GP Locum Tales From The Kimberley Region
Working as a rural GP locum provides unusual cases, diverse caseloads, unique environments, and quirky characters in equal measure. Dr Max Higgs has met his fair share of the latter, and he does a fine job of evoking the ups, downs and in-betweens of GP locum work in rural Australia. This week, Max shares some anecdotes about his time as a rural locum in the Kimberley region of WA, originally titled Elvis Has Left The Building.
I like to start the day with a coffee. Yesterday I changed my routine and began with a stabbing; the effect was the same as that of six long blacks. The victim of the stabbing was remarkably relaxed and sanguine. A carving knife flung in anger from close range by a crabby spouse can mortally wound, so emerging from the encounter with a severed artery in the lower leg, necessitating resuscitation and evacuation by RFDS for emergency surgery, didn’t seem like a bad result.
Unlucky to be stabbed but lucky to be alive, it all depends on your point of view—like the strange formations visible around Kimberley town when arriving by air. What you see depends on what you are looking for and changes with the time of day and the angle of approach. Anthropologists have mistaken them for crop circles; to geologists they represent reefs of newfound mineral wealth. Once on the ground, a walk around the airstrip and the footy ground reveals truth in both interpretations.
Large parts of this place are ringed with decades of empty beer cans, shoals of variegated aluminium halos. To the geologist they represent the makings of the next mineral boom. The gold mines hereabouts are thriving, rare earth metals are on the rise, but aluminium is where the really big money will be made. No need to bother with the tedium and expense of mining and refining bauxite either, the finished product is right there for the taking and perpetually replenished. It’s an aluminium Magic Pudding: you truck it out on Monday and by Friday what you removed will have been re-deposited with interest.*
The eye of the anthropologist is more discerning; there is meaning in colour and a story to be read in the subtle patterns of deposition. White means light beer, the perennial staple laid down in seasons of stability and relative harmony. Green is the colour of the heavy Victoria Bitter, abundant in times of plenty and harbinger of a community teetering on the brink of dystopia. As a descendent of those responsible for the introduction of alcohol to this country I have no right to be sanctimonious. As one familiar with the interior of the glass house of intemperance I should not throw stones, but a few days of ramped-up domestic violence, falls, fits, fights and pancreatitis can harden your heart.
Which is not to say that alcohol is the root of all illness here. Diabetes, pneumonia, heart disease, syphilis and kidney failure—in no particular order—don’t spare the abstemious. Big doses of antibiotics, the innate toughness of little kids, the RFDS, dialysis and even organ transplants all save lives, but not always.
Kidney failure is rampant but transplants are rare, thus the renal part of the Indigenous health gap remains a chasm. The dialysis nurse told me that those in the health department who decide these things have determined that this is unacceptable. The number of transplants must increase forthwith—fresh goals have been set, there are new targets to be met. Smokers and drinkers are excluded from the transplant waiting list. Tobacco and alcohol are both addictive and a fundamental part of the daily diet for many, thus the need for transplants increases but the waiting list does not and the number of "tossers" in Canberra making ignorant decisions is infinite.
‘Tossers’ are endemic up here too, but are generally of the more benign, rubbish-throwing variety. We have a small back yard that yielded seventeen plastic bags, two balls and a small thong (pink) last week; we are staying on the cleaner side of town. For most a casual pastime, but for others a vocation—there are compulsive ‘tossers’ with no moral compass.
Kimberley patients present late and leave early. I have admitted, at 11PM, a woman with raging pneumonia, a freshly charged mobile phone, intravenous antibiotics and fluids running; only to be greeted by an empty bed and a vacant room at six the next morning. Like Elvis, she had left the building and provided no forwarding address. I have seen two police, armed with guns and copious cups of coffee, share the room of a drunk man with a head injury in order to make sure that he didn’t slide under the door, walk through a wall or auto-defenestrate and render himself unavailable for interview next day.
The tendency to disappear is not confined to times of illness—many adults seem to be perpetually absent. The ratio of children-to-adults at family-orientated social functions appears to be roughly fifty to one, and minors of primary school age roam freely at night with their younger siblings for company. I may be missing something. Perhaps the parents are present in another dimension; sometimes the normal laws of nature don’t apply here whilst other less expected conventions do.
Life is a paradox.
The perpetrators of domestic violence—in marked contrast to most farmers I know—are courteous drivers and always use their blinkers in town. I have seen skinny, barefoot, mat-haired children with a sleek and well-groomed dog on a lead. When parental guidance is offered it tends to be refreshingly forthright. On discharging a young lady after treatment for pneumonia (yes, she waited to be discharged instead of doing it herself), my learned medical advice was reinforced by her father. “You should take your tablets. You can’t smoke. You can’t drink. You can’t even smoke marijuana”.
Cheers! I’m out of here.
*MPMI—‘Magic Pudding Mining Investments’—will be floated soon, watch out for it in the Fin Review and get in early.
Many thanks to our guest writer, Dr Max Higgs. A former country doctor, Max has been working as a rural GP locum since selling his practice in Inglewood. This article originally appeared in The Medical Director under the title Elvis Has Left The Building.
Do you want to know more about working as a rural locum doctor in Australia or New Zealand? It's a fantastic experience and we recommend you reach out to a member of our rural generalist team. A lot of our rural locum doctor jobs involve hospital work. So in addition to having your FRACGP or FACRRRM, you will require ALS2 or equivalent.
If you are a rural locum doctor and have a great yarn to share, we’d love to hear from you.