Dr Caroline Dowling (1988), Urologist and Old Lauristonian recently wrote an article based on her experiences surrounding COVID-19 pandemic.  We are very proud to share this with you.

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My Corona

Thinking back to the September holidays last year, lounging around in the sun with a book, none of us would have quite predicted what lay ahead in 2020. For most, lives will change forever and many not for the better.

I first became aware of the Sars 2 COVID-19 pandemic as a novel and complicated virus in January that had broken out in an area of China called Wuhan about which I was entirely unfamiliar and so I really thought little more about it. Our news and our lives were dominated by the bushfires which seemed a much more tangible threat. When our principal Susan Just started communicating to the school in late January about Coronavirus as it was then termed, hot on the heels of reassurances about Howqua and the fire danger, it became a little more real.

But term got underway and as we do, we nestle back into our self-absorbed and “busy” routines and I actually gave very little thought to the virus and on the 24^th February I boarded a plane to Phoenix Arizona for a medical conference. There was some additional screening to make sure you hadn’t been to China but not much else said. Phoenix is always sunny and the virus did not rate a mention at an excellent meeting on all aspects of female pelvic medicine and reconstructive surgery and neuro-urology which is my sub-specialty practice which my close friend’s joke is about a better put together or “designer vagina”.

When I transited back to Australia on the 4^th of March via San Francisco, the airport was deserted, and I felt happy to be back home having listened to about every cough on the flight with increasing alacrity. News from home then was the reporting of the first death from Coronavirus on the 1^st of March in a case from the Diamond Princess or one of the “floating petri dishes” as they rapidly became known at work. By the time I was back at work on the 5^th of March there were 57 national cases. Two days later one of my poor colleagues was very unfairly tarred and feathered by the state Health Minister for consulting with a mild cold in his Toorak General Practice unaware of the unfolding situation with the virus in the USA and that he actually had COVID-19. I shuddered at the thought that it could have equally been me.

The situation rapidly unfolded from there; the Grand Prix was cancelled and by the 15^th of March we were instructed any health care worker returning from overseas had to self-isolate for 14 days. In an example of the inconsistencies we have seen in the management of the pandemic, my travel companion, a urologist from Bendigo, was instructed by her area health service to self-isolate and not work until her day 14, she had flown in two days after me. In retrospect it is then astounding that the Ruby Princess docked on the 19^th of March and no one was sent to self-isolate until the next day, after 13 passengers tested positive, by the 24^th of March that number was 133.

I am the Director of Urology at Eastern Health, this is the hospital network that covers 2800 square kilometres of metro Melbourne from Balwyn to the Yarra Ranges. Our flagship hospital is the new Box Hill Hospital which opened in 2017 just before I was appointed. Urologists are surgeons who treat men, women and children with problems involving the kidney, bladder, prostate and male reproductive organs. These conditions include cancer, stones, infection, incontinence, sexual dysfunction and pelvic floor problems. Funny career choice for a female I still get asked, well not really when you consider the number of male obstetrician and gynaecologists, and urologists at least treat both sexes. I digress, but my job involves organising 15 other urologists and junior medical staff, two of whom are actively training to be a urologist, to deliver care to the patients treated at Eastern Health.

So what would I be doing worrying about COVID-19 then? It’s a long way from my usual neck of the woods? That’s a real question and not for one minute do I deserve the accolades that the front-line staff have earned in this pandemic. My role for the past few weeks has been around preparation for a surge in COVID-19 positive patients. If there were a very large number of patients we had to be prepared for prioritising patients who were not COVID-19 positive who still needed urgent surgery such as for cancers, training staff in PPE use for when we had contact with COVID-19 patients and importantly become part of the COVID-19 team if there were a very large number of patients who needed care, including in the intensive care and crucially, maintaining staff morale and reassurance, there has been a massive mount of anxiety and stress around the potential ramifications of a large surge, for obvious reasons, for health care workers.

I have escaped what all medical staff who are not used to dealing with flu pandemics fear, that is redeployment into a much less familiar role. My junior staff had occasional shifts in the COVID-19 screening clinic (the one where you drive through and they stick a swab up your nose a long, long way and my nurse described it after being screened as “awful, it actually feels like they are scraping your brain and you can feel the same tingling sensation for a while after”) but fundamentally I have spent the last six weeks since the 15^th of March preparing for a party that we will thankfully for now, do not have to attend because of the drop in cases from the impact of border control and social distancing.

I have however had colleagues in the UK redeployed, which means instead of being a urologist, operating on the abdomen and pelvis for 15 years you suddenly find yourself manning a ventilator in ICU instructed by an Intensive Care Specialist or “Intensivist” in the care of critically ill patients with COVID-19 as your health system is so overwhelmed there are now too many sick patients for the regular intensive care staff to look after.

The success of social distancing, our border closure and our general living on “quarter acre blocks” and not on top of one another has afforded us, for now, the great escape. Now at the end of April we had today 8 new cases nationally, compared to where we were on the 15^th of March which is when I feel it really hotted up for myself and my family at 54 cases and the threat of it increasing as it had internationally.

I have spent the last 6 weeks in a state of anticipatory anxiety. Initially we were advised at Eastern Health that we would be “overrun by Easter” and there was talk statewide of commissioning Jeff’s Shed to house 1000 ventilated beds. That news made me feel very anxious but could never quite fathom that level of disaster or lack of control in our system, or perhaps that was a protective response to keep me focused. Anticipatory anxiety involves endless Zoom meetings, to the point where someone, in the cycle of memes and messages to keep up the humour, concocted a fake New England Journal of Medicine article entitled “Interminable Meetings Found Ineffective for Treatment of COVID-19”.

Elective surgery came to an abrupt halt and we had to prioritise the neediest for surgical access and keep elderly Australians away from the hospital. We had to convert all our clinics to Telehealth, a massive logistic exercise and change in the way we interact with our patients. I had to split my team in two so that the two halves never crossed paths and there was always a fresh team at home protected from illness. I had to learn about personal protective equipment in a new way and train my team and recommend all sorts of new and bizarre habits like no watches, no sleeves below the elbow, no jewellery whatsoever, leave your bag behind, put mobiles in snaplock bags and the like to protect the team and make sure we didn’t take any virus it home.

I indulged in some panic supermarket buying mainly because at one point I became concerned that if my husband, who is an Intensivist and is at far higher risk and I, both became ill, the kids would need to fend for themselves as the grandparents are isolated from us and cannot risk themselves stepping in. A godsend then came when our former nanny lost her paralegal job, shocking for her, but suddenly there was someone in the house to rely on. She did however look a little shaken, but willing, when I suggested she might get stuck here with the kids if we went down and had to recover in a quarantined part of the house. I certainly didn’t think I would be having that conversation any time soon.

So where to from here? Julian and I have read endless amounts of material from home and abroad and he in his role even managed a Zoom meeting with an intensivist in Wuhan. All we know I am afraid is we don’t know enough. There are still many “what ifs” and incredibly unclear scenarios. We don’t have a vaccine and don’t even know if and when one will come. Immunity is still questionable having had exposure. Very few of us have been exposed. We have escaped the worst of a medical catastrophe that has gripped the globe and ripped through cities many of us have visited. I have heard fear in the voices of my international colleagues facing the reality of their dire situation.

We now face a long, tedious and uncertain road out with certain dire economic impacts. A life of not hiding from but living with COVID-19, gradually lifting restrictions and managing outbreaks as they occur. Keep Calm and Carry On? Continue to draw on the strength we found to go into and endure lock down, watch Trump memes, hold virtual book group, exercise whenever and wherever and however you can. Draw on the ANZAC spirit even though we didn’t get to properly celebrate and support one another as we always have and will continue to do so, the dawn driveway brass band that echoed the last post through Camberwell an excellent example. Escape the cycle of think-plan-worry that dominated us, because hell you can’t plan ahead for now. Learn to value simplicity and being stuck. We will grow again as a nation and realise the value of our personal and natural resources and what we can do at home and reduce our reliance on others. Hopefully make our own PPE and ventilators would be one plus and other key supplies that I am waiting for at work as they are stuck around the world and celebrate the ingenuity of those who have created something equivalent locally. Having been spared the worst of the health catastrophe, the only crisis for Australia will be to not reflect and learn from the crisis.