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What Lies Beneath

In Courage, Hope for a Better Future

Johnston, Michelle MBBS

doi: 10.1097/01.EEM.0000616488.53228.d6
What Lies Beneath



Emergency physicians excel at facing tough situations. We walk in when the odds seem near impossible and do our best despite whatever obstacles are present. In a way, this is our bread and butter, our MO, our pride.

But here we are, hurtling toward a new challenge of almighty, almost unthinkable proportions. And it's a truth whose gaze many of us still find hard to meet. It's the future, coming at us faster than we can get our heads around it.

Climate change, climate breakdown, climate catastrophe, this global crisis of unprecedented fury—however you want to term it—is knocking on our door, ready to disrupt everything we hold dear. The climate crisis is no longer a belief, something you can choose to ignore. It's not like faith or political persuasion or any other ideology. You don't get to choose. It is a red, hot fact. And every single one of us has a role to play.

You've all heard the numbers. The latest United Nations Intergovernmental Panel on Climate Change report tells us the planet has already reached 1°C above the preindustrial level. (Sept. 25, 2019; This is not much short of the 1.5°C the 2018 report said would be the tipping point, and we are nowhere near the emissions reductions required to rein in the increase. (UN IPCC. Four degrees, which will happen by the end of the century if there is inadequate action, means an uninhabitable planet.

But the numbers, clearly and scientifically backed up, don't seem to be enough. Too many of us still look away. We avoid the hard conversations and try to pretend the truth isn't there, leaving it to lurk in the periphery of our reality.

Maybe we need to see it closer, smell it, view it as we do other unpalatable things, to prepare ourselves to deal with it no matter the cost. We need to have our eyes open and see what will imminently threaten our patients and the world they inhabit. We in Australia have watched roads and train tracks buckle in previously unrecorded temperatures, seen the skies empty themselves of birds, viewed once blue and sparkling rivers dry out to mud and spew up dead, rotting fish, witnessed coral reefs bleached and withered to sea dust. Next door to our cities with our shops and Christmas lights and rooftop bars lie scorched, cracked salt plains littered with white rib cages and skulls. Species have blinked out overnight. Glaciers have dissolved, ice shelves crumbling into nothing.

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A Human Right

Still too abstract? We see vulnerable patients dying from the heat or suffering in the wake of newly strengthened climate events: hurricanes, floods, wildfires. These are real and present threats to health, and health, which all of us know and believe, is a human right.

Because it's not just what's on our own doorsteps. Somehow, we've been unable to extend empathy to other humans in lands distant. We need to recognize that each of us on this earth, despite the lottery of birth, has the same rights, and we all have a responsibility to each other. It is an interconnected planet: There are powerful bonds between every living person, as well as between humanity and ecology. Nobody has more basic rights than another, and what we do in our lucky Western lives intimately affects those for whom the wheel of fortune has spun less favorably.

Island nations are already beginning to go under. Droughts and food insecurity are rearing up, ready to create unimaginable numbers of refugees. Oceans are at their tipping point, fish stocks dwindling. The prime minister of Fiji said at the 2019 UN summit, “Acceptance of this living nightmare is morally unthinkable, and denial is unconscionable.” (COP23. Sept. 23, 2019; It should not have to take our own mansions slipping into the sea or our riches being whittled away to make us act. The time to act is now. Well, yesterday, but in the impossibility of that, today.

This is a Christmas column, and the theme of Christmas is hope. There can, however, only be hope in strength, in courage. The first thing we must and can do as a group is not to look away, as difficult as it is. It needs to be part of every conversation, every meeting, every vote, every school's syllabus. The facts are in. If we cut to net neutral emissions immediately, we might at least be able to slow the freight train. This is our great and only hope.

Your voice matters. Your opinion matters. Your support of protests and climate emergency declarations helps. Your dollar going toward those doing the hard yards, as well as removed from those who are not, is powerful. Your votes are critical. Your conversations in your departments are vital. Your preparedness is imperative. But most of all it is your bravery, while 2019 winds itself down to slumber, that will hold the only hope we have. This is our Christmas, all of ours.

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Dr. Johnstonis a board-certified emergency physician, thus the same as you but with a weird accent. She works in a trauma center situated down the unfashionable end of Perth, Western Australia. She is the author of the novel Dustfall, available on her website, She also contributes regularly to the blog, Life in the Fast Lane, Follow her on Twitter @Eleytherius, and read her past columns at

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