Beginnings

My husband and I move from Auckland to Melbourne in mid-January. Before we leave, I buy us the last two N95 masks from Bunnings Warehouse in Grey Lynn and stash them in my suitcase atop silk blouses and medical textbooks. They are, of course, for the bushfire smoke.

We have briefly wondered whether we are making the right decision. Australia is burning, and on Kangaroo Island there are charred koalas falling out of trees. My sister-in-law in Sydney sends through photographs of Sydney Harbour unrecognisable through smoke. She has a 6-week-old baby who has never been outside without two layers of muslin over her carrier, and we discuss Vitamin D supplementation.

It’s over forty degrees for the first few weeks in our new city. The shipping crate containing all our possessions is delayed at the border: because of a bushfire-related backlog, Customs are prioritising incoming relief supplies. We sleep for a month on an inflatable air mattress with a ceiling fan thwacking overhead, and cook things we can make in one saucepan.

 

Dust

I start work at the hospital in early February in hastily-purchased new clothes. My own – along with my stethoscope – are still quarantined 20km down the road in Port Melbourne. The rain, when it falls, is brown in colour (the product of particulate matter in the atmosphere, apparently). The queues for the local car wash go around the block after every downpour. After work, we sit at the local pub and watch the Australian Open; two dollars from every pint sold is donated to the bushfire relief.

At the hospital orientation day in the first week of February, they pack us new doctors cheek-by-jowl into the auditorium. The air-conditioning is blasting so hard we can barely hear. Among other briefings, there’s a short presentation by an Infectious Diseases nurse about what they’re calling the “novel Coronavirus”, with a few pictures of gown-clad doctors peering at test-tubes. Ask anyone who’s come from China or Iran about respiratory symptoms, they say: I jot this on the side of my orientation handout as a curiosity. We have had similar presentations over the years, none of the threats amounted to much.

Mum texts a few days later: have you heard about this new “Kovid-19”? sounds nasty. I correct her spelling, but tell her it’s nothing to worry about.

 

Fridays, summer

On Fridays, I drive to an outer suburb of Melbourne to do gestational diabetes clinics at a local community centre. It’s more than an hour from the CBD, and the houses are low-lying and dusty. There are 80 pregnant women each afternoon and just four doctors, but the consults are brief: review the blood sugars they’ve written down in their notebooks, and give brief dietary suggestions or change the insulin doses accordingly.

The community is working-class, deliciously multicultural. We talk about the carbohydrate content of dahl and chappati and string hoppers and Red Rooster. Some women are onto their fifth, seventh, ninth pregnancy; they often have a toddler in tow and many are still breastfeeding the most recent. They’re asked to annotate their blood sugar records with anything that might have caused an aberration; they write “stress+++++”, “too much white rice”, “vomited”, “birthday cake”.

There’s a nice feeling in these clinics: gestational diabetes needs to be taken seriously, but in the overwhelming majority it is a mild and easily managed condition. These babies are likely to be born healthy, their mothers have tight bellies and wide smiles and precious cargo. We laugh about reflux and swollen ankles, and the women chat amongst themselves in the waiting room. The clinic finishes late, at 6pm, and it’s a nice drive back into Melbourne: a wide toll-road, fast against the traffic, the sun setting behind the cityscape, the weekend beckoning. I always leave feeling inexplicably content.

 

Seismology

In early March things happen with nauseating speed. There are outbreaks on the Diamond Princess cruise ship, in Northern Italy, in Iran, in a hotel in Tenerife. Then the Louvre is closed, then all medical student electives are cancelled, then the supermarket shelves are bare of rice and tissues and toilet paper. There are a handful of cases in New Zealand, the media pours over their flight itineraries. The Pope delivers his weekly mass via video link, making history in the process. Our doctor chat-threads go all night, because none of us can sleep: we discuss asymptomatic transmission and statistical models. We are all catching up at different speeds. Most of us do highly specific subspecialties – dermatology, orthopaedic surgery – and haven’t thought about viruses for years. Sorry, but what’s PPE?, one doctor asks early on, frustrated by all the three-letter acronyms.

City wall; phone shot by the author

On Friday 13 March I drive out to the same gestational diabetes clinic and on the way learn that Disneyland is closed and MOMA is closed and the NBA is suspended and Coachella is cancelled and the Melbourne Comedy Festival is cancelled and the annual Pasifika Festival in Auckland is off and Norway and Denmark are in complete lockdown. I have a friend sitting a high-stakes final surgical exam the next day: cancelled. She has been studying for two years, and when she calls me I can’t understand her for the sobbing.

The clinic that day runs as normal, the waiting room heaving. I move insulin doses up and down and tell women to stop drinking orange juice. There’s something there, though, moving about – vibrating – under our skins; it’s like the way farmyard animals can sense an impending volcanic eruption. I need a calculator for basic calculations, and forget the name of a patient between calling her in the waiting room and sitting her to begin the consult. When I get out at 5pm the US has closed its borders and I drive home feeling like I am in a dreamscape.

Melbourne street; photo by Sam Wall

We go to dinner that night at a still-bustling wine bar, and I have three glasses in very short succession. Later, I leave on my own and go to the supermarket to get milk for a pre-bed tea. I walk past row after row of bare shelves, and panicked-looking people taking photographs of them. I feel a little wobbly in my heeled boots under the harsh lighting. At home I lie in bed and look at graphs of national ICU capacities and tips about being strong.

 

Winter

Five months later, and I haven’t been out to the gestational diabetes clinic since. By the following week, we had switched indefinitely to telephone consults; we now stay in our inner-city hospital consulting rooms and work our way through a list of patients to phone. The women email through cellphone screen shots of their testing logbooks, there are endearing little smears of blood beside the figures they’ve recorded in ballpoint.

Melbourne street; photo by Sam Wall

The afternoons of phone calls feel inexorably long; I drink instant coffee to get through. We’re supposed to be chipper about how flexible we’ve been in adapting to this new format, but the consults have lost their texture and their light-heartedness overnight: it’s hard to smile at someone over the phone, particularly behind a hospital-issue face mask. Some women just never answer – we ring them week after week, leave chirpy messages asking them to get in touch. Most don’t.

We’re thick into the second wave here in Melbourne, back in what we are calling “lockdown 2.0”. It’s no longer novel or bizarrely energizing, just cold and relentless. Each day Daniel Andrews, the Victorian Premier, issues new restrictions: we cannot leave our suburbs to exercise, we must wear masks outside the home, we have an 8pm curfew. Police are stationed on every corner. I run down the streets in our city-fringe suburb and suddenly realise how desolate the buildings are looking: all the shopfronts boarded up, handwritten signs in the window, most sites vacant or for lease. Films of dust settle on the high heels in my favourite shoe shop. A handwritten sign reads “Closed for the apocalypse”.

City graffiti; phone shot by the author

People walk dogs and babies, these dumb happy things dragging them out into the cold afternoon for fresh air and exercise. One lady has a black puffer jacket over her flannelette pajamas, she wears a cloth facemask and slippers and is the poster girl for our times.

There’s guilt, too. Our extended families just think of my husband and me as doctors working in Melbourne; I know that they imagine us in intensive care, operating ventilators and suctioning airways. The reality, of course, is that we are specialists in areas that are well-removed from acute medical inpatient work. Endocrinology and diabetes is an important specialty but it’s office-based, subacute, nuanced; it’s a specialty with chronically (rather than acutely) ill patients and plenty of time and lots of blood tests. Three years ago, I could do all that fast-moving stuff; I’m now preparing to do my PhD and spend most of my time reading research articles on the way female hormones impact breastmilk composition.

Thrown into relief by the pandemic, my work sometimes feels shameful and self-indulgent. Other days, though, it feels just as important as what the Proper Doctors are doing: I review ten, twenty patients a day, we talk about their thyroid hormones but also their depression and their JobKeeper entitlements and their blood sugars and their progressively-heavy drinking and their carb cravings and marital issues.

I think about what Rebecca Solnit would refer to as the “tyranny of the quantifiable”: the fact that the widely-reported statistics do a good job of capturing R0 numbers and ICU admissions and national debt, but not the more slippery and mysterious impacts of this pandemic. I think about the way that babies in prams look at faces, and should learn to recognise facial expressions, but now just see black cloth.

Melbourne street; photo by Sam Wall

It must be said, too, that some of the quantified but less reported statistics about this pandemic are the ones that terrify me most. Here in Victoria, there has been a 30% reduction in reporting of cancers since lockdown began in March. This doesn’t mean they’re not occurring, but that patients aren’t presenting to doctors with the symptoms. The cancers will be diagnosed later, by which time they’ll be more advanced. Another study shows that 45% of current PhD students in Australia are considering disengaging from their studies due to the financial pressure of the pandemic. 5% are currently or  imminently experiencing homelessness and 11% skipping meals. These are, of course, the people who we’re hoping to rely on to develop vaccines and rebuild our social services in the years to come.

 

Hubris

I think of the women I reviewed at the gestational diabetes clinic that last day in March: they will now, of course, have had their babies. Gestational diabetes usually remits after pregnancy, so they won’t be testing blood sugars anymore. But they’ll all still be out there with their newborns, sterilising bottle teats and entertaining toddlers and worrying.

The pandemic reinforces the size of the city – we’re on to a whole new crop of pregnant women now, ones whose whole pregnancies will be defined by COVID-19. They don’t attend antenatal classes, and will never make the friends there who might become a coffee group. Over the phone many describe feeling isolated or afraid, and not having left their houses for weeks. Their midwifery clinics are virtual, they attend ultrasound scans without their husbands. One woman is told over the phone that her fetus has Down’s Syndrome.

In the Guardian, Jessa Crispin writes, “Every pregnancy is a crisis. Like all crises, they are best managed as a team and not on your own.” She could not be more accurate. When the government locks down several public housing towers in the North of the city, we hear about a woman in forced separation from her premature baby in a nearby neonatal unit, unable to deliver her breastmilk.

Every morning – standing masked at the hospital coffee counter – I flick past the obstetric business cards in my own wallet feeling vaguely ill. Pregnancy under these circumstances now seems different, like it requires precise and deliberate action, an inception rather than a conception. My former practical and personal uncertainties are now eclipsed by mammoth existential concerns: is COVID-19 the first in a series of humanity’s pre-terminal spasms? Are all the things we know children need (security, connection, faces, schools, grandmothers, birthday parties) going to return? How will any generation ever fix this? Is it utter hubris to create life under circumstances we know to be desperate?

Perhaps. And I do think that, most days. My husband and I have put procreation plans temporarily on the back-burner, and my Instagram algorithm has noticed. Instead of fertility clinics, I’m now offered floral cloth facemasks and wine delivery services.

But there’s this, too:  the equally impressive hubris of the human fetus. The pregnant women I review have unborn babies that have increased their circulating blood volumes by 50%, accelerated their heart rates, fundamentally changed the way their blood sugars respond to carbohydrate. Fetal-derived cells can still be found in the brains of child-bearing women years after the women’s natural deaths. Pregnancy loosens ligaments, makes teeth fall out, can cause bizarre skin conditions and fulminant liver failure.

I sit in clinic and click past hundreds of these little sods on my screen each day. On the ultrasound scans, I look at their huge heads and their tiny cascades of fingers, their kidneys already filtering and their thyroid glands already manufacturing functional hormones.

On my good days, I think, they’ll be okay.

 

 

Kate Rassie is a medical doctor. She is currently living and working in Melbourne on a fellowship in endocrinology and diabetes. She previously lived and worked in the same specialty in Auckland. She is a dedicated New Zealander and, above all, a lover of words. The photographs accompanying the piece were shot on film by her colleague and friend Sam Wall, also a Kiwi doctor, who has returned from his own time in Melbourne.