Dr Gavin Fincher MB.ChB (Otago) FACEM [1982-1984] | Scots College

Dr Gavin Fincher MB.ChB (Otago) FACEM [1982-1984]

Do you know there are 42 causes of chest pain? The chances are you don’t, but it is one of the reasons why people like Gavin Fincher spend six years at Medical School, then one year as an intern, two years as a resident intern, and a further five years training – including three rounds of difficult exams – to complete their fellowship.

As an Emergency doctor it’s Gavin’s role to figure out what particular cause is responsible for a patient presenting at Accident and Emergency clutching their chest – is it the heart, lung, pancreas, gall bladder? Is the shortness of breath caused by pneumonia or too many party drugs?

Gavin says he loves the thrill of being a diagnostician. He graduated from Otago University and was drawn to Emergency Medicine as he considers it to be the ‘hard’ end of medicine.

And of course, this year, Emergency Rooms all over the globe are in the front line of the World’s Covid-19 response.

Gavin lives and works in Brisbane. He moved there after attending an Emergency Medicine Conference and speaking with a doctor who worked at the Princess Alexander Hospital and was offered a role. He has worked at the Prince Charles Hospital for the past 14 years. It is a major teaching hospital in Brisbane with an emphasis in cardiac and respiratory medicine and cardio-thoracic surgery. They have a number of heart, lung, heart and lung and “triples” (heart, lung and liver) transplant patients plus adult super-speciality Cystic Fibrosis, muscular dystrophy, pulmonary fibrosis, COPD, pulmonary hypertension, congenital heart, and coronary artery bypass to mention a few, among a wide range of high level complicated patients for whom contracting Covid-19 could be disastrous.

Gavin says Emergency medicine doctors are trained for disasters and pandemics. “Personally, I have been onsite for bus crashes, and was leader of 4 teams receiving patients from Cairns when we evacuated Cairns public and private patients just prior to cyclone Yasi. I always felt something big would come like Covid-19”.

“Because the hospital had previous experience dealing with SARS and the swine flu, where there were no vaccinations in the initial phase in the case of swine flu and not at all for SARS– as soon as we heard about Covid-19, we considered our options and once cases started to arrive via aircraft initially we divided the department into two groups, infectious (red area), and non-infectious (green area). We needed to keep everyone as safe as possible and initially given there was an uncertain supply of PPE (personal protective equipment) we had to conserve our resources. The difficultly being that Covid-19 has mimics of other conditions for example cardiac (myocardial infarction), and ENT (loss of smell), which can make triage very difficult.

At the middle of March 2020, Brisbane had cases imported from China, the US and Europe.

“We used negative ventilation rooms, which are rooms that when the doors are closed have their own internal ventilation systems with viral filters and separate exhaust systems, to keep the hospital and staff safe.” A negative ventilation room once the doors are closed circulates it’s own air. Note the big difference between a system like this and that used in other situations where the air may be circulated through multiple rooms or seats.

Gavin wears scrubs and PPE at work as he finds it impossible to remain socially distant when he’s treating a patient. Unfortunately, wearing the PPE feels like wading through mud so tasks take much longer and everything must be washed down between each patient, making it very time intensive. Before heading home, he showers and puts everything in the wash. At home one car is the “Covid-19” car used for work and another is the “non Covid-19” car. Given the high number of health professionals who have had Covid-19, despite PPE, due to the unavoidable close contact it has proven quite a challenge. In saying that, at this point none of the health professionals at The Prince Charles Hospital have become infected at work.

It is not for the faint hearted. We worked out in the initial phase that the risk of death appeared to be 1:500 up to age 50, about 1 in 90 at 50 and 1 in 25 at 60. The risk increasing with medical conditions and decreasing with increased fitness. These numbers have changed now.

And of course, it’s not just medical, nursing and other front-line staff who have had a hard time of it. Although they have seen hardly any cases of flu this season due to the social distancing regulations, they are now seeing a growing number of patients presenting with mental health issues related to stress from Covid-19 in the community and drug and alcohol related problems.

His advice to anyone thinking about Emergency Medicine is to understand that it is not for everyone.

“The drama and excitement suit a Type A personality, but it can be stressful as you have to be calm in the face of a storm, and be able to keep focused. However, if you are interested in community service then it is incredibly rewarding. You’re saving peoples’ lives.” Literally on a daily basis, some of which becomes very routine due to training e.g. the treatment of heart failure or pneumonia.

A note from Gavin:

“This year has been like no other year. With Covid-19, I, like others, put my affairs in order. I felt it important that people at the front line needed a voice given the extreme high-risk circumstance we are working in.

Thank you for including my experience. I am very grateful for the efforts of my Queensland community, as I am sure your emergency people in Wellington are for your community efforts.  We are a designated Covid-19 hospital which means that as you read this, we are likely to have covd-19 positive patients from the quarantine of Australians returning from overseas. Queensland has chosen to admit all Covid-19 positive patients to a hospital ward to maximise community safety and minimise the chance of transmission. We have no community transmission and have not had any community transmission for months.

I am happy to help point those interested in Emergency medicine in the right direction.

Form VII Cricket Team 1984 Gavin is middle, front row


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