This week, new case numbers are finally down and have been for a few days. Zero cases on Monday and Tuesday, and only a few over the past two days. As the weather in Melbourne is changing for the better, hopefully soon too will the spirits of its residents.  It has been a long and hard winter for many of us.  The pandemic has affected all of us, albeit different people in different ways, but all of us nonetheless.

I am a doctor in the northern suburbs of Victoria, where arguably the state took the largest hit, with several of the worst aged care outbreaks in the country.

Dear colleagues and friends,

Thank you for your efforts. Thank you for your time, your energy, your dedication. Thank you for your compassion, your empathy.

When the first nursing home outbreaks were known of, the hospital’s Residential in-Reach service mobilised rapidly to provide staff and support to the affected nursing homes. Doctors and nurses from the hospital geriatrics department quickly formed teams to enter these facilities to test, treat and provide palliative care to residents. They were in there seven days a week: in full PPE, caring for residents but also communicating with anxious families wanting the best for their loved ones but unable to see and be with them due to strict visitor restrictions. Sometimes even helping with meal prep! Ultimately some of the residents would recover, but some would not.  My colleagues faced these challenges every day for weeks that turned into months. Thanks to the geriatrics team’s forward planning from the first wave, when the second wave hit they were able to respond in a timely fashion to not only support but provide first hand medical and nursing care to residents in the affected nursing homes.

Arguably no one hospitals’ response to the pandemic has been perfect – this is something we have never faced before.  But I say with pride that at my hospital overall we responded well; we did our best and beyond.  An emergency department outbreak was quickly contained with lockdown, contact tracing and deep cleaning procedures undertaken immediately. Specific wards were designated for “suspected” and “confirmed” COVID-19 patients.  Infectious diseases, respiratory, general medicine and ethics teams collaborated closely to formulate strategies for best inpatient models of care for all patients in the hospital.  Collaboration with emergency medicine and intensive care teams were also paramount.

That specific COVID-19 wards were opened was a key initiative. One was primarily staffed by general medicine, infectious diseases and respiratory teams, and a daily huddle amongst teams, nursing, allied health and palliative care staff allowed for a multidisciplinary approach to management.

A second ward for patients for whom a more palliative approach to their management was appropriate was also created. These patients were more frail, multi-morbid, and many already had advance care directives and limitations on extent of aggressive treatments. This ward was staffed by doctors with both geriatrics and palliative care expertise. Teams on the COVID wards focussed not only on the medical aspects of care but also ensured that communication with families or carers was maintained by a ritual of daily phone calls post-ward rounds. To address the impact of visitor restrictions, a simple request for donations yielded even more devices than what the hospital already provided, for patients to use to communicate with loved ones who could not visit.

At this juncture I should declare my bias: I am a palliative care doctor, and I am proudest of the team that I work with for proactively rising to the occasion and providing symptom-based care for patients; whether or not deemed to dying, but suffering from effects of COVID-19.

Apart from actively participating in ward-based care, the palliative care team also created accessible quick reference guides for all clinicians for symptom management, end-of-life care and communication strategies in COVID-19, care-at-home packages for families wanting to look after their loved ones at home, and medications packs for symptom management for patients returning to nursing homes to ensure they had supplies on return.  I am also a cancer doctor, and I am proudest of my team for negotiating the difficult and delicate balance of protecting our vulnerable patients from COVID-19 while still trying our hardest to provide best possible cancer care.

Another important initiative – hospital wide survey – was instigated by two junior doctors to pro-actively address staff concerns and stressors (this is ongoing and directly linked to the Occupational Health and Safety team). The hospital has responded to feedback in positive and concrete ways such as developing wellbeing sessions, clearing outdoor spaces for staff to eat and take breaks while still being able to achieve social distancing, and thanking staff by not only acknowledging gratitude in public forums but also providing tokens of thanks in the form of goodie bags.

All staff, from consultants, who led teams by presence and example, junior doctors and nurses, who worked tirelessly and sometimes in full PPE every day, allied health teams, non-clinical personnel (administration, clerical, cleaners, porters), all parts of the hospital – people were asked to step up, adapt, be flexible about their work – and they were.  People were anxious, tired – some depressed and scared – later weary and exhausted, but people pushed on.

This week, we celebrated as Melbourne’s months-long restrictions were eased. Colleagues and friends, take a bow. Thank you for all you’ve done. I know now, COVID-19 or no COVID-19, we’re going to be OK.

Jaclyn Yoong

Medical Oncologist | Palliative Care Physician Northern Health