An hour into a long-haul flight, I am called to help a woman experiencing a serious panic attack due to overwhelming family circumstances.
The flight attendant implores me to avoid a flight diversion. An astute passenger says, “Doc, if you need it, I have Lorazepam.†Lorazepam is a short-acting drug to reduce anxiety.
I tell the pilot that given her past use of the drug, it would be reasonable to try Lorazepam to lessen her acute distress. His only response is: “You can give it, but you’re responsible for the consequences.â€
The pilot’s words seem like a warning, so I decide not to medicate her. Instead, I settle down on the floor of the toilet that by now stinks of sweat and vomit, hoping to somehow lull her into a calm with words alone. Predictably, she worsens, the flight attendant finally notices, and the pilot diverts the flight. The medics rush her away.
“You must protect yourself,†a passenger consoles me. “Sometimes, helping others just isn’t worth the trouble.â€
To this day, I rue my inability to fulfil my duty as a doctor.
Sometimes helping others just isn’t worth the trouble.
I’ve been thinking about this as news emerged of a physician, Dr Hasan Gokal, who went out of his way to help only to encounter terrible political retribution. Late at night, the county health employee opened a vial of vaccine to inject one patient and was left with the task of finding 10 more eligible patients in the six hours before the drug expired. Gokal had two choices: to waste the remainder or quickly find some patients eligible for, and willing to, have the vaccine.
He went driving while also calling patients from his contact list. Four high-risk patients got the vaccine at home. Of those who assembled outside the doctor’s house were a nonagenarian, a dementia patient, a medical receptionist, and the mother of a child on a ventilator. Past midnight, the last patient had changed her mind and a final dose remained.
With minutes to go, he gave this dose to his wife who suffers active sarcoidosis, a chronic lung disease, reassuring her that the precious drug was better off in her arm than flushed down the toilet.
All the doses were utilised, the authorities informed, and the paperwork filed. To any reasonable person, these actions appear beyond the call of duty and indeed, what any decent, ethical professional might do in a time of scarcity and devastating need. To wilfully waste a vaccine would not only be unconscionable but make a mockery of all those unable to get one.
For his troubles, Gokal was fired by county officials who stated that he should have thrown away the unused doses. The district attorney prosecuted him for vaccine theft and abuse of process and power. The court threw out the criminal case but not before his children had opened the door to the glare of cameras and the doctor’s name was mud around the world. In one day, he had gone from hero to zero.
Perhaps the most troubling thing is the seemingly casual but deliberate reference to a lack of “equity†among the vaccinated at a time when there has been much focus on the gross inequities laid bare by the pandemic.
“Are you suggesting that there were too many Indian names in that group?†Gokal said he asked. Yes, he said he was told. The physician being Pakistani, this prompted some mirth that the doctor had actually done his bit for subcontinental harmony. But jokes aside, it is unsurprising that a subcontinental doctor has on his books a large number of subcontinental patients. The occasion demanded urgent action and without evidence that he turned away some patients in favour of others, the accusation of racial favouritism smacks of political opportunism.
Australia has now begun the first round of vaccinations. Thanks to deliberate misinformation and genuinely evolving questions, the initial welcome seems more muted. Trust in science is low. Trust in elected officials is lower. Australia has a strong and admirable healthcare system, but the vaccine rollout is the greatest logistical exercise in peacetime, so it would be foolhardy to assume that there will be no hiccups.
This became quickly evident when two patients in Queensland were mistakenly given a higher dose with no immediate complications. The error was declared and investigations are under way. In all likelihood, there will be other errors, and there are two lessons we can learn from Gokal’s experience.
One is to stay well away from politicising the process. The Texan district attorney is a Democrat in a Republican state, proof that politicians of all persuasion are tempted to create news where none exists. It would be far more helpful if they recognised the great importance of delivering a consistent message that leaves no doubt in anyone’s mind that unlike the illness, the vaccination process will not discriminate between the haves and the have-nots.
The second lesson is that while transparency and accountability are vital, healthcare professionals must be trusted to do the right thing because the evidence is clear: the vast majority of them do. Professionals who have had a front seat to the deadly toll of the virus are resolute in their motivation to move the public towards safety. The best thing governments can do is to get out of the way, not micromanage the rollout, and allow the people doing the administering discretion over their decisions. Blaming individuals won’t help; continuously improving processes will.
Gokal has been lauded by the public and professional societies but it’s understandable if it all feels like too little too late. He is unemployed, his reputation in tatters and his mental health at stake. No wonder he describes it as the lowest point of his life. As Australians begin their turn at being vaccinated, let us hope that the only casualty of the process will be the virus, not a health professional trying to do the right thing.
