3. Why did you and your brother Les Galler both become intensive care doctors?
Les got into medical school when he was 16. I took a more circuitous route. That was a freer time when going to university wasn't about getting a job, it was about getting an education. After my BSc I was a bus driver for 15 months. The medical school took a bit of a risk with me but you don't need to be super smart to be a good doctor. You've got to like people. It's not just about technical competence but finding the right treatments for people by actually listening to them.
4. How did you end up at Middlemore Hospital?
There were very different cultures in the Auckland hospitals in the 1990s. Auckland was filled with ambitious, combative, Type A personalities. I was picked as a "Middlemore guy". We used to joke that the health board gave most of the money to mates at Auckland and Greenlane. The place was a dump - every tile was cracked, every loo leaked. You could smell the blood and beer when you'd walk into the ED on a Saturday night. There were gang fights in the waiting room. It was rough yet it was full of good people who really cared.
5. In your book you describe real cases to cast light on how medicine works. Did your patients permit you to tell their stories?
Most of the stories are composites based on real events but a couple are absolutely true including Carlos, the cyclist, who gave me permission to use his name. We've kept in contact during his extraordinary recovery over the last 20 years.
6. When it becomes clear a patient is dying, how do you tell their loved ones?
Truth telling is important under those circumstances. I talk about recognising there's a process under way which we need to respect. It's dishonest to pretend we can fix things when we clearly can't. I use terms like "return them to a more natural state" or "put them in the hands of God".
7. How do you broach the topic of organ donation?
We do it about five times a year at Middlemore. I used to think getting a family to say "yes" to organ donation was a win but now I think it's getting the right answer for a family because they're the ones who live with it. It's incredibly important to develop a relationship with the family so you have an ongoing conversation. Just decent, humane, compassionate behaviour; being around, being approachable, taking a genuine interest and sharing information as best you can. We never ask a family to decide to take their loved one off a ventilator. We present a plan and talk about why we believe it's the best thing to do. It's a very intense couple of days. You may have 30 people in the room, an interpreter, you might be talking to family overseas by phone.
8. Do you have to get consensus from the whole family for organ donation to take place?
Ideally. The patient is dead, so our duty of care is to the family. Tearing a family apart to get someone a kidney is not acceptable. It makes the process so much easier if people have those conversations when they're alive. It's good to document what you'd want in an advance directive but there's no way you could cover off every possible circumstance. That's why it helps to talk to a trusted family member or friend who knows your values and can apply them.
9. Do you think we could be getting more organ donations than we are?
We're trying our best but I think the process could be improved. A review is under way and Organ Donation NZ is looking at ways to identify more donors and manage them differently so every family has the opportunity to make the right call for them.
10. Do you support Lecretia Seales' campaign for doctor-assisted dying?
The idea of someone suffering and dying with pain and real distress is abhorrent to me. I think it probably does happen which is why we need to have this discussion. In intensive care we will assist patients so they're comfortable. That inevitably can accelerate their passing but it's quite different from actively ending someone's life at a time of their choosing. If someone was in enormous pain and dying I could rationalise giving significant doses of morphine knowing that their death may occur sooner but I would struggle with giving them a lethal injection. Not just as a doctor but as a person. We might be better off investing in better access to really good palliative care.
11. What do you think of recent research suggesting Samoan people may be genetically predisposed to obesity?
I've just spent a year working in Samoa where diabetes is a plague. That didn't exist before the 1980s. There may be a genetic predisposition but environmental factors have brought this on. The idea that it's personal choice and people just need to pull up their socks and make better choices for themselves is rubbish. Because a whole lot of factors are at play you need to surround the issue with a range of evidence-based interventions and apply them in concert with each other. We've done it to some degree with smoking and road trauma but not alcohol or obesity.
12. Does seeing so many poverty-related diseases at Middlemore get you down?
It does. That's why we all need to be involved in prevention. Governments worry that we're spending too much on health yet so many of their other policies stack more and more people at our front door. The obesity epidemic is a case in point costing us billions of dollars and the fact we're not confronting it as we should is an appalling abrogation of leadership in this country. To tackle this effectively we need a strategic plan with a range of policies working in alignment across domains - including government regulation of the food environment - over a generation or so. As a nation we deserve better.
• Things That Matter: Stories of Life and Death by Dr David Galler, Allen & Unwin, 1 August, RRP $36.99
