One of New Zealand's top burns surgeons has opened up on the human cost of treating Whakaari / White Island victims – including being taken to breaking point himself. Neil Reid reports
WARNING: GRAPHIC CONTENT
The tears came shortly after Richard Wong She turned on the ignition of his car after another gruelling shift at the forefront of caring for White Island victims clinging to life at Auckland's Middlemore Hospital.
And they flowed - each night - as the death toll gradually rose as tourists lost their battle for survival because of the horrendous burns and internal injuries suffered when Whakaari / White Island erupted underneath them on December 9, 2019, killing 22 people.
In an exclusive interview before the one-year anniversary of the tragedy, Wong She - the clinical leader of National Burn Centre of New Zealand, located at Auckland's Middlemore Hospital - has spoken of how some staff who had put their lives on hold to help care for patients were sent home because of the trauma associated with the aftermath of the tragedy.
And Wong She – who has more than 20 years' experience on the frontline of critical burns care – revealed he wasn't immune from the heartbreak, being overcome with emotion and breaking down in tears when he got into his car after long surgery shifts.
"It is a very real thing," he told the Herald on Sunday.
"Maybe I am wrong. I am of the understanding that as a leader the team needs to see confidence, they need to have a plan; they don't want to see someone buckling down in the corner saying 'I can't cope, this is too much. I don't know what to do'.
"[But] there is a raw human emotion of what happens to people and their families that is such that if you didn't cry, I am not sure that you are actually human."
Wong She's car became an emotional sanctuary for him during the aftermath of the eruption as burns specialists – including surgeons, nurses and therapists – worked day and night to treat patients.
The care of those in hospital was put ahead of everything else going on in the medical teams' lives. Wong She said the sacrifices his family had to endure meant he wasn't going to further burden them with his own emotions.
"I had already promised my family all sorts of things that I then reneged on. Normally my family are a great sounding board but it wasn't really fair for them [during White Island]," he said.
"So, it left the car. It has proven to be something that I have done over the years. But there was quite a bit of it over White Island. It was huge, the number of lives and families that were affected were massive."
Given the level of investment the teams had in their patients, when anyone in their care died, it had been "tough" on all involved.
That led to some staff being told to go home.
"The stories are devastating. The circumstances have been tragic," Wong She said.
"And what we had to do to look after each other is that we had to send some people home because, especially if someone passed away, it was: 'You need time to process this'.
"I would send people home to chill and relax and have a beer. It is just part of the job, which is why I cry in the car, not in front of everyone else."
WONG She was at breaking point before White Island erupted with such devastating consequences at 2.11pm on December 9, 2019.
When news first filtered through to Middlemore Hospital that a volcano had erupted his first reaction was: "Aha, sure".
"Denial is essentially it," he said. "Part of the reason for the denial, we weren't sitting around doing nothing. I was exhausted."
In a candid interview, Wong She revealed hours earlier he had been in tears to his manager talking through his workload and concerns; including the day coinciding with the changeover in registrars at the burn centre.
"I had been in my senior colleagues and managers' office, gutted, saying 'I can't cope. I can't cope with what I have got because what I have got is so far being about 200 per cent over capacity. I have been operating all day and all night the previous week. I am exhausted, I am tired, my support is going. I don't know how I am going to cope'.
"It wasn't just because of that one week, it was because of the preceding two months. We were slammed.
"So when someone says a volcano has gone up it is 'Oh', partly through denial because actually you know I can't cope with what I have got, please don't tell me it is more."
Given his vast experience on the medical frontline, Wong She said he had also experienced many false alarms over potential catastrophic events.
Initially there was an "absolute vacuum of information" about what might have happened on White Island.
"That was the hardest thing. How do you gear up for something you have no idea what the scale is?" he recalled.
As staff monitored news reports, details of patient numbers and injuries started being entered into a hospital database.
Wong She said the team at Middlemore Hospital and the National Burn Centre immediately started "ramping up", including the specialised skills of staff on duty and other staff who could be called in.
"So it was really making sure who was around, what skills do they have, what else is around, and also forewarning our intensive care unit: 'Hey guys, we are going to get really full'.
"Now they are already full and they were looking at me like, 'Well, what are we meant to do with all of these patients?' I was like, 'Well they are having to go somewhere'.
"They are only going to go somewhere if someone else is happy to take them. And also we can only open up beds if staff are prepared to come in.
"And that is the one advantage, the only advantage, of a terrible, terrible disaster ... that suddenly everyone is prepared to pitch in."
WITHIN hours, patients – including those clinging to life – were being airlifted from Whakatāne to Middlemore Hospital. Other patients were transported to burns and intensive care units at Christchurch, Waikato and the Hutt hospitals.
Wong She said he was struck by two "very distinct patterns of injuries" by patients he saw.
"There were those that were close to the crater when it erupted and these people were covered in ash. Initially it looked like the ash would peel off. And that the underlying burn was actually not too bad," he said.
"But by the time they got to us, that ash had not just caked itself on but based itself in to the point that you couldn't just wash it off. And not only that, but there were some patients for whom that ash had actually been blasted into their tissue. It had become embedded in them."
"If you look at the photographs of White Island and you see the helicopter that was blown off its [landing pad]. That helicopter is quite a distance away from the crater. The people were much closer.
"The amount of force to move a helicopter across a pad, the amount of force it takes to break the rotor blades ... '[some] patients were even closer to the crater. The amount of blast force that they must have endured just defies the imagination.
"There was a very high mortality rate for a group of them."
The second group's physical injuries were not as grave, but they were still in a very bad way by the time they got to hospital.
"I believe that one of the tour guides told them to hide behind a rock. And that absolutely saved their life," Wong She said.
As well as the soot, patients had also been covered by hydrofluoric acid during the eruption.
"It is a really dangerous thing and can cause some quite life-threatening bio-chemical abnormalities," he said.
"And in fact these patients were covered in it and were behaving biochemically abnormally. So when we discovered that was the case a couple of hours in, then suddenly our initial plan to deal with the huge influx had to be altered. And the alteration was that we needed to get rid of the acid, we needed to get rid of the hydrofluoric acid embedded in the tissues."
Medical teams were to perform numerous life-saving and lengthy procedures in the days and weeks that followed December 9.
And for those caring for the injured it meant working in operating theatre environments described as "miserable" by Wong She.
A loss of skin means burns patients can't regulate their temperatures, meaning theatres have to operate in warm conditions. Burns surgeries are carried out in theatres kept around 28C. Temperatures in theatres for other surgeries range between 16C-18C.
And because of the risk of inhaling the ash the White Island patients were covered in, all members of burns surgery teams also had to wear N95 masks, which Wong She said were "incredibly difficult to breathe through".
"We are drenched in sweat," Wong She said.
"You are in a super-heated environment, you are melting under sweat, you are trying to breathe through these masks ... it really is miserable. But it is interesting what you ignore when there is a task at hand, and the task at hand is your patient.
"It is an arduous operating environment. And I keep having to remind myself that I chose to do this as a career. And I take my hat off to my colleagues who didn't choose to do this but actually they did, when push came to shove, when we needed the help, they came in and did what needed to be done in an environment that nobody would really want to work in."
SUNDAY, December 22 is a painfully agonising night which will always be etched in Wong She's memory.
It is the night he lost one patient – 42-year-old American Mayuari Singh – and came perilously close to losing her 49-year-old husband Pratap Singh.
"That just about killed me," he confided.
Both were in critical condition as they battled burns and a raft of other injuries, after their sight-seeing trip to White Island resulted in disaster.
Wong She was called back to Middlemore Hospital on the night for an urgent surgical procedure after mould was discovered by lab checks in tissue samples taken from Mayuari.
She was on dialysis because her kidneys had stopped working. The medical team had decided to give her an anti-fungal treatment and then get her into surgery.
At the same time, Pratap was having breathing difficulties because of debris in a breathing tube. Wong She said it had been decided his tube would be replaced in a theatre so it could be carried out under "controlled conditions".
"One is already in the operating room getting ready to have their breathing tube swapped. And the other one is getting ready to finish her dialysis, stop the anti-fungal medicine, so they are ready to go back up to theatre with us to remove all this fungally infected tissue."
But as the medical team was finishing giving Mayuari the anti-fungal treatment, she went into cardiac arrest.
"We did CPR for a very long time ... 45 minutes. We gave her every medicine that we knew, we did every manoeuvre we could ..." Wong She said.
"It is a very, very difficult thing to say, but actually in that room there were five consultants and we had been going for 45 minutes, we were all looking at each other and going, 'We are not going to win ... we can't get her back'."
While battling to try and save Mayuari's life, Wong She received a phone call from another theatre, being told: "Where the bloody hell are you? We need you to help with Pratap because we are in trouble now."
The top surgeon said despite a new tube being inserted, Pratap still couldn't breathe.
"We tried all sorts of [things] and there was only one thing left for us to do if we were to have a chance of survival and we had to call somebody in to help us do it, and that is to split his abdomen open. And so we did it.
"It made enough of a difference that they were able to [save him]."
Wong She revealed it was now believed Mayuari had gone into cardiac arrest after suffering hypokalemia – a low level of potassium. He said it was "buried in the fine print" of the anti-fungal medicine that the condition could be a "very, very rare side effect" of the drug.
Those who had treated the Singhs were left traumatised by the night's events.
The next day Wong She had to send "some people home because they were distraught".
"But I couldn't send everyone home. That was also extremely difficult."
For a time, Wong She had been upset that his actions in saving Pratap that night had stopped "that very 'romantic' story when husband and wife passes away only separated by minutes".
"I stopped that," he said. "Coming back to that night, there are times when I feel very guilty that I stopped this couple from having that very romantic passing of within minutes of each other.
"But this is where the value of the team comes in, and one said: 'Well you know what, I don't think his children would have found it very romantic'.
"It was the words I needed to hear to keep going. Long before Covid, long before we were all told to be kind to each other, we were actually doing that and needed to do that with the heartache and the devastation was so traumatic that we needed to help support one another."
Tragically, Pratap died from his injuries several weeks later; 50 days after the eruption.
"We moved Heaven and Earth for that poor man and his family," Wong She said.
"In the end we couldn't get any further because he got the same mould that his wife got; and it was in multiple places. Our options were to do a multiple limb amputation or to give him the drug that essentially killed his wife.
"And on top of that he had also sustained a number of other quite significant injuries and complications. There becomes a point where actually looking at the whole scheme, this was not in Pratap's or his family's best interests to keep going."
A YEAR on and the mental wounds remain for some of those who cared for the White Island victims – just like the physical scars and mental injuries remain for those who survived.
Wong She said what got those involved on the frontline through was a "very common goal" to help those who needed it the most.
"That makes working at Middlemore an absolute privilege and an honour ... that everyone is dedicated to do the very best that they can. That is just what we do."
He said one of the medical team's greatest successes was that "we survived".
He stressed the medical response was a "huge national response to a national disaster". The help of burns care specialists from overseas who also travelled to New Zealand to help also couldn't be underestimated.
The mental and physical reminders for those who survived the tragedy will last for the rest of their days.
But Wong She said those tourists he had treated and spoken to had made it clear their feelings towards their Kiwi life-savers.
"They came to New Zealand on a holiday and the country bit them, it bit them bad. But actually the New Zealanders fixed them. We did that for them, we do that for everyone else who we are caring for."