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The Price of Life in Doomadgee

By Posted in Family, First Australians, Medical Tagged , , , , , , , , , 2 Comments

Just before noon the phone called me from the river to the hospital. The hospital held me until long past midnight.

A man with his jawbone fractured, pushed right out of alignment, said: “There was a fight. I was watching it and a man came up from behind, on my right side, and king-hit me.”

I called a plane to take Sampson to Mt Isa.

Eight thousand dollars.

 

A man came in and showed me his hand, puffed up, a boxing glove of soggy blood under the skin. Beneath the blood, the head of the metacarpal bone had snapped. I said: “You’ll need an operation. We’ll fly you to Mt. Isa.”

Eight thousand dollars.

 

On the TV Rafael Nadal struggled into night with back muscles in spasm. A chubby baby, feverish and short of breath, took me from the tennis. Over the previous day or two I had seen this baby at peace. He filled all who saw him with delight. Such abundant flesh, so well at home in grandmother’s embrace.

This was their third night visit in 48 hours. Grandma brought him in this time as previously. She nursed the weeping Buddha and comforted him. The rule in Aboriginal health says, “Three strikes and you’re in.”

I said, “He’ll have to go in. To Mt. Isa. You can go with him.”

“Grandmother said:” I can’t. I’ve got my own six-month old at home. I’m breast-feeding him.”

“What about his mum?”

“She doesn’t have him. I do.”

The letter from Child Protection said the same. So Aunty went.

 

Very late at night came an urgent call. The voice said: “A man has come in with a high temperature. He’s very old.”

The thermometer said: “39.9 degrees.”

That sort of fever says “sepsis.” In this man’s case his septicaemia arose as a complication of pneumonia.

I asked the man about symptoms. He shook his head. He had no complaints.

“What about pain?”

He said, “I think my head hurts.” He said it as if he was far from the pain. The pain was a sensation like memory; he had to summon it to name it.

The man sat bent forward, breathing quietly, speaking softly, his bushy moustache a permanent smile.

At his side sat a young woman. Her gaze never moved from the breathing old man.

I asked, “Is he your grandfather?”

She said, “Yes.”

“Will his wife come…?”

The young woman said, “No, just me. Me and my brothers.”

“He’ll need to go to Mt. Isa. Your grandfather is seriously ill.”

A sad shake of her head, She said: “I can’t go. My baby… My brother will go, one of my brothers, Ambrose.”

“How old is your Ambrose?”
“Eighteen.” Seeing the doubt on my face she said: “Ambrose will look after him properly. Us three – my brothers and me – we live with him, we look after him. We do everything.”

 

The old man’s vital signs went from worse to frightening. The sphygmomanometer said: “60/40”.

The Emergency Consultant at the Flying Doctor Base in Mt. Isa said, “The plane is on its way. Give him Adrenaline.”

We gave him adrenaline. We gave him three different intravenous antibiotics and a fourth, by mouth. Hunched forward, moving only zephyrs in and out of his chest, the old man breathed and the breath did not speak to my stethoscopic ears.

I said, “Please lie back if you can.”

He lay back, air moved in and out, the silver bush on his upper lip filled and emptied, emptied and filled, semaphoring life. The blood pressure machine said, “80/50…90/65…110/70”.

The young woman gave way to a brother. The brother, after a time, gave way to another. This was the eighteen year old, tall, thin, lightly muscled. His bearing was solemn.

The sound of an aircraft flying low overhead changed the tempo.

Quickly, quickly, gently, many hands helped the old man slide from the couch to the ambos’ trolley that he would ride to the vehicle and on to the airfield.

We pushed him towards the ambulance parked outside the front door. Lining the wall, gathering in numbers, gathering over the fretting hours of the old man’s time with us, waiting, standing quietly, were three daughters – themselves matrons – and men of all ages, boys, small kids supported on young hips and attached to slender breasts. Only minutes earlier the waiting room had been empty. All had stood outside in the dark and the heat. The chill of a hospital ward did not invite them.

All eyes now followed the old man. Hands reached for him. The ambos halted, the file flowed forward, a wave of silent care. I saw one woman, a daughter, her eyes swimming, her lips trembling. I stepped forward and said: “Your father has been desperately ill, but he seems to be turning the corner. He’s holding his own now.”

She said: ”He didn’t want to come to the hospital. He was scared. He thought you might fly him out to Mt. Isa. When they flew Mum out, she…” The voice, soft, husky, now faltered:“…Mum never came back.” 

 

I looked at the gathering and asked: “All these people – all his descendants?”

She said, “Yes, all his kids and his kids’ kids and their kids.

And there’ll be just as much family waiting for him in the hospital in town.”

 

The ambos took the old man away. The family melted away.

 

The senior nurse breathed out and said: “If I come to my final hours and I am surrounded by that much love, I will know I have lived a successful life.”

 

***

 

While the nurses tidied the Emergency Rooms, I wrote up my clinical notes. A nurse approached, apologetically. She said, “Would you mind? We have a lady here with a cut head. It might need stitching. It was a belt buckle.”

In ED an old lady sat. Seated opposite her, too long of limb to sit without sprawling, were two large men in navy blue with large guns at their hips.

I looked to the lady. She wore a patterned dress in black and white whorls. The bodice was splattered with red. Her head was a savannah of silver-black curls. I had to search for the laceration which was small and shallow. Blood had clotted in a thin line between the margins of skin. Nature had stopped the previously brisk bleeding.

There was not much to do, nothing medical.

I asked, “What happened.”

The nurse said: “Fifty dollars.”

The nurse shook her head. Was she angry? Disbelieving? Or simply busy with the wound?

She resumed: “Her husband demanded fifty dollars and when she didn’t hand it over he hit her with his belt buckle. Isn’t that right?”

The old lady spoke for the first time. She said, “Sixty.”

Unhappily, guardedly, I turned to the police officers and asked: “How can I be of help to you gentlemen?”

The taller one had blue eyes. His firm face softened. He said: “You can’t. We’re just waiting here until you’ve all finished, then we’ll drive her home. Don’t want an old lady to walk home alone. And it won’t be her home. We’ll take her somewhere else, somewhere safe.”

The District Medical Officer’s Logbook

By Posted in First Australians, Life, Medical Tagged , , , , , , , , , , , , , 1 Comment


Hg is a district medical officer in remote australia

The DMO takes phone calls from the remotest places in Australia

The cases he describes are typical and fictional. And true:

2100 hours – a large man screaming in pain from his twisted testis.

2105 – given morphine intravenously

2110 – still screaming; more morphine

2115 – in agony; crying; more morph

2118 – no better; given a fourth dose; settles; given an oral opiate for continued effect

2120 -2150 – called Flying Doctor, arranged retrieval to the Base Hospital, briefed Flight Nurse, briefed Emergency Dept at the hospital.

Plane will take off at 2235, pick up patient at 2355, ETA at hospital 0045 hours. He has six times the normal dose of opiate aboard his large body. He will undergo urgent ultrasound to confirm the diagnosis. If confirmed surgery will follow to save the testis.

Meanwhile the phone has not cooled in the DMO’s hand:

2107 hours – a doctor in an Aboriginal community some 2 flying hours away calls seeking retrieval of a 79 year old Aboriginal man, normally active, sociable, a traditional healer, a man of high degree who has suddenly fallen ill. His urine tests positive for infection and his high fever and racing heart and falling blood pressure register a likely septicaemia.

Air retrieval is urgent. DMO makes a further six phone calls to the parties to this retrieval. The plane will not arrive for a further three hours, leaving the remote nurse and the remote doctor with a failing treasure.

2204 – A triple zero call to the ambulance alerts all services to a rollover 20 kilometres from the nearest settlement, about 130 kms from the Base Hospital. Two grey nomads have hit their heads and walked away from the wrecked vehicle. They will be treated as fractured necks until a CT scan proves otherwise: a vehicle that overturns while travelling at 100 kph belts a neck with sudden brutality. Persons walking away from the car might never walk again.

2224 – An unconfirmed and unclear report of a third person trapped in the wreckage. Ambulances set out from the small community driven by remote nurses who handle everything from births to deaths to attempted hangings. None of those tonight, thankfully. So far.

2241 – Six hundred kms distant from the septicaemic old man another goes down with a similar illness. This man, aged sixty, looks eighty. We send a plane, knowing that the flight will not commence until 0300. Aviation hazard statistics show that risk is highest after 3.00 am. This retrieval will end at some time from 0600 to 0800, when the crew will be at their lowest ebb. More phone calls – at least six per evacuation, sometimes as many as twenty.

The DMO’s shoulders and neck tighten during the 13 hours of the night shift. The bladder calls but calls in vain.

2300 – a baby has bronchiolitis, needs oxygen, is supported capably in a clinic 350 kms from the nearest hospital. The planes are both out. Two nurses pack up babe, mother and all their gear into the ambulance and commence the 8-9 hour return trip. The nurses will be on call tomorrow night too.

2340 – a bloke has a headache. His head has ached for the last six days, ever since the rock chucked at him hit him on the head. He looks well enough, his vital signs are alright, but who knows which little artery bleeds quietly away, building, building a pressure on the brain that might bring a stop to respiration?

The DMO arranges this man’s evacuation for first thing in the morning. Meanwhile the man sleeps. He will probably wake up. The plane that retrieves him will also bring the station hand whose ovaries, tubes and womb are on fire with the infection that her man gave her before abandoning her 15 months ago.

Midnight and the calls come less frequently. The DMO climbs onto the couch by his desk and waits for oblivion. He yawns great, jawcracking yawns. He falls asleep. The phone rings at 0040: the nurse in the most remote community calls about a woman whose labour has started. The baby was expected in 13 days. Mother-to-be is nineteen and this is her first baby. Her English is poor, she is shy – or scared mute. The nurse – “I am not a midwife, doctor” – reckons the contractions are infrequent and brief. The waters have not broken. There is no blood. There will be no aircraft until 0930 at the earliest. The non-midwife will be alone in a room with a ticking womb through the remainder of this long night. Telephone calls proliferate – from DMO to obstetrician , to RFDS, to Emergency Department, to the flight nurse, and – repeatedly – to the solitary nurse in the clinic in Deepest Woop-Woop. Drugs are ordered to halt labour. Observations are taken, reported, discussed: Nessun Dorma.

The DMO keeps notes, trying to enter them in real time into the computer whose softwear has an inbuilt stuttering tendency, suddenly freezing in mid-sentence, then as abruptly thawing. From time to time the computer does its programmed unbooting. The DMO is old, computers are new and the NBN cannot come fast enough. The DMO swears a lot at the softwear while reserving the most supportive and encouraging words for his allies, the nurses, with their patients in their far and lonely posts.

The labouring lady sleeps. The non-midwife checks an inscrutable belly for contractions, peeks furtively at a pad for liquor or blood, listens to the baby’s heartbeat, monitors blood pressure,

The DMO wants to sleep. He lies down, looks balefully at the phone – silent for now – and delivers a little speech to himself: The phone will ring. It will wake me. That’s what I signed up for. That’s my job – no phone, no job. Don’t complain. The DMO finds this speech inspiring: he will fight on the beaches, he will fight in the streets, he will never, never… The phone rings. It is the flight nurse, reporting on the safe arrival of the old seer with sepsis. She needs the current observations on the second bloke. More telephony. More self-conversations about sleep, work, the meaning of life.

0350 – the ambulance service rings. A triple zero call has come in of a man, raging, threatening harm to himself and to others. The call came from a clinic 80 kms distant. The caller says the patient lives in House No. 174. Police have been called.

The DMO calls the clinic in that community, disturbs the sleep of a nurse who must go out into the dark to find a patient who hasn’t called her and who is quite unpredictable. DMO enlists her help but commands her to keep her distance until the Police arrive. Once she can safely assess the patient she is to call back and the DMO will face the mutually demeaning task of certifying another human insane. The nurse goes out into the cold – it is minus two centigrade. In the event she searches with the Police, fruitlessly. The harmer is not found.

0600 – the DMO briefs the flight nurse on the first of the day shift aircraft. Before this he answers phone calls from nurses supplying the latest observations and reports on their charges.

It is 0635. The shift will end at 0800 – give or take the handover to the day shift DMO, and the paperwork, and the catch-up note-keeping on the flukey computer.

The DMO decides to make a cuppa. Night will soon be over.