Intensive care specialist Dr David Galler describes himself as a "panel beater" rather than someone who saves lives. Photo / Jason Oxenham
Intensive care specialist Dr David Galler describes himself as a "panel beater" rather than someone who saves lives. Photo / Jason Oxenham
FROM THE ARCHIVES: The stage adaptation of intensive care specialist Dr David Galler’s bestselling memoir, The Things That Matter, has finally been resuscitated, two years after its premiere was cancelled by Covid when Auckland went back into lockdown. In this 2021 story, Joanna Wane talks life and death with the man described as a world-class physician with “the mind of a superb scientist and the soul of a fine poet”.
If there’s one thing human beings are good at, it’s dying. We hit that target 100 per cent of the time.
Dr David Galler got a good laugh from the audience when he used that line in a TEDx talk tagged as a glimpse into the mystery of death. As an intensive care specialist, he’s made a career out of working with the living as they “skirt around death”. Of course, what he was really saying is that most of us struggle with our own mortality and aren’t good with dying at all.
Galler doesn’t think of what he does as saving lives. Often, it’s more like panel beating, patching up people to get them back out on the road in better condition than when they arrived. In the intensive care unit, it’s mostly about making the best of the situation you can.
"Sometimes it's one where you can't save someone's life; you can't make them better," he says. "That whole idea of walking into the room and seeing someone there who's clearly dying and everyone is expecting you to do something ... There's pressure on you [as the doctor] to force a decision on the family.
"But when you sit down and listen, it becomes clear you don't have to make a decision. It emerges out of the conversation, and that's kind of lovely. Because the end does matter. In the ICU, the nurses in particular and the doctors work very closely together to ensure the end is a good one for the family, as much as it is for the patient."
You might recognise Galler as a former reality TV star from Middlemore, a series filmed at the South Auckland hospital in the 1990s. Reviewer Diana Wichtel (now a Canvas columnist) used to refer to him as the doctor with the [flamboyant] shirts. He also has a penchant for hats.
When Canvas knocks at his door, he’s dressed in a T-shirt by New Zealand men’s label Strangely Normal and a Comme des Garcons cardigan from the Play range, with its distinctive heart-shaped logo. But he’s wearing a red-spotted shirt with sneakers and shorts in the photos he posted on Twitter in March [2021] to mark his final week as a “Middlemore lifer”, after 31 years. There was a formal farewell — “I practised not crying” — and the ICU team, which has its own rock band, threw him a party. You get pretty tight doing that kind of work.
"The enormity of the job is kind of terrifying sometimes." Photo / Jason Oxenham
Last month, he was back at Middlemore, giving a guided tour of the emergency department to the cast of a new play, Things That Matter, based on his bestselling memoir. Expectations are high for the production, which premieres in Auckland with Ian Hughes as Rafal Beckman in the lead role. The book was published in 2016 to much acclaim; one reviewer said it was as if a poet had been commissioned to write an episode of ER. It’ll be a strange experience for Galler on opening night, watching his life unfold on stage. But even he was “quite moved” by parts of the script when playwright Gary Henderson showed him an early draft. “I’m relieved they’re not using my name, that gives everybody a bit more distance,” he says. “It’s not ‘my play’. But it’s very authentic, no question about that.”
With the world still on the knife-edge of a global health crisis, the timing couldn’t be more appropriate. Galler, who spent seven years as the principal medical advisor to Helen Clark’s Labour Government, had originally planned to hand in his badge at Middlemore in April 2020, but stayed on to help the hospital prepare for a potential onslaught of Covid-19. Coping with the surges caused by Sars and “swine flu” had been challenging enough, but he knew the damage would be devastating if the pandemic swept through his patch.
"It would have been massive, that kind of loss," he says. "The health system would have been totally overwhelmed, with doctors and nurses so traumatised they'd never work again, which is what's going to happen in the UK. Some of them would have died, too. It would have been an unmitigated generational disaster if it had got out here [in South Auckland]. And it didn't, because we acted just in time."
The last-minute change of plans left Galler temporarily homeless. He and his partner Ema Aitken, one of two judges who established the Alcohol and Other Drug Treatment Court, had rented out their Auckland house to kick off his post-Middlemore phase with some overseas travel. (Their son Max, who’s based in London, has worked as a human rights lawyer in Cambodia, while daughter Petra is now a self-employed caker after a stint as pastry chef at Peter Gordon’s Auckland restaurant, Homeland.)
Galler and his partner, Auckland judge Ema Aitken, a key figure in the establishment of the Alcohol and Other Drug Treatment Court. Photo / Supplied
Instead, the couple spent lockdown in a temporary bolthole out at Piha. From there, it was a 50km commute to South Auckland but the roads were empty and Galler liked the drive. By the time they moved back home and opened their mail, he'd stacked up $3000 in fines from a hidden speed camera that had repeatedly pinged him somewhere along the way.
Despite officially "retiring", it's fair to say Galler hasn't really slowed down since. He remains on the Middlemore Foundation board and is actively involved in the Government's health sector reforms, which include dismantling the District Health Boards and the establishment of a Māori Health Authority.
A passionate campaigner for greater social equity and action on climate change, he's part of the Health Coalition Aotearoa, which aims at reducing preventable health conditions, and supports Take My Hands, a charity that redistributes usable medical equipment and resources to those in need in the Asia-Pacific region. A man of cultured tastes — there's a Gretchen Albrecht painting on his living-room wall — he's also on the board of the New Zealand Portrait Gallery.
However, stepping back from the frontline has involved a psychological shift. "I was watching a cop show, a British one, a month or so after I left and there was a great resus [resuscitation scene]," he says. "I thought, 'S***, that was good.' And I had a moment thinking, 'I'm going to miss that.'
"But I've also felt relief. Sometimes things may not go as well as you expect them to, and suddenly you're reminded of just how close everything is and the consequences of not getting it right. That huge burden of responsibility is no longer mine."
Galler’s memoir, Things That Matter: Stories of Life & Death, shimmers with both his compassion for the patients who have found themselves in his care and his absolute fury at the broken system he holds responsible for creating so much carnage in the first place. The South Auckland full house, he calls it: a six-card hand of obesity, diabetes, heart disease, hypertension, chronic kidney disease and gout — fuelled by poverty and substandard, overcrowded housing.
Galler photographed in 2003 with his older brother Les, who is also an intensive care doctor. Photo / Richard Robinson
He was horrified by news reports a few years ago that revealed Middlemore was riddled with rot and toxic mould. “That the most vulnerable population in the country is served by a building as sick as they are, it’s totally and utterly unacceptable. It’s just wrong on every front,” he says.
"The conspiracy of South Auckland makes me angry. Furious, actually, the way policy has been influenced and captured by business, abandoned for generations to the fast-food industry, the liquor stores and the pokie machines. You send people back out to the same old environment and nothing changes. Because nothing changes."
Among senior medical staff, the burnout rate is high. Galler, who worked as a bus driver in Wellington before graduating from medical school in his mid-20s, considers himself a glass-half-full kind of person. "But you can be drained enormously by jobs like this, if you don't protect yourself. And at Middlemore, the work's hard, because of the relentless nature of what you're dealing with. There's no end to it. The waves just keep coming, and most of it's outside your control. The enormity of the job is kind of terrifying sometimes."
Galler describes the intensive care unit as a crucible, where the trappings of life are boiled down to their core. In 2019, he was part of the specialist trauma team that worked through the night on some of those most critically injured in the Whakaari/White Island eruption. Not all of them survived.
An off-diary visit by Prime Minister Jacinda Ardern in December 2019 to the ICU at Middlemore Hospital, where burns victims from the Whakaari/White Island eruption were treated. Photo / Supplied
"I'm quite an emotional person, I do feel things," he says. "Maybe it's something that's happened to me as a result of the work and the things that I've seen. It's impossible not to be affected by it, but you have to hold yourself together to do the best you can for that person, no matter what it might be. And you do have to give to get. Not getting could be an even bigger cause of burnout.
"When I get all sentimental, I say they are small acts of love — the intimacy of sitting down with someone when they take their clothes off or you're sticking a finger in their arse — and the relationships you build over a very short space of time, how deeply you connect because of the circumstances you find yourself in.
"I've been involved in the most extraordinary conversations with people I'll never forget. And people I'll never forget. If there's anything I was going to miss, it's that."
Galler's memoir is bookended by the deaths of his parents — his father, from heart disease, and his mother, from cancer 22 years later. Both were Polish Jews who lost most of their families in the Holocaust. Zosia, Galler's mother, was an Auschwitz survivor and part of her story has been incorporated into the play.
Auckland Theatre Company had approached Gary Henderson several years ago about adapting a book for the stage, but he'd struggled to find one that worked until he heard about a talk Galler had given at the Going West writers' festival.
Henderson has worked with actor Ian Hughes before and is delighted with his casting as Raf, saying his gentleness, strength, calmness and vulnerability are all qualities he wanted the character to imbue. “There was something about the humanity of the book that really moved me. To me, it’s about human connection. And the nurturing of families to accept that someone is going to die was a big part of that.”
Galler's father, Aron, used to say that once he was dead, his remains could be flushed down the loo. Galler doesn't have faith in an afterlife, either, although being Jewish has given him a strong sense of continuance, the unbroken thread that links the past, the present and the future — a concept he thinks we need to get our heads around in the West.
As a visiting specialist at Samoa's main hospital in 2015-16, Galler reduced the mortality rate in the intensive care unit from 80 per cent to 18 per cent. Photo / Supplied
If we live on at all, he believes, it's in the memories of others. Still, he's open to the existential mystery that surrounds death. "I've been alongside a lot of people when they've died in the hospital setting. What I think has stayed with me is the profound shift from being alive to dead," he says.
"No matter how near death you might be, there's a warmth, there's a beating heart as weakly as it might be; there is still something there. Then when that stops, how quickly it turns. The 21 grams — the weight of the spirit. What do they call it in wine? The angels' share that just disappears. It's like that, isn't it?
"You can choose to read something into those things or you can choose not to. You can live life through a technical lens and see everything in a linear fashion, or you can live life through a much more spiritual, complex lens.
"I've said to junior doctors, 'If all you're interested in is the technical skills of medicine, you're a technician.' Being a doctor is about applying those skills in a way that is deeply human."
• Things That Matter is on at Auckland’s ASB Waterfront Theatre from August 11 to 27. A special discount offer is available for healthcare workers, with tickets priced from $45.
