Coping with life and ice

Sickness, death, love and loss are part of the fabric of rural life; so much so that they barely raise an eyebrow let alone dent the spirit, writes Dr Max Higgs

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Dear Julia,

You can only work with what you are given so locuming in a different town every two or three weeks is a challenge.

Your accommodation might provide Wi-Fi access but no frypan and coat hangers but no clothes pegs.

There may be a butcher in town but no counter meals at the pub because the cook has shot through with the plumber. Newspaper choices will be limited; though you will always be able to get The Weekly Times or The Stock And Land.

The television remote will have flat batteries and the toilet paper will inevitably be the thinnest, cheapest, most abrasive that the local health service can buy. Mono layered Home Brand is a fact of life for the country locum and there is no escape from gastro-oesophageal reflux either. Dyspepsia is rife in rural and remote Australia so chances are your first patient will always want a repeat script for Nexium.

Apart from that, each new location will find you working with a fresh cast of characters, each with a unique understanding of illness and an individual world view.

Last week one of my first patients was a man who claimed he had worked miracles with vitamin C. He awoke with a cramp in his calf, took a capsule, went walking for 90 minutes and got better – leaving him convinced that ascorbic acid had cured him. I didn’t want to start arguing with patients on my first day so let it pass.

I then also backed away from a religious discussion with the next customer, who announced “I don’t like the Dalai Lama, he’s too similar to the Pope. Too religious, keeps promising things he can’t deliver”.

Equanimity is the rural norm, no more so than in the nursing homes, where the atmosphere is laid back, residents chatty and the routine flexible. After a week of weather in the mid-40s Mick announced on Friday afternoon that he had a thirst, was giving carpet bowls a miss and firing up his gopher for a trip down town to “interview Madam Four X for a while”. The nurse in charge told him to wear a hat and have a couple for her.

Country EDs are generally placid places lacking the frenzy atmosphere of a city A&E department. Saturday evenings provide a standard diet of geriatrics who have fallen, depressed 40-year olds, freshly assaulted teenagers and a child who tripped over the cat and cut her head. Bigger towns with more hotels provide a drunker clientele but little more drama. A patient who recently spent a night under observation (reason unspecified) did not enjoy the experience because “Everyone else was drunk, in pain, being catheterised or had the shits”.

Sickness, death, love and loss are part of the fabric of rural life; so much so that they barely raise an eyebrow let alone dent the spirit.

Betty is 90, she and her brother used to ride a real horse to and from school when she was young. She still recalls learning a tough lesson about the abruptness of death on the way home one afternoon. “The horse dropped dead. It was amongst thistles and we got prickles in us.” Hard to know which had the greater impact – the dead horse or the prickles.

On the other hand, Bronwyn is 41 and healthy, but carries the memory of falling gravely ill with leukaemia when she was 11. “There were 13 kids in the haematology ward and I am the only one left.”

In dealing with the challenges posed by adolescents country parents seem to “accept it and get on with it”. Their approach is both phlegmatic and fatalistic when the Gordian knot of ice addiction ensnares their children.

Kevin is an old patient I keep in touch with; I asked him how his boys were. “Pretty good, thanks doc. The older one’s moved to Ballarat and the younger bloke’s in jail for dealing. At least he’s got plenty of time to keep up with his reading.”

Barry is separated from his wife and teenaged daughter but still contributes to the parenting. “The missus rang the other day and I asked her how our daughter was. She said ‘Ashleigh’s pretty good. She’s only smoking a little bit of ice at home’. Didn’t sound ‘pretty good’ to me.”

Trevor is back on the cigarettes. “I’d given up until my daughter got on ice, that threw a fuckin’ spanner in the works. I took her up to the local hospital and waited 45 minutes at reception. The receptionist had to piss off home because her son had been busted for drugs.”

Ice is intergenerational in many struggling country towns– leaving hard choices – and not only for parents.

Candice is 38 and in yet another dysfunctional relationship. She has no money, a broken leg and an ice habit. Her period is overdue and the thought of cooking dinner makes her vomit, yet Candice is unable to see beyond her next fix. Her children are growing up too fast and may soon abandon her.

Another patient, Bluey had a similar “cutting ties” story. Bluey was taking a road trip from Melbourne to the top end and his old mate Macca asked to come along.

On arrival in Darwin, Macca wanted to head straight to the beach, which mystified Bluey as he didn’t know his mate could swim. He was even more surprised to see Macca stride fully clothed into the surf and, with the water lapping his midriff, upend the contents of an urn into the Timor Sea.

On exiting the water Macca explained that the ashes were those of his father and no, casting them into the ocean was not a sentimental gesture.

“He was a hopeless addict and a complete bastard. I just wanted him to be as far away from me as possible. Can we go home now?”

I’m sorry that your childhood couldn’t last forever.

Love, Dad

Dr Max Higgs is a former country GP, a current rural and remote locum and a collector of stories