Splendid Isolation: One Locum GP in a Rural Town
Erstwhile raconteur and GP Locum, Dr Max Higgs, serves up another round of yarns based on his experiences as a rural locum in outback Australia. This week, his focus is on how his patients have coped with pandemic-induced isolation. Their coping mechanisms are, to say the least, idiosyncratic and quirky. Max has given his permission for the following article, Splendid Isolation, to be published here.
After autumn rain, isolation and contemplation come naturally to a Mallee farmer. Alone on a tractor with ten thousand acres of crop to sew, he worries more about the threat of red legged earth mite than that of corona virus. His thoughts are more meteorological—of follow up rain and late frosts—than viral. Connected to the earth and the seasons but not to social media, news of the outside world comes to him from the radio at lunchtime and a quiet read of The Weekly Times before bed.
A small country town is the best place to be doctoring during a pandemic—life here continues much as usual. The social distancing edict makes some consultations louder, but the patients are no less social. Even pimply adolescents are “Pleased to meet you doc”. The sprightly matriarchs are frighteningly friendly—one announced her approval of my dress sense with “I’d do you for that shirt!”; another greeted me with “Have you got a missus?”
Country patients don’t only want to know all about the doctor, they need no invitation to share their own stories. ‘Squirt’, the local carpenter, proudly showed me several photos of his “Three teenaged daughters: Alana, Diana and my wife”. I politely remarked on the beauty of the three ladies. “Not surprising doc. I was the local bachelor of the year in nineteen ninety-two you know”. He then produced the newspaper cutting (lead article on page three of The Mallee Express) as evidence. I don’t know how strong the field was in '92, but Squirt was proud of his win. My next patient, a self-proclaimed psychic on a disability support pension, (like butchers and pubs, there’s one in every decent town), was pleased with himself too. Gavin is in a rich vein of form, he specialises in predicting death and has “A one hundred percent strike rate!”. I chose not to deflate him by pointing out that in my home town the resident cat in the aged care facility shared the same ability. No one gets out of a nursing home alive.
Mavis and Stan are not inhibited by pandemic sanctions. Their lives are “Fuller than the family photo album”. Largely self-sufficient, they have always grown their own fruit and vegetables and kept chooks. Mavis turns their excess eggs into pav rolls which she leaves on the doorsteps of less fortunate neighbours. Stan specialises in jam. His strawberry and rhubarb “Has quite a tang”; the plum and port mixture is “Smooth and soothing”. A shed equipped with a welder and a small forge allows Stan to “Knock up a bit of metal art with old scrap from the farm”. Mavis gets her exercise on her Malvern Star; “I go for a spin down the highway to Mittyak, it’s only twenty-five miles or so”.
Country people know a lot about each other and don’t get too hung up over privacy, which can be very helpful for a locum GP. My consulting room in a town out west overlooked the ambulance entry to the emergency department; a convenient set up in a one doctor town, you can always see what’s coming. As can the patients, and they are happy to step in and triage.
Ten thirty on Thursday morning and my examination of Bob the Postmaster’s ear (another BCC) is interrupted by the beeping of an ambulance backing in. We both look out the window.
“That’ll be young Kayla again, I reckon doc”.
“Diabetic girl. Doesn’t manage her insulin properly. Always calling the ambulance. It’ll be a hypo or ketoacidosis, happens every week or so. No need to hurry, all the nurses know what to do with her”.
The doors open and the trolley emerges. “Hang on, I’m wrong! It’s not Kayla! It’s the school principal! She’s usually a very fit woman, wouldn’t call an ambulance for nothing. You better go and see to her, I’ll come back later”.
On a frosty evening in the Riverina, a dishevelled man with abrasions on his elbows and blood oozing from one corner of his mouth wandered into the ED. He had no idea what had happened to him. A diagnostic dilemma, but the night nurse was not perturbed.
“I wouldn’t worry too much about this bloke doc. He’s had a fit, he’ll come good in half an hour or so”. A brave call I thought, how could she be so sure? “’Bones’ is an epileptic. His parents have gone to Sydney for a week so he’s back on the grog and not taking his medication”.
“You know him then?”
“Yeah, I go out with his cousin. Look, poor bugger’s even wet himself”. She was right, Bones came good in half an hour.
Those living on the edge of town, in the no man’s land between thousand-acre paddocks and quarter acre blocks, embrace isolation as a lifestyle choice. Many share their slice of arcadia with animals. Paul is fifty-two and does not miss Melbourne. “It’s not quite the arse end of the world, but you can climb up a tree and see it from there. Corona viruses have no effect on me; I self-isolate on twenty acres with three whippets. I’m a gregarious recluse, doc. The whippets are attentive listeners and very tolerant. I couldn’t wish for better company”. The humble echidna also makes a fine companion animal. Molly has swapped a dysfunctional suburban marriage for an old miner’s cottage and a pet ‘porky-pine’. She says it’s pretty much the same as having a small dog. “He doesn’t bark when strangers are about of course, but he won’t get distemper or chase cars either”. Her ‘porky-pine’ is quite content to settle in a basket before the fire on a cold day; a silent, faithful companion.
An insular life shared with animals can sometimes cause problems. Tom, a farmer in his eighties, apologised for being late. “A bad day doc. I hit six roos and a pig on the way in”. Tom has a weather-beaten face and was philosophical when told he would need more skin cancers removed. “Can’t be helped. That’s what you get for chasin’ cattle on a horse every day of your life. I’m a white fella livin’ in a black fella’s country; that’s the problem”
Back in Sydney my brother in law, inspired by Norman Swan and other high-profile experts, has taken up armchair epidemiology. Leon spends his days reading, listening to the radio and thinking. He does a lot of thinking and agrees with Tom: most of our troubles are the result of where and how we choose to live. He stopped travelling ten years ago after concluding that planes and cruise ships are mobile petri dishes. A seventy-year-old sedentary chain smoker, Leon employs Trumpian logic to rationalise his COVID risk. He chooses to believe that his age and nicotine addiction are offset by the Plaquenil he takes for his rheumatoid arthritis. The pandemic lifestyle suits Leon, he is quite content to do as the Romans did during the plague. Isolate and contemplate.
Like a Mallee farmer on a tractor.
Thank you to our guest writer, Dr Max Higgs. A former country GP, Max has been working as a rural locum GP since selling his Inglewood practice. This article originally appeared in The Medical Director under the title Splendid Isolation. You can read more of Max's work at the Grumpy Old Doctor. You can follow Max's rural locum adventures on Instagram.
If you haven’t had the chance to locum in a rural or remote town in Australia or New Zealand and want to know more, it's a great experience and we recommend you reach out to a member of our rural generalist team. Many 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 ripping yarn to share, we’d love to hear from you. We hope you have enjoyed our weekly blogs this year. We'll be back in mid-January and wish you all a very Merry Christmas and a peaceful new year.