Lucy Morgan: so much more than COVID warrior

THE day the MJA caught up with Dr Lucy Morgan happened to be the day she found out she had been promoted to Clinical Professor at the University of Sydney’s Concord Clinical School.

“I am incredibly proud to have climbed the ladder from a ‘pretty ordinary’ HSC mark to the point where I have a PhD, a research portfolio and busy clinical practice, and now the academic recognition of the title of Clinical Professor,” she said.

It’s the culmination of 30 years spent caring for people with chronic and acute lung diseases, including a storied research career “clarifying minutiae and solving puzzles”.

“It’s the idea of clinical research, that benchtop to bedside, translational research that I love,” Dr Morgan tells the MJA.

“I love the concept that if you spot a chink or a crack in the way we care for people, that you can gather a group together and map out the size and shape of the crack, experiment a bit and, almost always, the very process ends up with the crack being filled.

“Clinical research is not usually about building whole new walls but there’s definitely the opportunity for ongoing restoration. And I like the idea that we are mastering our craft and training apprentices at the same time.”

Dr Morgan’s father was the first in his family to go to university, and he went on to become an academic in the world of media, so there were no immediate family medical role models to drive her towards medicine. Her mother was an occupational therapist who had long shared dinner table stories of creative ways to help people to recover from injury and illness.

“I can’t pretend it was a lifelong goal,” she says. “I did grow up knowing that I had a fascination for the biological sciences, especially botany and marine biology. I also had a sense that I was a people person. I thought I might end up being a teacher.”

That changed in Year 12 when she caught glandular fever.

“I had been quite a high achiever in high school but the glandular fever really knocked me for six,” she says.

She took herself off to the GP and that’s when things changed for her.

“She promptly made the diagnosis and looked after me, and I developed a rapid girl crush on this woman. I just loved her and I had a real sense that she got something good out of caring for me and all her other patients too.

“I had this intense realisation that I wanted to grow up to be as much like her as I possibly could, and to do for other people, what she did for me.”

In a lovely sequel to that anecdote, after seeing Dr Morgan in one of her many COVID-19-related television appearances in 2021, the GP got back in touch – “it’s been very special to be back in touch”.

After glandular fever impacted Dr Morgan’s Year 12 results, she went on to a science degree at the University of Sydney, and then transferred to the University of Newcastle’s medical degree.

Once she graduated she searched for an internship somewhere with a reputation for looking after their junior doctors.

“There were a very small number of hospitals that got five-star accreditation for their JMO management and Concord was one of those.”

Thirty years on, she’s still there, now as a senior consultant.

“What became clear to me during those years of junior doctoring, is that I love hospitals,” says Dr Morgan.

“Some people hate hospitals and can’t wait to get out of them, but I loved the collegiality and the whole system of a hospital. I didn’t want to go into general practice, not because I disliked primary care, but I didn’t want to leave the mothership. I wanted to be part of the mothership.”

Many options for further specialisation presented themselves, including infectious diseases and oncology, but a tap on the shoulder from a former supervisor tipped the scale in favour of respiratory medicine.

“A professor of respiratory medicine for whom I'd worked as a junior doctor said to me, would you consider respiratory medicine because I think this could give you the infectious diseases aspect and the oncology,” she says.

“It was a kind of come fly with me, and I'll give you a career, sort of thing – it was the lovely mentoring of a junior doctor by a senior colleague; another personal interaction with someone that I admired – an invitation to join the gang.

“It's not accidental that I ended up in medicine, but the bit of the body that I chose to specialise in was circumstance really. And it combined the sorts of things that I'd always loved – a combination of acute things that get better quickly, if you can work it out; chronic problems, where you get to develop a real, long relationship with your patients. You might not cure them, but you can have an impact on the journey, on their quality of life.”

The past 2 years have, of course, been dominated by COVID-19.

“What I was doing was looking after hundreds upon hundreds of patients who were very, very sick from COVID and needed hospital care,” says Dr Morgan.

“Delta was particularly traumatic for us. There was so much anxiety for everybody, at every single level of clinical interaction. There was stress and anxiety about the unknown, we did not know what was coming. We did not know what we were going to do, we did not know how this virus was going to impact us. And all of that had to happen at a time when we were very, very stretched for resources.

“And we, as a community, were as yet unvaccinated.

“So I would have to say that 2020 – the Delta wave – was the most traumatic for me, because there were so many young people so sick, so many died. It was just terrible.

“Then you've got to turn around and pull up you socks and do it all again. We're all getting tired, and we were all very distressed and anxious about bringing the infection home to our families.

“Omicron was busy in a different way. There were 1000s and 1000s of cases. It tended to affect much older people, and they were in hospital for a long time. They didn't need the intense respiratory support that so many had required in the earlier phase, but there was no less intensity to the number of people being admitted to hospital.

“This exposed different cracks in our system, exhausted junior doctors, an incomplete nursing workforce, things like that really made it hard.

“COVID-19 has by no means gone, but the number of patients presenting to hospitals needing intensive care support and those who are very, very sick has just dropped off.”

What’s coming next?

“I think that the real challenge for us as a nation for the next few months is to get over our battle fatigue, get everybody boosted and work out a way to deal better with all the other health issues facing Australians,” Dr Morgan says.

“Because by the time winter comes around, many millions of Australians will be more than 6 months since their last dose.

“I can't quite see past COVID-19 yet, and I'm conscious that there's no such thing as ‘back to normal’.

“Some of that is in a good way – we do not want to go back to there. There are things that have happened out of COVID that will force a good shake up.

“For example, nothing beats the intimacy of a face-to-face consultation. But you know, what? Virtual consultations are a damn sight better than nothing and we can learn how to make them more effective.

“The pandemic brought out the best in many of us. Clinicians rallied to share battle stories, write guidelines, wade through the literature for each other and debrief. Virtual platforms were not as much fun as having a beer together but there was the opportunity to gather the troops frequently and rapidly share the latest updates. And that really mattered because things changed so quickly.

“I knew I was getting stressed when I would wake in the middle of the night in a cold sweat and the fear that I had missed the latest memo from the CEO.

“I’ve helped head up some of the respiratory Community of Practice written guidelines, and I've been part of the living documents,” she says. “Those are wonderful tools that have totally changed our day-to-day practice, and we shouldn't go back to the old normal from that point of view.

“We do need to work out a way of delivering benchmark clinical care to patients with chronic diseases that are not COVID. Because that aspect of our work has really suffered.”

For now Clinical Professor Lucy Morgan is in her element at Concord and Nepean Hospitals.

“To get a job as a specialist physician in a public teaching hospital – that was a kind of pinnacle for me. It was what I always aspired to – a consultant specialist in a big public teaching hospital, within a department of people that I really like and professionally admire,” she says.

“Public hospitals are not glamorous, the bedspreads do not match the face washers, there’s no risotto or pho on the menu. The buildings are always falling down. But these are the hallowed halls of clinical excellence.

“That’s what I want to be part of.”

Communicating public health messages in a relatable way is also important to Clinical Professor Morgan.

“I'm still embarrassed about my media appearances last year, because I'm not a polished media performer,” she says. “But one of the things that made me feel good was that I was told by several of my patients that I brought an authenticity to the communication of the health messages, and that they were proud of me. Another esteemed colleague emailed me out of the blue to suggest that I might have changed the public conversation about COVID-19.

“Speaking publicly about aspects of health that I have the experience to comment on, even when politically tricky, is absolutely part of my job. That is what I should be doing. We should all be doing it. We've got a powerful role as advocates for our vulnerable patients.

“Authentic communication of clinical information to everyone who needs to understand it is an important part of being a physician. This has to be part of our job description along with being a team player, a commitment to the joys of teaching and the capacity to cope with uncertainty and rapid change.”

Given all the power, money and time in the world Dr Morgan has no doubt about the issue that needs most attention going forward.

“The biggest challenges for lung disease are around action on climate change,” she says.

“Protecting our environment is unbelievably important to respiratory health. Whether it's about respiratory viruses, ash and bushfire smoke, air pollution, particulate matter. It's not just all about tobacco, it's about dust from droughts, particulate diesel matter, coal, gas, fire, mould from flooding rains, polluted water.

“It’s about the impact of these phenomena on lung cancer risk, premature low-weight babies, pandemics, allergies and airway diseases“.

Dr Morgan also believes the role of primary care is vital to maximise the health of Australians.

“[We need] an empowered primary care network, who feel valued and have the capacity to earn a good living delivering what we might call old fashioned family care not constrained by a 15-minute consultation,” she said.

“Empowered primary care, better supported, and funded would help provide greater equity of access to great clinical care for all Australians. That’s good for all of us.”