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Out of Touch documents the unique experiences of Western Australians during the COVID-19 pandemic that hit Australia in early 2020.

Dr Michelle Johnston is an Emergency Physician at Royal Perth Hospital in Western Australia. In this interview, Michelle outlines what a day in the emergency department looks like and how the impact of the pandemic unfolded for the team and the hospital’s patients. Michelle shares that COVID-19 highlighted the severe inequalities many people face within Australia as well as the incredible strength of her co-workers and other essential workers during this time.

[TRANSCRIPT]

My name is Michelle Johnston; Doctor Michelle Johnston when I’m at my day job and just Mum on my other days, or Michelle when I’m home writing, so I have a few different jobs, but one of the reasons I guess I’m here talking about what’s been happening recently in Perth is my role as an Emergency Physician; that means I’m a specialist in emergency medicine. I like to call it like I’m a specialist in mess, and trauma, and violence, and the crumbling fabric of societies, kind of how I see my speciality. I work at Royal Perth, which is the inner-city trauma centre, sort of in the middle of it all in the middle of the city. I’ve worked there as a consultant for 20 years, but as a doctor, fully before I became a specialist 10 years before that, so a good 30 years as a doctor in the trenches.

So, Royal Perth itself is Perth’s oldest hospital, and it’s sort of built up over many years to be many things to many people, but the Emergency Department itself sees, we see about 70,000 patients come through the Emergency Department. There is no question that a place like Royal Perth Emergency Department shines a very bright spotlight on inequality. We see a lot of problems with drugs and alcohol, methamphetamines in particular, homelessness, domestic violence, because no matter how good a society is, there’s always, there’s no true safety net, and sometimes the only safety net is the Emergency Department of the inner city and that’s what we do.

We first learnt about COVID very early – it was about end of January beginning of February, and I remember it very distinctly, because as the consultants who are running the department we sort of run it for a 10-hour shift and then we hand on to the next one and we all crowd around this little computer, we have one little computer that we love to do the handover, we talk about the problems in the department, what issues are going on, what the bed state is like, all those sorts of things. I can absolutely recall us all crowding around the computer when the information first started coming out, and people were putting printed-out paper on the wall just behind the computer saying: “Can you ask if anyone’s been to Wuhan, and if they have a fever and a cough”, and we were going “Where? What is a Wuhan? I’ve never heard of a Wuhan”, and we’re all busy on the google. We have these pieces of paper that come on the wall fairly frequently – they usually come from a combination of the State Epidemiologist, Australia-wide Epidemiologist, going through the State Health Coordination Team, and these communiques come out, and there’s a little circle that’s been drawn on China to show us Wuhan is, and so we start googling, and it’s this kind of circle’s getting bigger and bigger every day we come, and we still don’t think anything of it, because we’ve been there before.

I get goose bumps even remembering back to that time we’re coming into work wide-eyed going “Oh my gosh”, and then we start hearing about what’s; we get information, podcasts, and it was when it hit Italy, and we saw the images of the ICUs and the doctors coming out and the nurses coming out, covered in tears, people are dying, we’re doing CPR on our friends, and our colleagues, and that’s when it hit, it was around that time. Obviously, New York started to rise up and we knew that that was the time that things were going to change. And things started to change very, very quickly for us. We had this collective reckoning of the soul, thought “This is going to happen to us”, we realised it was all, that we were all going to be at risk, and there were people, there were our colleagues dying in other parts of the world – people we knew.

That’s going to be around mid-March I think, beginning to mid-March, when we realised that we had to set up for this because we’re, we will not be protected, there is nothing that’s going to do to protect us from this. There was lots and lots happening behind the scenes, and the Western Australian government, the Western Australian health system have been phenomenally good. We very quickly restructured our staff, our area, our equipment, and that was certainly the time where we had COVID patients coming in because we are the inner-city and all the COVID patients were in the hotels. So they were all coming through to Royal Perth when they needed to come through.

I mean a couple of really remarkable things about that very rapid restructuring, was: one, having to reinvent ourselves every day. We would come in and, because nobody knew about, nobody knew about how to manage this disease. Nobody knew how to assess it, how to investigate it, how to manage it, what to use, how to intubate the patients. We were bringing in boxes, we were taking out the boxes, we were saying you needed this PPE, you needed that PPE, what PPE do you need if you’re just doing this, doing that. It would change every day. So we had all that going on, and that’s really tough because we’ve still got our normal job. The normal job is kind of, stretches you to 99% of your ability, and then all of this going on.

So there was that but then there was obviously the psychological burden. I mean you look back now and you think well, we’ve been so lucky, but we were really scared, and we were all sleepless before it started because we could see what happened, and we were watching people who didn’t deserve to die, die in these terrible circumstances being looked after by their friends. Anyway, we were there ready to go, ready to take it. We all stepped up. None of us stepped back, we all stepped forward and said “I’m going to do this” and we all did extra time, and my job was coffees and chocolate as well as the poetry, they’re important things to me. Just to come in each day, “Are you OK?”, “Are you all alright?” because obviously, we’ve got a lot of junior staff too, and my job is to make sure those junior staff are supported. We’re sort of older and crusty now, and we should be able to look after ourselves; we look after each other.

Everyone is aware there are places in the world that have done well with PPE and places in the world that have not done well. I had this amazing day where I got delivery of said black-market masks, and I go outside, and I’m in my scrubs and I don’t look attractive, I’m just looking like a mess, and I walk down and this latest-model Rolls Royce pulls up out the front of the ED, I don’t think the car park has ever seen a car like this, and a quite dapper man in a suit gets out, pops the boot, and there are my boxes of masks that I’ve managed to source. And I’m feeling, I just, I wished I could take a photo and I so wanted to have, “Look at me, look, I could be in a movie doing this”, but I couldn’t tell, I couldn’t show anyone.

A couple of things: I really did want to be able to mention, we talked earlier on about inequity, and how it shows up the inequity, and there’s no question that in the rest of the world that’s been a big issue: that the disproportionate effect COVID has had on the lower socioeconomic groups, people of colour, all sorts of people who are not white, wealthy, that sort of echelon who’s sort of pulling the purse strings and controlling things, and it has… for lots and lots and lots of different reasons as a huge societal issue. But one thing Perth did, at the beginning that just made our hearts soar was opening up of hotels for homeless people, so homeless people were taken off the street, and put into hotels, and it was the first time I’d ever heard of it. It just felt so good – we could do it!

“The new normal” is something that is talked about a lot and I think that has so many elements to it. The most narrow way of thinking about it is that COVID’s not going away for a while, the vaccine is going to be very, I don’t know no one can predict it, but it’s certainly not a given. However, to me the new normal is climate change, we can’t, we just can’t want to go back, because whatever we did before, pandemic or not, was wrong, was bad, killing our planet, sure as Tuesday, so that to me, it’s an opportunity for us to re-look at how we do things. Will we? That’s the big question.

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