COVID contemplation in splendid isolation

A small country town is the best place to be doctoring during a pandemic, life here continues much as usual

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Dear Julia,

The drought has finally broken and after autumn rain, isolation and contemplation come naturally to a Mallee farmer.

Alone on a tractor with 10,000 acres of crop to sow, he worries more about the threat of red-legged earth mite than that of coronavirus. 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” and 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. ‘Chips’, 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 1992 you know.” He then produced the newspaper cutting (lead article on page three) as evidence.

My next patient, a self-proclaimed psychic on a disability support pension, (like butchers and pubs, there’s one in every town), was pleased with himself too. Gavin is in a rich vein of form, he specialises in predicting death and has “a 100% 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 town, it’s only 25 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. 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.

Thursday morning and my examination of 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 Carla again, I reckon doc”.

“Who is Carla?”

“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 Carla! 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?

“Bucko 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.” She was right, Bucko came good in half an hour.

Those living on the edge of town, in the no-man’s-land between 1000-acre paddocks and quarter-acre blocks, embrace isolation as a lifestyle choice. Many share their slice of arcadia with animals. Paul is 52 and does not miss Melbourne. “Coronaviruses have no effect on me; I self-isolate on 20 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 80s, 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. 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 Dr 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 10 years ago after concluding that planes and cruise ships are mobile petri-dishes.

A 70-year-old sedentary chain smoker, Leon employs Trumpian logic to rationalise his COVID-19 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.

Stay safe.

Love Dad

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