felt confronted and upset by the details of what had happened to his staff member. He wanted to talk it through with someone he trusts: Sim. Sim had been on the phone all day to people in quarantine but she was glad Adrian called. ‘I don’t want anyone to feel like they’ve knocked on the wrong door. If you ring us about a staff member, we’re not going to turn you away. We start by saying yes, and then we think about where to go next.’ From Adrian’s story, it sounded like he remembered the important things. It gave Sim a sense that their family violence training was working. Even if it kept her on the phone for another hour that night. Sim has worked twelve days straight and into the evenings. It’s another Sunday and her first day off. When I text to ask if she would like to talk, she says she’s a mess. I think the question should actually be, Would you like to talk to me? Of course I would. But when she texts later that afternoon to say she’s ready, the timing is off. I’m about to get in the bath. Would it be weird if I called you from the bath? I text. Not for me! The bath in our apartment is funny and short with semi-mouldy bath toys in the corners. But I’m short too, and once the toys are on the floor, they’re out of my eyeline. I prop my phone on a chair and sink into hot water. The PJ Masks soundtrack (background to most of my relaxing moments these days) seeps its cartoon heroism under the door from the loungeroom. I touch Sim’s name on my phone. ‘Hi,’ I say, laughing off my embarrassment. ‘I just got in.’ ‘Oh, I would kill to be in a bath.’ She sighs. Their rental only has a shower. I wish I could run her a bath and leave her there for hours with chocolate and a huge cup of tea. She’s in tears in seconds. She was awake for hours in the night. She has chilblains and tinnitus and her period. She’s exhausted. She doesn’t think she’s doing this right. Any of it. She’s not competent and she doesn’t understand why anyone would think she can do this job. ‘I’m mean to my housemates. I’m mean to my girlfriend. I’m not a very nice person to be around. And I said I’d cook dinner tonight, because tonight is the only night I’ll be able to. But …’ I can hear how much she doesn’t want to cook dinner. How tired she is. I’m thinking about trying to organise them a meal. Is there something in our freezer? Can I sort out a delivery? As I’m listening to Sim, Jack pokes his head around the door and his face lights up. There’s nothing he likes more than being in the bath with me. ‘Can I get in? Can I? Can I? Can I?’ I have to rescue my phone from drowning as he clambers on the chair and tosses his clothes around the

floor. ‘Sorry Sim, I have to go.’ I hang up on my friend and help my child get his tight singlet off over his head. He scrambles into the water and starts using my legs as roads for his matchbox cars. I bribe him with the idea of more TV later so he will sit still and allow me to comb conditioner through his matted curls. I let him blow raspberries on my tummy and we both laugh hilariously at the splattery noises we make. When I hop out, I run more hot water in the vain hope he’ll stay in there long enough to let me get dressed alone. I don’t do anything about organising dinner for Sim. The next time we speak, Sim tells me about another nurse in quarantine. She had two children, and the six-year-old had extreme asthma, so they were really worried about safety. She FaceTimed her children from her bedroom and tried to figure out how to play games with them through her window to the garden. She was heartbroken but coping. Someone had a three-year-old who didn’t understand why Mum couldn’t come out of the bedroom. The woman sat on the other side of the door and listened to her child’s wailing tears. Unable to go and comfort her. Someone else said her husband didn’t cook, so their seventeen-year-old daughter was doing all the cooking. While also studying for her final year of school. At home. Sim spoke with a nurse who speaks Cantonese. A Cantonese-speaking patient had been telling her he had a sore throat. She kept saying to a doctor, ‘We need to get this patient tested. He’s got a sore throat. He needs to be tested.’ The doctor disagreed and it later turned out that the patient was positive and the nurse had to go into quarantine. Sim agreed that it wasn’t okay, helped the nurse figure out her quarantine logistics. Sim spoke with a neurologist in hotel quarantine who bemoaned the fact that, even now, he still didn’t have time to watch TV. He was on one of the wards where everyone was furloughed, including most of the neurology doctors, and the emergency department still needed a neurologist. He was conducting consults with ED over video-link for hours every day. She called a family with children where both parents were positive and realised they didn’t have enough food to get them through until a home delivery slot was available. Karrie approved a courier to deliver packed meals from the hospital. For the first time in her role as a nurse, Sim felt as though resources were not an issue. She could get people what they needed when they needed it. Most days she didn’t get much time for a break. Emily or one of their housemates would walk across the backyard to leave plates of snacks by her office door – figs, crackers, nuts and chocolate – easy for eating quickly between calls. Some days Sim took an entire shift to iron out problems with one particular person. Some days she called thirteen people in four hours. ‘I’m wired, I’m overtired and I’m dreaming of spreadsheets,’ she said to me. Sim and Karrie started developing processes, thought about how they could be most useful, how often people needed calls, what other teams and services were available for them to connect to. They were also orientating new team members daily. It was like trying to build an aeroplane while it was already in the air. Their team was just focusing on the close contacts and had been told that people who were Covidpositive were being taken care of. But they began to get the feeling that Covid-positive people weren’t being cared for to the same degree. People in quarantine started saying, ‘My colleague is sick and they’re not getting these phone calls.’ Karrie spoke with the doctor in charge of welfare for all the staff positive cases. There was only one of her and she was feeling swamped. They added the doctor to their team, and the positive staff to their list. Now they had two specialised arms: one calling staff in quarantine and providing advice about potential symptoms, testing and quarantine dates. The other calling staff who were positive. This team needed to have a good understanding of the likely progression of symptoms, knowing when to escalate to a medical review or home monitoring, and advising on clearance processes. One of their colleagues in quarantine had a panic attack and they ended up having to send an ambulance. Karrie decided they needed more specific skills on the team. They pulled in a mental health nurse, an occupational therapist and a social worker. They were all working remotely, using at least three different platforms, innovating with the tech they already had and learning the best ways to collaborate with each other. There was so much important information they all had to learn quickly. They huddled each morning over video conference, and during the day would pass specific cases to each other according to speciality. Some cases they dealt with didn’t come from their call list. They came via word-of-mouth. They called a quarantining physio who responded, ‘I’m fine, but can you please ring my colleague because he’s really distressed.’ Sim called the colleague, Kim, a health assistant whose job was to go out in the community to provide in-home care – helping frail people with simple tasks such as getting out of bed and doing a little walking. Kim was asked to provide support for an elderly person who had just been discharged from one of the hot Covid wards. The patient had tested negative twice but Kim wore full PPE as a precaution. When Kim arrived, the patient was quite unwell and coughing all over him. ‘I’m really glad I wore the PPE,’ Kim said. ‘But doffing was really hard.’

Doffing, taking off PPE, is a complicated process and must be done in a particular order. In the hospitals they have a dedicated area for doffing and a specific bin – one that doesn’t close with a flap and cause ‘bin wind’. But health workers in the community were doffing into the back seat of their cars and it was even trickier. When Kim put on his PPE, he had to remember to double-glove one hand. At the end of his visit, he removed this glove first so he could open the car door with a gloved hand. Then he had to get his PPE off and into a plastic bag in the back seat of the car. But this was a windy day. The wind was ruffling his gown all around him and blowing it up towards his face. The next day Kim’s patient tested positive. Kim wasn’t officially considered a close contact because he wore full PPE. But he was worried. As Sim listened it became clear that Kim was anxious and upset. He was self-quarantining without hospital support. He was feeling short of breath, which is a classic Covid symptom. But also, he knew he was really stressed. ‘I don’t know if it’s Covid or anxiety!’ he said to Sim. She organised for a medical review. A few days later there are reports that a cleaning company is taking staff to the Fair Work Commission for refusing to work after a coronavirus outbreak. I feel sick that someone thinks they have the right to force people to work in a place where they are reasonably afraid of infection during a global pandemic. Within a day the company stands down. But Sim has more to tell me about cleaning staff. ‘I have to tell you about some Spanish sharehouses,’ she says. ‘So it turns out there are lots of Spanish young people on student visas; I know of at least – oh, have I spoken to nine of them? There are probably more. They work as contract cleaners so they’re employed through a cleaning company.’ These contracted cleaners are over and above the regular hospital cleaning staff. They’ve been brought in to clean the high-contact surfaces: lift buttons, stair rails, high-flow areas. In the past week, a lot of them have either been quarantined or become infected. ‘And it’s a tricky thing,’ Sim says, ‘because they were working at our hospital, but they were contracted to a company, so there’s been a question about who should be supporting them.’ One of Sim’s Staff Health Welfare colleagues, a nurse called Lynda, got in contact with Sim. ‘I’m really worried. I’ve just spoken to a Spanish guy in a sharehouse, and he said they don’t have enough food, they don’t have enough blankets or heaters, they don’t have any support or services, and they can’t leave because two of them are positive. It’s so cold today, can you see if there’s something we can do?’ They already had the go-ahead to courier hospital blankets to anyone who needed them and Sim set this in motion. But this sounded like they needed more than just blankets, so Sim asked Lynda to call back and get a few more details about who was there, how many of them were on the hospital list and if there was anyone else in the house. Lynda called back with an interpreter and began asking for people’s names and dates of birth – which was how she could locate them on her list. But the guy she was talking to didn’t want to answer those questions. He was starting to sound afraid, and Lynda began to wonder if maybe there was someone with visa issues in the house. If they were afraid and secretive and didn’t give all their information, Lynda knew it would make them harder to care for. She was slowly able to win their trust and it became clear that two people in the house, the two who had tested Covid-positive, had been at Royal Melbourne Hospital. The third, a partner of one of the cleaners, had not worked in the hospital and was waiting for test results. Their situation was bad. The heater was broken and the landlord was refusing to fix it, citing the current lockdown restrictions. Sim and Lynda thought this was probably wrong, but they are not experts on tenants’ rights and advocating for landlords to fix heaters was beyond their scope. The people in the house had fevers and they didn’t have any Panadol. Nobody in the house had money. Lynda asked gently, ‘What were you thinking about doing for food? I mean, if we hadn’t called?’ ‘Oh,’ he responded, ‘we were thinking about going to a church.’ The hospital could offer hotel rooms to the cleaners who worked for them but not the partner. At least in a hotel they would be fed. But they didn’t want to separate from each other, and they really didn’t want to leave anybody alone in that house. So Sim called someone higher up in HR to see if she could work around their current guidelines so everyone was safe and cared for. The guy in HR was busy and Sim felt dismissed. ‘Why didn’t they just go home when this whole thing started? Why are they even here? Call the cleaning company.’ So Sim called the cleaning company. A brusque man with an Australian accent was brushing her off before she could finish asking her question. ‘No,’ he said. ‘What do you mean? What are you talking about? We’ve been in contact with everyone, and they’re fine. Everyone’s told us they’re fine. There’s no problems.’ Sim took a breath and said, ‘I’m really worried about this particular situation because I don’t know why they’d be telling us that they’ve got none of these things if they’re fine.’ After some back and forth he offered to call his supervisor. ‘She speaks Spanish, she’ll call them and suss out what’s going on.’ ‘Okay,’ said Sim, ‘but can you get her to call me back afterwards?’ When the Spanish-speaking supervisor called back, she was smooth and reassuring. ‘Oh no, Simone,

I’ve spoken to them all and everyone’s fine, it was all a misunderstanding.’ ‘What?’ Sim asked. ‘I don’t understand.’ ‘Oh, their English is not very good, and so when you were talking to them in English, they just got confused,’ the woman explained sweetly. ‘But everything’s fine.’ ‘Well, that’s not actually the case, because we had a professional interpreter,’ Sim began. ‘Oh, no, no, it’s all fine, there’s no problem.’ None of this felt right and Sim had a sinking feeling about things being covered up and people suffering because of it. Not to mention the issue of spread if people weren’t being supported to quarantine properly. The hospital HR guy sent Sim an email saying that he had someone in the office who spoke Spanish and he would ask her to call the house. Sim wasn’t sure about this. Wouldn’t an interpreter be more professional? But by now Sim had been on the phone about this case all day. At 6 pm the Spanish speaker from her People and Culture team wrote to say that the household now had blankets and a heater and someone would be dropping off groceries. The sharehouse was officially no longer Sim’s job and she should have been clocking off but she felt unresolved and worried. She was concerned that someone from the cleaning company had told their staff not to talk to the hospital. Something had happened to make them clam up. Then the next day she spoke to a second sharehouse of Spanish speakers where there was one positive person, two people in quarantine, and someone else who was not a cleaner. The person Sim called wasn’t positive, but it became very clear that the quarantine wasn’t ideal. It was a small two-bedroom apartment and the Covid-positive person was sharing a bed with someone who was supposed to be quarantining. Initially they told Sim that the two girls were in one room and the two boys were in the other, but soon Sim realised that something wasn’t quite adding up. ‘Look, it doesn’t matter, we’re not judging here, it’s just that we need to know who’s been in contact with who so we can help figure out your quarantine dates.’ The story came out that they were two young hetero couples who felt like they might get in trouble for sharing rooms. Again, it took Sim all day because it required various phone calls to people at high levels and several interpreted calls with the sharehouse because she had to keep getting more details about things that they didn’t realise they needed. The two couples were really worried about money because they were on student visas and they didn’t have much. Obviously while they were quarantining, they weren’t working. They wanted to know about the government payment. At that point Sim thought to herself, I don’t know, does it work for people on student visas? Even if it did, she could see their challenges in communicating with the department to get that money and finding the supports they needed. They were distressed at the prospect of being separated into hotels. They clearly had a sense of community and were looking after each other. Sim tried to figure out a way it would be possible, in this small two-bedroom apartment, to separate the positive person from the two in quarantine, from the fourth person, who hadn’t been a contact but possibly should be in quarantine now. ‘Please,’ they asked Sim, ‘is there enough food if we go to these hotels?’ ‘Yes, you get three meals a day and snacks,’ she told them. Eventually the two who were quarantining moved into a quarantine hotel, and the positive person moved into a positive hotel. But the fourth person hadn’t worked at the hospital. Sim talked him through quarantining himself alone at home and checked he had enough food. It was all she could do. In between quarantine calls and her continuing work as a sexual health nurse, Sim is still working some shifts at ICU and Peter Mac. She has patients who are quiet and patients who are delirious after massive brain bleeds and cardiac issues. She has busy days with neurosurgical teams and consultants visiting her patients. On one ICU shift the medical team was talking about moving her patient towards end-of-life care. Sets of doctors were coming in and out to see him and make decisions and Sim was both very busy and feeling sad for her patient and his family. A medical team arrived. Someone in a mask and shield said, ‘Simone! It’s me, Stacey, from the Staff Health Monitoring team.’ She reached out and touched Sim’s arm. Sim was also in a head-covering, goggles and a surgical mask. Stacey was one of the doctors Sim had been checking in with each morning before making calls to quarantine. They had only ever met on a screen. ‘I recognised your eyes,’ Stacey said. Somehow, in a moment of feeling fragile, the empathy from Stacey made all the difference. ‘I just really clocked that physical contact so much,’ Sim says to me later. She holds on to the knowledge that someone she trusts will be caring for the patient she is handing over. ‘Stacey will still see him, she’s part of the medical team that will see him,’ she says. Two days later Stacey and Sim see each other’s faces again, but this time on monitors in their homes as they meet before calling more of their colleagues in quarantine. People quarantining also had a hotline they could use to call the staff welfare team. On the weekends the hotline number was diverted to the team leader – often Sim. ‘Hello?’ The voice on the other end was young and sounded female.

‘Is this … is this the hotline for the … for the Covid staff health team?’ ‘Yeah, that’s us,’ Sim said. ‘Can I just …. can I ask … is this anonymous?’ ‘Ah, what do you mean by that?’ ‘Do I have to give my name to talk to you?’ ‘No, no, you can ask questions and that’s totally fine. You don’t need to tell me who you are.’ ‘If I got furloughed and I was isolating at home in the same house as my boyfriend, but we were still sharing the bathroom, would that be illegal?’ ‘No,’ Sim explained, ‘that’s not illegal. That’s fine. You just need to make sure that you clean the bathroom in between uses to try to prevent the infection spread.’ But the request for anonymity raised some red flags for Sim. ‘Has someone said something that’s made you worried about this?’ Pause. ‘Yeah,’ the anonymous caller said. ‘People are talking about how you can get into trouble if you’re not in a hotel. They say you can’t stay at home if you don’t have your own bathroom. They’re saying that’s illegal.’ ‘No, there is nothing illegal happening here. We give some recommendations around what quarantine can look like and we can offer a hotel if that’s useful for you, but there’s no problem with you managing it at home. Our job is to talk you through how to make that work.’ ‘Oh,’ her voice was full of relief. ‘Thank you, that’s great.’ The anonymous caller was ready to hang up, but Sim kept her on the line. Her caller had sounded quite frightened and Sim was worried about how threatened she felt. ‘I am a bit worried because it sounds like there’s some misinformation spreading. Is it possible for you to let me know what sort of area you work in so we can provide some education to that team?’ ‘I’d rather not say,’ the caller responded. ‘I work on … I work on a ward.’ ‘Okay.’ There are a lot of wards in the Royal Melbourne Hospital. Sim and the team had been so focused on trying to deal with the people already isolating or quarantining that they hadn’t had a moment to think of what everyone still working might need to know. And it looked like, instead of clear information, there were harsh rumours spreading amongst staff. Sim and her housemates had a plan for if Sim or Em were furloughed. They knew which bathroom they would use and how they would divide up the house. Their housemates had agreed to do the cooking for all of them and drop the food at the bedroom door. But you can’t have a quarantine plan if you don’t know what the requirements are. Sim spoke with Karrie and they quickly set up several ways to distribute information to the entire Royal Melbourne Hospital staff: if you get furloughed, this is what quarantine looks like; this is the support we will give you. Sometimes care is just clear information at the right time. Sim realised that many of the nurses she was talking to were from Royal Park aged care – a nearby but separate campus of the Royal Melbourne Hospital. As with previous wards where everybody was furloughed, the names started coming up on the team’s call-list before they were notified about the onground situation. It wasn’t until she’d spoken to a few people that Sim realised how bad things were at Royal Park. The nurses she was talking to were mostly older women who had been working with the same residents for years. The nurses knew the residents intimately: how they liked their toast buttered and which window they liked to sit under. Their grandchildren’s names. Over a few weeks, more and more of the residents from Royal Park started dying. They died with only nurses and doctors beside them. Their families said goodbye over video-link. The nurses who had cared for them for years were in quarantine. The nurses cried when Sim called them. They told her about the residents they knew who had died and they asked for news of their colleagues. These nurses were infrequent users of social media. But their workplace was in the newspapers. Several wards were declared not fit for pandemic purposes and were urgently closed down, all the residents relocated. Now the nurses, alone in quarantine, didn’t know where they would be working next week. Would they have a job? Sim and the team called some nurses daily. One nurse, a Greek woman in her fifties, was Covid-positive and isolating in a house with her family. She was in a small bedroom with an ensuite. At day twenty-five she still had a bad cough. She had panicked, fearing that it would suddenly escalate and the shortness of breath would come back. A few days later she was feeling a bit better and trying to get some exercise. She decided she would practise her Greek dancing in the small space between the bed and the wardrobe. ‘I get quite breathless but I’m going to try and do a little bit of dancing every day,’ she told Sim. The woman was struggling with sleep. Her room got only an hour of sun a day, and all the rules of sleep hygiene, like only using your bed for sleeping on, were out the window. All the things that would normally help with her circadian rhythm weren’t available to her. Her family were lovely, they were messaging her all the time and asking if there was anything else they could bring her or do for her. ‘But you know,’ she said to Sim, ‘there’s one sound that I haven’t heard in the past three weeks, and I’d

really love to hear it.’ ‘What’s that?’ Sim asked. ‘The vacuum cleaner. It’s been three weeks now and I haven’t heard the vacuum cleaner.’ They both laughed. And soon Sim was onto her next call. Over the second wave in Melbourne, more than 750 staff at the Royal Melbourne Hospital were furloughed for being Covid contacts. About 260 staff became infected. At one point the team was calling over eighty staff a day. Some of those phone calls took one person’s entire shift. One day, one of the senior doctors looked at their call-list and threw her hands in the air. ‘This is not sustainable, we need extra staff, this is not going to be sustainable.’

CHAPTER 10

Pool Nurse

Heya Sim! Can I ask you for some advice? I’m having a bit of a hard time with something. Sim had just finished her work for the evening when one of her colleagues, Franki, messaged her. Yes, of course. I’m going for a walk in about 15ish … can I call you then? Franki works for the Nurse Resource Transition Pool at the Royal Melbourne Hospital. He’s what they call a ‘pool nurse’. This means he works across all kinds of wards in both the city and Royal Park campuses of the hospital. He is permanent staff but, unlike some nurses who work regularly on specific wards, pool nurses are allocated shifts wherever there’s a vacancy. They are sent where they’re needed. For the past several months, Franki and his fellow pool nurses have mostly been needed on the ‘hot wards’. He has been nursing Covid patients. It’s been hard, hard work. Made harder by the fact that so many of his colleagues consistently misgender him. They refer to him as ‘she’. When Franki first started at the hospital he used a different name and different pronouns. Sim met him last year when he attended her second-ever family violence training session. Franki, a grad nurse, approached Sim at the end of the half-hour session and the two of them struck up a friendship. Franki first started using his new name when he worked on a trauma ward. He’d spent a long time thinking about it and had settled on Franki. He went into work that day, and his previous name was up on the whiteboard. ‘Hey,’ said Franki to his manager, ‘I’m actually going by the name Franki now.’ ‘Oh yeah, cool,’ she replied. She rubbed off his old name and wrote, ‘Franki’. It’s one of his favourite memories of transitioning at work because it was so casual. So simple. Some other people at the hospital made it easy for him. Someone in HR changed his email, someone else organised him a new name-badge and changed his name on the roster. They streamlined processes. He didn’t have to fight to justify himself. The staff on the trauma ward got to know him for who he was. Then, at the start of this year, Franki started working on pool. It was around the same time Covid really kicked off. Being a pool nurse is challenging even without global pandemic conditions. It is daunting going to different wards, different specialty areas each day. Franki would get a quick orientation at the start of the shift: the layout of the ward and where everything was. He didn’t know the other staff. Each shift was a whirlwind. On the Royal Park campus for aged-care patients, not only did a huge proportion of the patients get sick, so did the staff. There were wards where every single regular nurse, including the unit manager, were either Covid-positive or quarantined. The pool nurses stepped in. Later, Sim introduced me to Franki and he told me about it directly. ‘I had a two-week stretch of nights at Royal Park so I saw the same people for a while. Sometimes a person was fully conscious, and I was having a conversation with them, and then a few days later I would see them again and they would be acutely unwell, unconscious, just essentially being palliated. It could be forty-eight hours, and this person could completely deteriorate in front of my eyes. It was wild. ‘And there was the added layer that people’s family members couldn’t be with them. So I was trying to facilitate a very fragile situation with them in any way that I could, whether it be FaceTime or talking to them on the phone.’ Franki worked all night, every night, in full PPE. Scrubs, gown, gloves, mask, face-shield. He carefully changed, time after time, as he moved between tasks, making sure he got the order right. The PPE is vital to people’s survival. But Franki says it can make his patients feel disconnected. ‘I feel like it’s … it’s not a very human situation for them. This is their last twenty-four hours. They’re not even really seeing a smile. They can only sort of see a square portion of my face. It’s a lot to process; it’s so traumatic.’ In the midst of the outbreak at Royal Park, on a ward where all the regular staff were gone, Franki cared for an older Italian man, Matteo, who reminded Franki of his own nonno. It was months since Franki had seen his nonno and it was both sweet and heart-twistingly sad to care for someone who felt so familiar. ‘My family are Italian,’ Franki said as he checked Matteo’s respiratory rate. It was fast but not too bad. ‘Oh,’ said Matteo. ‘Where are you from?’ ‘My nonno is from Sicily, from Sortino.’ ‘Good. That’s good,’ Matteo said, patting his hand. Matteo was only meant to be staying at Royal Park temporarily while his family were setting up a more permanent living situation. But in a matter of weeks he began to look starkly different. He stopped eating

and lost kilos and kilos of weight. He needed medication to stop secretions pooling and gurgling at the back of his mouth. Franki was at Matteo’s bedside one evening when his son called. Matteo’s weak hands fumbled for his iPhone. He didn’t have the strength to lift it to his ear. Franki held the phone so Matteo could listen to his son on speaker. ‘Dad, please eat something,’ his son begged. Franki held the phone and held himself together, listening quietly as Matteo’s son began to cry. ‘Please Dad? Please? Tell me you’ll eat something.’ Matteo’s son sobbed down the line and Franki looked at the old man’s face. He’s given up, Franki thought. He just wants to die. It was only a few minutes of a single busy night. Everyone else on the ward was a pool or agency nurse. The manager had come across from ICU; all the regular staff were gone. It was chaotic. Nobody knew where anything was. Nobody was familiar with the patients. It was one nurse to eight very sick patients with high-care needs and Franki felt like he was running for whole shifts at a time. Patients needed help to go to the toilet, or they needed their pads checked and changed. Patients with dementia got out of bed and wandered around or, worse, fell. Many patients couldn’t turn themselves in the bed, which meant that, uncared for, the bony prominences pushing into the mattress for too long would cause sores and skin breakages. They were very unwell with Covid and not eating, meaning there was even less cushioning between their skin and bones. It takes at least two nurses to turn a patient and they need to be turned every two to four hours. Franki helped his colleagues with their patients and they helped him with his. The nurses sweated under the PPE as they worked to turn people. ‘My scrubs were disgusting by the end of it,’ he tells me. ‘They were wet from sweat.’ Many of the patients were on morphine for their pain or because it helps with the respiratory distress caused by Covid. The morphine was in a double-locked cupboard needing two nurses, a key and a swipe card to enter. Each time Franki had to give a patient a dose of morphine, he needed to find another nurse so they could open the cupboard together. His fellow nurses called on him to do the same. ‘You’ve got to balance caring for your own patient allocation and helping other people out,’ he says. There was a sense of working as a team under tough adversity. Franki felt like the nurses were working well together, supporting each other, getting the job done. They also referred to Franki as ‘she’ a lot. It was tiring. Each time someone used the wrong pronoun, he felt like he was being pushed outside himself. Each time, he faced his own internal conflict about whether to correct them or not – when it meant potentially handling someone else’s big feelings. Maybe they would be hostile? Or openly curious about things that are very personal to him? Or what if they become overly embarrassed when they realise their mistake and are desperate for reassurance from him? Often, people are simply dismissive and forgetful, like who he really is doesn’t matter to them. Franki is very sweet and generous. He knew his colleagues were under enormous pressure and had a whole lot of information to process. Like Franki, they had been carefully doffing and donning PPE in order over and over again, calculating dosages, holding phones and watching people die. Like Franki, they had another ill patient to rush to. He didn’t think people were deliberately misgendering him or trying to hurt him. He says it wasn’t malicious. ‘It takes a lot of mental energy to be a nurse; you’re engaging with patients, you’re engaging with other clinicians, you’re emotionally and mentally putting a lot of energy into your work.’ Franki thought he could make it easier for people to remember. He got a big black marker and wrote ‘He/Him’ on his face-shield. Sometimes they still forgot. ‘It’s like the icing on the cake. Just to have a really tough day, seeing people passing away, or having to facilitate calls with family members whose loved one is dying. And you know, a disease that’s affecting everyone. Then getting misgendered on top of that. It doesn’t exactly make it any easier. Sometimes I just don’t have anything left in the tank to correct other people with my pronouns. ‘It’s frustrating sometimes because as a pool nurse, I might bring all this energy into doing it and then I might be somewhere else tomorrow. So I would have to do it all again.’ It added a blanket-layer of exhaustion to his day. An extra level of feeling just a bit invisible. He wasn’t talking about wanting his patients to change their behaviour. ‘I guess I have more of an understanding when it comes to my patients because … that’s my job. I see myself in the capacity of a nurse. It’s not about what gender I am.’ When he’s with his patients, he’s focused on their needs. ‘But I do feel like the more my colleagues use the right pronouns for me, maybe my patients will get it too.’ Franki tells me about one unlikely patient. She was ninety-four and had Parkinson’s and then contracted Covid. He looked after her in a hot ward in the city campus and even though she seemed very fragile, she made an excellent recovery from Covid and was being moved to rehab. As Franki helped her prepare for transport she said, ‘I really hope there are a few more men on that ward – because it’s slim pickings around here!’ Franki laughs, ‘She was a really, really funny lady. I guess she’s just living her best life in her old age.’ It makes me think of what Sim says – that we need to drop expectations about which patients might want to talk about sexuality. And it reminds me what I know to be true but has somehow come into question in public discourse – that people at higher risk from Covid do have a best life to live. A life that is

worth protecting. Franki changed out of his scrubs in the nurse’s locker-room and bundled them carefully into a plastic bag. At the car, he pulled out his can of Glen20 and carefully, thoroughly, sprayed down his shoes. He didn’t cry about Matteo. He didn’t cry about his other patient who had died or about being misgendered again. He didn’t cry. He drove home. He came into the house via his personal back way, straight through the garage, directly to the laundry. Scrubs into the washing machine on the hottest possible setting. Straight to the shower. Then to spend the evening and night alone in his bedroom. He has spent months hanging out only in his bedroom, except when he’s cooking or doing his laundry. He was having trouble sleeping. ‘I was really stressed that I was going to give something to my family. Even when I wasn’t at work, I was worried at home that I was going to give them Covid. Switching off doesn’t really happen because it’s still everywhere – the social media, all my conversations. Every, every single thing I did was all about Covid. And I think for us healthcare workers, this was really distressing because, you know, when we’re being confronted with so much at work, coming home and trying to have some sense of normality …’ His body was sore. His back was sore. They have very clear safety practices and plenty of systems and tools for helping lift and take weight. But still, he came home aching. Still, his body wouldn’t let him relax. His brain just kept on firing. There were nights when he would sleep only one or two hours. In the morning he had to weigh up whether it was safe for him to go to work. He also knew the hospital was desperate for staff and asking everyone to work overtime. He felt that taking time off was letting down his colleagues. But at work, Franki would be administering strong medications, and he needed to know he could give them safely. He needed to do patient observations and note them down correctly. He needed to go through the steps of keeping himself and his patients free from infection, over and over again. He was managing Covid’s dangerous breathing difficulties. It was life and death. He absolutely had to get it right. Some mornings he knew he had to take personal leave. He wasn’t safe to do his job. Any time he got the slightest symptom, Franki called in sick, went and got tested, and waited in his room until he got the results. Once, while he waited, he called a colleague, Ali, who had also recently been tested. Ali lives with his mum who is chronically ill; she would be a severe risk if she caught Covid. Franki talked about being scared of infecting his family. Ali agreed emphatically. ‘Dude, I was like, sleeping in my car until I got my results because I didn’t want to go in and give my mother a deadly virus that could kill her.’ Franki got a great sense of relief when he finally had a moment to talk with his colleagues about how he was feeling. He told me, ‘We’ve all had a lot of similar, scary and isolating experiences, you know, the people I worked with on the Covid wards. It’s very comforting, talking to colleagues about it, because they understand and it’s a pretty wild experience to go through.’ Franki called Sim when he realised he was struggling with his mental health and that it wasn’t just Covid. He described his workload combined with the emotional impact of constantly being misgendered by his colleagues. He didn’t want to complain. ‘I know it’s really hard for everyone at the moment.’ ‘No,’ Sim said. ‘This is … this is hard.’ They talked about options for educating more of the hospital staff, they talked about Transgender Awareness Week. They talked about Franki making a video for his colleagues. They talked about how the lack of education amongst the hospital staff might affect trans and gender-diverse patients. In the midst of all this, Franki wants to be an advocate for other people. ‘You know, for patients who are trans and gender-diverse, they might arrive in hospital with their deadname and the wrong pronouns on their paperwork – and a super awesome nurse would note the change on the system and have their wristband updated. Or they could have a nurse who doesn’t know anything about it and makes their hospital experience a really horrible and dysphoric time.’ Sim has spent a lot of time thinking about this. A recent study of healthcare for gender-diverse Australians showed that 58 per cent of respondents said fear of mistreatment was the biggest barrier in accessing healthcare. Discrimination has direct and sometimes devastating impacts on people’s health. This makes it an issue for health professionals. In her job as a nurse educator, Sim was asked to run a healthcare-specific training session about trans and gender-diverse inclusive practice. She knew that, as a cis woman, it wasn’t something she could do alone. She worked in her own time with several trans and nonbinary people and Zoe Belle Gender Collective to develop and deliver the new session. Sim calls me after she’s spoken with Franki. ‘I just felt sorry. So sad. Because this is someone who has been working in the thick of it. Franki is doing the job that we need most at the moment which is filling the gaps and going to all the hot wards. It’s a bloody hard job. The workload he described has been intense – physically and emotionally. I can’t imagine adding to that with the denial of his identity. It has really been affecting him. It makes me a bit angry,’ she says. ‘He said I was the first person he’d told about how the misgendering was affecting him. I was the person who came to mind. It made me feel really … ah, I don’t know. I don’t feel deserving of that but I’m really, really glad he told me.’ I know exactly why Sim was the person who came to mind. A few weeks ago, Sim sent me a photo captioned, Too much fangirl?! It was an image of her room with a pillar of band posters down one wall. All of them women – in

checked shirts and Akubras, dungarees and boots, guitars in their hands, irony in their gazes. The posters are lit with a row of overhanging fairy lights. But the way she fangirls is part of something bigger about Sim: her unequivocal sense of the goodness of people and her unashamed sharing of that love. As her friend, I live in the beneficial glow of this. I have absolutely no doubt that Sim thinks I’m fabulous. She is the most consistent sharer of all my publicity, the most enthusiastic voice in the room. The one sending me pictures of the adorable children in her life clutching my books excitedly. She and Emily are at all the launches, smiling together. More often than not, they are volunteering to sell books or sweep up after everyone else has gone home. Sometimes I’m afraid Sim has put me on a pedestal that’s about to dissolve in the reality of all my flaws. But mostly I understand that she already sees my flaws and they don’t get in the way. Franki lives in Sim’s glow too. Franki is a gentle, kind and lovely sweetheart, she said when she first emailed me about him. In the same way that she found leggings for everyone in our acro class, Sim wants to share with me the stories of the people she sees around her. She wants me to record them too. When Franki tells me about their phone call, he says, ‘Honestly, I felt so relieved after talking to Sim. She just straight up said it wasn’t good enough and started to talk about what we could do to make it better. She’s amazing.’ It makes sense that involving Franki as an advocate for other trans folks gives him a sense of hope about his work. He wants to be part of making the hospital a better place. Franki clearly loves his job. ‘I am very, very grateful for all the opportunities I get to experience at the hospital.’ When he was at university, training to be a nurse, one of his lecturers told him, ‘Part of the nurse’s role is advocating for your patient.’ ‘I love, love, love the patients. I think the real privilege of being a bedside nurse is being with a patient for the entirety of your shift. If you’re on the same ward, you might look after them several days in a row. You really get to know the person.’ He tells me about another patient, Deng, who had been knocked off his bike and really messed up his arm. ‘This poor guy hated hospital. Like, no-one enjoys being in hospital, but he absolutely loathed it. He was just hanging to get home so badly.’ Franki cared for Deng for several shifts. Deng had had surgery and skin grafts on his arm and had to stay a few days to make sure the grafts had taken. If it didn’t work, he might have had to stay longer and have more surgeries. ‘Do you think I can go home today?’ Deng asked as soon as Franki walked into the ward. ‘Well, it depends on what the doctors say when they come around and check you.’ When the doctors finally came in, they were busy and talking amongst themselves. Franki could see that Deng really wanted to ask if he could go home, but the doctors didn’t give him an opening to speak. They turned to leave. ‘Hey, guys, hang on,’ Franki said. ‘I think Deng’s got a couple of questions.’ The doctors came back in and spoke with Deng. They said he could go home later that day. After they left, he turned to Franki. ‘Thank you so, so much. I thought they would just leave!’ ‘Yeah, no worries.’ Franki smiled behind his mask. When Franki talks to me about Deng, he muses, ‘It would really suck, being in that position. And, you know, if that was me, I would want someone to stand up for me when I couldn’t, or didn’t feel like I could, stand up for myself.’ I don’t think he’s noticing the parallel between the way he cared for Deng and the way Sim is thinking about him. He’s too focused on his patients. ‘For a lot of the people I see, horrific things have happened to them, things that nobody imagines themselves going through. This is a really scary time for them and it’s something that may affect them for the rest of their lives. I think it’s in those moments that you really want someone to care. The last thing you want is for this horrible thing to happen and you’re in all this pain and then the person looking after you is a dick, right?’ At the Austin a few weeks ago, while working one of her sexual health shifts, Sim had a call from a department manager. One of their staff had been in the tea-room, eye-rolling a patient who had requested different pronouns than were on their paperwork. That manager asked Sim to run the trans and genderdiverse training she had helped develop. In amongst days of ICU shifts and quarantine calls, while Covid cases climbed in Melbourne and Franki was working pool, Sim sat online with a group of health professionals, explaining the importance of using people’s preferred pronouns. From there she went straight into individual phone conversations with patients who were seeing her as a sexual health nurse consultant. And out of that to going through the hospital’s policies on sexual harassment to see what was missing in terms of reporting and stopping the behaviour. In the evening she calls me to tell me how overwhelmed she’s feeling. She’s just come home from a walk with a friend she hasn’t seen for a long time. They walked the chilly footpaths of Brunswick as the sun set and Sim wanted to spend hours and hours together. Saying goodbye without hugging, after such an unsatisfactorily short time, has left her sounding chokey and quiet. And then she tells me about planning for the first meeting of the sexual safety working group at the Austin next week. They will be setting up better processes for staff reporting sexual harassment by their patients. ‘It feels big. There needs to be follow-up and I feel like it falls heavily in my lap, even though I don’t

have the power to do the things.’ ‘You’re only working at the Austin one day a week, Sim!’ I say. I want to tell her to take time off. I want to book her a holiday somewhere with a beautiful view. I try to suggest talking with her managers about dialling back her workload. But Sim explains that her managers are a little busy right now. She talks about one manager who’s been helping at an aged-care centre where Covid has struck hard. More than a hundred residents were infected. When staff from the hospital arrived, the residents remaining in the facility needed immediate care. Many had to be relocated quickly. Tents were set up on the grass outside the nursing home from which to manage the situation and a whole detachment of additional nurses were called in. Sim’s manager was supporting her colleagues to liaise across several organisations including both state and federal government, trying to organise care as quickly and safely as possible. ‘She’s been working to get the most unwell patients into transport safely with minimal exposure to other people. She said that the media was surrounding the place for much of the day. As she was leaving at eleven o’clock one night, she noticed a photographer hiding behind a car taking photos of her. It was really full-on. But anyway. That’s why my manager has been busy.’ Somehow, Sim’s already back to talking about the sexual safety working group, thinking about how to develop responses to patients sexually harassing nurses. It’s daunting. ‘I don’t know that we can fix this in three hours of online Zoom,’ she says, her voice rising with incredulity at the task she’s facing. ‘I know,’ I say, ‘because it’s like fixing the patriarchy but slightly smaller.’ She laughs. ‘Yeah, but not that much smaller.’

CHAPTER 11

Covid Nurse

I’M WRITING FAST now, pulling together Sim’s story more quickly than anything I’ve ever written. Listening

to her is still one of my most relaxing times – I just lie on my back with my eyes closed because I can’t walk or do chores while we talk; it interferes with the recording. I keep noticing that my skin is buzzing and I wonder if it’s possible for skin to buzz from anxious loneliness. Does skin feel tense and jangly from months of catastrophic global grief? Or maybe I’ve been overdosing on caffeine. In Melbourne we’re coming to the end of what was supposed to be a six-week lockdown but we already know the cases aren’t low enough yet. They’re hovering around eighty and we’re going to have to stick it out for longer. My mum calls while I’m washing the dishes. If I could have a small change from the current rules, she asks, what would it be? I pause. ‘Honestly, if I can’t have childcare, I don’t know what I do want.’ There’s nothing I can have any time soon. Eating dinner at people’s houses and laughing into the evening. Afternoons on a picnic rug with several friends, trying not to watch our children while talking quickly about everything we’ve been thinking about. Acro class. The ability to read a book without being interrupted by the persistent, urgent need to check the news. I already know I can’t have any of these things any time soon. The day the state government will announce the roadmap for what will hopefully be our last stages of lockdown is Father’s Day. Jack and I cycle up the train-line to buy a huge bunch of irises and fresh croissants and bring them back to our apartment for breakfast. The three of us head out into the bright spring morning and ramble through Royal Park for our allocated hour outside per day. When we get home, the announcement has begun. We turn on the TV and are immediately both glued to our phones. I scan the list. They’re giving us an extra hour of exercise a day and – ‘Childcare starts on the twentyeighth,’ I say. Three more weeks. We can do three more weeks. Though just looking at that span of time before me makes me feel exhausted. Then I see they’re giving us playgrounds and I almost weep. We carry on with our day. Jono mops the floors and folds three loads of laundry while I clean the bathroom with ‘help’ from Jack. I make special Father’s Day pizzas and we clink glasses to Jono. Jono does bedtime while I clean the kitchen and by the time we meet on the couch it’s 9 pm and my bones are aching. I’m fine. I’m just tired. I’m fine. We turn on the TV and I mush my cheek against Jono’s shoulder. I’m fine. I wake in the morning with a migraine. I hold Jono and sob. ‘It’s too long. I can’t do it. It’s too long.’ Later, when I’m fuzzy with painkillers, Jack shows me one of his toys. ‘Isn’t it beautiful?’ he says, and I start crying again. ‘Do you want to call your friends?’ he suggests. I call Sim. Sim has been in ICU with a Covid patient. When she texts me to talk about it, I leap to say yes, close the door and press record. Carl woke up in the Royal Melbourne Hospital after twelve days intubated, sedated and on a mechanical ventilator. He’d had Covid for twenty-four days. Carl is a young man, forty-two, fit and healthy without any of the ‘comorbidities’ people talk about. He was a schoolteacher who caught Covid from his teenaged daughter and ended up very unwell. Being intubated for longer than two weeks is dangerous – those tubes are hard and they push against the soft internal tissues. There’s a risk the tubes will cause pressure injuries in the throat or even paralysis of the vocal cords. As well as this, people who are intubated and on a ventilator are usually sedated – because most people have an uncontrollable gag reflex. Long-term sedation carries its own risks, like loss of muscle tone and cognitive function. After a patient has been intubated for over a week nurses start asking, ‘Should we think about a trache?’ A tracheostomy means they can wake a patient up while keeping them ventilated. Patients with a tracheostomy can start doing physiotherapy and can be slowly weaned off their ventilation. They can’t

talk initially but they can mouth words or write things down. Yesterday Carl had a tracheostomy. The trachea (what we often call our windpipe) is a tube made of rings of cartilage. In a tracheostomy the surgeon or intensivist makes a hole in the patient’s neck and inserts a breathing tube down the trachea. Between the two tubes is a gap that needs to be sealed, ensuring that the air only travels through the ventilator into the lungs and back into the ventilator. A good seal means they can achieve good air pressure – which is needed to inflate all the tiny air sacs in the lungs, called alveoli. In the case of a tracheostomy, the seal is a small balloon around the tube called a cuff which can be pumped up with a little syringe. Sim arrived at the hospital at 7 am for handover from the night nurse, a bright Irish woman called Kelly, who explained Carl’s case and some of his history. Carl was dozing while Kelly and Sim talked outside his room. ‘We tried to give him lots of TLC and calmness overnight,’ Kelly said. She explained that Carl had been sedated for a fortnight, had a difficult surgery the day before and had been in shock. ‘I didn’t wash him because I wanted to let him sleep after yesterday,’ Kelly said. Sim nodded. It made sense, though the washing is usually the night nurse’s job and it meant extra work for Sim today. ‘I brushed his teeth, but he really wants to try it on his own today,’ Kelly continued. ‘And he wants to try getting out of bed.’ Sim nodded again. She thought these things would probably be achievable. ‘And he hasn’t had a bowel movement in eleven days,’ Kelly said. ‘But there are a lot of signs that things are gonna happen soon!’ Some of the drugs given to people who are sedated have the side effect of slowing down bowel movements. Now that Carl was conscious, they were giving him the opposite: something to get him moving. Sim introduced herself to Carl, who had shaggy blonde hair, beautiful tattoos and a gentle manner. He could understand what Sim was saying and responded expressively with his face. He stayed still when she needed him to, could gesture for her attention and help her to turn him on the bed. A lot of people after fourteen days of being intubated and unconscious wake up irritable or possibly slightly delirious. Carl was sweet. Sim clicked through his record on the EMR. It was the most information she’d handled for a single patient on the new system. Lots of observations to take regularly, lots of documentation of ventilation settings and modifications, some IV medications and some nasogastric. There was medication to reduce the risk of blood clots, medication to stop his stomach acid forming ulcers. There’s a tradition in ICU that once-a-day medications are scheduled for 8 am. Sim wished some of these medications could be scheduled for a different time of day. She’d just been introduced to Carl and wanted him to feel safe and comfortable with her. She had to do all her safety checks, a team was coming by to turn him and soon the whole ICU team would arrive for ward round – which is when all the doctors and the nurse-in-charge come by each bed to make a plan for the day. She checked and checked things again, knowing that with so much going on, there was room for error. The ward round arrived. The consultant was in a cheerful mood and happy with Carl’s progress. ‘What we’re gonna do today is get him out of bed. Get him facing the window and getting some natural light. See if he wants to FaceTime his family and brush his teeth. And then probably some really bad telly.’ There was a laugh in the room. ‘Yeah, he’s probably not well enough for quality telly today. We’re at the level of really bad telly.’ The consultant pulled up Carl’s x-ray on the screen. ‘Now that’s a classic Covid chest,’ he said. Sim looked closely. Carl’s lungs were covered in lots of little white patches, like cottonwool. Darkness in an xray indicates open space – air in the lungs. The white patches indicated that the alveoli and tiny bronchial tubes were full of fluid, unable to take up oxygen into the blood. Sim couldn’t hear much when she listened to Carl’s chest; it wasn’t the sound she was familiar with, of somebody with a regular pneumonia where the lungs sound crackly and loose under a stethoscope. The ICU round team did the maths on Carl’s oxygen, looking at the levels in his blood compared to what was going in through the tube, measuring how much oxygen was getting from the alveoli into his blood. Theoretically, based on purely mathematical figures, he was working at about 50 per cent of ideal, which meant if they took him off the ventilator he would probably be dead. ‘Can you check the cuff pressure?’ someone asked. Sim checked using the manometer, a small handheld dial that she attaches to the cuff valve. The needle shot up through the green zone and into the red. There was a problem. Carl’s cuff pressure was set too high. A high cuff pressure can result in complications ranging from sore throat and hoarseness to necrosis, and even rupture. Or it might mean the trache tube is too small so the balloon needs to be pumped tight just to reach the wall of the trachea. Simone twisted the valve to release the cuff pressure. A sound like a bubbling snore filled the room. Carl had an air leak because his trache tube was, indeed, too small. The doctors needed to make a decision about what to do next and had other patients to visit on their round. They adjusted the cuff pressure to a workable but not ideal mid-range and left Sim with Carl for

the moment. She wanted to make sure he was comfortable and that he knew and understood the various tubes and lines going into him. ‘Do you know what these things are?’ she asked. ‘And these?’ Carl nodded. He mostly understood. Then he pointed to his legs and raised his eyebrows. ‘Oh,’ Sim said, ‘those are calf-compressors that squeeze your calves to stop you getting any DVTs – blood clots in your legs.’ People who have to stay in bed for days and days wear a big wraparound sock that squeezes intermittently. It can be annoying having your calves squeezed all night long, but Carl seemed resigned to it, once Sim explained. ‘Do you know where your urine’s going?’ she asked. Carl pointed to the tube. ‘Yep, into this bag here,’ Sim said. Carl did another gesture. ‘Do you mean for your bowels as well?’ Carl nodded. ‘No, there’s no tube there.’ Carl widened his eyes, looking quite surprised. ‘Okay, so if you feel like you need to go, we’ll get you on a pan. I’ll need three other people to help me get you onto it, so we’re going to have to work together on this.’ He grabbed his pen and scrawled, ‘Will all the people stay?’ ‘No, no. They won’t all stay,’ she reassured. ‘But do you want me to go as well?’ Sim was worried about his air leak in the trache and didn’t want to leave him with the doors closed. ‘No,’ he wrote, ‘you can stay.’ ‘Okay cool,’ she said, relieved. ‘I’ll stay.’ She explained that there was a chance she would be outside the room when Carl felt his bowels were about to move and that getting him onto the pan might take her some time. As an ICU Covid patient, Carl was in a single patient room and Sim was wearing full ‘respiratory plus’ PPE precautions: long-sleeved gown, duckbill mask, face-shield and gloves. Every time she went in and out of Carl’s room, she had to don and doff her PPE, in the correct order, with a whole lot of handwashing in between. The order of the steps changed a tiny bit recently with new information from infection prevention, but there were posters and Sim followed them carefully. All of this meant that Sim knew she couldn’t just pop in quickly if Carl needed her. It would take time. But even while she was outside the room, they could see each other through the glass. So they came up with a hand gesture for him to use if he needed to poo. He would cup his palms together and make a pan shape. She said, ‘So if you make this shape, and I see it from out there, I’ll know you need the pan.’ ‘I’ll be the one out there with the red headscarf,’ she said, gesturing to the one individual element noticeable amongst her scrubs and protective equipment. She likes wearing a splash of something bright, especially here, where so many of the colours are uniform. After about an hour and a half at Carl’s bedside, Sim doffed her gown and gloves inside the room, disposed of them, washed her hands and stepped out. On the other side of the door she removed her visor and mask and washed her hands again. Each item can only be touched in certain places and needs to be handled and disposed of in a particular way. She had been out of that room and out of her gear for only a moment when she looked up to see Carl cupping his palms together. At least I know what he needs, she thought. She found the people she needed to help and they quickly and carefully donned fresh PPE. His bowel sounds gurgled through the room, sounding like a microphoned stethoscope. Carl’s tummy was big and tight as they worked carefully together to lift him over the pan. Sim asked her team to leave the room and Carl sat on the pan for some long minutes. ‘Are you done?’ Sim asked. Carl nodded and raised his eyebrows as if to say, Of course! Can’t you tell? ‘Oh, these masks make it really hard for us to smell,’ Sim said. She gestured for the others to come back in. As they lifted him off the pan, Sim saw that it was brimming full. A good half a litre of thick brown custardy faeces. It was the kind of precarious moment nurses deal with all the time – three people working to roll and lift a fourth off a very full pan on a mattress. But Carl was very calm and deliberate in his actions. When the nurses rolled him on his side to take the pan away, they didn’t spill a drop in the bed and the sheets stayed clean. Sim cleaned Carl thoroughly with wet wipes and got him comfortable again. He took up his pen and paper and wrote, ‘I’m really sorry about that.’ ‘Don’t you worry,’ Sim said. ‘You’ve gone eleven days. I bet it feels good to get that out.’ Kelly had said Carl wanted to brush his own teeth. While someone is intubated and sedated, nurses brush their teeth for them. As well as general mouth care, toothbrushing is a preventative technique for pneumonia. It reduces the microbial load in the mouth – microbes that might travel down the tube and into the lungs. But it’s a complicated process. They have to work carefully without bumping the tube.

They can’t use too much fluid because their patient isn’t swallowing and also they need to avoid getting water in the airways, which increases the risk of pneumonia. Sim organised a brush and toothpaste and stood beside Carl as he thoroughly brushed his teeth. She could sense his satisfaction as he smiled and took the rinsing water and a cup to spit into. Carl swilled the water around his mouth, held the empty cup at arm’s length and spat. A perfect arcing fountain directly into the cup. They both burst into laughter, Sim muffled in her mask, Carl silently around his tube. Sim needed to give Carl a wash. With a bedridden patient, this is a slow, gentle process of using wet wipes kept warm in a warmer. Sim helped Carl to thoroughly clean his body. He had been lying unconscious in bed for fourteen days absolutely reliant on other people to turn him and clean him. The places that had been resting on the bed could so easily have gotten horrible pressure wounds, but his heels, elbows, the back of his head were all healthy and clear. There were no spots where the skin had broken down, no areas where he had stayed too sweaty or gotten dry and flaky, no wounds anywhere on his body. An experienced nurse can read the history of a person’s care on their body. There have been horror stories coming out of some aged-care homes, of people left unwashed for days. Pictures of bandaged wounds with ants crawling out of them. Signs that lack of resources or broken systems meant that people were looked after in very cursory ways. As Sim washed Carl’s perfect skin, she had a sense of the enormous interconnected team of people she was working alongside to look after a single person; the diligence of nursing care that had contributed to him being this well. She was grateful to be in Australia, where cases hadn’t risen like they have in other parts of the world. There are times and places where this work has been impossible. Sim spent the day with Carl explaining everything to him as she went along. In the back of her mind was the awareness of the difficult journey both behind and ahead of him. She wanted him to feel as safe and comfortable as possible while he was in her care. She spent more time in the room with him than she usually would. Even when she could do some things at the computer outside, she stayed inside and did them there. He seemed quite calm and as though he liked having someone around. When she stepped out of the room, she was glad she had her distinctive headscarf. There were often a number of different health professionals outside Carl’s window, and she watched his eyes seek and find her flash of red several times that day. Carl wanted to try getting out of bed, but there wasn’t time. The doctors had decided they needed to do another tracheostomy, in theatre under a general anaesthetic. Sim would need to prepare him for surgery. She explained to him about the air leak, and what the new surgery would mean. ‘This could be a lot better by tomorrow,’ she said. When the doctor came in to talk Carl through the surgery process, he’d already had some time to get used to the idea. But he wasn’t happy about it. Two tracheostomies in two days and general anaesthetic after being sedated for a fortnight is a lot. ‘You know,’ the doctor explained, ‘we need your consent to do this. It will significantly improve your outcomes but if you choose not to, we’ll respect your wishes.’ Carl paused. For ten seconds he paused. Ten seconds is a long time for a question to get no response. Then he reluctantly nodded. By the time the team came to collect him for surgery, it was near the end of Sim’s shift. Several different people arrived outside the room, in incomplete PPE, needing to get themselves organised. There was a lot of hustle and bustle around Carl, but Sim’s job was done. She went in and held his hand and explained that when he came back from theatre she would be gone. ‘It was really nice to meet you and I hope things improve for you from here.’ He mouthed, ‘Will you be here tomorrow?’ Sim’s heart sank. She wouldn’t be. And if she were, she wouldn’t be assigned to him. The unit has a general strategy of allocating different nurses to ICU patients – with the idea that fresh eyes on a patient every day might see problems that were missed yesterday. But when patients ask if they’ll see her tomorrow, Sim finds it hard. They spend this vulnerable time getting to know their nurse and the next day they’re faced with someone else. She suddenly didn’t want to tell him she wouldn’t see him tomorrow. ‘It depends … on allocations,’ she said. ‘But you’ll definitely have a good team.’ As Sim doffed her PPE again, carefully, piece by piece, checking the poster and washing her hands at each step, as she walked the hallway to gather her things and change out of her scrubs, Carl was wheeled away to theatre, ventilator beside him, for his second surgery in two days. Sim may or may not find out what happens to Carl.

Conclusion

The Friend

IT’S THE END of September. Staff infections at the Royal Melbourne Hospital have been down to zero for a

few weeks. For the first time since the pandemic began, Sim gets properly fit-tested for an N95 mask. They use a particle generating machine with tubing attached to Sim’s mask to see how much is getting past the barrier. The science of how we keep ourselves safe from Covid is developing all the time. Sim brought in one of the types of masks she’d been using regularly to see how it held up under the testing. It failed. She tried several other varieties and none of them worked. ‘It’s the shape of your nose,’ the woman said. ‘It’s very hard to fit.’ ‘What happens if you don’t get a good fit with any mask?’ Sim asked. ‘You’re probably not allowed to work in the hot areas,’ the woman replied. She finally found one that fit. It was a particular mask in very short supply. ‘You hunt down a few of those and carry them around with you, okay?’ the woman said. But Sim is unlikely to be working with Covid patients for a while now. There are no Covid cases in the hospital. She did her last shift with Karrie and the Staff Health Monitoring team. ‘It felt so strange. It’s been about seven weeks that we’ve been doing this, and when you think about it, that’s not long at all. Sometimes, seven weeks goes past and I don’t accomplish very much at all … and in the last seven weeks we did so much.’ The team has packed their job away into neat files, ready to be unpacked again when needed. They don’t need a whole team on calls anymore – though some of the staff who had Covid are still unwell and we have no idea what the long-term impacts of the disease will be. The global pandemic isn’t over. As I write, the second wave is sweeping through Europe. India has passed six million cases and Brazil is heading for five million. Just looking at the USA feels unbearable. We’ve passed a million recorded deaths worldwide and the ABC is reporting the true death toll is probably double that. But here in Victoria there were only five new cases yesterday. Sim is back to her regular days on the family violence team and sexual health role, with the occasional shift at Peter Mac. Jack is back in childcare. The apartment is suddenly spacious and full of spring sunshine. Outside my loungeroom, things are constantly changing, but the shops and cafes are still closed and we’re not allowed to be out of our homes without a mask. Soon, Melbourne will pass a hundred days of lockdown and things will look different in ways I can’t predict right now. But I have time. I’m writing hard in focused chunks throughout the day. I also answer a call from my friend who is a single mum and wants to talk through the next set of life decisions for herself and her child. Another friend has a child in hospital with concussion, unconscious for two hours, and I can’t imagine what it’s like to sit at that bedside. My friend who miscarried messages me to say she went running for the first time in weeks and I send back a celebration text. I hang out the washing and arrange a play date in the park for Jack tomorrow. For each of these, I put down my pen, close my laptop and jump out into my community. We often hear stories of the writer who works uninterrupted, alone for hours and months. Sometimes I feel deeply envious of that stretching luxury of silent, uninterrupted time. But on days like today, I hold onto a truth: that my interruptions are my relationships. And without my relationships I would not be a writer. Jack and I cycle up to Em and Sim’s house where they’ve just had a pile of mulch delivered. The housemates are out the front in sunhats and dirty jeans, digging and spreading straw and caring for their plants. They stop work to lean on the fence and say hello. They don’t have masks on, because they’re in their own front yard. Mine is a scattering of sparkly peaches across my face, and I stay on the footpath to keep the regulated distance from my friends. Sim has a book for me to read and a purple flower for Jack. Em smiles gently. She’s almost finished her osteopathy degree and will have her own treating room in a clinic next year. She’s still doing some ward clerk shifts and has no plans to stop any time soon. Sim is planning to take a day off a week throughout October. ‘I think it’s better to take my foot slowly off the accelerator, rather than slam it on the brake,’ she laughs. We’re all waiting for the kilometre limit to change, for the borders to open, to see our families. Jack tells them about how we had pizza in the park and the moon rose gigantic and orange and then soooo many bats flew over our heads.

‘Oh, can we do that together one day?’ Sim asks. ‘For sure,’ I say. We’re allowed to do that now, though we can’t go inside each other’s houses. Jack runs races against the stopwatch on my phone to the power pole at the corner and back. We talk about things that aren’t work and aren’t Covid in the ninety-four-second gaps between when he needs attention. Jack clutches his purple flower against his handlebars as we cycle home. He brings it upstairs to show Jono. ‘Isn’t it beautiful?’ he says. ‘Sim gave it to me.’ • Sim is nominated for an Excellence in Nursing award by someone at Royal Melbourne Hospital but she doesn’t know who. She forwards me the email, saying, I’ve just received this … it’s nice – but it’s kind of strange as it doesn’t tell you exactly what you’ve been nominated for … I glance through the list of potential categories and see, ‘Nurse of the Year – Leadership’. ‘You’re a leader, Sim,’ I say. ‘But I’m such a hodgepodge nurse who doesn’t really fit a clear category,’ Sim says. ‘Sim,’ I say, ‘I think the advocacy work you do is leadership. It’s not managing a team, but it is definitely leadership.’ ‘I guess it is …’ ‘It’s definitely leadership. Definitely, definitely,’ I say. ‘It’s funny because I really feel quite fraudulent,’ she says. And suddenly I am tearfully furious about the fact that Sim doesn’t see her own brilliance. How many women work this hard, this flexibly, with so much tough integrity, and such high, loving expectations, with skill and expertise and ability to navigate systems and relationships and just cannot see their own value? There are about 345,000 nurses in Australia. They all lived and worked through this pandemic. This is only one story. The Director of Nursing emails and explains that she nominated Sim herself. She forwards the paperwork, which concludes: I would describe Simone as a brave and fearless leader with a passion for making a real difference to the lives of her colleagues and the recipients of care across Royal Melbourne Hospital. I would describe Sim as my friend.

Acknowledgements From Ailsa First and most importantly: Sim. Thank you. Thank you for telling me your stories while you were in the thick of things. Thank you for trusting me when your heart was hurting. Thank you for letting me record all our conversations and for not holding back. I couldn’t have written this book if you weren’t so incredibly open with me and it’s been an honour to be by your side (while socially distanced) this year. Also thank you for your eagle eye, looking through my drafts over and over again: as you checked facts; as we worked together to make sure people’s privacy wasn’t broken, that language was correct, that we were being as respectful as we could. Thanks for creating the resources list and organising all the feedback from your colleagues. Thanks for your deep attention to meaning and context. You brought a nuanced understanding to the story that made it a far better version than the one I initially showed you. Sim, you put so much work into making this happen. Doing this project with you made this year somehow possible for me. Thank you. Emily, thank you for your ward clerk stories. You didn’t initially sign up to be in a book, but I’m so glad you are. Thank you for the hours you spent combing through the whole manuscript and talking over all your thoughts with us. Your thorough, thoughtful, respectful responses were exactly what we needed (and I’m glad we deleted the word ‘foreplay’). Franki. Thank you for your hours and vulnerability. Your part of this story is such an important one and I hope you never have to go through a time like that again. Jono, thank you for being so relaxed about our lives being represented here, for your enthusiasm for this project and your love of me. I’m not going to say thank you for the hours you enabled me to work – because so you should have! But I’m thankful that equality is our baseline and we keep working towards it together. Jack, you didn’t get to choose whether you’d be in this story but I hope if you ever read it, you’ll understand why I wanted you here. Caring for you has taught me so much about what care really means. Thank you to the many wonderful health professionals who read this book, or sections of it, and helped us with clinical details, patient privacy and gave insightful feedback: Denise Heinjus, Executive Director Nursing Services, Royal Melbourne Hospital Karrie Long, Director Nursing Research Hub, Royal Melbourne Hospital Caroline Fisher, Family Safety Team and Research Lead, Royal Melbourne Hospital Melea Tarabay, Director of Communications, Royal Melbourne Hospital Michelle Spence, Nurse Unit Manager, Intensive Care Unit, Royal Melbourne Hospital Frances Carboon, Clinical Nurse Educator, Royal Melbourne Hospital Jac Mathieson, Chief Nursing Officer, Peter MacCallum Cancer Institute Josh Hart, Nurse Unit Manager, Radiotherapy Department, Peter MacCallum Cancer Institute Wilson Lai, High Acuity Team Registrar, Peter MacCallum Cancer Institute Vanessa O’Shaughnessy, Director of Communications, Peter MacCallum Cancer Institute Emma Wadeson, Director of Nursing, Division and Statewide Services As well as many others whose lives and words made brief appearances here, including: Stacy, Lynda, Gemma, Renae, John, Christine, Ben, Myles, Deepika, Anja, Amy, Michael, Zoe, Hans, Ali, Rach, Anna, Kate, Katy, my beloved mum, and the many who are unnamed. Thank you. Thanks to Sally Anne from On Time Typing who wrote up transcripts of some phone calls, clearly, correctly and fast. When it was crunch time, you were very needed! To the team at Hardie Grant Books. Emily Hart – I suspect neither of us have raced through a project from start to finish quite so fast! It’s been a wild ride, kicked off by your response on the very day I pitched to you, asking if we could talk tomorrow. For a writer like me, that kind of email is more exciting than being asked out by a crush. Your relaxed competence is extremely reassuring and I’ve loved working with you even though we still have never met IRL. Thanks to Nadine Davidoff for thorough editing, Vanessa Lanaway for proofreading, Kirstie Grant for publicity, Katty O’Neil in marketing, and all four of you for your strongly expressed belief in this story, which is very helpful when my own doubts set in! Thanks to Laura Thomas for the striking cover design and Graeme Jones for snappy typesetting. And thank you to the many other folks who are working hard behind the scenes (often from your loungerooms with children on your heads) to make this into a book and take it into the hands of readers. Thank you to Marisa Pintado who helped to get the manuscript into the right hands, and to Christie Nieman, Miriam Sved and Nat Kon-Yu for first believing in us as a writing team. Extra special thanks to Emily Bitto for reading this manuscript in an early form and writing a book-cover quote that made me cry. Thank you to the City of Melbourne who supported the first few weeks of this project with a COVID-19 Arts Grant. Without this impetus, I don’t know if the book would have happened. I want to say thanks to the booksellers, who delivered books to my door when I wasn’t allowed through theirs. I’m very grateful for all you do to keep our industry alive. Particular thanks to my locals, Neighbourhood Books, Brunswick Bound, Readings Carlton and The Little Bookroom. The moment when I

thought you might be closed for weeks of lockdown were honestly the most adrenaline-filled of my year. I’m so excited to visit you again. The Women’s Circus, who brought Sim, Em and I together and helped us to build the love and trust we have in each other. You’ve shaped all of our lives and we love you so! Thank you always to my dear writing colleagues and to my friends who listened and listened as I talked through this project. You know who you are. From Simone Ailsa, this book sits as testament to the power of friendship, and I am so incredibly honoured to be one of the many people you hold close. This book started as an offer of support, and I can’t thank you enough for those many hours of conversation, debriefs, virtual hugs, tears and love. When you told me about the potential of a book contract it felt so surreal (amidst the already intensely surreal life that has been 2020). But I wouldn’t have chosen to embark on this project with anyone else. Thank you for sharing these stories with such care and gentleness, but also continually drawing attention to important issues we both have wanted to write about for a long time. I’ve read over the manuscript so many times, but each time I’m overwhelmed by the sensitivity and realness of your writing and also a huge amount of gratitude for you. Thank you for involving me in this work every step of the way. It really feels like something we have created together. To my lovely darling Emily. As we reach the milestone of ten years together, I want to thank you for all the myriad of ways you share your love with me. In hard times you are so good at supporting us to get through, without turning it into a crisis in our relationship. More than ever I’ve felt grateful for your calm ways, steadfast love and extraordinary cooking skills. To my housemates, who made food, shared laugher and gave space for difficult emotions. I heard someone say the other day they wouldn’t have liked to have been in a sharehouse in lockdown – but for me that’s definitely not true. I think you have been the very best of folk to share this time with. To my family and friends near and far who supported me with calls, texts, care packages, tech support and love. You are all so special to me and I wish all our interwoven stories could have been shared in this book. To my colleagues – the nurses and other health professionals who have worked so incredibly hard in so many diverse ways over the past months. The care you provide to your patients and workmates inspires me daily and I feel, now more than ever, very proud to stand among you. And finally to the people who were in need of health care and services, and specifically to the people who I met as patients – people who shared some of their most vulnerable moments (and incredibly intimate details of their lives) with me. I hope this book gives an insight into the health professionals behind the masks. You are the reason we do this work.

Background Reading Australian College of Nurses, ‘The sexual harassment and/or sexual assault of nurses by patients’, 2020 Australian Institute of Health and Welfare, ‘Family, domestic and sexual violence in Australia: continuing the national story 2019’ Australian Institute of Health and Welfare, ‘Nursing and midwifery workforce 2015’ Behrouz Boochani, No Friend but the Mountains, Picador, 2018 Caroline Fisher, Georgina Galbraith, Alison Hocking, Amanda May, Emma O’Brien and Karen Willis, ‘Family violence screening and disclosure in a large metropolitan hospital: a health service users’ survey’, in Women’s Health 16, 2020, pp. 1–9 Eugenia Flynn, ‘This place’, in Natalie Kon-yu, Christie Nieman, Maggie Scott and Miriam Svad (editors), #MeToo, Picador, 2019, pp. 17–24 Jess Hill, See What You Made Me Do, Black Inc., 2019 Adam Hill, Adam Bourne, Ruth McNair, Marina Carman and Anthony Lyons, Private Lives 3: The Health and Wellbeing of LGBTIQ People in Australia, Australian Research Centre in Sex, Health and Society Monograph Series 122, 2020 Fiona Jenkins, ‘Did our employers just requisition our homes?’, The Canberra Times, 4 April 2020 Lucille Kerr, Christopher Fisher and Tiffany Jones, TRANScending Discrimination in Health & Cancer Care: A Study of Trans & Gender Diverse Australians, Australian Research Centre in Sex, Health and Society Monograph Series 115, 2019 Elizabeth McLindon, Cathy Humphreys and Kelsey Hegarty, ‘“It happens to clinicians too”: an Australian prevalence study of intimate partner and family violence against health professionals’, in BMC Women’s Health 18.113, 2018 Our Watch, ourwatch.org.au Ailsa Wild and Simone Sheridan, ‘Not our job: a nurse’s story of sexual harassment by patients’, in Natalie Kon-yu, Christie Nieman, Maggie Scott and Miriam Svad (editors), #MeToo, Picador, 2019, pp. 207–216

Resources for those in Australia If you or someone you know is experiencing family violence you can call 1800RESPECT or visit 1800respect.org.au For 24-hour state-wide help including emergency transport and accommodation: Australian Capital Territory: Domestic Violence Crisis Service, 02 6280 0900 New South Wales: NSW Domestic Violence Line, 1800 656 463 Northern Territory: Catherine Booth House, 08 8981 5928 Queensland: DVConnect, 1800 811 811 South Australia: Domestic Violence and Aboriginal Family Violence Gateway Services, 1800 800 098 Tasmania: Safe at Home Family Violence Response and Referral Line, 1800 633 937 Victoria: Safe Steps Family Violence Response Centre, 1800 015 188 Western Australia: Women’s Domestic Violence Helpline, 1800 007 339 Men who are experiencing abuse or are worried about their use of violence can call MensLine Australia on 1300 789 978 QLife provides anonymous and free LGBTIQ+ peer support and referral, call 1800 184 527 (3 pm – midnight every day) or visit qlife.org.au Nurse & Midwife Support provides free and confidential 24/7 mental health support to nurses, midwives and students Australia wide, call 1800 667 877 If you are experiencing emotional distress or struggles with your mental health you can reach out 24/7 to: Lifeline, 13 11 14 or online chat at lifeline.org.au Beyond Blue, 1300 224 636 or online chat (1 pm–12 am every day) at beyondblue.org.au

Published in 2021 by Hardie Grant Books, an imprint of Hardie Grant Publishing Hardie Grant Books (Melbourne) Building 1, 658 Church Street Richmond, Victoria 3121 Hardie Grant Books (London) 5th & 6th Floors 52–54 Southwark Street London SE1 1UN hardiegrantbooks.com All rights reserved. No part of this publication may be reproduced, stored in a retrieval system or transmitted in any form by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior written permission of the publishers and copyright holders. The moral rights of the author have been asserted. Copyright text © Ailsa Wild 2021

The Care Factor eISBN 978 1 74358 746 1 Cover design by Laura Thomas Cover photograph © Sky-Blue Creative / Stocksy United

Supported by the City of Melbourne COVID-19 Arts Grants