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Locum StoriesDr Ed Charleton worked as a locum for the Rural Doctors Network (RDN) during 2006 and 2007. Many thanks to Dr Charleton for his diary journals.
To find the above locations go to Google Maps 23 December 2007 - Bombala - But it’s not a DRY cold… They say that in Bombala you can experience all four seasons in one day. At least the locals say that - over and over again, usually in response to my inquires (locally known as whinging) as to where the tropical weather has gone that we travelled so far to enjoy. So far today it’s just been the three - winter, autumn and spring. It’s warmed up now and the rain has stopped, so we can turn off the heat in the house for a few hours. With any luck, it might be summer by Christmas, though last year - apparently - it snowed. Lesia arrived in Sydney last weekend, and we filled up on urban atmosphere for a couple of days before returning to the bucolic charms of country New South Wales. I really mean that about the country being charming. All the rain recently has turned everything green and the hillsides are really quite lush and picturesque. Lots of wildlife, too. (Talking of wildlife, as I was writing this I heard a yelp from the other room, as Lesia spotted what she described as a lizard. I was hoping for something along the lines of a Kimodo dragon or monitor lizard, but it was just a ghecko - a family of them, actually - living under the front steps. Cute and harmless - otherwise I’d be yelping too). I actually had an evening last week when I wasn’t on call and we drove to the coast - Pambula and Merimbula. Lovely, clean little towns just few kilometers from one another, with miles and miles of beautiful, empty, sandy beaches. Even the drive there felt exotic, as it was through mountains covered in rain forest greenery that would have looked right at home in Jurassic Park. We saw rabbits and possums and had to slow down for kangaroos more than once on the drive home. Apparently, collisions with kangaroos are a big problem here - many Australians have ‘roo bars welded to the front of their vehicles. Very sophistimicated. The work has been varied and interesting. You never know what might arrive through the door at the hospital and the remote location often means more immediate decision-making than in an urban setting. I transferred out a sixty-two year old man with unstable angina to Canberra today. The cardiologist seemed unimpressed by the urgency of his condition. I offered to wait until the patient became sicker - maybe with ECG changes - but we agreed in the end that he should be somewhere more appropriate if that were to happen. Nice chap. The ambulance being called meant that we were able to send out the bloodwork on the other inpatients, otherwise someone would have to have driven with it to Cooma, the nearest pathology facility, an hour away. Gotta go - there’s something on the roof, and Lesia is - ahem - calling again… 8 December 2007 - Bombala - Little Miss Muffet At least I was in the right place when I saw it. Other than that, this week has been relatively uneventful. Bombala is a lovely little town nestled in the foothills of the Snowy Mountains; it’s about 1000 m above sea level so the climate is quite temperate. Not like the dry dusty heat of towns further west. I actually had to put the heat on in the house a couple of nights this week. The landscape reminds me a quite a bit of Ireland, with rolling green hills and, unfortunately for me at least, quite a bit of a rain to go with it. Apparently, only two thirds of the country is currently under drought conditions, as opposed to eighty five percent this time last year. Today is nice though, 25 degrees and sunny, so I finally got to wear a pair of shorts. I hope it stays that way as I only brought a couple of pairs of long pants with me. The work has been quite interesting, with a mix of routine clinic encounters and some excitement at the hospital. The other night we had to transfer out a patient that turned out to have a gangrenous gallbladder. We actually got a call from the surgical unit a couple of days later congratulating us on the promptness of his medical care. It was actually quite touching, but I’m sure the doctors in the big hospitals make it a practice to stroke the egos of the country docs just so we don’t feel like complete woodentops. Everybody’s been very hospitable, but I’ve yet to have the opportunity to enjoy the local watering holes much, given that I’ve been on call since I arrived. Yesterday I had the opportunity to be shown around the new hospital that’s due to open in about six weeks. It really is quite an impressive building and promises to be a wonderful facility for the locals once it’s up and running. I can’t understand why it’s so difficult to find doctors to serve the community. The setup here would be absolutely perfect for a relatively new graduate; challenging medicine, a welcoming community that appreciate your services, and an overall pleasant environment, just an hour from the coast and an hour from mountains. I’ve worked in worse places, and at thirty degrees below. Hopefully, once the new facility is open they’ll have better luck with recruitment. One thing hasn’t changed since last year. Almost every program on television has something to do with cricket. Except for lawn bowling, which makes cricket seem quite riveting by comparison. *White tailed Spiders are vagrant hunters that live beneath bark and rocks, in leaf litter, logs and detritus in bush, gardens and houses. Tufts of specialised scopulate hairs on the ends of their legs allow them to walk easily on smooth or sloping surfaces. They make temporary silk retreats and spin disc shaped egg sacs, each containing up to 90 eggs. They are most active at night when they wander about hunting for other spiders, their preferred food. They have been recorded eating curtain web spiders (Dipluridae), daddy long legs spiders (Pholcidae), Redback Spiders (Theridiidae) and black house spiders (Desidae). During summer and autumn White tailed Spiders are often seen in and around houses where they find both sheltered nooks and crannies and plenty of their favoured black house spider prey. Human interaction/Threats: A debate continues about the involvement of White tailed Spider bite in cases of severe ulcerative skin lesions seen in patients diagnosed as probable spider bite victims. Typically, in such cases no direct evidence of spider bite is available. Sensational media reporting of supposed cases of severe "necrotising arachnidism" has given the White tailed Spider a bad reputation. However, a recent study has monitored the medical outcomes of over 100 verified White tailed Spider bites and found not a single case of ulceration (confirming the results of an earlier study). The available evidence suggests that skin ulceration is not a common outcome of White tailed Spider bite. White tailed Spiders around your house can be controlled by catching and removing any that you see and by clearing away the webs of the house spiders upon which they feed. For more information go to White-tail Spider bite, Medical Journal of Australia. 24 January 2007 - Maude - “But it’s a dry heat” Last night Gubba, a federal parks warden who’s married to Jean, a clinic nurse, took me “out bush”. We drove out in his truck to Tooronga Station, a property that’s currently closed to the public, pending upgrading of the trails, etc. There were miles and miles of open scrub - it was hard to imagine how anything could live there, but the wildlife was abundant. We drove along by dozens of kangaroos, and Gubba pointed out the difference between and Eastern Grey, a Western Grey, a Big Red (I think), and a Blue Flyer. (Not that I could tell…) We even spotted a couple with joeys in their pouches. There was a house at the property, originally built for the station hands, and Gubba has spent what must be countless hours fixing it up and creating a garden around it. It was right on the bend of a river, and surrounded by the only green grass for hundreds of miles. Like a little Garden of Eden. There were fruit trees, though all of the fruit - figs, apples and oranges - was missing from the lower branches; eaten by emus, for whom it’s a special treat. We saw a few emus around the house, but not the group that Gubba feeds by hand, which was a shame. We drove home by the village of Maude - population around fifty souls. Enough for a bar, though. Inside reminded me of Crocodile Dundee’s local in Walkabout Creek, except no one was throwing knives - at least not when we were there. Gubba is aboriginal; his name apparently means “white man”, as he grew up being razzed about being a “coconut” on account of his white mother, though he’s fiercely proud of his aboriginal heritage and culture. He and Jean met by accident - literally - when he damaged her car, and after she’d finished screaming at him, they started dating. She taught him to read and write. He even went to university, so he could obtain the degree he needed to work for the parks department. Quite the achievement. He’s offered to take me camping next weekend. I have to admit to being tempted, but the prospect of 38+ degree heat and swarms of friendly flies gives cause for sober second thought. Today I drive to Melbourne. I plan to meet up with a GP I met when I was here last and we’ve booked tickets for the theatre at the Arts Centre. Talk about a contrast of cultures. 21 January 2007 - “Hay and Hell and Booligal” “And the people have an awful down I don’t think Banjo Patterson was being even close to fair when he wrote the poem that those lines come from. The town of Hay is actually very welcoming. I arrived here following a two hour drive over One Tree Plain - you can guess how that got its name - and found quite the pleasant little surprise. (I saw a wedge-tailed eagle on a telegraph pole on the way. It flew off as I tried to get a picture; the wing span was at least five feet.) The town is home to 3000 people, but feels bigger. It’s in the heart of traditional sheep farming country, and has lots of history. Many of the old buildings - the post-office, railway station, courthouse and even the gaol - have been renovated to their original condition, and are still in use today. (Except the gaol, of course.) The inhabitants clearly have a well developed sense of civic pride, and it shows in how well the public buildings and houses are presented. Most gardens are carefully tended and have green lawns - no small feat in the middle of the bush during the worst drought in living memory. It probably helps that town is located on the Murrumbidgee river, which meanders right through its centre. The other day I took a wrong turn and ended up at the riverside, to see people boating and swimming at one of its bends - like a scene from a Mark Twain novel. Very picturesque. The river water is a little - well - brown, but there’s a lovely swimming pool complex as an alternative, with free entry. Last night I played – or was subjected to – a game of tennis at the home of the local pharmacist. Everyone was at least a dozen years older than me – and a whole lot better tennis players. I took my humiliation as gracefully as possible, but it was a challenge. The house had its own tennis court and was right on the river bank. Living in the country has its advantages. Being on call has kept me busy. Lots of minor trauma, aches and pains and lacerations to suture, but still no facilities to X-ray or to do lab testing in a hurry. We had to send a simple wrist fracture into Griffith - 2 hours away - as we couldn’t even X-ray it, much less reduce and cast it. It’s frustrating, but a fact of life in the country. We have X-ray on Tuesdays - during the day. On the positive side, for me, at least, if not for the patient, I got to treat a redback spider envenomation. I’d heard about it, and dreaded being confronted with a case, but it was fascinating. We had originally sent the patient home, as there were no signs of a serious reaction, but he came back at 3AM today with a full-blown reaction. Fortunately, it wasn’t life threatening and he responded well to treatment, including antivenom. It was a textbook case, and quite cool to be involved with. Snake bites are a different story - a 16 year-old boy died in Sydney last week from an eastern brown snake bite. On a related note, we killed a redback spider two days ago - it was on the floor of the Emergency Department as I was suturing up a laceration. Creepy. 7 January 2007 - West Wylong - Fleecing the locals Scott is the owner of the Globe Hotel, here in West Wyalong. He’s a great guy, and something of a goodwill ambassador. The first night I was here, I went in and introduced myself as the new doc in town, and he in turn introduced me to a bunch of local people. So now, when I go into the Globe (my “local”) it’s “Hi, Doctor Ed - howya goin’?”. It’s like “Cheers”; only I hope I’m not Cliff. I think I’m more of a skinny Norm, myself. A few days ago, Scott took me to his farm and we sheared a couple of sheep. He did the first one, and, truth be told, much of the second one, but I got to take the wool off the back - the easy part, which I called a “tourist shearing”. Even at that, the sheep ended up looking like Billy Idol when I’d done with it. All the other sheep moved away, like they were embarrassed to be seen with him. It’s hard and hot work. I can’t imagine how the professionals get through more than one hundred and fifty a day. On Friday night we did a pub crawl - all of three pubs. It was fun though, and went on until after 2am. Saturday on call was tough at the start, but a thirty minute nap at lunch recharged the batteries. Call was very quiet, so Brian, the local “chemist” (pharmacist), suggested going for a motorbike ride on his four wheel drive quad bikes. His brother was visiting from Sydney, and the three of us went out again to Scott’s farm and tore up the dirt around the culverts and dams- most of them dry, unfortunately. It was a blast. This afternoon there’s a barbeque at Scott’s. Likely the usual suspects. I have a week longer here, before moving deeper west into the bush. I’m looking forward to the change, but I’ll be sorry to leave. 12 December 2006 - Question: How does an Australian cope with the temperature when the mercury hits 35 degrees? Answer: He puts on a sweater. I finally got up early enough today to go for a run. Not exactly far - just a couple of kilometers - but it’s a start. My excuse has been that my knee was sore, but it seems to be better now, so no more excuses. (Well…) The only time of the day to exercise is in the early morning, at least for me, if I were ever to do so. By about 9 or 10am it just gets too damn hot. Though I still see locals out running in mid 30’s temperatures. I suppose you must get used to it. It was 43 degrees on the weekend, which was not as bad as I expected it would be, but it’s cooled down to 35 today - quite livable. I’ve been on call for the hospital today, which has not been too onerous so far - touch wood. The patients seem so appreciative whenever I explain what’s going on, and are amazed when I write down the names of their conditions so they can check them out later on the internet. I have a feeling that Australian doctors don’t talk to their patients much, and the patients don’t expect them to - like old style British medicine. There certainly seems to be a low threshold for prescribing medications. I was in Melbourne for the weekend. It’s a gorgeous city, with a lovely mix of modern and Victorian architecture. It was so nice to see a building again that was higher than two storeys, and more than three people in one place at the same time. The drive was interesting - the landscape varying from green oasis to red-brown desert. Some places resembled quaint English villages, whereas others looked like the surface of Jupiter. The whole country is in the middle of the drought of the century, which, combined with the heat, has meant lots of bush fires. One fire front in Victoria was two hundred and eighty kilometres long with up to 600,000 hectares in jeopardy. If you think about the scale involved, it boggles the mind. The smoke was thick enough on the highway that you could look directly at the sun, and the tops of the buildings in Melbourne were obscured by the haze. I stopped for a rest on the way home, but the flies were so persistent and numerous it was pointless - you couldn’t even wind the car window down - so I just drove on - six hours each way. Next posting is in West Wyalong, about one and a half hours away. I shall be staying in a cabin in the local caravan park, which should be interesting. At least it’s air-conditioned. The local doc, whose house I was supposed to be staying in, lives 15 minutes out of town, which was considered too far away - for a locum - to be on call from. Just as well, as he has neither cable TV nor internet access at home. I don’t know how some people survive. Talking of which, I’d better be getting off home, as “Last Man Standing” is on tonight. When there are only three channels, anything worth watching is like gold dust. Now that I'm working for a living - after a fashion - there's been less time to write. I have a gap between patients currently, so this should be a good time to catch up. Last night I had dinner at Dan Pettersson's. He's an Englishman who went through the surgical training system in Sheffield, then came to Australia for a visit - and stayed. He was shuffled from pillar to post by the Oz registration/ training system and spent over four years in a remote location in Queensland called Backwater, or Blackwater. Sounded like something of a challenge. He's well established here in Leeton as the local GP surgeon and quite pleased to be so. We drank a bottle of red wine each, which seems to be the going rate as a dinner accompaniment here, given that it was also the amount imbibed the night before at Belinda Bailey's, another practice partner. (Not counting the beer and scotch...) Fortunately, everything's within reasonable walking distance. Belinda lives in a lovely mudbrick house that she and her husband physically built themselves. It's kind of an adobe structure - probably the local equivalent of a Canadian log home. The Australian medical system is frustrating beyond belief. Every prescription has rules surrounding its use, as part of the Pharmacare system. Everything’s lowest cost equivalent, which means that a lot of meds can’t be used unless the patient is prepared to pay the full cost. For many drugs, the doctor has to call and ask permission from a government clerk. I’ve had my qualifications and documents vetted by the Rural Doctors Network, Immigration Australia and the NSW Medical Board, at which point I was qualified to apply for a Provider Number - so that I could see patients, order investigation and write prescriptions. I’ve been here for three weeks now, and am still waiting for the number. Apparently it can take up to 28 days - notwithstanding that I’ve had one in the past and that my professional particulars have already been thoroughly scrutinized. So I’m ordering tests on my partners’ forms and they’ve pre-signed a bunch of blank prescriptions for me - and I’m officially working as the equivalent of a medical student - which is ridiculous. The only positive, for what it’s worth, is that the practice has my services gratis, pending the provider number coming through. Oh well, back to “work”…
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