Bill English has become New Zealand’s thirty ninth prime minister. I’ve met Mr English. In the mid-90s when I was clinical head of Emergency Medicine at Middlemore Hospital, South Auckland, he was Minister of Health. He dropped by one day and we had a chat in my office. He asked me what the department needed, and I said it needed to double its resources. At the time I didn’t think this went down too well, but in fact it happened, in spades. Middlemore ED is now a 130 bedded facility with four resuscitation rooms, run by 56 medical staff, 22 of whom are consultants. I am proud of the fact that I played a small part in the development of Australasian emergency medicine.
In order to further the cause of emergency medicine, it was necessary that the specialty have a public profile. Hence in the mid-90s I had dealings with the media. I don’t think of myself as a person particularly comfortable in the limelight but at the time I didn’t mind. I even relished it. The fact is I was living on my nerves. My world was full of murder and mayhem and for some inexplicable reason I would wake up in the morning full of beans. I couldn’t explain it then and I can’t explain it now.
For a time I had a slot on Radio Pacific. I would arrive at work at 8 am and do an interview about the activities of the night just gone. The subject matter often involved road trauma, interpersonal violence, drug and alcohol abuse, multiple morbidity and the problems of patients with significant pathology presenting late. TV NZ interviewed me one Christmas about the challenges the department might have to face over the festive season. The hospital saw this as an opportunity to offer preventative medicine and the delivery of sound health care advice. Then a television company negotiated with the hospital to run a weekly fly-on-the-wall documentary, Middlemore. Episodes of emergency medicine were televised. I was never very keen on this idea. Any time I was on camera I always knew that the dynamic of the medical consultation was altered. There was a third party in the resuscitation room. But again, the hospital recognised it as an opportunity to deliver a form of health care in a different way. So it happened. I remember I was interviewed on the programme one week about the epidemic (it was no less) of major trauma in Auckland resulting from road crashes, often alcohol related. I recall making some disparaging remarks about human irresponsibility culminating in a throw-away remark, “It’s pathetic.”
It turned out that “It’s pathetic” struck some sort of chord. I started hearing recordings of myself on radio and TV saying “It’s pathetic!” as the media took it upon themselves to tackle the scourge of drink-driving. For a week or so I had a kind of Andy Warhol fame. I would walk the length of Middlemore’s immense medical corridor and colleagues coming the other way would nod at me. Then, ten metres further on, they would shout back at me, “Pathetic!”
Then I went to an emergency medicine conference in San Diego, California. I recall one evening we crossed the bay to dine in the Hotel del Coronado, a magnificent old style hotel with décor in deep brown varnished wood. Outside, we had a stroll on the beach, where Marilyn Monroe and Tony Curtis filmed Some Like It Hot. That night, I took a call from a New Zealand radio station. They wanted to use my “It’s pathetic” quote as part of a publicity drive to improve New Zealand road safety. I said no. They tried to change my mind, and in many ways were very persuasive, but I stuck to my guns. The reason why I was so adamant was that I did not believe the public would make a distinction between a criticism of a human action and the criticism of a human being. “It’s pathetic” would morph into “They’re pathetic.” That sort of attitude is absolute anathema to medical practice. And mind, Middlemore Hospital is at the heart of disadvantaged South Auckland where the bulk of Maori and Polynesian people stay. Many of the people involved in episodes of major trauma were, are, Maori and Polynesian.
I recall some of my colleagues thought I was being perverse, even sanctimonious and pompous. But I’ve never had reason to change my mind.
Not that I always got it right. I remember doing one particularly gruelling night shift and in the morning getting a call from a New Zealand newspaper. My guard was down. “Is it true, doctor, that in the event of unsuccessful resuscitation from cardiac arrest, medical students are sometimes offered the chance to practise intubation of the deceased?”
I answered yes.
At home the following morning, my phone rang at 7am. I answered, assuming it would be the hospital. No. It was the media, the first of many calls that day. I had an uncomfortable 24 hours. The Professor of Medicine at Middlemore was kind enough to say to me, “You only told them the truth.” But the fact is that to intubate somebody who has just died is unethical, because the person has not consented to the procedure. And I chaired the Hospital’s Medical Ethics Review Committee. I used to think I could get by on “common sense” but fortunately there was a lawyer on the committee who would occasionally gently point out to me how hopelessly wide of the mark was my “She’ll be right” attitude.