Features Australia

We can be heroes (or martyrs)

Do I join my fellow doctors on the front line?

11 April 2020

9:00 AM

11 April 2020

9:00 AM

I’m a doctor who fears becoming a coronavirus martyr.

There are attractions to being cast as a health care hero, flushed not only with potential adulation but with the rewards of free coffee at McDonalds and half-price chicken at Nandos.

But the threat of a deadly, cytokine- mediated embrace with the demonic Covid-19 would only be more imminent, PPE or not. Being hooked up to a ventilator and saying my final goodbyes via Skype through a poor network connection is a demotivating influence.

Despite not having worked in an emergency or intensive care ward for decades, hospital administrators are assessing my preparedness to work on the front lines of a potential medical crisis.

While Australia is not there yet, and will hopefully never be, the situation is so grim in parts of Europe and America that medical students yet to graduate are being asked to man hospital wards with retired doctors well into their seventies. It’s the medical equivalent of sending out fifteen-year-olds into the Battle of the Somme, like lambs to the slaughter.

‘If we’re fighting a war, let’s act like we’re fighting a war,’ said New York Mayor Bill De Blasio last week while pleading for health workers around the country to be enlisted to areas of need.

In considering what a psychiatrist still remembers from several years as a junior doctor in hospital wards, I don’t need to underplay my skills out of fear. Almost nothing. I might offer soothing words of support or encouragement to family, but relatives of coronavirus victims aren’t allowed visits. I could install cannulas, the needles placed in forearm veins which allow for fluids and drugs to be given through a drip.

One thing I do remember is the repeated assertion that the age of infectious disease had largely passed, other than in the developing world or among especially disadvantaged populations such as Aborigines. I spent time among Aboriginal communities in the Northern Territory as a medical student. Examining chest X-rays of patients with tuberculosis there was considered an exciting educational privilege, something virtually impossible in city facilities.

Prestigious centres such as Harvard and Yale had discarded their infectious diseases departments in recent decades. Medicine, we were told, was now about chronic disease managed by teams. Even cancer, HIV and certainly mental health  issues were such examples.

Well, don’t call it a comeback, but it appears infections and their invisible, microbial masters weren’t ready to wave a historical goodbye just yet.

I am torn between a powerful desire to support my colleagues effectively putting their lives in danger and trying to minimise my risk of contracting coronavirus.

We have enough work in mental health, given the sector is behind the scenes of both the health and economic crises we face. In the past month, I have already become more adept in deciphering subtle changes in facial expressions through a computer or phone screen.

But the nagging insult that has always been thrown at my kind, that we’re not real doctors, does sting at a time like this. Perhaps it is time to display my metaphorical, medical testicles.

The international precedent is less than encouraging. Health care workers are three times more likely to acquire the virus according to statistics from Italy and Spain. Those with a greater volume of exposure are especially under threat, as shown by the original doctors who voiced the alarm in China. Li Wenliang was censored after alerting his colleagues, only to die at the age of thirty four having been fit and healthy.

Health care workers who came out of retirement in Italy and Spain were disproportionately killed or seriously ill while trying to serve their country in crisis. Along with those in emergency or intensive care wards, ear/nose/throat specialists and anaesthetists are especially at risk.

Some health care workers in Britain are being asked whether they have drawn up their wills before committing to their shift in intensive care units.

Hospitals in London and New York are reporting up to a quarter of their staff either sick or in quarantine.

Perhaps in Australia it will be suggested we take out ten grand in super before committing to such work.

I remember learning resuscitation techniques as a trainee where we had to apply criteria in seconds about how to ration treatment in the event of catastrophic events. Massive car crashes or bomb attacks might be examples. I have never heard of any colleagues actually having to put those teachings into action.

Much like soldiers in battle, doctors around the world face the prospect of moral injury in grappling with their conscience about dispensing justice, who lives and dies.

Administrators are engaging ethical committees to help build more objective guidelines, but the final decisions must still be implemented by tormented doctors, before being communicated to distraught relatives via phone or Skype. They are often doing this without adequate protective equipment.

The notion of serving in health is about a commitment to save lives and reduce suffering, but nobody imagines the sacrifice might also mean a threat to one’s own life.

In more traditional countries like India, doctors are being thrown out of housing blocks around fears they may carry the disease. Here, a local colleague unthinkingly caught public transport wearing her scrubs, something she had done for years, only to cause sheer panic among the other passengers. Many doctors or nurses currently working with coronavirus patients sleep in hotels or separate rooms after their shifts to protect their loved ones. There is an unseen tension between health care staff being held aloft as heroes but simultaneously being viewed as threats.

I have never felt a stronger sense of camaraderie about my colleagues, right around the world, risking their own lives to save others. I would not hesitate to join them on the front line if it was deemed necessary. But meanwhile, pray that from either lack of adequate supplies or from sheer viral exposure, more of our medical heroes are not forced to become medical martyrs.

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