April 2017

The Medicine

Working regional

By Karen Hitchcock
A stint in a remote Western Australian hospital brings its own challenges

Late last year, I resigned from my full-time city-hospital job. I still work there – a clinic or two each week, a few months on the wards each year – but not every day. I thought I had the money thing sorted. Turns out I owned my time outright, but had to pay the mortgage and everything else by Visa.

So I find myself in a small town in Western Australia, 5000 kilometres from home, working at a regional hospital. When I was a registrar I swore I’d never locum again, but here I am, broke enough to leave my daughters for a month, camping someplace they can’t convince enough doctors to live. They put me up in a three-bedroom brick holiday unit. There are rooms of small single beds, kids squealing in the pool. The beach is across the road behind a scrubby sand dune. When I open my front door, I can hear the ocean roar and smell rotting seaweed, but I don’t go and look. I close all the curtains and turn the air conditioner on full. The unit has the same prison-like rough-hewn bricks inside and out. Sand from the cement between the bricks showers my bed day and night, as if I’m being forced to sleep in it as punishment for ignoring the beach.

The town is working class, with colossal unemployment and a large Indigenous population. I don’t see a European car for an entire month. I walk through the shopping centre to the supermarket. I’m the only one wearing a suit, the only one in heels. The only person who smiles at me is the gay check-out guy, who asks where I’m from and – ignoring the queue – tells me all about his recent escapades in Brisbane.

Big or small, town or country, hospitals are mostly the same: the sick flock, the staff doing what they can. This hospital has no sub-specialty doctors and no intensive-care ward. There are just three general physicians and our teams of junior staff. If the patient is too sick or their disease too strange we fly them to Perth. I ship out a man with Guillain–Barré syndrome, a few with big heart attacks and one massive pulmonary embolism. The old, the can’t-cope, the pneumonias and the failing hearts stay with us. As do the attempted suicides, the young alcohol-rotted livers, the bad teeth and the nowhere-else-to-sleeps.

The two permanent physicians are excellent immigrant doctors, smart, without bravado and happily working the wards all year long. They recommend afternoon trips and offer me dinners, but I’m on a tight schedule: wake, exercise hard, work, eat lettuce and plain yoghurt, watch Netflix, sleep. I talk to my daughters daily by telephone, FaceTime or Skype. I order them Uber-delivered gelato, close my eyes and imagine them eating. Each night I watch a TV show about a group of perfectly diverse, beautiful lesbians who all have high-powered careers and yet manage to spend much of the day in cafes, clubs, each other’s beds and high drama. Even if they have children.

The hospital has a handful of Australian-trained interns, but the majority of its registrars and residents were educated overseas. Some are highly experienced specialists who couldn’t bear the trauma of repeating – or are bracing themselves to repeat – years of training to fulfil Australian requirements. One or two come from a pool of virtually unemployables, hired now and then by desperately short-staffed hospitals. As the locum I cop the dodgy team. My resident is unable to understand spoken English unless it’s relayed in slow staccato. He can follow one-step commands, but seems unable to think. On our rounds I make him carry a piece of paper upon which he is to note his accumulating tasks. I tell him it’s not a list of jobs, it’s a list of things to do so our patients don’t die. My registrar has just arrived in town and – when he gets off his email and does look at me – offers only belligerence or indifference. He believes documenting medical history and physical findings or his discussions with doctors in Perth to be a waste of time. He neglects to check the repeat blood tests on patients with catastrophic electrolyte imbalances, and when I explain that preventing cardiac arrest is part of his job he yells at me. The only way I can explain the pair’s complete lack of curiosity about or concern for our patients is that the patients are not real people to them. I attend the bedside of a distressed, old white patient surrounded by doctors and nurses from around the globe. When the patient catches sight of me he calls out, “Finally, someone normal.” Perhaps it’s a kind of poetic justice that the place is staffed by refugees.

On my last day before I fly home I treat a woman with advanced lung cancer. She’s not old but has one of those faces desiccated by decades of hard work and harder smoking. We drain 2 litres of fluid out of her chest so that she can breathe. She tells me she only just found out that she has eight months to live. Then looks at me, waiting. I pull up a chair. She grimaces in pain from the tube hanging out between her ribs but refuses analgesia. I convince her. We talk. She starts to cry. “I never cry,” she says. “I can usually keep meself together.” I hold her hand, which she has edged towards me. I say, “You can cry here … It’s all too terrible. But we’ll get the drain out this afternoon and you’ll be able to go home to your family.” She keeps crying. I keep hold of her hand. “Bev,” I say, “you have hundreds of days left to live. Hundreds of days.” She looks at me, wipes her eyes. I say, “So, go home and live the shit out of them.” And then we are both laughing.

Karen Hitchcock

Karen Hitchcock is a doctor and writer. She is the author of a collection of short fiction, Little White Slips, and the Quarterly Essay Dear Life: On Caring for the Elderly.

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