Some updates to June 2020

Dear Colleagues,

I hope everyone is coping with the lock-downs around Australia which seem to have been so effective compared with overseas. 

I have had some nice responses from Helen Hopkins, Romany and Russell White, Tim Ingall, Peter Bennett, Katherine Brown, Minas Coroneo and Mark Henschke: see below.  Congrats due to John Vaughan for his OAM Queen's Birthday award for service to Life-saving and General Practice.  

Helen Hopkins wrote:

Thanks as usual for the update, Andrew.

Australia has dealt very well with the threat from nature and we all should be pleased with cleaner skies and lowered emissions, but no one is singing about that very loudly although I wonder if Greta Thunberg and her minders are still on the payroll?

Scepticism aside, we do live in interesting times.

I continue to work two days in general practice enjoying my patients, the intellectual challenge and the opportunity to contribute. Physically and psychically I am well having recovered mostly from surgery chemotherapy and radiation. Ongoing Anastrazole is an oestrogen blocker which I will continue for 5 years with flushes, muscle and joint pains a constant side effect and finger nails and hair soft, short and brittle still from chemo.

I managed to get through it all with no loss of work nor missing daily cycling and swimming. I set myself that challenge and glad I adhered to it. It is surprisingly easy to start to feel sorry for oneself otherwise.

Now we are all old together life has different pleasures. I’m signing up for The Fungi Festival with The National Trust in Bowral next year. I have long had an interest in fungi and love to forage and illustrate their fascinating forms. There is a day of Botanical illustration and a Fungifeast!

I keep in touch with Libby Bassett. 

Kind remembrances to all,

Helen

From Romany and Russell White:

Greetings Andrew,

Thank you for your Autumn message, connecting in these surreal and unprecedented times and the update on our colleagues working in the field and involved in other pursuits. It has certainly been a time to reflect, reassess and appreciate the freedoms we took for granted before,

There seems to be some light at the end of the tunnel here unlike the situation overseas and can only wonder how some countries were so unprepared in the light of your interesting review on Denise Grady's book  'Deadly Invaders' with its ominous predictions written in 2005, even earlier than Michael Osterholm's book 'Deadliest Enemy ' written in 2017 which we have found engrossing to read reiterating that Mother Nature is 'the greatest bioterrorist of them all!'

Good to hear you are well and combining work in Redfern with life in the Southern Highlands, and presume there has been recovery in the region from the ravages of the Fires in Summer. Travel plans this year screeched to a halt for many and one wonders when global travel will safely resume, certainly Cruises will never hold the same appeal again!

Best wishes from us both for good health and better times ahead for us all.

Romany and Russell.

From Tim Ingall in Scottsdale:

Hi Andrew – thanks for sending this Class informational email.  While time is passing us by, there are many of us still active in different ways, not all of them medical.  Living through the COVID-19 pandemic in the USA has been in parts interesting, challenging, and frustrating.  Here are some observations from my home office where I have been working since Mayo Clinic shut down the face-to-face outpatient practice and elective surgery in mid-March. 

•         Telehealth has enabled me to see many new patients from out of state and locally as well as seeing follow up patients.  Our Neurology Department has 12 years of experience in doing Telestroke consults in regional hospitals.  Mayo has a Department of Connected Care and they worked with us to set up encrypted audiovisual consults with patients.  They establish an audiovisual connection with individual patients and then link-in the physician.  The actual consult is straightforward, but the resources needed to set it up and support it are significant.

•         As Chair of Clinical Ethics in Arizona, I was tasked with setting up an Ethics Triage Team which would be activated if there is a patient surge and we have a situation where scarce resources need to be triaged.  Most obviously, this would occur if we didn’t have enough ventilators to support all patients who needed to be intubated.  The ethics team would be responsible for making unilateral decisions to withdraw life sustaining treatment for some patients so that other patients with a better prognosis could be intubated.  Doing this in the US is challenging because every triage protocol that has been created has either been challenged legally by patient advocacy groups, or put on hold because the Office of Civil Rights decides the protocol needs to be reviewed.  All protocols state that triage decisions will be made without consideration of many factors such as race, gender, sexual identity etc.  Many advocacy groups believe that the protocols are biased against people with disabilities – this has been a real challenge because disability definitions during the pandemic have been changed and now any chronic illness (severe heart failure, metastatic cancer, etc.) is defined as a disability.  This makes it very difficult to use all the clinical variables you need to determine the short to medium term prognosis of patients, which is necessary for any fair process to triage scarce resources.  This has been challenging to say the least.

•         The lack of federal and state coordination to address the pandemic has been disappointing and frustrating.  There is plenty of blame to go around, but the White House response has been dismal.  I am not a fan of Trump, and what I view as his erratic and inept leadership has only reinforced my dislike of the way Trump does things. The missteps and missed opportunities federally, and the scattershot approach to implementing stay at home and social distancing guidelines by the states has contributed to a chaotic, ineffective public health approach which has resulted in the US having 1/3 of the world’s total number of positive patients, and ¼ of the world’s deaths attributed to COVID-19.  The only effective, collaborative response happened in New York with their Governor, Andrew Cuomo, coming across as someone who is calm, pragmatic, and willing to work with others.  Unfortunately, given the extreme partisanship that is present over here, I can’t see that the changes needed to have a more functional public health approach will occur.

Best wishes to everyone in our Class – stay safe and healthy!

Tim Ingall

From Peter Bennett:

Dear Andrew

Thanks for keeping in touch and for the pictures which bring back memories.  Your efforts are greatly appreciated.

We have just finished thirteen years on the APY lands in northern South Australia where I worked at the Indulkana and Mimili clinics and my wife Rosie as teacher and then deputy principal at the school.  I have gone fairly deaf which encouraged my decision to finish up when I had the opportunity given by a doctor prepared to take over my clinic work.  It was a very special time in my working life.  The communities were generous in their friendship and the close working relationship with remote area nurses was a great joy.  I had locum shifts planned to help with holidays but biosecurity for service providers is tight and this doesn't look possible at present. I am worried that by the time things improve I will be too rusty to be re-activated but hope I can find something useful to do. Meanwhile we enjoy more time with our lovely daughters and grand-daughter as far as possible under current restrictions.

Best wishes to you for continued good health and happiness, Peter Bennett

From Katherine Brown:

Thanks, Andrew.

Still working and below are my contact details.

Thanks for your dedication to this task. I enjoy keeping in the loop.

Regards

Katherine

Clinical Associate Professor Katherine Brown

University of Sydney & University of Wollongong

Medical Director, Ambulatory and Primary Health Care

Illawarra Sexual Health.

From Minas Coroneo:

Dear Andrew,

I hope all is well in these troubled times.

Thanks for bringing the 78ers up to date, job well done!

We are all well although our New York daughter and her family have been in the middle of it.

The attached paper may be of interest - it turns out the eye has an unexpected and likely critical role to play in Corona virus pandemic.

This raises the possibility of topical, prophylactic treatment – we’re setting up a clinical trial.

Minas Coroneo

LATE FINAL EXTRA!!  Mark Henschke has written too: 

Dear Andrew,

I join the big ‘thank you’ for being the conduit for our 1978 medical graduates.

I remain in the workforce as a P/T Senior Lecturer at the UNSW Rural Clinical School in Coffs Harbour, coordinating the Year 3 program. This is my tenth-year teaching after my many years as a GP Obstetrician in Armidale. Academia does not get you out of bed in the middle of the night – often below zero in winter. 

I read Peter’s [Bennett] missive with great interest. Over the University summer breaks, I have enjoyed locums in Northern Territory at Wadeye, Groote Eylandt and Santa Teresa in Central Australia. The communities are very welcoming, and many remote area nurses are very skilled and are often called upon to make difficult clinical decisions. They are an impressive bunch. But it gets very hot in mid-summer. Most days 42-43 deg C

Congratulations to ‘The Sheriff’ [John Vaughan] on being awarded an OAM in the recent Queen’s Birthday Honours List, services to General Practice and Life Saving. I spoke to John at length last week. He remains the same gentle self-effacing bloke we all remember; much loved by the many GP Registrars he has trained over the years. His legacy will live on in their work.

Mark

 Dr Mark Henschke,

Coffs Harbour. NSW

+61 (0)438 722 355