Health

As we move towards a ‘Covid normal’ return to workplaces, the importance of sick leave has never been greater. By Melanie Cheng.

Has Covid-19 finally taught us to stop coming to work sick?

Community health involves dealing with patients of all ages.
Credit: AAP / Glenn Hunt

When my late uncle, a high-school teacher, once reflected on the hundreds of students he had taught over the course of his career, he said there were only a handful he could recall clearly. When I retire, I suspect I will say a similar thing about my patients. If so, I know Tony will be one of the few I remember.

Tony was in his late 60s when we met, in a windowless consulting room in the northern suburbs of Melbourne. He’d grown up in a tiny village on the Mediterranean Sea and exuded a warmth from his brown eyes and maple-coloured skin.

On this particular day, Tony was complaining of a lightheaded feeling on his morning walks. The diagnosis was immediately obvious on palpating Tony’s pulse. His heart was pumping at an unnaturally slow place – hovering somewhere between 30 and 40 beats a minute. It was amazing he could stand at all, let alone walk several kilometres. I rushed him to our treatment room for an urgent electrocardiogram. It confirmed what any clinician with even the most basic understanding of cardiology would have suspected: complete heart block. The practice nurse called an ambulance.

The next time I saw Tony, he arrived with a new accessory – a matchbox-sized device in the soft triangle of flesh between his shoulder and his chest. He wore the gadget proudly, like a Boy Scout might wear a badge. But the pacemaker wasn’t the only addition to our consultation that day. Tony was accompanied by June, his wife of 40 years.

I didn’t know it then, but one of the small delights of my longer than expected stint in community health would be beholding the loving banter between Tony and June once a month. Theirs was the kind of relationship better suited to a Hugh Grant movie than real life. I think they enjoyed it, too – showing off this precious thing they had spent decades perfecting together. But what I loved most of all was how unsentimental they were about it. When I – 10 years into my own relationship – asked them what the secret to a happy marriage was, they replied, in unison and without hesitation, that the answer was, quite simply, compromise.

On this morning, Tony and June were less focused on each other and more focused on their gratitude – to me and to the practice nurse and to the community centre they had attended for as many years as they’d been married. I smiled and accepted their thanks and gift of homemade chocolate brownies. Later, in a quiet moment, I tried to explain that any doctor would have done the same. Tony and June were having none of it, though – as far as they were concerned we had saved Tony’s life.

Eventually, when the dust had settled, Tony and I resumed our monthly appointments for blood pressure checks and prescriptions. Tony’s pacemaker proved as reliable as the fake Rolex I had bought at a Hong Kong street market – still going strong, without so much as a battery change, for almost a decade.

Months morphed into years. Tony and June welcomed several grandchildren, and I welcomed a baby girl of my own. On my return from maternity leave, Tony was among the first patients to book an appointment. He and June arrived together, bearing a Hallmark card and matching smiles. They asked after my daughter with genuine interest, and when I told them she wasn’t sleeping, they offered their suggestions – perfected by trial and error over decades – for how to get her to sleep through the night.

Tony’s visits marked the passage of time with the regularity, if not the frequency, of Tony’s pacemaker itself – a dependable fixture in my otherwise unpredictable working life. He and June were always there, until one day they weren’t. I waited five, 10, 15 minutes, but neither of them came. I tried calling their home phone but nobody picked up. I rang June’s mobile; it went straight through to message bank. I contemplated leaving a message before deciding they were entitled to miss their appointment without being hassled by their GP. I pushed on with the morning schedule but an unease hovered over the rest of the day.

It was weeks before I saw them again. In the meantime, I missed our conversations. Ever since I’d returned from maternity leave, I had been struggling to balance the competing demands of work and home. My daughter, like most kids starting childcare, was perennially unwell – barely recovering from one virus before succumbing to another. If I wasn’t at home caring for her, I was at work, surviving on a whiff of sleep and worrying about her. I felt bad for always calling in sick, putting my colleagues out, having to reschedule all my appointments. Perhaps part of the reason I enjoyed my consultations with Tony and June so much was because they reminded me of a time when I was a better, sharper, more present doctor.

When I finally set eyes on Tony again, I could tell something terrible had happened. He looked like a small, washed-out version of his former self. When he clung to June’s arm, it was less as a gesture of affection and more as a means of simply remaining upright.

“What happened?” I asked as soon as they had settled into the room.

The flu. June spoke for him. It had really knocked him about. He had ended up on a general medical ward of the local hospital with oxygen and an intravenous drip for almost a week.

“It’s not even the season for it!” Tony said, incredulous.

Once again, I was reminded of the power of influenza. My daughter had needed attention at the Royal Children’s Hospital for a flu-like illness earlier in the year. Thankfully she, like Tony, had lived to tell the tale. But her recovery had been gradual. Today, I took great comfort from the rare but unmistakable glimpses of Tony’s old cheekiness as the consultation neared its end. He was going to be okay. Everything was going to be okay.

And then, just as he was leaving, he dropped a bombshell.

“I still don’t know how it happened,” he said, clinging to the doorframe. “I’d hardly left the house in the week before I got sick. I’d only been here, to see you, at the clinic.”

Instead of calling my next patient, I went back through Tony’s notes, skimming frantically. He was right – he’d attended the clinic about three days before he presented to hospital. I retraced my own movements and worked out that on or about the same date I’d been recovering from my own illness. Another one of my daughter’s many childcare viruses.

Could it have been me? I wondered. Could I have given Tony the bug that landed him in hospital? Could I – in some vicious and ironic turn of fate – have put the patient who credited me with saving his life at risk of harm, even death? It was impossible to know the answers to these questions. The index case could have been any one of the patients in the waiting room that day, or someone Tony had sat next to on the bus, or one of his several grandchildren. But the possibility remained.

Looking back on these events now through the prism of the pandemic, I cringe at my recklessness. But these events occurred almost 10 years ago, at a time where many of us, perhaps even most of us, were still going to work with a runny nose. I remember seeing a documentary about the deteriorating situation in northern Italy at the beginning of the pandemic and being shocked to observe one of the ICU doctors working despite suffering fevers and chills the night before. Then I recalled the years I’d spent in underresourced and understaffed hospitals, where a sickie was met with a collective groan and much exaggerated rolling of eyes.

There has been a lot of talk about the seismic cultural shifts we will behold in the wake of this once-in-a-century global event. I wonder if one of them will be a long overdue respect – among employers and employees alike, particularly in the healthcare sector – for the much-maligned sick day. I learnt my lesson from Tony the hard way. But if I’d only cared to look, the guidance was there all along – in the principle of nonmaleficence originally described in the 2500-year-old Hippocratic Oath, and later popularised by the Latin phrase: primum non nocere. First, do no harm. 

Names and details have been changed.

This article was first published in the print edition of The Saturday Paper on Oct 2, 2021 as "Do no harm".

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Melanie Cheng is a doctor, writer and The Saturday Paper’s health columnist.