26 Feb, 2021
Earlier this month, Joe Kennedy sat down with one of his regular contacts in the medical field, located in Western Australia. Going into more depth about the experiences of doctors dealing with the effects of COVID-19 in Perth, Joe asked 6 simple questions that sparked tremendous insight into the current climate. For privacy reasons, the doctor’s name has not been used in this interview. QUESTION ONE To kick things off, how was 2020 for you and your colleagues? Hi Joe, 2020 was pretty unchanged for most of us here in Perth from the COVID front – we had, like everyone else, the initial concerns about the arrival of COVID on our shores. We had a flurry of preparation trying to sort out new policies, protocols and PPE training, had a few patients to look after in the hospital and in the intensive care unit, and then, luckily for us in Perth, by June, it all settled down apart from a few cases in quarantine and thankfully, none since then who have been sick enough to require ICU admission. I think I can safely say that my colleagues and staff in my unit have been very, very thankful that we’ve been spared the experiences of our colleagues, both internationally and nationally. We have pretty much been functioning looking after the “business as usual” cases almost all the way through 2020. The main bulk of cases in ICU here have been trauma, and despite an initial brief drop in case presentations during our very brief lock down, has been essentially running hot with high bed occupancy rates. QUESTION TWO What were the major differences in 2020 compared to pre-Covid days from a clinical standpoint? Interestingly enough, the pattern of presentations has changed somewhat – bearing in mind that we have an emphasis on trauma in my hospital, the pattern has fluctuated depending on the prevailing lockdown situation. There was a shift to domestic type cases – (falling of roof, fall from ladder, chainsaw injuries etc) as the lock down directed everyone’s energies towards home renovations (Hooray for Bunnings!) and much less high-speed trauma as travel was restricted between metropolitan and country areas. Subsequently, when those restrictions were lifted, there’s been a return to the usual high-speed vehicle trauma, and probably actually more cases, as WA’s strict border control has resulted in more travel within the state. Mental health related presentations have also increased, as people have struggled to cope with the uncertainty of our current conditions. WA has been effectively living in a state of quarantine, with little ability for travel interstate or internationally, and the impact on family networks and supports has led to fracture lines in mental health and coping strategies. Illicit substance related presentations have also been affected by COVID – availability was heavily impacted by the lack of international and internal logistics early in the Pandemic, and domestic manufacture of substances took over, with decreased drug purity leading to a variety of interesting side effects. I think the biggest impact for us in our practice has been the difficulty in not having non-WA based next of kin see their relatives here in ICU. Exemptions (as the name suggests) are restricted and take time to process, and in a unit where trauma presentations predominate, untimely and sudden death have led to many difficult situations where family’s interstate and overseas, have had to have the end-of-life process managed via phone and video links. This change in our practice has continued here in WA because of the prolonged state-wide border closure, and our role in end-of-life care has been more demanding and difficult. I recently had a patient with un-survivable head injuries who had no NOK in WA – speaking with his family, showing his distraught relatives images of him (they had wanted to see him, this was very distressing, as you can imagine with severe head and facial trauma), reassuring the family that whilst they couldn’t be here with him, he was still amongst people who cared. This was emotionally very difficult for all the staff involved, with everyone, from nursing staff, social worker, (myself) and the family all in tears by the end of that video call. This has been the new normal for us now for many months, but I also want to acknowledge that this is in no way as challenging as what our colleagues have faced on the COVID frontline in the hot zone. QUESTION THREE When Covid first reared its ugly head, there was a lot of uncertainty as to how serious the virus was. How do you think your Health district coped with making sure all the Healthcare and Medical workers were protected in the right way? Hindsight is a powerful tool and weapon, and whatever criticisms we had (and we had many) of the initial process, we have been in WA at least, really fortunate to have not had our preparedness tested to stress-point. We certainly didn’t deplete our stocks of PPE or go onto the second and third stage of the pandemic plan, where cohorting, using third party ventilators etc ever became a serious consideration, and so it is very difficult to fairly assess where we would have wound up had we needed to do so.