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Letter 155 |
One Doctor’s View From Inside the Australian Healthcare System |
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| The Australia Letter is a weekly newsletter from our Australia bureau. For this week’s issue, the newsletter is written by one of our readers, Dr. Amaali Lokuge, an emergency physician at The Royal Melbourne Hospital. |
When my director cut short his camping holiday on Australia Day, to come back to the emergency department at the Melbourne hospital where I work as an emergency physician, I thought he was unnecessarily sacrificing his life for the sake of his work. Covid-19 was still mainly confined to China. Italy was not yet in crisis and New York wasn’t even on our radar. But in hindsight, his return was prudent. |
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The fever clinic attendances surged. We were seeing 30 to 100 extra patients per day in an already stretched system. A coordinated emergency department and hospital strategy was required, and unfolded as if by magic. |
It wasn’t magic though; If you looked closely, you could see the signs of people working way beyond their scheduled hours. Doctors and nurses and support staff were at the hospital hours before the day shift began and we would see them late into the evening shift. The tired lines around doctors’ eyes etched a little deeper each day as they rushed past at a speed just below running. |
It wasn’t until March that the reality of what we were facing started to filter through. A hundred patients died overnight in Italy and we were speechless with grief. Was this what was coming for us? |
We would not be able to cope with a similar onslaught. There are around 30 ICU beds in our hospital — how quickly would these be full? This is not something we have had to face before. |
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People often ask me how I cope with the stress of emergency room medicine. But the reality is, we have so many resources where I work that when patients come in sick and dying we can usually resuscitate them. People rarely die because we don’t have the facilities to help them. |
But this disease was different. It seemed to take and take and take, until there was no more to give. We were not ready to face patients dying because we didn’t have a ventilator to help them breathe, or because we didn’t have the nursing staff to care for them. |
In those early weeks of March, we worked at what felt like superhuman speeds to get ready. Always at the back of our minds, the mantra we kept repeating: it’s coming, it’s coming, and we are not prepared. |
Somewhere deeper down lingered other anxieties: Would we get sick like the health workers overseas? Would our loved ones be safe? How would we cope with so much death? |
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Everyone was worried about someone: the elderly parent; the child with an immune deficiency, which may be deadly; the sister who was currently immunosuppressed from chemotherapy. |
To add to our anxieties, the emergency department became eerily quiet. The patients would trickle in at single digits per hour. Was this the quiet before the storm? |
Every morning we would read the international news with dread and horror. People were dying because systems were overwhelmed. Health care workers were preparing their wills before it was too late. Families with emergency physician parents were sending their children away to safety. We devoured the information, always wondering when it was coming for us. |
Then something miraculous happened. Restrictions applied with lightening speed were curtailing the spread. People stayed home despite the chafing irritations of isolation. Everyone was doing what was necessary to look after the weak and the elderly. And in a way they were to looking after us, the health care workers, too. |
The surge did not occur when it was supposed to. We worked so hard, filled the hospital to capacity with extra staff and equipment, wrote guidelines on treatment and made plans for the influx of patients, all within days. But the patients failed to arrive. The wave never swelled to a tsunami. |
We are now caught in a limbo of waiting. People aren’t dying in the numbers we predicted when observing the disease in other countries. The tragedy has, so far, failed to unfold. |
Economists have started to write about the cost of this strategy in terms of money spent per human life years saved. People question the wisdom of Australia’s harsh social distancing restrictions, which will have repercussions for years to come. |
But as I think of what we might have faced — the sheer sadness of so many lives lost in so short a time, the trauma of being helpless in the face of a disease we don’t know how to control — I am so grateful that my country may be spared what others have had to suffer. |
The tyranny of distance and the shocking bushfires that kept the tourists away delayed the inevitable spread of virus in Australia, enabling a brief glimpse into our possible futures. This has meant that we were able to choose the path of humanity — and not economic rationalism — to deal with this disease. |
We will have to pay for our response for years to come. But my hope us that we will still be whole, and free from the scars of failure and grief. |
Do you have a story to tell about the way your workplace has dealt with the current situation? Let us know at nytaustralia@nytimes.com. |
Here are this week’s stories. |
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Around the Times |
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