A foot in both worlds

Cate Swannell
Med J Aust
Published online: 21 April 2014

Dr Graeme Duke is an intensivist with a happy knack for making the most of the opportunities that come his way. It’s advice he passes on to his students daily.

There is a universe of contrast between a modern, well equipped intensive care unit (ICU) in a large Australian city hospital and a remote village in Vanuatu, where health care is rudimentary at best and absent most commonly.

These are the worlds Dr Graeme Duke, a self-described “ordinary intensivist” at The Northern Hospital in Melbourne, inhabits.

For the past 6 years, Dr Duke has spent a month annually on the Pacific island nation as part of the Vanuatu Prevention of Blindness Project, a joint venture between UnitingWorld (an agency of the Uniting Church), Rotary and AusAID.

“It’s a stark contrast in a whole lot of ways”, Dr Duke tells the MJA.

“Vanuatu is one of the poorest Pacific nations and their health care is decades behind us. Access to even basic care is difficult and there are very few health care workers.

“It’s a beautiful, glorious place. The people are poor but they seem happier than many Australians”, he said.

His time in Vanuatu is spent doing the basics of primary health care — general check-ups, eye checks and, occasionally, changing the lives of children.

“We are often the first and only doctors they see and we can pick up a lot of congenital problems”, Dr Duke says.

“We found a boy with a club foot who is now having surgery in Hamilton, New Zealand, to correct that. We found a young girl who is now having facial surgery here in Melbourne. And there was another who needed a hole in the heart corrected.”

Like many of the big decisions in his life, Dr Duke describes his involvement in the Vanuatu project as “serendipitous”.

“A mate of mine was taking his yacht to transport some of the volunteers around to some of the more inaccessible spots, and I just decided to go along as the doctor. I had a lot of fun.

“But as a sailor, I make a great doctor.”

Dr Duke graduated from Monash University in 1980 and initially specialised in anaesthesia, spending about half of his time in ICUs.

“I did not choose intensive care as a specialty; it chose me”, he says. “After 12 months I decided I would either have to learn to do this properly or stop.”

He has been an intensive care specialist for the past 25 years. The first 22 were spent at the Preston and Northcote Community Hospital and The Northern Hospital, 18 of them as the director of intensive care.

Three years ago he decided to step aside from his administrative duties and concentrate on full-time clinical work.

“I was happy as director and I was handling it fine, but it was the clinical work I was enjoying the most”, he says. “It was part of my long-term, ‘slow retirement’ plan to reduce my workload.”

“It’s given me more time for teaching as well.”

Dr Duke describes intensive care as interesting, engaging and rewarding.

“Most patients in ICUs survive — about 85%”, he says. “But of course there is a downside. We witness a lot of pain, suffering and hardship.

“What makes it easier is that you are never on your own. There are other doctors and nurses around and you learn to rely on each other for support.”

Australians, he says, no matter what their cultural background, don’t talk about death very easily.

“We don’t grow up with it around us the way earlier generations did.

“It’s still the case that it’s taboo and most people don’t even think about it until they have to — when something comes out of the blue.”

Things are getting better, however, he says, as doctors involved in end-of-life care become more adept at talking honestly with patients and their families about the chances of meaningful recovery.

“We’re much better at giving advice than we used to be.”

Dr Duke admits planning has never been part of his career strategy and that becoming an intensivist is the best decision he never made.

“Things have turned out all right”, he says.

“I tell medical students: ‘Don’t ignore doors that open for you just because you think they might not interest you. They might turn into something great.’ ”

In a hospital panel presentation on the topic “what do you know now that you didn’t know before”, Dr Duke summed up his best advice to students:

“We all feel lonely at times. But the loneliest moment in life is when you experience the pinnacle of your career, the ultimate — what you thought would deliver the ultimate — and it has let you down”, he said.

“So I always tell students and junior doctors: ‘There’s more to life than medicine; and there’s more to life than having a good time.’ ”

  • Cate Swannell



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