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00:05Our public health service is under pressure like never before and it's the frontline staff who
00:13are bearing the brunt. The unprecedented levels of staff burnout, nursing resignations. Staff
00:19from 150 public hospitals participating in the strike, the first in the decade. Staffing
00:25shortages they claim are jeopardizing patient and staff safety. But what's it really like to work on
00:32the hospital frontline? Three Australian icons each with a unique connection to the health system
00:39will go beyond the headlines to find out. Former tennis pro and commentator Yelena Dokic. We talk
00:46about sport and athletes and grand finals and being in the spotlight but then these incredible
00:52health care workers do something that is really pressure, that is really stress and that's where
00:58you really have to worry about their mental health. Hollywood movie star Ruby Rose. I owe health care
01:04workers my life. I had a car accident you know I didn't know if I was going to be paraplegic.
01:08I
01:09relied entirely on the nurses for everything. Right now the system is completely failing us but they
01:14are the ones keeping it together. And food writer and TV host Matt Preston. Knowing a lot of people
01:20who work in the public health system, it's amazing what they do. You're dealing with people at the
01:26lowest, sometimes at the lowest points in their lives. How do you deal with that pressure? They'll
01:32immerse themselves with the frontline workers and witness the pressure of making life and death
01:37decisions. That's not good. Can you open your eyes? At two of Australia's busiest hospitals,
01:44St. Vincent's Melbourne and St. Vincent's Sydney. I have no idea what I'm about to do. I have
01:52absolutely no idea. I'm nervous. I haven't been in emergency department before. I'm hoping that the
01:58way that my brain will digest it is to sort of feel like it's almost make-believe. They will experience
02:03firsthand the extraordinary challenges staff face right across the medical frontline. From the high
02:10stress environment of the operating theatre. A tiny error can make a huge difference in the success
02:16and the failure of this surgery. Yeah, I didn't think I was going to walk. I really need him to
02:21be okay.
02:22Jesus. To occupational violence. Some days these nurses who are working really hard, they are hit,
02:28they are kicked, they are punched. I'm trying to think of another workplace where assault is an
02:33accepted part of your job. To the emotional toll of treating the critically ill. Everyone's praying for
02:39you. Sorry. Do you find it quite triggering being in this environment? It's better that she doesn't
02:45see me cry. I don't know how they do it. In this high stress environment, what does it really take
02:52to save life? I like to think I can push through everything but this is one of the hardest jobs
02:57in
02:58the world. You have to make life or death judgments on the spur of the moment. Everyone I meet in
03:03here is
03:03reminding me that there are really beautiful people in this world. I'm a little bit in shock. I honestly
03:09didn't think it was like that.
03:25Last time Ruby got her first taste of life on the hospital front line when she witnessed spinal surgery.
03:33This time, she'll be working in a department with a very different set of pressures. The intensive care unit.
03:40It's an area of the hospital she has experienced before when she almost lost her life.
03:46When I was 17, I had a car accident. As I turned, all the lights went green because of an
03:52ambulance going to the hospital.
03:54And so we all just drove into each other. I had gone through the windscreen. I was unconscious and
03:59not in a good way. And they got me into the hospital and, you know, I was there for many,
04:03many weeks.
04:04You know, I couldn't walk or anything and I had to use a bedpan. I relied entirely on the nurses
04:09for everything, you know. And I think they must have known, I mean, not having as many visitors as
04:14they were probably expecting as well, that they would have been understanding that they had to then be that for
04:19me.
04:19You know what I mean? So yeah, just really grateful.
04:25My number one fascination with the ICU was really how the nurses are doing this.
04:30What are the struggles or what are the more challenging aspects?
04:33Is it just the nonstop trauma? Is it hours? Is it that they need more staff?
04:42St. Vincent's ICU cares for patients suffering from life-threatening illnesses and also treats complex
04:50major trauma cases from across New South Wales. But intensive care is a notoriously challenging area
04:57of medicine. In Australia, around one in 12 ICU patients will not survive, adding to the emotional toll
05:06on staff. And with burnout at an all-time high, it's estimated that a quarter of intensive care nurses
05:13intend to leave the department. Today is a little nerve-racking. I have a little bit of tachycardia.
05:19My body probably knows that I'm going into something that could be confronting. A lot more emotions,
05:24a lot more discomfort. I can only imagine that this is going to be one of the worst days of
05:29a lot
05:29of people's lives in there. St. Vincent's Sydney employs a team of around 150 intensive care
05:37specialists. Hogan Buescher is the unit's director.
05:41I'll give you a little walk around. This is our cardiothoracic unit now, so we have nine beds here.
05:48In this part, we specifically look after patients after heart surgery, lung surgery, but also the very
05:54specific things St. Vincent's is known for, which is heart transplant and putting artificial pumps into the
06:02heart and to the lungs as well. So all of that is very specialized. There's a very specific set of
06:08skills you have to have. Every patient has got a nurse, but if a patient is really critical, you can
06:14have
06:14three or four nurses actually just all concentrating around that bed and various doctors as well and
06:19other teams. Any patients who are as sick as our patients need the same attention at two o'clock in
06:25the morning
06:25as they had at midday. Now we're moving into the second part in the general ICU. We've got 11 beds
06:36here.
06:37Most of the patients need multi-organ support, most often in the form of greasing support,
06:43so mechanical ventilation. So all our bed spaces have mechanical ventilators as well. Patients sometimes
06:50have 10, 12 more pumps actually sitting there with various medications going in to stabilize them as
06:56well. Incredible. How is that, you know, for yourself but also for some of the younger nurses when they
07:01have to sort of put people on life support? That must take a lot of strength to sort of deal.
07:08I think it
07:08requires a special mindset if you want actually to become an ICU nurse or an ICU doctor or work in
07:14ICU in
07:15general. You have to be prepared for those tragic stories, get together as a team as well and talk
07:21about it as well because otherwise you really run the risk of burnout and it's it's a stressful work
07:27actually. One thing I've noticed is that there really isn't any one particular person that can
07:36do everything, let alone even just one or two. I'm watching how they're doing this dance, I'm watching
07:41how they're communicating. It just seems like everything is constantly moving and changing
07:46and scary and important. Today all 20 beds are full with each patient needing highly specialized care.
07:55Ruby is starting a 10-hour shift under registered nurse Emma. She must assist her in delivering care
08:02to Mark who's recovering from an operation to drain excess fluid from around his heart.
08:09He's also suffering from a past traumatic brain injury.
08:13Mouth a bit dry. Yeah, we can get you something for that. All right.
08:18Actually, Ruby, you can probably help us with this. Yeah, let's do it. My heart rate only increased
08:21by 20, I think. You're fine. Yeah, yeah, yeah. Mark, I'm just going to be putting something slightly
08:25cold just to get some of the dryness out of your mouth. Is that all right? Is that not hurting
08:30you or anything?
08:31Yeah, I don't know. Good, good. Does it feel nice? Yeah, it is weird. Weird? Yeah, sorry about that.
08:38Oh, that looks better already. Yeah. Beautiful.
08:43Emma was saying that her first day on the ICU ward was terrifying. Even as she was saying that,
08:49I started sweating. She was explaining to me there's this device here that does all the
08:55suctioning and it gets the blood and then it oxygenates and that if for some reason this little
08:59thing is not quite right, then the oxygen can go back up the pump and that would be incredibly
09:03devastating because it could go to the heart. Just little things like that where she's like,
09:07so you just want to check this every 15 minutes or so. Yeah, terrifying. Terrifying.
09:14I wanted to ask what it takes to be an ICU nurse. I think you've got to be wise a
09:19certain way.
09:19Yeah. You've got to be able to connect with people and you have to be able to go in that
09:24room and
09:24boil up all really quickly with that person no matter who they are or what they've got going on
09:29in their lives. And even if we have patients who've got a breathing tube in, they're, you know,
09:33sedated or maybe they're paralysed and they're not moving, we still talk to them as if they're
09:37completely awake or even when someone passes, making sure that person has dignity. Have you
09:41lost the patient? Yes. Yes. It is part of the, I guess, the nursing journey. It's just part of the
09:48job. Giving in that peaceful passing on, I think, is one of the most rewarding things you can do as
09:53a nurse and there's an absolute privilege to care for someone as they pass. Yeah. Yeah. I did this
10:00adopt a grandma thing during COVID when they don't get visitors in nursing homes and they don't have
10:04family and whatever. And I would Zoom with my lady Iris and the idea is that you do it, you
10:10know,
10:10forever. But after Iris died, I was like, I'm not sure I could be a nurse. But you guys doing
10:17that
10:17on a day to day is just, yeah, well done. And, you know, the loved ones, the families and your
10:22friends,
10:22that's also part of our love, supporting them. What do they need as well? That's right. Yeah.
10:26It's the whole picture. Yeah, totally. Yeah, absolutely. Sorry. Yeah, it's okay.
10:45Sorry. Yeah, I just, uh, I don't know what happened, actually.
10:51I probably shouldn't have talked about Iris and my experience there because I still miss it so much.
11:01I feel sort of very unprofessional having started crying. But, um, just look at this,
11:08like, young nurse that's doing, like, what she's doing with this smile and professionalism.
11:16She's teaching another nurse and she's also teaching me and she's also looking after him.
11:19and now she's looking after her family. It's like, we just had a moment.
11:30It makes me proud to be a human being, that there are other human beings like this.
11:35And I think everyone I meet in here is reminding me that there are really beautiful people in this
11:39world. Yeah. Sorry.
11:59Across town, Matt is preparing to start his next shift.
12:04Last time, he experienced the challenges of working in the acute geriatric ward.
12:10This time, he'll face a different set of pressures as surgeons treat a condition that men can find
12:18terrifying. Prostate cancer.
12:21I think about my health an awful lot. I've been thinking about it since I was 35 when I had
12:26my first
12:27ever blood test. But I think as men around the world, we tend to be one of two things, either
12:34very
12:34lackadaisical about our health or even or even were scared about what we might be told.
12:41The challenge of our prostate removal is if you have a selection of arguably the worst
12:49side effects of any medical procedure you can have for a bloke. How do you deal with that afterwards?
13:09Prostate cancer is the most commonly diagnosed form of cancer among Australian men. It accounts for nearly
13:164,000 deaths a year. When caught early, survival rates are extremely high. Yet the fear of the side
13:25effects of surgery can determine from getting tested. Matt will be shadowing surgeons in St.
13:33Vincent's Urology Department. So what's happening today? So today, we're doing a radical prostatectomy,
13:39robotic radical prostatectomy, which is the current standard way of removing a prostate if a man has
13:45prostate cancer. And you're doing this? Traditionally, how would that have been done?
13:50So we traditionally did an open operation, a cut in the abdomen. Then we remove it. Much bigger
13:55dissection. So much more refined, precise surgery. Side effects are a massive issue with this surgery
14:01because they hit it absolutely the heart of things that men hate. Incontinence, wearing a nappy,
14:07erectile dysfunction, you know. I think it's being able to understand what it actually means and what
14:12does incontinence mean? What, you know, will you be completely impotent or do we have supports and aids to
14:17that? A lot of men are very scared about erectile dysfunction. But if the cancer is at an earlier
14:22stage, you can do more aggressive nerve sparing, which is what every man reads about before they
14:27come to see us. We see this all the time. That man, this is his first and only experience of
14:33this.
14:33Sure. We've got to give them the perspective, what they can do before, what's going to happen after.
14:38Not all men with prostate cancer need surgery. But for those where the cancer hasn't spread,
14:4410-year survival rates after the prostate has been removed are above 90%. Today's patient is Tristan.
14:54His cancer was only discovered when he went to see a GP following a surfing injury.
15:01I never go to a GP. Because I was a new patient, it did a blood test. And then only
15:07because I had the
15:08tests so that it showed it. I then organised the biopsy and it showed cancer. Yeah, I've had no
15:16symptoms. I'd never felt sick. Still don't feel any different from 20 years ago, you know, 30 years ago.
15:24There's no symptoms with this. Sure. That's the point. So then another scan to see if it's spread anywhere,
15:31which it hadn't, thank God, and then... So you were at that, was it stage three where it's kind of,
15:36it's there, it's contained, but the risk is going to... So you have an option of radiation or surgery,
15:42and I went with surgery. What, why did you go, why did you go surgery?
15:46Well, I prefer to have it out. Yeah. And then go from there.
15:51Yeah, sure. Whether, you know, I prefer to live as long as I can.
15:53Yeah. And that will hopefully remove the concern of not knowing if it's metastasised.
16:00We never know with down the track anyway, that's why. Sure, sure. Great. Well, good luck.
16:08I would love to be surprised at the fact that Tristan doesn't go to a GP and, you know, hasn't
16:14been
16:14blood tested. But I think it's really, really common because you're healthy, you're fit.
16:18There's no obvious symptoms. I think it's really, really common with Australian men.
16:22It shouldn't be. Those things all addressed early, much better, less invasive outcomes can come from that.
16:43Last time, Yelena experienced the pressures of delivering emergency medicine.
16:49This time, she'll be returning to ED to work in an area that's extremely personal to her,
16:56the Domestic and Family Violence Unit.
16:59For me, family violence started at the age of six when I started playing tennis.
17:05Literally from the first day that I hit that tennis ball.
17:09My father never laid a hand on me before that, but when I started playing tennis, he did.
17:14And it got very abusive and very violent very, very quickly.
17:18And it escalated from there to the point that I was at the age of 16, 17,
17:26kicked and punched in the head so hard that I was left unconscious.
17:32It got so violent that I didn't know if I would survive the next beating.
17:38Family violence and domestic violence really affected me, but also my whole family.
17:42The surrounding around me, it tore my family apart, but it almost broke me as well.
17:49And it almost cost me my life.
17:58In Australia, it's believed that one in four women have experienced domestic violence.
18:04And every eight days, a woman is killed by a current or former partner.
18:12Abuse often occurs behind closed doors and goes unreported.
18:17To support the victims, St. Vincent's runs a domestic and family violence service led by social workers.
18:25The majority of women are admitted to the service after presenting at ED, often for an unrelated condition.
18:33I'm very nervous because of my own personal experience, it does hit close to home.
18:40But I do also want to see what the social workers do have to deal with and how hard that
18:46is.
18:47And it's something that I feel very passionate about.
18:52Yelena will be shadowing social worker Bree.
18:55So what do you see the most of on a day-to-day basis? What kind of cases?
19:00We see lots of violence here, alleged assaults, so sexual assaults, domestic violence and sudden deaths and sometimes child protection
19:07issues as well.
19:08So I'm really interested in the family violence part of it.
19:13How much of that do you see?
19:14It's often, it's frequent and it's sad and it doesn't discriminate.
19:18As we know, it's the intersection of mental health and family violence.
19:22It's here all the time.
19:25Every morning, the social workers get together with the medics to see if any new cases have presented.
19:32Bree has picked up a referral for a woman who has a history of family violence.
19:37We'll go and assess her if we can.
19:39It's you and if you'd like to come along.
19:41Yeah.
19:41I guess I just want to check in around you and your well-being and do you find it quite
19:45triggering being in this environment?
19:47A little bit.
19:47Yeah.
19:48But I would like to see what you do and just what that looks like still, so.
19:54Okay.
19:55I don't know how she's going to be in there, so we'll just introduce ourselves.
19:58I'll stay outside.
19:59Huh? You can stand next to me.
20:00I'll be behind you, yeah.
20:11Oh, yeah.
20:14Knock, knock.
20:15Hey.
20:23In the emergency department of St. Vincent, Sydney, Yelena Dockich is about to meet a patient
20:29whose social workers suspect has been attacked by her partner and possibly sexually assaulted.
20:37Good morning.
20:38This is Yelena.
20:40She's going to shadow me today, all right?
20:41Hello.
20:42It's the first time the woman has talked about her experience.
20:46I wanted to come in and talk to you about the things that you've been enduring at home,
20:50and it sounds like there's been some violence.
20:52Tell me about your perpetrator.
20:53Has he ever used a weapon against you?
20:55Has he tried to strangle you or anything like that?
20:58He has?
21:02I know how difficult that is to go and get help if you're struggling with your mental health.
21:07I grew up in a culture, environment and family where it was a shame to talk about that.
21:14You can talk about domestic violence and family violence, child abuse and mental health,
21:19and at the same time it can be hard to explain it to other people of what that feels like.
21:25You go through this incredible physical abuse, but you also go through this emotional,
21:32psychological, financial abuse.
21:34Depends on what your experience is.
21:36It can be hard when you don't feel seen and heard, and not just feel, but when you know you're
21:42not seen,
21:43heard, loved and accepted by your family, which was my experience.
21:49I certainly was left with no social skills, not even being able to string two sentences together,
21:55not being able to look people in the eye.
21:58And that was right at the time when I had to retire from the sport that I absolutely love,
22:04due to mental health struggles.
22:07Do you want any blood-borne virus screens or SCI checks or anything like that?
22:12It's a swab, a vaginal swab, and then a urine test in a jar.
22:16Yeah, I'm glad you're here. I'm really glad you're here.
22:21I'm sorry.
22:25It's better that she doesn't see me cry.
22:31That was very hard to hear, and very hard to hear about the violence and the abuse that
22:36she's experiencing. That she was body slammed and that she was almost strangled,
22:45um, and that she still had physical injuries and, and was checking her face as well.
23:09I'm going to leave you to it. I'll get her nurse to fix that, because she's still got, um, a
23:13fair bit to go.
23:15I'll come back, all right? Thanks for letting us hang out. We'll see you in a sec, all right?
23:19All right. Thank you.
23:24We'll just sit here. Are you all right?
23:26Yeah, wow.
23:28I feel bad for...
23:29It's a lot.
23:31A lot.
23:31Just a lot.
23:33You know, a very vulnerable person. It's a lot for any one person to have to handle.
23:37Yes. Any thoughts or reflections, there's a lot going on.
23:41There's a lot, and you have to start from the beginning.
23:43Yeah. To ask her a lot of questions, including her family. You can see how she actually really
23:49trusted you, and she started to open up, and you...
23:52But you do have to ask all the really personal questions and deep questions as well.
23:58I'm jumping in and asking about the most intimate things of your life,
24:01and that is very invasive for anyone. That trust is really important. I want her to feel safe and
24:06comfortable to disclose everything that's going on to her. It was really triggering when you went from
24:11the physical violence, and then whether there's been any sexual assault, and she
24:19wasn't sure, and that's where she started to, you can see, think, and break down. That was
24:23really difficult to see.
24:25And maybe no one's ever asked her that question before in her life, so it's...
24:28That's what we're here for, to really peel it back and find out those vulnerabilities and
24:32advocate for these patients and, you know, screen them with everything, even if that's not the reason
24:38why she came in, but let's do it, because we want to build a good relationship with the health system,
24:42so she comes back. So what are the next steps for you and for her?
24:47Yeah, so I guess in that assessment, there's a lot wrapped into it. It's just this advocacy ongoing,
24:51having to make decisions and prompt patients when they're distressed and unwell and emotional.
24:56You can't think because you don't have clarity. It's a trauma response.
24:58So it's really just being there, walking by them, encouraging them to do the right
25:03thing when they can't make decisions for themselves.
25:06The biggest thing that I took out of this is for Bri, how does she react and how do you
25:11not get
25:12emotional but also do you hold it back as well as much as you can if you do so that
25:17that person
25:18doesn't maybe see it. Social workers have to listen to stories like this every day and it's not one,
25:25it's so many. I don't know. I don't know how they do it. No idea.
25:45Around one in five Australian men will be diagnosed with prostate cancer in their lifetime.
25:51In some cases, surgery to remove the prostate may be the best option.
25:58Matt is in theatre where Tristan's operation is about to begin.
26:03It'll be done through robot assisted keyhole surgery. It's the gold standard for this type of procedure.
26:11Although in Australia, most robotic systems are located in private hospitals.
26:17The first little bit, we're just sort of setting it up.
26:20We enter the abdomen, then we'll inflate below the abdomen with gas, so CO2.
26:25We create that space and we'll get one of the cameras in.
26:30That's all the internal organs, large bowels and small bowel, and we're aiming towards the pelvis.
26:37The robotic arms are controlled by the surgeon from a nearby console.
26:41Here, the surgeon can see a magnified 3D image of the patient's internal organs.
26:48Very fine control, very precise movements, no tremor. And you can cauterize, so each of those have energy, heat, yep,
26:56so you can stop bleeding.
26:58Oh, that's crazy.
27:00You see it close up microscopically. It's amazing how much subtlety there is.
27:07Before we had robotic surgery, this used to be done laparoscopically by hand.
27:11Right. And the ergonomics was such that that was incredibly difficult.
27:18And so this is the colon here.
27:20Yeah, yeah, yeah.
27:21And we're just trying to get that out of the way. The bladder's up here, in this region here.
27:29And then the prostate is way down under here.
27:31Right.
27:34I had an image that would be press the bun, go for a cup of tea, come and it's all
27:38done.
27:38But it's, I think the main thing is, robotic surgery is still driven by human beings.
27:43It relies on skilled operators.
27:52Just on the sides there is where those neurovascular bundles are.
27:56Right.
27:56The nerves and the blood vessels.
27:57And that's erectile function.
27:58That's erectile function.
27:59So this is where you really want to be taking care.
28:04You can see the vessels are one or two millimetres.
28:07And so you've got to be very careful to peel that away.
28:09So, basically, you've got to peel away the, the, the prostate,
28:12which is a round urethra without disturbing the nerves on the outside.
28:17Yeah, exactly.
28:33So that's all the prostate.
28:35Yep.
28:37Checking that it's coming.
28:38Now here's the bag being deployed.
28:40And we just put that in there and zip that up.
28:44We're pretty happy that the cancer was confined to the prostate.
28:47And we're just joining the urethra to the bladder.
28:50So we stitch those up.
28:52Yep.
28:53That's the bag on the end of that string.
28:55And here comes the bag.
28:57There we go.
28:58So that's it.
29:00Prostate's out.
29:02Wow.
29:03This whole thing of having a hole in your abdomen and now do the prostate.
29:07Coming out of that tiny hole, it's amazingly small.
29:11It's a difficult cancer to treat sometimes because of where it is anatomically.
29:15Yep.
29:15But once it's dealt with, the cure rates are extremely high.
29:20What's next for this patient moving forward?
29:22So he'll be recovered, obviously, and go home in a couple of days' time.
29:25And then I, as I say to the patients often, that's when their job starts.
29:28There's a big build-up to the surgery.
29:30Mm-hm.
29:30And they have the surgery and then there's this flat period I see in patients.
29:35And all of a sudden it's like, well, what do I do now?
29:37They will get followed up in our Men's Health Centre down the road.
29:39Right.
29:40One of the major components of that is their pelvic floor physiotherapy for their continence
29:44and their sexual rehabilitation.
29:46When we speak to these patients often post-operatively, they ring about things that to us,
29:51it's like, you don't need to worry about that.
29:53But to them, it's a real worry.
29:54Yeah.
29:55And they get looked after in all those aspects of care.
30:00Robotic surgery may give the best results for the patient in this type of procedure.
30:05But it's not universally available in Australia and is more common in the private system.
30:11The reason is down to cost.
30:15How much is one of these machines?
30:17Five, six million dollars.
30:18Five, six million dollars.
30:19And then the ongoing contract for maintenance, about a million dollars a year.
30:23The benefit is really where the alternative would mean a bigger incision or a longer stay in hospital.
30:30For this, the cost benefit is significant, which is what it comes down to.
30:34But I think there are also costs that you can't necessarily measure.
30:37The return to work is earlier.
30:39The recovery is quicker.
30:41The side effect profile is thought to be less.
30:44So all those intangible costs.
30:48A surgery is an expensive procedure.
30:52One of the real challenges facing our public health system is that care is more expensive
30:59because we demand a better quality of outcome in terms of technology and in terms of pharmacological
31:07solutions.
31:08So this is something we have to ask the question.
31:10Where do you want to spend our money?
31:11Do you want to spend our money on, um, where do you want to spend our money on robots?
31:15Do you want to spend our money on nurses?
31:16Do you want to spend them on patient to nurse ratios?
31:21Do you want to spend the night...
31:21Do you want to spend our time job shows this time, right?
31:28Do you want to spend your money on aircraft restoration?
31:49So these are our suction canisters, we're just going to pretty much get rid of them
31:52and replace them.
31:53And we just disconnect it so this pops out.
31:55Great.
31:56And you want me to do that with the other choice?
31:57Yeah, that'd be great.
32:01Hannah's next patient is 46-year-old aviation worker Matt, who has a history of heart problems.
32:08He was rushed to hospital after suddenly falling ill and needs an urgent operation to install
32:14a mechanical pump in his heart.
32:17Matt's heading off to theatre today, he's getting an LVAD put in which is sort of pump
32:20at the bottom of the heart and eventually we'll get a heart transplant.
32:23He has got a background of heart failure and he was put on ECMO which is the highest form
32:28of life support, massive toll on the heart.
32:30You're all good man, I know there's lots going on but we're going to get you off to theatre
32:33very soon and so people will be rushing around for a bit and then we'll get you off there
32:36okay?
32:37You're all good, you just chill for a bit and then we'll see what's happening.
32:40There's a lot going on, I'm still a bit confused at the moment.
32:43So how long is that surgery?
32:44Uh, depends on the patient usually but it's probably about four hours.
32:48It's a big procedure.
32:49He'll come back out with a breathing tube in.
32:50Yep.
32:51Um, and then will he stay here for monitoring for quite a while?
32:55Usually about a week at minimum.
32:57He's got his lovely partner Kristy coming in as well so that will help before we get in
33:01there.
33:03For Matt, it's the latest in a series of life-saving operations.
33:08Kristy, hi.
33:10Why, every time something like this happens do you get more used to it or do you get less
33:14resilient and more worried?
33:16Oh, it depends.
33:18We've had some operations where he's been quite awake and he's had to go in and have this done
33:23and that's, and I'm like feel good.
33:25Yeah.
33:26But then we've had other where he's been like literally rushed in there and they've
33:29told me that he might not make it through this surgery.
33:32Last night he didn't really want me to leave.
33:34He, he feels more comfortable when I'm here but he's quite confused so, which is really,
33:39really heartbreaking because he kind of doesn't really understand what's going on right now.
33:44Yeah.
33:45This hopefully will be one of the last surgeries but it's like a stepping stone so we'll see
33:50how stable he can get on this type of pump.
33:53Yeah.
33:53And then, yeah, and then he'll be probably a transplant.
34:00Before being taken through to the operating theatre, Kristy is allowed to see Matt one final
34:07time.
34:08Hey babe.
34:09Babe, I'm here.
34:10I'm here.
34:11How are you feeling?
34:14I've got a lot of lines, I'm sorry mate.
34:17I can't talk.
34:18You can talk, you're talking to me now.
34:21I know, but I can't talk to you normally.
34:24I know.
34:25That's okay.
34:28Your sister sent you a message saying good luck.
34:36I think I sort of forgot how risky some of these surgeries are and how vital they are
34:41going to go out to somebody's survival.
34:43Hearing from Hannah the long list of complications really adds a lot more weight into what we're
34:48watching and what we're feeling.
34:51I'm just wishing for the best and hoping for the best.
35:06In ICU, Ruby is waiting for her patient Matt to return to the ward.
35:12The operation to install a pump in his heart has been completed, but Matt has been kept
35:18in the operating theatre.
35:21ICU nurse Hannah suspects something may have gone wrong.
35:26But you can actually look at some of the blood results from theatre.
35:28Normally you want your lactate to be less than two.
35:31Less than two?
35:32Yep.
35:32And then they've just done one at quarter past one at 7.1.
35:35Gee.
35:36Yep.
35:36So when you are in a really critically unwell situation, you'll go into this lactate temiac
35:43state where your body is breaking down your muscles and releases lactate into your blood.
35:49So a higher lactate level, 7.1, is pretty significant.
35:53Okay.
35:53So I would say that something is happening here.
35:55It could be that he's bleeding.
35:56It could be that he's gone into a septic sort of shock or some sort of shock state.
36:01Yeah.
36:01But that'll be why.
36:03Okay.
36:04Yep.
36:07It's been far longer than what we would expect.
36:09It would be impossible not to feel absolutely devastated if something sort of worse than just
36:15a little bit of a delay happened.
36:18I imagine Christy's absolutely stressing more than anybody else in this building right
36:23now.
36:37Prostate cancer is the most commonly diagnosed cancer in Australia.
36:43Depending on the patient, surgery to remove the prostate may provide a cure.
36:48But the side effects can be devastating.
36:53St. Vincent's provides a clinic specifically to help men in their recovery, offering all-round
36:59holistic care and psychological support.
37:03It's one of only two in Australia.
37:07But its funding relies on philanthropy.
37:10With Ben and David, the surgeons who operated on Tristan, heavily involved in the fundraising.
37:17Morning.
37:19Morning.
37:19How are you?
37:20Much of it is done in their spare time.
37:23Surgeons by day.
37:25By night, mask champions of men's health.
37:29How do you get involved in fundraising and setting up the Men's Health Centre?
37:32We see these men every day and we see them struggle with this.
37:37And historically they haven't had those supports.
37:39I mean, breast cancer gets a lot of support, really great funding.
37:43A lot of women are great advocates for their own health.
37:46Men historically haven't been.
37:47So more services are available to men in the private sector, but in the public sector it's
37:52been much harder to make them available.
37:54So we thought we would have all services available to all men on an equal basis.
37:59And that's how we sell this service.
38:01Why is that not being taken care of already by the health system?
38:05Because this is, you know, a major cancer cause in men, affects an awful lot of men.
38:12This should be everywhere.
38:13But the problem is, who's going to fund this?
38:15Our constant battle is with budget in the hospital.
38:19The discussions go on on a weekly basis.
38:21We have the St Vincent's Curran Foundation and they raise huge amounts of money.
38:26And the hospital does rely on that, but there are significant budgetary constraints.
38:30I wouldn't want to be in their shoes.
38:32It's hard.
38:32How do you choose where the dollars go?
38:35There's a finite resource.
38:36When you were both starting out as bright-eyed, young doctors,
38:40did you ever see yourselves being fundraisers as well?
38:43I don't think I ever saw that aspect of medicine.
38:46I think you go in thinking I'm going to operate on everyone and save lives and be the hero.
38:51You learn fairly quickly though about the difficulties in the hospital system.
38:55There's limits to everything now.
38:57It's all come down to minute budgetary issues, which I guess has to happen, but it's certainly not how I
39:03saw it 20 years ago, 30 years ago.
39:08That role of the hospital within our community, the more time you spend in the space, the more you understand
39:14the complexities of how everything works.
39:17And how it's this huge organism where every element of the organism has to be working together.
39:24And that complexity, I think, is something that I didn't really understand.
39:30We are missing things that need to be fixed.
39:33The medical professionals know what those problems are and they're not being fixed.
39:37And is it fair that we rely on people like David and Ben to step in and try and fill
39:43that gap?
39:45Yelena and Matt have each worked in two different areas of the hospital so far
39:51and have experienced firsthand the pressures on staff.
39:55They find a few moments to catch up.
40:00Hello.
40:02How are you?
40:03Good, good to see you.
40:04Oh my gosh.
40:05How do you feel?
40:07Uh, yeah, nervous, anxious.
40:10I'm learning a lot.
40:11You're being bombarded with totally new experiences.
40:14You know, you're in surgery, you're in wards, you're...
40:18What's been the one thing that has impressed you the most about spending time in the health service?
40:23For me, it's been the pressures that the doctors and the nurses and the healthcare workers are under
40:29and the load and also even what they have to deal with.
40:32I've been impressed with how calm they are under pressure, how they deal with it all.
40:37I've been really impressed with the load that they still go home,
40:41that they have to look after themselves, but also that they actually find it rewarding.
40:46There's a definite sense that this system works because the staff want it to work.
40:52Mm-hmm.
40:53The question is, it's a bit like an elastic band.
40:55How much can you keep turning it and turning it until it snaps?
40:59And I think there are a lot of people on that verge of going,
41:02it's too hard, I'll just go and get a job in a shop.
41:05But you just know that really there needs to be a long-term solution.
41:08Of course, this is a tough job.
41:08I like to give everything a shot and think I can kind of push through everything,
41:14but this is, I think, one of the, if not the hardest jobs in the world.
41:23Up in ICU, Ruby is still waiting for news on Matt,
41:28following his major surgery to install a pump in his heart.
41:32Two hours after the procedure was completed,
41:35she hears that Matt has been transferred back to intensive care.
41:39But his condition is critical.
41:44Can you let me know what's happened?
41:46He's in a very sort of hypercritical phase of his care right now.
41:50We've very heavily sedated him.
41:53The need for his body is relatively low at the moment.
41:56This is quite a low cardiac output, but it's enough, we think.
42:02And we'll be monitoring that.
42:03So it's ensuring enough blood flow around the body,
42:06enough support for the right side of the heart,
42:09for the LVAD to work.
42:11If any of those things fail, he runs the risk of not surviving.
42:16Yeah, okay.
42:18And Hannah's going to be the mainstay of this gentleman's care
42:22for the next couple of hours.
42:24We don't want to do anything too prickly.
42:26No.
42:26He's very, I would say, brittle.
42:29And we want to very, very gently, if at all,
42:32start reducing support.
42:35When Hannah's happy, we'll get the partner in
42:37because this is very emotional for family members.
42:40Yes.
42:41Very confronting seeing a loved one in this situation.
42:44Yeah.
42:44And so a lot of our job as intensive care specialists
42:47is to make sure that we support the family members through this.
42:50Yeah.
42:51I mean, I don't know how you...
42:52That's like another part of the job description.
42:54But a very important one.
42:55Very important.
42:56Yeah.
42:57And that's kind of...
42:58Not only do they have to do all the clinical work
43:00and the actual medical work,
43:02they also have the responsibility of supporting their families.
43:05And then when they do lose a patient,
43:07they often have to be the ones that give the news.
43:10And then you're sort of expected to be fine.
43:12And then go into the next and go back to clinic.
43:15I think we would be doing a massive disservice
43:18if we didn't really address the fact
43:20that this is a hugely emotional job.
43:22I just don't see how burnout is inevitable.
43:33In ICU, Ruby is shadowing Hannah
43:37as she assesses Matt following his major cardiac operation.
43:41Hannah feels he's stable enough for his partner, Christy, to see him.
43:45Hi.
43:46How are you going?
43:47How are you feeling?
43:48Yeah.
43:49Just want to see him.
43:50Yeah, come in.
43:51He is stable.
43:52He's still on a lot of support.
43:53Obviously, they're all bad as well.
43:55But...
43:55And surgeons are happy.
43:56He's stable.
44:02She's talking to him and touching him
44:03and I'm watching his blood pressure go from 75 to 70.
44:07You can see that whether he can hear it, understand it, whatever,
44:09he feels something and it's creating more calm.
44:13I'll tell your mum and everything that you're okay.
44:16Everyone's praying for you.
44:19All she cares about is him being him again.
44:22I think with that kind of love and support,
44:23he's got a much better chance of doing exactly that.
44:26Matt faces a long road to recovery.
44:29The mechanical implant may have saved his life,
44:32but it's not a permanent solution.
44:35He will eventually need a heart transplant
44:37in another major operation.
44:47And then...
44:48There we go.
44:49Perfect.
44:50There we go.
44:52Beautiful.
44:53Ruby's time in ICU has come to an end.
44:57That's okay.
44:57Yep.
44:58ICU kind of messed with me a little bit.
45:00I might need a bit longer to process it.
45:01I didn't think I'd be confronted in the ways that I was.
45:05Yep.
45:05But highlights were staff.
45:07Just incredible staff.
45:09And realising that one of the most critical departments
45:12is run by these incredibly strong women.
45:14And not to say there weren't incredible males there as well,
45:17but, like, I've definitely not achieved anything in my life
45:19compared to these women.
45:22The job of a nurse has expanded in a hundred different ways
45:26since we've known it, but it's also exhausting.
45:29I do wonder how they get through it.
45:32What I really took away is their senses of humour,
45:35their ability to kind of see through the stuff that isn't working,
45:38to find the hope,
45:39just to be there for the patient and do their job.
45:44Everything about this place is humanity at its best.
45:55Matt is coming to the end of his time in the urology department.
45:59Before he leaves, he wants to catch up with Tristan
46:02following surgery to remove his prostate.
46:05Hi, Tristan.
46:06Morning, Tristan. How are you feeling?
46:08I'm well, thank you.
46:09Did you see a big smile on your face?
46:11Yeah.
46:11How do you feel?
46:13Good.
46:13Yeah?
46:14Did you think you'd recover so quickly?
46:17No, I thought it would be a bit longer, but it's been amazing.
46:20So, home today.
46:22Yeah.
46:22And he's got a bit of an expectation with the Men's Health Centre
46:25about what comes next, which is a recovery over the next week.
46:29Getting rid of all the tubes and catheter at about a week, roughly,
46:32and then getting on that road to recovery.
46:34When do you actually know whether you're cancer-free or not?
46:36We catch up in a couple of weeks and go through all the pathology
46:38to make sure, you know, what grade is the cancer.
46:42And then at about six to eight weeks, we check that PSA
46:44and monitor how he's going and hopefully he's doing really well.
46:47And we're looking for a zero reading on PSA.
46:49That's what we're looking for.
46:51You've gone through the scary thing of going into an operating theatre.
46:54What advice would you give to other men in terms of what they should do?
46:59Always have your checks now, whether it be for prostate, heart, whatever.
47:03You know, you're never too young, really, to have these checks.
47:06Great. Well done. Congratulations.
47:08It's fantastic. You're looking so well.
47:09And I hope you have really good outcomes really quickly.
47:12Fantastic. Pleasure.
47:14Early detection of prostate cancer is life-saving.
47:18Yet in Australia, the number of cases detected at stage one stands at around 36%.
47:26Often, it can be found early through a simple blood test.
47:31The earlier we get to a problem, it seems, from everyone I've talked to,
47:36the better the outcomes, the quicker the outcomes,
47:38and more importantly in these times, the cheaper the outcomes.
47:42Post-Covid, we all stood around talking about nurses being heroes.
47:47But I don't think we have the right to do that if, as men,
47:50we don't take our health seriously
47:53and we don't provide them with access to problems that we face early enough.
47:58For me, getting that blood test, understanding what's going on with your body,
48:03identifying problems early are a way of respecting what the people in this building go through on a daily basis.
48:20In St Vincent's ED, Yelena is coming to the end of her shift,
48:26shadowing social workers in the Domestic and Family Violence Unit.
48:31Seeing how victims are offered help and support early
48:34has made Yelena reflect on her own experience.
48:38I was actually afraid and actually felt ashamed for wanting to get mental health,
48:44and I didn't do it for 15 years because of that reason.
48:49I'm not even sure that there was a turning point.
48:51It was just that I realised that things were getting so out of hand and violent
48:56that I genuinely might not survive the next beating.
49:03It was also affecting me so much emotionally and mentally.
49:06I wanted a way out.
49:07I escaped in the middle of the night during a tennis tournament and just ran.
49:12I just had my tennis rackets in my suitcase
49:15and pretty much went to the next tournament with nothing, no money, nothing.
49:20I was literally homeless in that moment.
49:24Many cases of domestic violence are only identified for the first time in ED.
49:30At St Vincent's, the victim is then offered counselling.
49:35After her shift, Yelena goes to meet a woman who is currently using the service.
49:40It empowered her to leave her abusive husband after 20 years of marriage.
49:47Her voice has been disguised to protect her identity.
49:51So it was really difficult to ask for help?
49:53Yes, yeah.
49:54The issue I have was he was never physically violent.
49:57It was emotionally controlled.
50:00You end up in this position where you feel totally powerless in every aspect of your life.
50:07As the journey goes on, you give up another bit of yourself,
50:11but another bit of your self-worth, and you don't realise it.
50:15OK.
50:21The consequences of domestic family violence and the trauma is much broader, isn't it,
50:27than maybe physical abuse. It's much bigger than that.
50:32When somebody punches you or hits you, you've got a bruise.
50:35And that goes away.
50:37But emotional abuse, it stays with you.
50:39I needed the empowerment.
50:41I needed to know that I could do this on my own.
50:46It's the first time I think I could see the hope.
50:50I'm not going to say it's an easy ride, but it's worth it.
50:53Ooh.
50:54Definitely, it's been worth it.
50:56I'm living the life I want to live, instead of in the shadow of my husband.
51:06Yeah, I don't know. I'm just... My emotions are everywhere, sorry.
51:09I just... Yeah, I...
51:12I want to cry, and it makes you sad, but at the same time, I am so proud,
51:17and she inspires you and empowers you, and you see the courage
51:20and the bravery it takes to ask for help, to come out and talk about it.
51:26But that smile and the way that her eyes light up,
51:31that will stay with me forever.
51:33Being seen, heard and accepted by just one person can save a life.
51:40Yelena has seen the impact long-term counselling can have.
51:44She's keen to find out why these services are not more widely available.
51:49So before she leaves, she's meeting Adele,
51:53the manager of St Vincent's Domestic and Family Violence Service.
51:57How big a problem is domestic family violence?
52:02When you talk about numbers and prevalence,
52:08we're still operating from what we call incident-based,
52:12meaning if the police get called out to a domestic violence incident,
52:17that's one incident.
52:19There could be a woman with four children.
52:23That's five victims.
52:25We're not counting the victims here.
52:29We need to get the numbers right.
52:33Because it is still seen as a periphery problem, societal problem.
52:39What is the one thing that makes you the most sad, upset,
52:45with the job that you do and the things that you see every day?
52:49That it's not seen, certainly in society, as a major health issue.
52:56Would we dare screen for breast cancer and then say,
53:01you've got that, but sorry, we can't do anything for you?
53:04So it's at that level that really stresses me
53:08that there isn't more on-site based hospital domestic
53:13and family violence services.
53:15Well, it makes you come back every single day again
53:17and get up and do what you do
53:19because it is difficult to see a day after day.
53:22It is, yeah.
53:23Why do you do what you do?
53:24My greatest reward in this space
53:28is I get to work with some of the most courageous people I know,
53:37that I will ever know,
53:39that have the courage to walk in these doors.
53:43There is something that's quite humbling
53:47to be able to sit with people that have experienced violence and abuse.
53:52They're the bravest people I know.
53:56If this was around for me, it would have been a very different story
53:59and I actually thought about that as Adele was talking.
54:02That would have been amazing and...
54:07I don't want to cry about this.
54:08I don't want to make this about myself at all
54:10because it's not...
54:11I feel like I'm still very lucky and fortunate to be here
54:14and to have what I have today.
54:16But the issue is that this is incredible, but it's rare.
54:21We don't have this at all the hospitals.
54:23In fact, we only have it at a select few.
54:27And St. Vincent's here in Sydney is one of the rare ones,
54:30and that's the issue.
54:39Next time, Ruby, Yelena and Matt delve even deeper
54:43into the public health system.
54:45His epilepsy is so challenging
54:47that it's worth leaving no stone unturned.
54:49We're putting clenotane electrodes in through the brain,
54:53and that waiting to find out whether as a 23-year-old man
54:57you've regained your life, that's a nerve-wracking moment.
55:00Last Sunday, I collapsed.
55:03I woke up and I couldn't walk.
55:05I couldn't walk at all.
55:06The nerve damage, so I'm only 30, and it's getting worse.
55:11These tumours, they start spreading everywhere.
55:13I would say at this rate,
55:15he probably would die of cancer-related problems
55:17within about the next million months.
55:19You got this? You're going to be okay?
55:21Yep.
55:21Alright?
55:22This is a super dangerous bit right there.
55:25I feel like on the edge of your seat here, holding your breath.
55:57If you or someone you know is experiencing family violence,
56:02call 1800RESPECT on 1800 737 732
56:08or visit 1800Respect.org.au.
56:12For counselling for men who have anger, relationship or parenting issues,
56:16call the men's referral service on 1300 766 491
56:22or visit ntv.org.au.
56:25In an emergency, call 000.
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