If you have ever spent time in Sydney you’ll know that it likes to maintain its shine and polish. Sydney does glamour and sophistication fabulously and Sydney is a stylish force to be reckoned with. Mostly. But like any great city, it has its demons.

Druggie grubbiness and reckless boozy abandon aren’t entertained much and the gritty realities of certain pockets of our city aren’t always welcome when they spill over into the more genteel and manicured neighbourhoods.

Despite multiple charities and organisations working tirelessly to provide services that promote a sense of acceptance and inclusion to those feeling disenfranchised by poverty, addiction or mental illness, some societal cracks remain, splintering Sydney’s glossy urban veneer.

As the Director of Emergency Medicine at Sydney’s St Vincent’s Hospital since 1983 and with a varied and impressive medical career prior, Professor Gordian Fulde knows Sydney. Warts and all. Such is his knowledge and experience that he has found himself catapulted into the media spotlight in recent years as the educated voice of reason in regard to the multiple effects of Australia’s increasingly apparent ‘alcohol culture’ as well as the escalating ice (Crystal Methamphetamine) drug epidemic. Both social afflictions sporadically sabotage our news air time, with their shocking tales of violence, heartbreak and fear.

Dealing effectively with these issues take guts, patience, humour and empathy. Luckily these vital attributes come naturally to this straight-talking, no-nonsense practitioner. From random, drunken ‘coward punches’ in the glittery gutters of nocturnal Kings Cross, to deadly overdoses and drug-related domestic violence, this doctor and his dedicated team of staff have seen it all, administering calm in the chaos time and time again.

Gordian 7

The Lock-Out Laws

In an attempt to curb this current surge of street violence, Lock-Out laws were introduced to bars and clubs in the Sydney CBD Entertainment Precinct in 2014. Not all Sydneysiders support this move, many taking to social media to air their dissatisfaction at these drinking restrictions but since they were enforced, it cannot be denied that there has been a dramatic drop in crimes of this nature being reported. Details of these laws can be found on the New South Wales Government website (link at the end of this article).

Even with the new lockout laws in place and the decrease in street violence, a trip to St Vincent’s Emergency Department on a typical weekend isn’t for the faint-hearted. Awash with the everyday accidental injuries or worrying ailments that most of us have witnessed or suffered from at one time or another, the weekend experience will also include the excessively drunk or drug affected. Intoxicated ranting, erratic outbursts, aggression (often directed at staff) and even the occasional colourful display of projectile vomit flying through the air.

One thing is for sure, the staff here certainly don’t have time to drink tea or scroll through social media.

The Ward

My morning spent with Gordian was a Tuesday. Part of me was a little disappointed when the invitation stipulated this day and time. I wanted some hands on drama and mayhem to write about and I didn’t think that a Tuesday morning would cut it somehow…

When I arrive Gordian describes this day as ‘quiet’. That said, every cubicle is occupied and every staff member is bustling and focused. By ‘quiet’ I think he meant that it wasn’t reminiscent of a drug-fuelled war zone with the proverbial hitting the fan.

Elderly patients are everywhere here. Gordian explains that the doctor in charge of elderly admissions has been run off her feet daily and it’s a struggle for the staff to cope. He’s seen a huge increase in elderly admissions to this ward “We are all living longer nowadays and this problem won’t get any easier I assure you.”

“Like any city we have poverty and it’s associated social problems…homelessness, alcohol and drug abuse. We aren’t alone in this. These problems are akin to others that we see far too regularly, domestic violence being one of them. If you throw alcohol or drugs into the mix of a man who is mentally unstable and violent, what would you expect? We see it all here and domestic violence doesn’t discriminate…rich, poor, in-between. Some hide it well until they end up here in a crisis situation.”

“The drinking culture here in Australia plays a big part in a variety of issues for sure. Alcohol is everywhere and is encouraged constantly. I’m not anti-alcohol at all, I enjoy a social drink or two but it’s the difference between partaking, celebrating or nearly killing yourself or others by misadventure. Some people simply cannot handle alcohol and it ends up in some kind of tragedy or disaster. It happens and we see it.”

He’s got a point that’s for sure. He’s certainly not the fun police, I can easily picture him being the life and soul of a party but he sees the ultimate in personal devastation and some pretty horrendous injuries every week from intoxication that quite frankly could have been avoided.

Ice Age

We were able to tour the ward and chat for a time before the ‘Bat Phone’ rang and everything changed in a nanosecond. This is the ringtone that means business. Serious emergency business. All eyes are immediately directed to the staff nurse taking the call and all wait intently for the outcome to assess their next move.

It’s quickly relayed through the ward that an aggressive, highly intoxicated person is being brought in by ambulance.

I look at Gordian and ask is it a man or a woman? “It doesn’t make any difference when they are that high” he replies.

Like a swift and calm military operation, everyone got to work with their various duties and within moments the designated cubicle was ready. Four hospital security guards and a social worker promptly arrive, they methodically pull on gloves and large protective plastic masks are placed over their faces.

Less than a minute later paramedics wheel through the female patient on a bed. Despite her petite build, they are struggling to hold on to her. Her age is hard to estimate. 20’s? 30’s? 40’s? Her face is ravaged with pitted skin, deep hollowed eye sockets and she has missing teeth. She is screeching obscenities and trying to take down everyone who dares come near her.

Her body looks like it’s convulsing, almost lifting off the bed and there is an intense fear in her eyes. Her filthy, oversized T-shirt rides up to her neck before a nurse swiftly pulls it down in a vain attempt to retain some kind of patient dignity in a remarkably undignified situation.

She is somehow transferred onto the bed and her arms are put in restraints while a quietly determined and softly spoken female registrar prepares the syringe with a sedative, talking calmly as she carefully administers the drug. Her reassuring words go nowhere, as the woman screams C***! in her face but she repeats her words anyway. Surely this doctor’s head must be aching? My ears feel like their bleeding and this situation has only been going on for 5 minutes.

I can tell from her exposed stomach that at one time she’s carried a baby. Probably several and my heart sinks, but I’m thinking about her children, not about her and I question myself and my apparent lack of empathy for the human being in front of me. All I can think is where are her children? Are they safe? Have they ever seen her like this?

Maybe my momentary lack of compassion is simply the shock of witnessing this confronting scene. Maybe it’s because I am a mother? Maybe it’s because I’m a crisis foster carer and I see the effects of adult drug addiction on children. I recently cared for 2 brothers, both under 6 years old, both had been removed from their home on numerous occasions by community services and both had endured a lifetime of chronic neglect. Their troubled and drug addicted family had been given multiple chances to make things right but they had failed. Again. These boys arrived on my doorstep with haunted eyes and dirty clothes, clinging to their case worker, looking like they’d just been pulled out backwards from a crack den in a war zone. Blood is thicker than water though so they say and despite their obvious suffering these bewildered little boys cried for their family every night for a week.

Maybe it’s actually just hard to feel sorry for someone who is screaming C***! in the faces of dedicated staff but the reality of this situation is overwhelming and it takes a while for my compassion to return. I wonder how she got to this point. What drove her to make these decisions? What emotional pain is she trying to override with this poison?

Suddenly there is silence and the patient is motionless, deep in sleep and seems to pose no risk whatsoever. Drama over right? Staff wait for the nod from the head nurse and resume their duties as if nothing happened. However, as Gordian points out, she now has to be monitored constantly for hours by multiple staff in case of complications due to her intoxication and then sedation.

I ask if there are other drugs that drain the system like this. “Many drugs are dangerous and many drug issues are great cause for concern here but the trouble with Ice is that it’s cheap and very easily accessible and it is without a doubt, the most destructive drug that I’ve ever encountered.”

That drain on their resources is obvious. Professional as they are, the emotional strain on the staff must be exhausting not to mention the fact that this patient is lying on in a valuable hospital bed and may jeopardise the emergency care of patients coming into the ward at any given moment.

Team Spirit and a Soft Place to Land.

The comradery and team spirit amongst colleagues is evident here. They have each other’s backs and no doubt they forge bonds that can only be possible when working in the most extreme of situations. “Humour is vital if you want to work here” he chuckles. Despite the challenges, it’s clear that there are times for laughter. “How else would you deal with the absurdities of life?”

Professor Gordian Fulde

“You have to be goal orientated to be part of this team and you have to be able to debrief after a difficult day. Much as this is provided here at work, you must have an understanding family or a supportive partner to go home to. Winding down is crucial too and no one understands my team’s challenges like their colleagues. I love to unwind near the ocean, I don’t get as much time as I’d like to actually get to swim or surf but just to be near it and watch the waves helps me to unwind after a stressful day. I also have an incredibly understanding family.”

Hazards and Security

“Our procedures for security and safety implementation are reliable, well rehearsed and effective, however, we can never to be too complacent. The drug affected, the mentally ill, domestic violence issues…we are all on guard here, all constantly on the lookout for something to kick off. Small hospitals without these rigid and strict procedures are more at risk, they would have more to worry about if a serious emergency was to surprise them. Their risk is less but ultimately they wouldn’t be as prepared as we have to be all the time.”

I’m shown around the impressive security HQ next to the ward. There are screens everywhere, every corridor and corner of public areas clearly displayed. A large team of security guards take turns in intently watching screens and then patrolling the emergency areas. Most of them are huge or ripped or both but all have nice smiles and generous manners. They would be perfect for diffusing the most fraught or threatening of any situations here and I find myself imagining hiring a couple of them for the next hellish kids party that I have to throw.

Professor Gordian Fulde

Fame

I ask whether his notoriety and fame helps or hinders in difficult situations. “Having a recognisable face helps actually. I guess if they recognise me maybe they have an element of trust in me, I generally seem to be able to calm people down, I guess it’s an energy. Of course, there are situations though that no one and nothing can help to calm down! We have all been attacked in some way, it’s tough but I’ve had quite a bit of practise.”

Professor Gordian Fulde

Rock and Roll, Sport & Sailing.

“Sometimes I’m asked to be the doctor on site for big rock and roll gigs like the Rolling Stones and, in the past INXS. It’s great! What a terrific experience and such fun to be temporarily catapulted into such a different world.”

“As the resuscitation doctor for the Australian Rugby Union and The Waratahs, I only am needed if someone is critically ill or unconscious as there are many other doctors and specialists involved including sports medicine and orthopaedics.”

“I am also the honorary surgeon for the Royal Australia Navy Sailing Association (RANSA), club doctor for the Australian 18 Footer and I also help out the Cruising Yacht Club of Australia with first aid and life support lectures.”

Professor Gordian Fulde

Heritage & Family

“My heritage is German, I came to Australia as a young child, both my late parents were doctors, it’s in the blood.”

“Both my daughters are doctors and both are with top blokes, I’m very happy about that. My wife is also a doctor and she is a great support to me when she’s not fussing over our 2 dogs! One is a rescue dog and the other one is a Russian Terrier with a head the size of a bear. I think of myself as extremely lucky to have the family that I have.”

“I love the occasional trip back to Germany and I am currently pretty devastated that a recent knee injury has made me cancel a skiing holiday this January in Europe. I also can’t surf and with Sydney spring well and truly here I’m more than a little disappointed!”

Professor Gordian Fulde

The Future

Professor Gordian Fulde is 67 yrs old and plans to retire at 70. I was surprised at his definite plan to retire in 3 years..wouldn’t he find closing this door challenging? “No, I’ll quite easily leave this behind. I love what I do as a job but I have a full life…spending time with my family, surfing, sailing, all kinds of activities. There’s nothing worse than someone hanging in there in their role when they should’ve let it go.”

Past & Current Titles

Professor Gordian Fulde has recently been awarded the regional honour of NSW Senior Australian of the Year and is now nominated for the National Australian of the Year.

Professor Fulde is responsible for all aspects of trauma training and administration for a staff of over 200 members at St Vincents Hospital. In addition to this administrative role, he is actively involved in the care of patients who present in the Emergency Dept, of which he holds the title of Director.

Director at Sydney Hospital Emergency Department.

Professor of Emergency Medicine at the University of New South Wales and Notre Dame University.

Founding Fellow of the Australasian College for Emergency Medicine and at various times has held the offices of Vice President, Secretary and Censor within that College.

Member of the Senior Court of Examiners for the Australasian College of Emergency Medicine and examines for the Royal Australasian College of Surgeons.

Stream Director of Critical Care for the South Eastern Sydney Local Health District.

Professor Fulde is an active media spokesperson on alcohol and drugs in the community and the

issues and implications that arise from their abuse.

Senior expert to the State Coroner, Medical Tribunal and Health Care Complaints Commission.

Member of the editorial board, a contributor to and reviewer of a number of Medical Journals.

Professor Fulde has a Bachelor of Medicine and Surgery from University of Sydney and Specialty

Emergency Medicine and Surgery qualifications from the Royal College of Surgeons and Royal

College of Physicians, Edinburgh.

Professor Gordian Fulde

Credits and Thanks

Photographer Graham Jepson

http://www.grahamjepson.com/

 The Security, Admin & Nursing Staff St Vincent’s Hospital Emergency Department

Dr Fiona Chow – Emergency Consultant

Secretary & PA Sophia Deegan

Professor Gordian Fulde

Lock Out Laws Information

http://www.nsw.gov.au/newlaws