Scalpel's Edge

A surgeon's notes

Zombie apocalypse

Zombie 005

When the Zombie apocalypse comes, the first world is in trouble.

When the Zombies come, health services could break down, as the newly affected infect those admitted in the bed next to them (see Walking Dead).  It seems well-established by popular media and television that public infrastructure breaks down eventually – meaning power and water supply will be intermittent.

Medicine is more difficult in those situations.  In Melbourne we were taught best practise.  We were taught that more supporting information is always better – it is better to wait for a CT or MRI, and discuss your plan at an multi-disciplinary meeting.  On the spot decisions are frowned on.  We all know our own foibles and mental processes will “tarnish” the decision.  Plus, its always great to have lots of evidence in the way of test results to defend yourself at morbidity and mortality meetings after the fact.

In fact, one of my colleagues made the mistake in the exam of saying he would discuss an emergency patient at MDM before operating.  It was a funny mistake, but I think that many of us learn to be conservative and not to trust our instincts.  But we aren’t encouraged to trust our instincts, and how to make decisions with inadequate information. Due to the plethora of available, trained surgeons, we are also never forced to make decisions on our own without consulting those who have more experience.

But when the Zombies come, medical life will change.  A GP will have to manage Rabies, accidental ingestion, cardiac disease and portal hypertension.  A surgeon will have to deal with delivering babies by caesarian section as often as performing a laparotomy.  What’s more, it may be that the hotel you have converted into a makeshift hospital doesn’t have an Xray machine, or constant power, or even good lighting.  Maybe you can sterilise some sewing thread to act as sutures, but there’s no way you can find a surgical stapler.  We will constantly have to make decisions with inadequate information and experience.

When the Zombies come, and medicine becomes fragmented, the third world will surely survive.  The populace all know how to grow their own rice and kill and cook a goat.  Most of them have heavy knives, and are experienced at cooking on an open fire.  They know where the nearest water source is, can fetch some, and even filter it for drinking.  The family doctors (and many health care workers) can deal with anyone who walks through the door – major trauma, stroke or cardiac event.  They can manage these things with limited drugs, and even deliver a baby (by caesarian) if necessary.  They understand instinctively the value of triage – the expensive drugs will make more difference in this patient than that patient.  Those that are trained as surgeons are another step ahead – trained to deal with any emergency, and willing to try.  They operate without CTs and sometimes without X-rays.  They can put in a spinal anaesthetic before performing the operation if needed, in case they are stuck on their own.

When the zombie apocalypse comes, it will be survival of the fittest. I’m sure we look down on the health scores of poorer countries, and they certainly don’t have the facilities or money to provide “world class care” in the expensive world.  That system relies greatly on medical insurance or state funding, due to extreme expense.  But when our systems break down, those countries will be the fittest.  

After the zombies come, will the westerners claim refugee status in the countries they once shunned?

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