Updated at 3.45pm with PN reaction

Nurses working at the hospital’s intensive care units open up about their own intensely stressful experience caring for the flood of COVID patients. And yet they keep going… By Fiona Galea Debono

Many of the “last phone calls” that patients make from the ITU, before they are intubated, are to their parish priests. They are afraid they will not wake up… and so are the nurses caring for them.

Opening up about their exhaustion, ITU nurses have offered insight into the “shattering” situation in intensive care units a year on from the coronavirus entering Malta.

The units are “beyond capacity”, they confirmed – the demand for care is now greater than the specialist professionals providing it.

The staff shortage and the increased workload has meant “prioritisation of care is on another level”, says ITU nurse Sacha Edlebi.

“We are no longer in a position to give the care we were so used to giving. This is a real blow. I wish we could do more…

“It is hard to accept that you are so busy you do not have the time to give each patient the standard of care you are accustomed to because you are managing more acute events or doing whatever takes priority.

“You begin to feel defeated when the workload is relentless and you just cannot catch up.

“We want to have a bed to offer the next COVID-19 patient, but we also want to have enough time to sit with and reassure them, to help them shave, do their hair, get out of bed and have a meal if they are well enough…”

‘Never enough time’

Even though they are doing their best to help save people’s loved ones, her colleague, Clare Borg, can also feel it is a losing battle at times.

Within 30 minutes of a COVID ITU bed being vacated, it is filled again, Borg states, chronicling the drastic changes from a year ago.

Back then, the ITU nurses’ major worry was donning and doffing their protective gear properly. Today, that is the least of their concerns.

“You enter the unit and you just know you are going to be overwhelmed: ventilators and monitors are bleeping, pumps are ringing, kidney machines alarming… Then there is all the rest… and never enough time.”

Despite long, intense and shattering stints of over six hours on duty, “there is so much to do that when the nurses on the outside call you over the walkie-talkie to say your time is up, you keep finding something else to do,” Borg says.

Patients with COVID pneumonia are so severely ill, many developing multi-organ failure, that ITU nurses are their constant “visual motivation” – and that is why they work so hard, she says.

They are working round the clock in hindering gear, she continues, admitting “we are on our knees, emotionally, physically, intellectually”.

Looking back, Edlebi does not think anyone would have imagined they would be in the situation they are in today.

The rate of admissions to ITUs is the highest since the pandemic hit, with six in operation, four specifically dedicated to COVID-19, and the seventh on standby amid record numbers of cases. The next step would be setting up makeshift units in emptied wards.

Patients are younger

Typically, nurses are allocated one patient each. If experiencing staffing issues, it could be two for a day – “and that would have been considered stressful,” points out Edlebi.

Fast-forward a year and it is easy to hear numbers and feel disconnected, she believes.

Today, patients are also younger, so “it is impossible to look at them, mostly in their 50s, 60s and 70s, and not imagine your own siblings, parents and grandparents; to lose a 60-year-old and think he is younger than my father…”

It is impossible to look at the patients, mostly in their 50s, 60s and 70s, and not imagine your own siblings, parents and grandparents

The ITU nurses have had their fair share of patients’ “last” phone calls. Despite arriving so deprived of oxygen that they struggle to speak, they tell their families they love them and that they are not sure when they are coming home.

“It is rather moving,” says an emotional Borg. “We reassure them, but even we are not too sure what is going to happen. We just know we are going to try really hard.”

Insisting she is not after sympathy, she says the effort is “crucial” and remains an honour.

“But we can do better; we can all pull through together.”

Beyond the call of duty

To help alleviate the workload, other nurses have stepped in and stepped up. And Edlebi acknowledges that “we have expected a lot from them as they have been thrust into this new role with a very steep learning curve and little time to train”.

While appreciating their sacrifices, this has, however, created an issue: not only is the senior and more experienced workforce now spread over several units but the bed capacity has also doubled to 40 plus. And on top of the ITU nurses’ “massive” workload is more junior staff that needs more support and guidance.

The team has gone beyond its work obligations, with charge nurses and consultants taking work home, answering calls at all hours and worrying about the unit long after they have left, she says.

Moreover, this level of stress has now been sustained non-stop for a year and has a cumulative effect.

“The truth is we are all stretched to our limit. We all worry for our health and that of our patients, and at the end of the day, we head home to our families and are expected to function and keep up with our day-to-day lives.”

For Edlebi, it means returning to a five-year-old, who does not understand she has had a hard day and is too tired to play. “It is heartbreaking,” she admits.

“What we want more than anything is to be given a chance to cope with the workload; to be able to provide the best care possible for everyone.”

Edlebi is joined by Antonio Mifsud in her appeal for everyone to come together to stop the spread and bring the numbers down so patients can have the level of care they deserve.

A charge nurse in the cardiac critical care unit, which was recently turned into another COVID ITU, Mifsud insists on abiding by health authority regulations.

Over the last year, he too has had to adapt, retrain and stay away from his family. The freelance artist has also had to put aside his passion for sculpture and religious art due to the amount of work in hospital and because it is so energy-consuming.

The future is unpredictable, Mifsud says, noting that not enough is known about the changes in the behaviour and composition of the virus.

He worries that no one knows when it will end.

Frontliners need psychological help - PN

The Opposition reiterated its call for psychological support for frontliners.

"The fact that they are unable to provide the maximum professional care that they would like to, and that they have been trained to provide, is further impacting them psychologically," spokesperson Mario Galea said.

"According to international research, the mental impact that the pandemic will leave on frontliners will be devastating, and could even lead to post-traumatic stress disorder."