When I started writing this, we were just emerging from the winter of 2022
. The latest wave had been the worst yet, my house had just been ruined by flooding, I was sitting alone in a silent motel room staring at the wall and thinking that my life could barely get any worse
. Everything felt raw and immediate, so I just sat at the tacky
little desk and wrote in a flurry, then got tired and distracted
and put it aside. Time went on, the deaths started slowing down, the nights were no longer quite so long, my face started to heal, and it started to feel slightly silly for me to rave about this little virus
that was blowing away on the spring breeze.
But then another wave followed, and another, and the deaths have continued behind the closed doors of our society. Though we tried to move on, we were just closing our eyes and ears. And I found that, try as I did to forget and move on, this awful time in my life wouldn't stay off my mind. A feeling crept into me, and I recognised it as the same one I was trying to obey when I first started writing this piece — the vague, uncertain feeling that if I put all these things into words, then maybe I can be rid of them.
Time: March 2020
Place: Toowoomba, QLD
My job: Medical admissions
Dominant variant: Wuhan ancestral
National new cases per day: 200-300
Local death rate: Zero
The world is a chaotic, unpredictable place. Who could have guessed that the reports we heard in December 2019 about a mysterious pneumonic illness, being investigated in some unheard-of part of China, would become the most important news of the past decade, or perhaps even longer? There are so many stories every day that we cannot possibly keep track of them — they fizzle out of our awareness, never to be thought of again. Political movements overseas, market instability, corporate mergers and takeovers, deaths and assassinations, scientific near-breakthroughs, and yes, new diseases and treatments for old diseases. How to know which ones will be as important in five years as the breathless reporters want to convince us they will be?
People from my generation vaguely remember the scares about SARS in the early 2000s, which never seemed to amount to anything. It was the punchline to jokes with vaguely anti-Asian undertones for a few years, then it faded into a meld of memories along with Britney Spears albums and bad fashion of the day. So it just seemed like no big deal when people were once again coughing in a place that was far away and generally hard to understand at the best of times. The disease sprang up within China, an opaque place where no piece of news is fully trustworthy.
One day it became rather undeniable that this shit was as real as the ground I stood upon, when a colleague told me that the death toll in Italy had just reached five thousand. That is a number that feels inherently big. We stared at each other, mutually confronted by the idea of mass graves being dug in first-world countries of the 21st century, and we didn’t know what we should say. We shared an embarrassed, pregnant silence — we were two junior doctors, well-paid and comfortable, acutely aware of how little we were doing about all this, and unsure of what exactly we would do about it if it ever reached our shores. So we did what everyone else did, which was nothing. Or rather, nothing different from before. Some of my friends covered their Facebook feeds with COVID information and messages of support for those far-away people who were suffering and dying — this seemed to them a worthwhile thing. #flattenthecurve.
We were buzzing with excitement, like soldiers on the verge of war — the prospect of a raging pandemic terrified us, but to some degree we also felt that it might be our reason for being. We heard stories about exhausted doctors in Europe and Asia, and some part of us longed to be deep in the fight like they were. I imagined our hospital transformed into a warzone, with the sick and dying crowding our hallways, my friends and I making do with a handful of ventilators and many vials of palliative morphine. A morbid fascination led us to do strange mental calculations: If there are 200 doctors in our hospital, and half of our community gets infected, and the mortality rate is 2%, then who will be the two of us that succumb? We looked around at each other and let that question linger. The oldest doctor in our department was in her 70s, she was a much-beloved physician who had lived through more hardship in her Baltic homeland than any of us could fathom, and now she was banned from entering the Emergency Department for the sake of her own protection. She told us she felt humiliated.
Another of our consultants was of a different frame of mind. She was young and presumed to be fit, but she was terrified. She carried her own alcohol hand-rub, wore oversized protective goggles at all times, and started buying her own N95 masks from overseas when the hospital wouldn’t supply her any more. She put gloves on before touching any other human being. One afternoon as we were all packing up to leave we got a ping on our phones — a message from her into the Department’s communal WhatsApp chat. She wrote, unprompted:
I was on call today with Gaby.
Door handles are death-zones.
We managed to open doors with our ellebows and feet.
But some doors are really impossible to open without touching the dead-zone.
We both hesitated....
“I’m gonna offer myself”
I had to react fast and I could just in time make a big jump to prevent her from giving away her life for me...
Whilst being in the air-jump
My last thought was for my children.
I touched the doorhandle
The final line was followed by a skull emoji
, with deep black pits for eyes. We all cringed, look around the room for her presence, then laughed, and went home.
Despite the fear, we found that the cases did not come. In fact, the opposite — people were afraid of the hospitals, they were seeing the crisis unfold on the news every night, and our wards were emptier than they had been in living memory. People seemed to just stop having heart attacks and strokes, or they decided they’d just live with it. Better to be crippled at home than to die on a ventilator in a COVID ward, they seemed to decide. And yet, despite the sickly air of fear, the COVID cases do not come. For what felt like a very long time, our island nation was embarrassingly unaffected by the pandemic. Then the first few cases appeared in our capital cities, brought here by, of all things, elderly vacationers on cruise ships. Plague ships, they came to be called. We watched the case numbers rise and fall in real-time graphs — even ten cases in one day filled us with a kind of anticipatory panic, as we considered the rate of transmission and the vague arithmetic of presumed under-diagnosis. Ten confirmed cases, we told ourselves, surely means a hundred or more in reality. Which meant a thousand tomorrow, and catastrophe the next day. But then, somehow, the numbers would peter out again and we felt ridiculous and relieved.
A few times there was a scare, in which an infected person had some brief contact with our town. What followed was a snap 48-hour lockdown, in which the streets went eerily silent, and the world suddenly felt rather empty and beautiful. Restaurants were keeping their staff fed and housed by turning themselves into hole-in-the-wall takeaway joints. I would often go to my favourite bar, where the bartender-turned-cashier would poke his head out and give me a brown paper package of fried entrees, two hard ciders, and a roll of toilet paper. I would take these home and watch the Pride and Prejudice mini-series from the 1990s, lying alone and satisfied on my couch. It was almost like paradise. (Two years later, I learned that this bar had been shut down after its owners became radical anti-vaxxers who violated public health orders one time too many.)
It was around the time of this first lockdown that the pandemic became visible on the face of our hospital. The main driveway past the Emergency Department was blocked off and a row of white rubberised tents were erected for the purpose of triaging anyone who fronted up with a cough. The staff who sat in those tents, mostly unoccupied and bored, were dressed from head to toe in plastic PPE all day. This area received a variety of nicknames from the emergency staff: Wuhan, the Zona del Rona, District 19, The Pub (because of all the Coronas), etc. I’m sure those tents had a real, official-sounding name, but I never heard it uttered. To get into the hospital by the main entrance we now had to submit our foreheads for temperature measurement by one of the local medical students. They looked happy, proud, and they took their new roles very seriously.
Most of the louder voices in the hospital were saying that this has all come far too late, that we had been almost stereotypically lax with our response to this world-changing event. I only felt that it was vaguely ridiculous. But what did I know, really? Like most things in my world, I had decided that it simply wasn’t worthwhile for me to have an opinion. I followed the rules, went to work, and otherwise stayed home, which was mostly what I had been doing throughout 2019 and 2018 and 2017. I walked into the ED each night, mask-free and confident, and I got on with the admissions. For any patients with respiratory illnesses, I shouted at them from across the cubicle to ask whether they have been to Brisbane lately, and if not, I stepped over to them and continued unhindered. I felt vaguely superior to anyone who complained that the pandemic was having any kind of negative impact on their lives. Clearly they just needed to be more like me; me who had no fear, who did not depend on this chaotic world for anything.
One morning my friend Ben sent me a video of him singing in his car. I hadn’t seen him in weeks, as we had been told not to socialise outside of work any more (and at work, to stick to our own wards unless strictly necessary). His pixelated face was swaying back and forth, the car stereo blasting ‘Come on Eileen’, and he yelled at the top of his lungs:
Yeah, my hands are so clean,
In this moment…
I’m in quarantiiiiine!
I watched it late at night, I laughed, I watched it again, and again, and I cried, just the tiniest bit. In reply I typed, ‘lol
, nice one dude.’ I don’t recall ever feeling so lonely
until then. I put my phone down and went to sleep.
Then one night I meet our first inpatient with the virus. I know he is on the ward because everyone has been talking about him. He came from a cruise ship, they say. But then why is he here, they ask, and not on the coast? How old is he, do they think he'll make it? Why isn’t the ICU taking him, don't they have their negative pressure rooms running yet? Why not? Aren't they ready for the wave? I don’t ask anything, I barely listen, I don’t really want to know. But I am covering the wards tonight, so he is my responsibility for twelve hours.
My shift is half done, it is past midnight, and I've been called to come see him. He looks very breathless and distressed, they say. I go to his room at the far end of the fourth floor. By some peculiarity of the building’s history, this is where the isolation rooms are. I stand in the corridor and I see him there, ten paces away from me, through the two small windows in the two sequential doors of the antechamber. One door to get in and gown up, then another door to get to him. On the way out, the gown and all the rest must go into a huge yellow HAZMAT bin in the corner, presumably to be incinerated. But there, as if at the end of a telescope, I can see him sitting by the dim light of his bedside lamp. He looks perhaps fifty, with greyish hair and a face of stubble. He sits in a chair, leaning forwards on his elbows, staring at the floor with an intense gaze, thick high-flow oxygen tubing under his nose. Even at that distance I can see the hypoxic blue tinge in his lips and fingertips. Suddenly I realise that I am frightened.
I put on the necessary gear, my face unused to the tight seal of the mask, and I gingerly open his door. He looks up at me, his mouth hanging open. I am leaning through the doorway, neither in nor out.
'I'm just one of the doctors on call tonight. I came to check on you.'
His shoulders rise and fall, and he nods slowly, though he seems not to be entirely with me.
'How are you feeling?'
'Yeah mate.' He breathes as if lifting a great weight. 'I’m alright.’
'Can I get you anything? Some water, some food, more morphine?'
He looks to the wall as if in far-away thought, then he shakes his head.
'Alright then, as long as you're OK. Hang in there, and press your buzzer if you need something. I'll be here all night.'
He gave me a limp thumbs-up as his gaze returns to the floor before his feet.
'Goodnight.' I close the door.
He died the following morning. I had gone home by then, but throughout that sweating morning I couldn’t sleep. I drank three measures of rum and took a shower, then gradually drifted off on my couch beneath the air conditioner. I woke up feeling hot and clammy, briefly panicked that I could have a fever. But I had no thermometer in the house — why would I ever have needed one? Instead I just talked myself out of it, reminded myself of the incubation period, and that a silly thing like a virus didn’t deserve to be feared.
Time: December 2020
Place: Toowoomba, QLD
My job: Rehabilitation
Dominant variant: Alpha
National new cases per day: 10-20
Local death rate: Zero
By now the wave has come and gone; the curve was not as flat as some would like, and yet we made it through, so it must have been flat enough. We had a handful of deaths in our town, though nobody seemed to have ever met them. There are essentially no cases outside the major cities, and those of us in regional towns all feel quietly self-satisfied. Still, the whole state moves and is moved as one, apparently: each time the case numbers rise just enough to give panic in Brisbane, the new restrictions fall upon us as well, despite our being two hours up the Great Dividing Range.
I like to find small subversions. I keep my mask on a hook in the office for a week at a time, donning it only when entering clinical areas. We all know that re-using masks is a bad idea, but nobody has explicitly told me not to. It’s to save on waste, I say. Which is not untrue, but besides the point.
I am perpetually incensed. Isn’t is fucking stupid, I repeatedly say, COVID is over. We’ve beaten it. And why not? A self-limiting illness with a short incubation period, and we’ve sent out whole country into enforced isolation for weeks at a time — how could it possibly survive? Especially out here, where we don’t live in apartment blocks, where our only gatherings are barbecues on the verandah, where we have all of this space? Haven’t we done our bit by now?
But still, I am beholden to the rules, and I am not the kind of person to openly break them. I scoff, I sigh, I roll my eyes, but in clinical areas I put my mask on, as mandated. I always used to feel a slight disdain for those doctors who chose to wear masks around influenza patients, or even when they themselves had a cold. In some twisted way it seemed to smack of weakness to me. I would proudly go to work with a high fever, walking in and out of the cancer ward to deal with more important things than my own mere viruses. I imagined myself to be a pillar of strength.
Where I am now is not a cancer ward, though it is no less full of frail and immunocompromised people. We are an off-site rehab unit, using a refurbished section of the old mental asylum. We are situated atop rolling brown hills on the edge of town, amongst centenarian Eucalypts with trunks wider than my two arms can stretch. We have our own kitchen, our own herb garden, and a constantly shifting family of elderly people who have, in some way or another, been let down by their bodies and need a month or three to get home again. All of them are chronically ill, so my job is, as my boss tells me again and again, to keep the plates spinning. One of our key performance indicators is the number of back-transfers we make to the hospital, or rather the number of plates that topple off their axis. So there is a delicate kind of debate that occurs each time I think someone is becoming too unwell for us — I call my boss and we discuss, with many pregnant pauses and deep inhalations, what is to be done. Usually we send them.
Testing is another point of contention; there is a kind of unwinnable calculus one has to perform. The courier only goes to the hospital once per day, and as a low-acuity ward our samples are treated as low-priority. This means a result takes two days to return, on average. So on the one side of the willingness equation is the danger of a possible case, which would spread through our ward in about ten minutes flat and create absolute chaos; on the other side is the two days that a patient must spend sitting in their room with the door closed, left out of group physiotherapy, losing muscle mass, not even allowed to shower because of the potential to aerosolise their exhaled breaths. When they leave their period of isolation they stagger out of their room as if re-entering the world from a POW camp, and their hopes of regaining independence are as close to death as they themselves appear to be.
So that is where we stand on Christmas Eve. Christmas has been coming for what feels like a year, and the decorations in the ward are all fluttering beneath the ceiling fans. Our ward has a crummy old air conditioning system, which despite constant blowing and thundering will not keep the temperature below twenty-eight, though stepping inside to that kind of atmosphere feels heavenly after being attacked on all sides by the heat and sun that obliterate everything outside. Inside we are safe, in a miniature tornado of lukewarm air. The tinsel is thrown back and forth in the gusts as I walk beneath it, looking forward to my day off tomorrow. Rehab is meant to be a cushy job, the kind of job that does not seep beyond business hours and certainly does not involve public holidays. But as we should know, people don’t die on a schedule.
Gerald has been going downhill for weeks, and it brings me very little comfort to tell my boss that I told him so. Gerald was referred for rehabilitation two months earlier, and I was entirely convinced that we were wasting what little life he had left in him. He had leukaemia, chronic lung disease, a broken hip, and a newly-found case of biventricular heart failure. 'Chronic multi-organ dysfunction' is a term I like for these situations — it helps to make things clear to people. But his treating team was convinced that he had the necessary motivation to get back to his two-storey home again, and Gerald managed to convince my boss of the same. So we took him. Yesterday he had managed to walk three paces unassisted, and then today he bleeds into his gut, takes to his bed, and tells me that we shouldn’t bother with another transfusion. I call my boss and tell him so. As usual, we wonder aloud what we ought to do.
I break the hissing silence. ‘I think we should send him to the hospital. I know they have beds on 6D.’
‘Hmm. maybe so. But it’s a back-transfer, you know.’
‘Yes, it would be.’
‘And we do need to keep hospital beds open for when the cases take off.’ This has quickly become a convenient excuse for many things in our health service.
‘It doesn’t look like the cases are taking off any time soon, don’t you think?’
‘Hmm. Well, maybe not. But it’s a back-transfer nonetheless.’
‘And realistically, there’s nothing they can do for him there that you can’t do for him where he is.’
‘I suppose not. But the nurses aren’t very comfortable with this. They’re not hospice nurses.’
‘Ah, come on now, it’s not complicated. People do need to stretch themselves from time to time.’
Another pause. ‘So we keep him then?’
‘Hmm. I do think so, yes. I know you can handle it.’
I try to make a plan that will hold him for the next 24 hours, and allow me to stay home for Christmas. I would be alone in my flat, no family gathering allowed, though I do have a turkey roll roast that would make a hefty feast for one, and a bottle of white wine with my name on it. The next morning comes, and luckily I haven’t taken either of them out of the fridge by the time I am called.
‘Gerald is getting worse, and he’s really agitated. We’ve used all the PRNs and he’s just crying. Crying so much.’
I sigh into the phone. ‘I mean, it's Christmas.' This is one of my vices — I need people to know my pain. She is silent, so I say, 'Just wait half an hour and I’ll be there.’
Walking from the car park to the front entrance I am beaten down by the sun, my eyes will barely open. At one corner of the building there is a group of people, arms around each other like a family, singing carols through the fly-screen to a man lying on his side in bed. His face is just visible through the tinted glass, and he is gazing at them beatifically. He claps when they are done, and they begin shuffling towards the next window. Only one visitor allowed per day, no groups inside the building; how cruel.
I go inside, I do not meet anyone's eyes, I put on my mask and go to Gerald’s room. The curtains are drawn and he is lying on his side facing the wall. The air inside feels very close, and stinks of sweat and other human excretions — the mask is even more suffocating in such an environment. There on his bed Gerald is shuddering, moaning, and making odd whistling noises with his teeth. His back is facing me and he is curled up like a baby. His bedsheets look clean, though.
I go over to him and put my hand on his shoulder, but he doesn’t seem to notice me, doesn’t turn to look over his shoulder. He jostles and shakes as I speak to him — I say his name, then louder, then louder still, and ask him whether he can hear me. I get no answer that I can make sense of. Then he begins to cough, and flecks of blood make their punctuation on the wall.
Outside the room I pick up his chart and hold the edges down — the whirling air around me wants to skip ahead a few pages. I look through his observations, the medications he’s been given, the notes from the overnight nurses. Through his door I hear the hacking cough continue, mixed with some other noises.
A nurse has been standing nearby, though I hadn’t noticed her. She says, ‘He is very distressed, I know it.’
‘Oh absolutely, yes. We need to sort this out.’ Looking at her eyes, I’m sure we’ve met before but I don’t know her name. Behind the mask, who knows?
‘Oh good, yes! What do you think?’ She seems hugely relieved.
Looking through his chart, at all the sedatives he has received overnight, I do some mental arithmetic. ‘Well, he probably needs a syringe driver. I’ll try to find the right form if you can get the pump set up.’
‘Great! Oh, he so needs it.’
‘The other thing is, we need to send off a COVID test.’
She becomes very still. ‘Really? I mean, a COVID test?’
Gerald’s coughs continue, muffled by the door. ‘Yeah, we’d better.’
‘But he’s not dying of COVID, surely?’
‘Well, no. Who knows. Has he had visitors lately?’
‘His wife comes in every day, that’s what they said in handover.’
‘Well, has she been tested lately?’
We stare at each other, both doing another kind of arithmetic.
‘Oh, ah, well... But they’re local! They wouldn’t be going to Brisbane or anything. How unlucky could you get?’
‘Yeah, I know.’
She begins to speak very quietly now, almost whispering. ‘She won’t be able to visit him.’
‘I know, yes.’ I sigh and look at Gerald’s back through the window. ‘Yes, I know.’ I go back and forth in my mind, trying to plug this leaky vessel. What if it’s positive — but what if it’s negative — but what if people knew we had done this — but what if they knew I did nothing? Each time I plug one hole, another springs up.
‘Come on, it’s got to be done.’
She does as I ask, and the test is sent away as we attach his syringe driver.
Gerald died the following morning. His wife begged and cried in our office. His test came back negative that evening.
Time: January 2022
Place: Darwin, NT
My job: Detox unit
Dominant variant: Delta
National new cases per day: 80,000
Local death rate: Zero
For three months, every day was the same. I drove for 20 minutes through the lush tropical greenery, entered the prison gates with the broken boom, then took a left turn to head around past the high concrete walls. Another minute or so, more open grassland, until I came to the octagonal corrugated iron building that was our detox unit. I parked directly outside the front door and never bothered to lock my car — there was no need out there in the middle of our sodden grassy field, where nothing but the distant highway sounds interfered with the calls of birds and their distant replies. The air was like soup and the glass doors of the building constantly dripped with condensation. I signed in at the door, collected a new mask from the box, put it on, and stepped inside. Suddenly the air was icy cold. The receptionist checked my temperature. I waved hello to a few people on my way to the clinic room which I had made my own, and I shut the door behind me. From the tall filing cabinet I pulled out a flocked viral swab in its paper packet, and a clear plastic tube the size of my thumb, with a few millilitres of watery PCR medium swishing around in the bottom. I removed my mask and pushed the swab down each nostril, going back until I felt it burning behind my soft palate. I wiped at my tears as I clenched my eyelids and held the swab aloft, waiting for the sting to abate. Eventually I broke the swab off inside the tube, closed the cap, wrote my details on the label, and replaced my mask. I dropped it into the daily testing tray at reception, then back at the desk I booted up my computer, and my first job of the day was to check my test result from the day before. It was negative for three hundred and sixty-five days in a row — the entire time I lived in the Northern Territory.
We were lucky to be so isolated. The territorial government had complete control over entry and exit, international tourists no longer came at all, plus we had the best quarantine facility in the country. We had been almost completely COVID-free all year, living it up in the sunshine. So naturally everyone balked at the mandates: the daily testing, the masks, the quarantine periods, the digital check-ins at every shop and restaurant and movie theatre, the temperature checks outside the hospital. But these were the very reasons why we could all live such a carefree life — the system worked. And so I did my daily screening, I asked every new patient in our detox unit about their travels and their COVID symptoms, and I then tested them anyway. This was the new normal and I was fine with it, albeit with a conscience made guilty by being so blissfully distant from the pandemonium of Melbourne and Sydney.
Once per week, The Director did what she called a ‘ward round’ of the detox unit. While that term would normally imply that we walk the ward and see the patients where we find them, there it meant that we sat in the clinic room and the patients were brought in to see us one after the other. They were mostly men with deep black skin and scruffy hair, some of them barely speaking English. They looked sheepish and anxious as they were shepherded up the outside walkway towards our waiting room, then called in one by one. I tried to help them relax by placing my hand on their shoulder, gesturing towards the free chair by the door, and making idle chatter while I opened up their file on the computer. The Director sat in the corner, legs crossed, watching us. She had her own routine: once we were settled and quiet she introduced herself. She called herself doctor, used her full name, and followed it with her title: Clinical Director of the Alcohol and Drug Service. Then she pulled down her mask, saying with a pursed smile, ‘This is what I look like!’ She would put it back up and then turn to me, but I had silently chosen not to partake in her little ritual. My mask stayed in place and I began the consult proper. ‘So, you’ve been here for a few days now, and we’re keen to know...’
For all of my three months in Alcohol and Drugs, The Director didn’t see my face. We were mandated by the territory health service to always be masked at work, and at first I was annoyed and incensed by the idea, but very quickly it became a habit, and then a kind of crutch. I started wearing it indoors wherever I went. I felt safe and hidden behind my mask. One Saturday I was in a bookshop and I heard The Director's voice, she approached in my peripheral vision as I looked through the new releases, and she pardoned herself as she edged in front of me, but not for a moment did she seem to know who I was. It was thrilling.
Almost everyone I knew was from the hospital, and I only ever saw their noses and mouths when we cross paths in the tea room or the cafeteria. Often I struggled to recognise them at first. Without their masks they looked wrong — their chins were too small, their mouths too narrow or too wide, their faces had a strange concavity to them that was wholly unexpected. They simply didn’t look like themselves until they put their masks back on. A few months earlier I had briefly dated a young woman who I met online, so she and her friends were the only people who looked natural in their own faces. Georgia. Though by this time we were no longer intimate, we still saw each other every week or two, and it felt both comforting and oddly thrilling to kiss hello and goodbye — so close, so rare.
In my own small ways, I have always been a contrarian. I will favour a band’s second-most popular album, skip the blockbuster movies, move across the country when everyone says I should stay. I suspect that simple contrarianism was the true reason for my newly militant stance on PPE, though it was easy to justify it in more proper terms when I needed to. Where once I enjoyed running counterways to all the fear and anxiety of the earlier pandemic, now I felt hostile towards all the looseness, the PPE fatigue, and the denialism that had fermented throughout two years of collective struggle — especially in a place like Darwin, where the successive waves had been far away and mostly ignored. Our general manager refused to get vaccinated, but rather than losing his job (as was promised during the rollout of free staff vaccines), he now worked from home and was barely heard from at all. He retained the largest office in our building, which the cleaning lady dutifully dusted down each evening as I walked past the door on my way home. Our nursing team leader took her vaccines as directed, but she was also adamant that her human rights had been violated. She spent most of her idle time in the reception area, mask beneath her chin, drinking coffee and listing off her grievances. Every day I heard her words echoing down the hallways as I sat in my office, typing notes or reading my emails — ‘Everyone knows natural immunity is better anyway.’ ‘You know my brother is in Sydney and they don’t even wear masks any more.’ ‘It’s all so stupid, you know how low the risk is of actually getting properly sick, right?’ The receptionist had to just sit there and take it. One couldn’t help but feel resentful; my response was to never be without my mask.
The Director didn’t see my face until my last day on the job. She and the other staff felt they had really gotten to know me in the past three months, and they were happy with the work I had done. They brought in some food and drinks — a big plate of antipasto, a cob loaf full of cheesy dip, a tray of sliced fruits, some alcohol-free white wine — and we made a picnic under the cover of the corrugated iron verandah behind our offices. I took off my mask and they all seemed pleased, though also puzzled by something they saw in me. Some of the older ladies laughed and leaned in, saying It's nice to finally meet you, and things to that effect. It was one of our many days in which there seemed to be almost no work to be done, so we gathered around a pair of wooden benches to eat and talk, almost with a sense of being on holiday. Everyone was laughing and chatting without the slightest trouble on their mind.
We had a view of the building’s central courtyard garden, lovingly tended by our maintenance man, Touon. He was a huge brown man with swinging dreadlocks, and his trees produced bananas and mangoes that were the best I’ve ever eaten. We all ate our fill of the picnic foods, then the rain started to pour down thunderously on the roof above us. We couldn’t speak, or rather couldn’t hear each other, so we just sat and watched the streams of water falling off the roof into instant flowing rivers, and the birds-of-paradise being tossed back and forth by the pounding of raindrops that seemed as large as grapes and somehow just as sweet. I was more struck by the beauty of this northern paradise at that moment than I had been on any of my weekeend day trips to the gorges, the rivers, the wetlands. I, and everyone else, was transfixed. Then, in the local fashion, the rain stopped as suddenly as it began, and we found ourselves in awe of the rustling silence around us.
The Director broke the silence with a bursting sigh. 'Well then!' She turned to address me, and I found myself to be the new focus of everyone's attention. She spoke on behalf of the unit, thanking me for a good three months of friendly collegiality, praising my better qualities and omitting all the others. She was confident that I would go far in life, and saddened that I was leaving. Indeed, everyone already knew that only next week I would be packing up and flying south, to a new home and a new job in Tasmania. ‘That’s the way with registrars, sadly! We just get to know you, and then you take off on us. Oh well. Thank you, and good luck.’ Everyone smiled and cheered and said their small thanks, then I made my own little reply with gratitude for all they had taught me. We all smiled. My favourite nurse gave me a book, The Director gave me a small bowl that she had sculpted and kiln-fired herself. I leaned back in my chair and felt very accomplished and comfortable indeed. I was doing well, wasn’t I. For the first time in such a very long time I was fine, just fine.
Something I didn’t know at that moment was that just across the way, beyond the banana trees, in the patients’ common room with the TV and the telephone, a homeless alcoholic woman called Therese was our own patient zero. Somewhere in the huge, unmapped network of Darwin’s indigenous long-grass community she had sat with someone, who had sat with someone, who had hitch-hiked over the border from Queensland the week before, and it was only upon Therese’s admission to our detox unit — on the day before my final day of work — that any of these people had any cause to be swabbed and tested for a novel virus whose very existence was barely a rustle in the trees of their unknowable lives on the fringes of developed society. Therese had told me that she was always coughing no matter what, and her shocking chest x-ray from earlier that year convinced me that she wasn’t exaggerating, so I didn’t mark her PCR test as urgent. Off she went to the dining hall, the bathrooms, the common room. Then that morning I had been distracted, or interrupted, or just mentally checked-out, and I neglected to look at the previous day’s results. I wandered around chatting, blissfully ignorant, doing a great job. And though the week that followed would see the whole detox unit get shut down and quarantined, for the moment I was free to bask in my own satisfaction. Chaos would soon be spreading like fire through dry grass as I sat on my aeroplane, bound for yet another distant new place, looking out the window and gazing down at the damp city that so quickly receded into miniature scale, all the people and their troubles too small for me to see.
Time: July 2022
Place: Launceston, TAS
My job: COVID ward
Dominant variant: Omicron BA-1
National new cases per day: 45,000
Local death rate: 21× average road toll
Something has been growing on my face. It started as a tiny nodule on my right cheek, invisible but palpable beneath my finger, perhaps the start of a pimple that needed some time to mature and be squeezed out. I tried to ignore it, which would have been easy if it hadn't been directly beneath the upper rim of my N95. I would wince at the surprising little sting it gave me each time I put my mask on, and I cursed those masks beneath my breath — I was convinced it was the masks that got it started in the first place. But surely, given time, my body would just take care of it while I got on with life.
Now it is much too large to ignore. It reminds me of a cricket ball hurtling my way, seen only too late from the corner of my eye, at maybe six or seven years old. The sudden thump and collapse, then the immediate appearance of a tense round lump on my forehead — tender and hard, too sore to touch, nothing to be done about it except wait, and cry. This one has same tight shiny skin, the sense of pulsation, the fear of what is brewing inside it: blood? pus? scar tissue? I believe it is an abscess, probably incubating a little colony of bacteria. I want to squeeze it and make it pop, and several times I try, but the pain is so intense that I have to stop just when I think it's about to go. I grip my bathroom sink and groan as the wave of pain passes over me, and vow that next time I will get it. After drying the tears from my clenched-up eyes, I put my mask over it and make my way to the hospital.
I have been working on the COVID ward for five months now, and I have been compiling a mental list of phrases that COVID workers cannot stand to hear. Perhaps the biggest one is:
'Back during COVID...'
We can all feel the cases rising and falling; we are buoys being tossed about by the sea. What the media calls 'waves' are more like the tides — huge and inexorable. From day to day we feel the beating of smaller waves, the difference being that you can see them coming, though once you are in the water there is no way you can dodge them. The tides shift everything that they carry, but the waves slap against us again and again. An upcoming wave is easy to predict a week ahead, if you look at the local newspaper. Mask mandates are relaxed — another wave. Kids go back to school — another wave. The Royal Show — another wave. Mandatory isolation ends — another wave. The big arts & music festival — another wave.
Our ward fills up rapidly and it empties out slowly, never being less than half-full. Patients always say the same thing: 'I just don't know how I got it!' I always reply with the same thing: 'It's not your fault, it's just everywhere.' They react as if they had caught tuberculosis, or Legionnaire's disease, or scurvy. Some disease of the half-remembered past.
When I walk down the streets, I can't help but resent people. People laughing in restaurants, piling into the movie theatre, hugging and kissing and dancing. I resent them the way we resent people who speed their cars through a school zone.
'Back when everything was all shut down...'
The pace of change is relentless. Sotrovumab. Budesonide. Ronapreve. High-flow oxygen versus non-invasive ventilation. Remdesivir and dexamethasone for the hypoxic ones, five versus ten days of treatment. Paxlovid. Molnupiravir. Baricitinib versus tocilizumab. A second pathway for remdesivir — three days instead of five, for the mild-disease-but-high-risk patients. Qualitative and quantitative PCRs, with cycle-time values that we track over time despite having no established reference ranges. Evushield. Second boosters. The treatment algorithms seem to grow more complex every day, and they multiply into separate but interlinked documents that each refer to some particular category of patient: truly a display of biological evolution in action.
Medicine isn't meant to be like this. We are meant to work within the realms of our experience, to only do things in which we have been sufficiently trained. We will only prescribe a drug if we are intimately familiar with its mechanism, its dose range, its common and serious adverse effects. And if there are two drugs of equal efficacy, the older of them is always preferable — we say that there is more data around it, that we are more familiar with it, or we can be more sure of its long-term safety. But I have learned that those rules no longer apply to me.
Now that we deal almost exclusively in medicines that are unfamiliar, fast-tracked, provisionally licenced, and quasi-experimental, there is a daily meeting to discuss all our patients and gain a consensus on their treatments. The meeting takes place over video conference. It is me, my boss, the Regional Director of Medical Services, the top Infection Control nurse, an Infectious Diseases specialist, nurses from the community isolation facility, and various administrators I do not recognise. They appear in little boxes on my laptop screen, most of them sitting in their offices, unmasked, in smart-casual clothing. I feel that I am making some kind of point when I dial in from the ward, only my eyes visible amongst the yellow and orange PPE. What that point is, I can't quite articulate.
The Regional Director is a small, jovial man. He is shaped like a penguin, short and rotund, with a long narrow nose whose reddish tip supports a set of half-moon reading glasses. He has gotten to know me over the past six months, or at least he believes so. We reflect upon each other a stilted kind of false levity — it is hard to say how much of its awkwardness is a result of video-call technology, the difference of our ages, or the enormous asymmetry in our power within this community. I assume that most of it is just my personality, such as it is. Still, he and I share a joke now and then, for the benefit of the other people logged into the meeting. When those jokes inevitably turn dark, I am reminded of another side of him — his name in the local newspaper most weeks, as part of The Inquiry. The Inquiry into some things that transpired in our hospital years ago, on the maternity ward and the children's ward. Things that were believed to be successfully covered up. But at some point this year someone started talking, and The Regional Director has chosen to take early retirement very soon.
'Ah, been brawling in the local bars yet again, I see!'
He is referring to the tape across the bridge of my nose. So far nobody has noticed my abscess, as most of it still sits within the boundary of the mask.
'Ha ha, yes, yes. I had one too many, yet again. Tenth week in a row! You'd think they might hit me in the ribs instead one day, but so far it's just the nose.'
He chuckles a little with mock sympathy. 'Ooh, well I do hope you are actually alright there, my good man. You look a bit downtrodden and sad.' That is true.
'Ha, no, no, it's OK. I just put the tape across there because otherwise the N95s give me a pressure ulcer between the eyes.' That part is also true.
'Ah, I see. Well, I’m glad you’re well, and well enough to hold down the fort! Anyway, let's get started then, shall we? Bed number one, how is he going today?'
'Staying home felt like being in gaol.'
The COVID ward is dark and windowless. It is located on the ground floor of our hospital, and all the windows are covered from the outside with black plastic sheeting. An extension is being built out there, and the sheets are to protect the patients from the roaming eyes of the construction crew. I am certain that none of them would mind being glanced at every now and then, if only they got to see the sky. The extension will be a row of negative-pressure rooms, specially designed for patients with transmissible respiratory illnesses. We all joke that COVID will be gone like the Spanish Flu by the time the rooms are ready, though that joke was only funny the first time. We had to surrender half our ward, and half our bed-capacity, to the construction site. The power goes off now and then, so the Nurse Unit Manager bought us a big box of torches from her own purse.
The COVID ward is also very cold. The Department of Health recommends at least six air-exchanges per hour in any hospital ward containing COVID patients, and the heaters can't keep up with such large volumes of cold outside air passing through. The ducts provide a constant whoosh and hum like a clothes dryer above our heads. One advantage of being swaddled in plastic PPE is that we staff are all kept quite comfortably warm, though if we ever need to exert ourselves we rapidly get soaked in contained sweat. Our patients, on the other hand, must suffer to wrap themselves up in bed. Thin white hospital blankets get piled up in layers of five or six, the people hidden deep within, and often we only see the tops of their heads. Wild unbrushed hair, sometimes beanies. They are afraid of the bitter cold, they complain of it more than anything else — more than the dyspnoea, the fever, the isolation, or the cough. And they do cough relentlessly, muffled beneath their blankets. Oxygen tubing snakes in through the layers, and the nurses check every couple of hours to make sure it's still attached to a face. They huddle in their beds and they rapidly become weaker from immobility, they shed muscle and fat as if they were coughing their own body mass out into the air around us.
The oldest patients all become incredibly delirious. Their brains are fragile and when things change too suddenly, everything gets scrambled — this is how I explain things to their worried families. They are feverish and malnourished, locked up in a darkened ward that is closer to a prison than it is to a home, and the only human beings they get to see are wheezy strangers and dozens of staff in full-body PPE. It’s hardly any wonder that their brains are in revolt. They sleep and wake at unpredictable times, they cannot hold a conversation, they often can’t even clean themselves or eat a meal without a nurse to prompt them every step of the way. They stare at the items around their bed with frightened incomprehension, they do not know what year we are in, they do not know why they are here. Many of them are silent and, as we say, ‘hypo-active’, but others lash out or become angry with everything. Each morning for two weeks one of our long-stay patients has called my intern ‘that slippery fucking banana over there’ — the intern himself invariably looks down at his yellow plastic costume, chuckles to himself, and replies, ‘At least she recognises me, hey?’
I walk from room to room, from sunrise until long past sunset — the sun goes down early now. The patients are mostly old, obese, and under-vaccinated. Though not all of them. One young woman spent three weeks on the non-invasive ventilator — she had a neuromuscular condition that meant her diaphragm could barely force a normal breath at the best of times, and her weakened vocal cords could not oppose themselves in order to perform a cough. Instead, she made a noise that sounded like vomiting every ten seconds, doubled over on her bed, trying to expectorate the mucus from her lungs. We cleared out a four-bed room just for her, as the sound of it was so distressing to the other patients nearby. Another man with a severe immunodeficiency spent fourty-one days in isolation before his PCR finally showed that his viral load was falling. Each day he would yell at us about how good he felt, how we just needed to let him go home, but his wife was similarly vulnerable and could not face the risk of co-isolating with him.
I work through public holidays, I lose track of the days of each week. I share my roster with another doctor named Bodie, and together we are responsible for the COVID ward for six months. We have a handful of interns who rotate in and out; one of them stays in the ward every night so that no outside doctors need to enter and risk cross-contamination within the hospital. Still, there are outbreaks upstairs from time to time. Our closed ward might be ticking along steadily, just keeping up with the influx and efflux of patients, when I suddenly get a call from the blue: A handful of patients have came up positive on the surgical ward, and I feel an enormous weight landing on top of me. I take a deep breath and sigh into the phone. 'OK, send them down.'
'Back to normal'
Now and then I wonder how long it has been since my hands touched another person's skin. At work I wear plastic, at home I am alone. A few times this year I've had coffee with women I met online, all nice people, but none of those encounters went anywhere. I crave other people, but gradually I am becoming afraid of them. I avoid door handles, I make contactless payments, I order food online and ask for it to be left on my doorstep. I exercise in my living room, and sometimes when I do my pullups in the doorway I will just hang there for a minute, eyes closed, breathing slowly, imagining myself as a vine that sways in the breeze, and I will turn my head to one side and softly kiss the flesh of my inner arm. The feeling and the sound of it are so exquisite that I sometimes cry.
Most nights I think of my last and only girlfriend, who is now four thousand kilometres away. Georgia. We were together for about two months during the northern dry season. We were good together, or so I believe in these moments. I think of her laughing at one of my jokes, talking about her day, walking along the empty waterfront, silently keeping company as we watch a movie on my couch. I miss her with a kind of ache that sits inside my chest. Then at some point, inevitably, I think of us in bed. Her closed eyes and sharp breaths, her sweat and my sweat, the smell and taste of her. Then I can only think of what always came next, after we had disentangled ourselves: she would turn towards the wall and curl up like a baby, I would run my hand along her side but she would seem not to notice, we would spend the endless night together but apart, me being utterly unable to sleep. And suddenly the rest of it comes back to me at once. Her never wanting to hold hands, her brief little hugs, her allowing me to kiss her. She told me that she had never been a 'physical kind of person', and neither had she ever been a 'talking on the phone kind of person'. So she was gone from my life now, if she had ever really been part of it at all.
One night I am standing in my kitchen eating dinner straight from the frypan, and I can feel her moving around inside my head. She is within me but also separate from me, just like she always had been. The moments we shared come and go so quickly — each time she let her hand drop from mine, each time she pulled away, each time she shrugged her way out of an embrace, each minute of those sleepless nights I spent staring at her naked spine — all those moments keep moving back and forth between my ears and I feel like I am about to explode. I drop my fork and push my forehead against the upper cabinet. I want her here with me but I also want her gone and forgotten forever, though neither of those things is possible. I squeeze my eyes and I pound my fist against the side of my thigh.
'Fuck, fuck, fuck' I say through clenched teeth.
She left me alone. Now she will not leave me alone. I want it back, I want it all to stop. My face pulls and aches with the expressions I am making in the silent house. Just stop, stop, please stop. I raise my fist and slam it down onto the counter.
My hand pops and is instantly painful, I cradle it with the other hand and slump to the tiles. A few minutes pass and one half of my hand is twice the size of the other.
I am so fragile. So weak.
'When you need to take a mental health day, you just take one.'
Sometimes in my newsfeed I see articles about frontline health workers who have quit their jobs. Both nurses and doctors are either quitting, or cutting back, or taking time off, or simply not stepping into the field at all. They point at the dire situations they have found themselves in, the historic levels of strain on our health system, the way their careers have gone off the rails, the lack of funding and resources, the poor conditions their patients must endure to get care. ‘This cannot go on’, they say.
They always use the same words: dangerous, chaotic, stressful, heartbreaking. Yes, all those words do ring true. But then they say — every last one of them — ‘I no longer had any choice but to leave’. For their patients, for their community, for themselves, they had no choice. To these people, quitting is a clear vote in favour of their health and sanity over their ego and salary. But as someone who has watched his colleagues resign, or choose not to continue their contract, or take a sick day when they are feeling overly stressed, I know what the people left behind are all feeling: terrified abandonment. Suddenly there is more work, greater demands, more patients, less patience, and absolutely no time to support one another, because it isn’t just happening to you, but to everyone around you as well.
There is a feeling I get when I try to run down my street — a horrible fearful feeling. I set out, I begin to huff and pant, and for a while I can tolerate it. I am strained and uncomfortable, but I am still breathing, and still moving. I tell myself that I can do this, and I am surprised to find that I can. If it just stays like this, I say to myself, I’ll be fine. But as my legs get just slightly tighter, or the ground begins to incline a little, or my throat starts to ache from the fast-moving moving air, a kind of panic overtakes me. I am gripped by a fear that no, things will not stay like this, they will only get worse and worse, and very soon I will be overwhelmed by it all. I will find myself in the middle of something awful that I cannot escape. And there is no telling how far it might go, how bad it might get. I cannot take it, the thought of it all overtakes my mind completely. An acute, overwhelming kind of despair is all that I am in that moment. I stop running and lean against something, breathing and calming myself, hopelessly embarrassed.
Climate change. The housing market. Plastic waste. Wealth inequality. The vanishing hair on my head. The staffing shortages in my local hospital and our crumbling public health service at large. All of these things are like running down the street, except that I don’t have the option to stop running.
So I find it hard to feel anything but scorn for these people who have opted out of the collective struggle. All the things they say are true, all the problems they want to illuminate are legitimate, but when they want to justify quitting by framing it as a protest, or as their only option, I simply don’t buy it. They surely must be aware that they are leaving behind a situation that is all the worse for their absence, and the people they once called colleagues will have to deal with it. The struggle won’t end just because they choose not to partake in it any more. ‘I just can’t give the right kind of care any more’ — that’s another phrase they seem to like. I fail to see the logic, though, in choosing instead to provide no care.
'I think those lockdowns gave us all a kind of PTSD.'
Late in the evening, I go through the doffing room and shed my plastic gear. Everything comes off in the right order, though if you asked me I could not tell you what that order is — my hands just do it as I stare at the walls. Gloves, gown, goggles, shoes, cap; each one goes into a separate bin that sits in a row along the wall. Between each of the six bins I rub alcohol into my hands, then at the very end I finally remove my mask and stare into the tiny mirror as I wash my hands in the stream of warm water.
My left eye is reddened, my right one barely opens now. My nose is pushed askew by the mass within my cheek, a purple-ish mass that has been scored with a deep diagonal indentation where the upper rim of my mask has sat all day. It throbs and stings in time with my heartbeat, now that the external pressure has been removed from it. To form a better seal on my masks I place surgical tape along the upper border of each one, and when I remove it there is a thin strip of inflamed skin beneath each of my eyelids. The elastic straps have made tough calluses around my ears. My lips are sticky and dry. I lick them and stretch out my jaw — it feels tight as if I have been speaking through my teeth all week.
Beneath the flowing warm water my right hand pulsates, and I gingerly rub it back and forth with soap and tenderness. I can make a fist if I move slowly, and the pain feels like a kind of release. I imagine stretching out the tiny scars that are forming within. The fifth knuckle is like a tiny plum, all shiny and fresh, ready to burst with sweet dark juices.
Like any other night, I put on a fresh mask and change out of my scrubs. I go outside to get my bicycle. This morning I realised my fridge is empty, and I need to get to the supermarket before closing time if I want to make any dinner. The air outside is cold, damp, and smoky. The moon makes brief appearances from behind ragged clouds. The pavement is wet, the cars make noises like waves upon the beach as they pass. I feel tired, thirsty, hungry, lonely. I push off down the hill on which the hospital sits, and let gravity take me forth. At the bottom of the hill, between me and the supermarket, there is a section of highway that passes through town — two lanes of traffic going in each direction. In that narrow window between the buildings on each side, I only see the cars shooting across like birds swooping through lamplight, quick and unpredictable. Now and then a massive semi-trailer grumbles past.
There's a little game I've started playing lately, and tonight I decide to give it another go. I roll on down the hill, gradually picking up speed, until the intersection is just a few seconds ahead of me. The traffic light is red, the cars speed this way and the other. I close my eyes and relax my hands, just resting them on the handlebars to hold the bike on a straight path. I focus on the cold, wet wind in my face — the only free-moving air that has touched my nostrils in twelve hours. I feel the vibrations in the road, I hear the cars and trucks whooshing across in front of me, and I keep my eyes shut. I have a feeling of total weightlessness and freedom, a cold empty void, and I wait. I feel the ground levelling out beneath me, I pass through the highway, I see pink haloes of light at each side of my inner eyelids, headlights that shine upon me as I slip through, and then — darkness again. I open my eyes and I am on the other side, where the ground is sloping up again. I pedal. I am alive, but I feel no different from before. I only feel tired.
I walk into the supermarket and put more alcohol on my hands. There aren't many people here at this hour, and most of them only take a couple of items up to the express lane. They are expressionless like me. I used to count the number of people without masks as a point of conversation on the ward the next morning. Then at some point it was the number of people who did wear masks. Lately I can't be bothered to count either way — usually the only one with a mask is me. Maybe I should be angry, or maybe I should get with the times. Who can say?
I take some pears, a box of pasta, and a chocolate bar to the checkout. A cheerful man in a red polo shirt beckons me forward. He scans my items as he scans me with his eyes.
'You alright there mate? Look like you've been in a fight. Ha ha!'
'Ha, yes... No, I'm OK, thanks though.'
'That hand looks rough. What's that you say, "You should see the other guy!" Ha ha!'
'Yes, no, it's been... just an accident.'
'Yeah, fair enough, shit happens I suppose. There you go, mate.' Silence as I swipe my card against the machine. It beeps. 'You know you can take your mask off, right?'
I look into his eyes and there are many things I wish I could say. But really, what would any of them mean?
'No, I can't.'
'I’m just so glad it’s over now.'
I am staring at my own miniature figure in corner of the screen, waiting for the video conference to begin. I look like a satirical Roman bust for our times. The speaker makes a sanitised version of a telephone tone that pulsates with almost the same rhythm as my face and hand. Then the screen opens up and everyone else is already there — somehow I was left waiting, but they had already begun.
'... and as we all know, he was never to be allowed back in, no way, no how!'
People shuffle and chuckle in their boxes. Everyone seems relaxed. Not so many patients today, the ward is half-empty. The Regional Director is entertaining his audience with an anecdote of uncertain origins. He peers down through his glasses, pursing his lips as he surveys the group again.
‘Ah, Gordon, I see you’re back with us in the land of the living!’
Gordon from the Infection Control Unit unmutes himself, and his voice sounds like footsteps on a gravel path.
‘Yep, the wife and I survived to tell the tale, hggghheh hggghheh hggghheh!’
‘And your little ones?’
‘Got through it like a dream!'
I sit rigidly in my plastic swaddling, eyes behind goggles, gloved index finger poised above the mouse in case I need to unmute myself. The small-talk is making me anxious, and I jog one of my heels up and down but the camera doesn’t seem to pick it up.
‘Yes indeed, I was none too happy with my own COVID experience in March. I wouldn’t recommend it!’
Muffled laughter from the few who keep their microphones always on.
‘Colin? Have you had COVID yet?’
‘Oh yeah, three times now. The last one wasn’t too bad.’
‘And what about our young registrar, right in the thick of it?’
This is my cue to speak. ‘No, not me, luckily. At least not that I’m aware of.’ My cheek aches and I am surprised by how nonchalant I sound.
‘Well, lucky you! Hmm hmm hmm. One of the never-positive, the super-immune! Getting through this whole mess unscathed.’
For a moment I think about what it might mean to be scathed. An image of death’s great scythe occurs to me; I picture that scythe cutting my body in two. It is bloodless and silent, like a hand passing through smoke at the campfire’s edge. I imagine being gone and never spoken of again. The pulsing in my hand slows.
‘Yes, I suppose so. Unscathed.’