Today’s post, the first of two parts to mark Sydney Mardi Gras, is by Paul van Reyk, foodie, social worker and queer activist. Paul’s article about nurses on the frontline of the ‘AIDS crisis’ during the 1980s in Ward 17 South at St Vincent’s Hospital, Darlinghurst, was presented to the Australian Homosexual Histories Conference at Melbourne University in November 2013.
It tells of the intensity, camaraderie and rollercoaster of nursing young people with the new and unknown – and lethal – condition that was AIDS in the 1980s.
This ain’t no party, this ain’t no disco,
this ain’t no fooling around
I’d like to kiss you, I’d love to hold you
I ain’t got no time for that now.
‘Life During Wartime’ by David Byrne
Nursing staff on Ward 17S in 1987 or 1988. Thanks to Colin Clews for this photo.
In October 1983, Ron Penny, then Associate Professor in Immunology at St Vincent’s Hospital, Darlinghurst, diagnosed the first case of AIDS in Australia. The man was admitted under Penny to Ward 7 South of the Cahill Building, the Immunology ward. Over the next two decades the ward, later re-designated Ward 17 South, arguably was to bear the brunt of hospital care for people with HIV/AIDS.
Professor Ron Penny.
This paper is part of a wider project to document the history of this and other dedicated AIDS units in Australian hospitals. The paper focuses on the nursing staff and hopefully goes a small way to redressing the lack of their voice in Australia’s AIDS history. It covers the period 1983-1993 from the first AIDS case in Australia to the beginning of trialling anti-retrovirals, the period during which this nursing practice was at its most challenging, by all accounts.
At the time of the first intake of people with AIDS, the ward was shared between vascular patients at the northern end and immunology patients at the southern end. There were 36 beds in all; five six-bedded bays and six single rooms for patients needing intensive nursing or infections requiring isolation.
The first people with AIDS treated on the ward were allocated the single rooms. This was because there was little knowledge about the routes of transmission outside of sexual bodily fluids at the time and there were concerns about the risk of infection to the other immune-compromised patients.
A Ward 17S patient and his partner: from an ABC Four Corners program in 1985.
As the numbers increased, a six-bed bay was added. The single rooms continued to be used for those needing the most intensive nursing, often the dying, and also for women, as there was never a sufficient number of women with AIDS at any one time on the ward to be able to allocate them a six-bed bay. Over the next 10 years all the beds were allocated to people with AIDS.
Increasing the bed numbers was resisted for some time by the hospital administration, for two reasons. The first was the pressure put on other units in the hospital by increasing the intake of people with AIDS, including Emergency and the existing hospital hospice capacity.
The second was discomfort among hospital administrators and some surgeons with homosexuality, in part because Saint Vincent’s was a very prominent Catholic institution and in part from homophobia per se. This failure to open more beds despite the availability of additional funding from the State Government was the focus of ongoing gay community anger.
Some pressure on beds was relieved with the establishment of AIDS units at Prince Henry Hospital, Little Bay, in 1986 and Royal Prince Alfred Hospital, Camperdown, in 1988 and the opening of the Sacred Heart Hospice with a dedicated AIDS floor in October 1998.
More beds were finally opened at St Vincent’s in August 1989. From the early to mid 1990s, the ward was at full capacity of 36 beds constantly.
Saint Vincent’s also ran an AIDS outpatient clinic beginning one morning a week (Friday), increasing to five days a week in December 1988. The Maitraya Day Centre was established by Saint Vincent’s and Darlinghurst Community Health Centre in November 1987, beginning one day a week and also increasing to five days a week in December 1988.
I think why the ward had such a good reputation was because the nursing was so good. The nurses we attracted did it because they wanted to. There was a strong empathy between the nurses and the patients. But they were very professional also. I don’t think any boundaries were crossed. Professor David Cooper
Who were these nurses of whom Cooper speaks so highly?
I had seen (Ward 17 staff) in the cafeteria and I thought, these people are full of love, they’re out there, they’re queer and if they are not they are queer-friendly and I was queer and coming out. I want to work with these people.
Anne Maree Sweeney, Registered Nurse and Clinical Nurse Specialist
Many were gay men and lesbians who wanted to ‘take care of their own’: friends, their wider social network, their community, sometimes their partners. Some of them were themselves positive. Others were heterosexual men and women who also had friends or relatives who were people with AIDS or who saw AIDS as a health crisis to which they wanted to contribute their nursing skills and wanted to do this alongside ‘like-minded’ people. Not unexpectedly, the ward had a higher proportion of male nurses than other wards in the hospital, at times as high as 50 percent. Most of them were of the same generation as many of those they cared for.
Mardi Gras in the mid-1980s. Photo by William Yang.
Some had been nursing for some years in oncology, paediatrics, critical care, respiratory illnesses or psychiatry. For others it was their first nursing experience. There was a lot to learn. Many of the presenting illnesses were rarely seen and certainly not in the young population they were dealing with. Treatments for these, and the later anti-retrovirals, were experimental and knowledge of their efficacy and side-effects were only learned from observing the results of treatment. They also learned new nursing skills when other specialist staff refused to deal with people with AIDS, like having to take blood for culturing or inserting canulas because pathology staff wouldn’t. Much of this learning was done at the bedside working with what they all describe as a genuinely collaborative multidisciplinary team, one which was not ‘doctorcratic’ and which encouraged questioning, critical incident de-briefing. This was supplemented through ward meetings and regular in-services. Some were supported to undertake the Sydney Hospital six-month postgraduate course in HIV/AIDS established in the early 1990s.
Later, Moys Gillespie recalls, new nurses would learn about the treatments, their doses and side effects from people with AIDS themselves.
The guys taught you. They knew their meds back to front. You’d take the drug trolley around and there’d be lots and lots. But the guys would say to you ‘I need that and that’. That was my first example of patients taking control of their own health in terms of questioning. It took a little bit of getting used to but I thought it was amazing.
Moys Gillespie. Registered Nurse and Clinical Nurse Specialist.
In sum, in the words of ex-NUM David Crawford, they were all ‘very skilled, very caring, and very driven.’
David Crawford RN and ex-NUM of Ward 17 South.
But then, you had to be to survive life in the warzone.
It was like working in Emergency every day. ‘So and so’s just stopped breathing. Grab the CPAP. Hang the bags. Put a line in. Try and get a doctor down as soon as you can.’ While that’s happening, three guys in the same bay are having diarrhoea that’s non-stop or intractable vomiting. Bleeding, bubbling lungs. Everybody was on oxygen… Top to toe nursing. There was a lot of screaming. Dementia. And everybody was dying. Anne Maree Sweeney
To hear more from the nurses who worked on Ward 17S, read part 2 of Life during wartime – nursing on the AIDS ward.
Many thanks to Paul van Reyk, as well as to Bill Paterson and Colin Clews for supplying photos for this article.