Sydney to Darwin: day two

Day two: Cobar to Port Augusta, 871km

We left Cobar at daybreak, when the sun was rising just out of the horizon. The change in the colour of clouds was reflected upon our car as we sped through the barren landscape. There were almost no cars on the road before we got to Broken Hill. The land was arid, but we still saw some animals - lots of wild goats, one kangaroo and a handful of emus. The emus stared at us as if we were aliens, and the kangaroo ran away quickly.

Just before I left for Darwin, I had a patient in ICU who told me lots of scary things about outback Western NSW, and according to him, the worst part was Wilcannia, where he alleged the petrol was often sugared and people robbed. It was rather frightful looking, with just a few decrepit caravans alongside the dust blown road. The only petrol station was run down and right next to an abandoned building with broken windows. The biggest building in town was the court house, which was painted with all sorts of graffiti. I was glad then, that we had advance notice to avoid it altogether, or we might not have been so careful with our petrol.

We stopped for a stroll and a coffee from Charlotte’s in Broken Hill. The main street was much like a bigger version of Cobar, with ornate facades and some buildings more than a century old.

The crossing into South Australia was very simple, and the sign flashed by before we even realised it. We stopped for lunch by the roadside in Olary, a simple two building town (one pub, one bottle shop). Here we found an abandoned train station with overgrown tracks, and it was hard to imagine what this place would have looked like once upon a time.

Train tracks at Olary

A few more small towns later, we were in Port Augusta. We drove over a stinky salt lake called “Bird Lake” where there were no birds. We were amazed by the sight of shops and supermarkets and traffic lights, after being in the bush for just two days. We stayed at a hotel right next to the port, a skinny stretch of blue sea over which there are two bridges, a modern one for traffic and an old wooden one for pedestrians. The sea looked nice enough, but when I went down to the water, I got stuck in the "sand" which was actually mud. My feet kept sinking and I ended up splashing mud everywhere.

Port Augusta

Nights

Darwin is such a crazy place to work - I already knew that before I started, but the reality is just starting to sink in now.

The hospital itself is sort of old, and perhaps I'm a bit biased since I've only worked at night, but the wards just seem semi run down. One night I felt like I walked into an orphanage, with a ring of what looked like steel cots in the dim light. I've also seen a few cockroaches around the place, and a lot of ants.. Run-down-ness aside, I went to an arrest in the middle of the night where the ward had no arrest trolley or ECG machine, and all that was available was oxygen and a cannula trolley. That was a rude shock to the system!

The wards are certainly not the flashiest, but the medicine is so much more interesting than in the Eastern states. The complexity of medicine here is not yet entirely revealed to me, but already I can see so many challenges. Language is a huge problem, and often patients will either speak little or no English, relying on gestures and interpreting from family members to get their story across. Never in my working life have I adapted my speech to such a basic functional level, but it just shows that sometimes complicated words are not actually essential.

The cultural differences are also quite evident - the Indigenous population have a very different attitude towards doctors, hospitals and medicine in general. Often the patients are guarded and reserved, not really wanting to talk much. Open questions get nowhere and closed questions bring answers that are not entirely convincing. Especially at night, patients don't respond well to being woken up and some refuse to be woken up altogether. I had one woman who refused to talk to me, and just pulled the sheet over her head. What do you do with that? I guess I just ended up walking away and coming back later.

And then there are the absconders, and those who leave against medical advice. I was lucky there were only 3 absconded re-admissions in my week, all of whom left the hospital to go drinking with their buddies and eventually got brought back from the gutter. When I re-admitted one of them, he punched a wardsman on his way up to the ward and ended up sleeping off the grog in ED the rest of the night.

All of that aside, medically I had an extremely interesting week, where I saw some amazing cases that I had never thought of. I'll write some down, so that one day I can look back upon this list of very first "firsts" (probably when I'm back in Sydney) and think ahhh, those were the days.

.. a woman with a loculated breast abscess (for which she had been partially treated multiple times but kept absconding from antibiotics), which made one breast four times the size of the other
.. a white cell count of 690
.. a woman with sick sinus syndrome who kept having asystolic periods in ED lasting up to 30 seconds
.. an entry in the notes by the ICU team treating a patient with K 1.4 - patient given 100mmol IV KCl and 8 bananas
.. patient ineligible for home oxygen until he stops long-grassing (no fixed address)
.. several whiteouts and one bilateral whiteout
.. the first cerebellar syndrome I ever diagnosed in a woman with a orange sized lung cancer
.. man with nephrotic syndrome
.. man, apparently allergic to cocaine
.. pemphigus vulgaris (only ever seen in books before)
.. rheumatic fever
.. patient who had to be retrieved from the pub because he couldn't wait for his Troponin to come back
.. 2 new PEs, one with a new R bundle branch block and one with S1Q3T3

Some nights were ok but most were really busy. Overall the patients were sicker, more complicated and had more chronic disease. It was shocking to see people in such poor states of health in their 20s and 30s, and it provoked much thought - end stage renal failure from diabetes in one's 30s? It seems insane, but that is the reality of life here.

After this week of nights, I am tired but excited about the future - the rest of the year is going to be really interesting, and so far, I'm pretty glad I moved up here. It's going to be an awesome year of medicine!

Sydney to Darwin: day one

Day one: Sydney to Cobar, 677km

It was misty with fine rain as we left the house, went down the M2 and through the lush greenness of the bush near Richmond, up Bell’s line of road through to Lithgow. We drove past Bilpin and Mt Tomah, places that I had visited so many years ago with Betty and Jean. Everything looked the same, except this time all was enveloped in thick fog.

We drove through Lithgow, a small but tidy town surrounded on all sides by towering mountains. Soon the mountains dropped away as we headed towards Mudgee and the land became more and more barren. Other than low shrubs and the odd tree, there was little vegetation and even fewer animals. Though most of the land was still fenced, we wondered who the land belonged to and what it was actually used for.

Coming up to Mudgee, we passed a handful of wineries with plenty of green grapes. Then it was flat again with little to see. We stopped for lunch by the roadside at a rest station just outside Dubbo, feeling like we were being slowly roasted in the heat. The last part from Dubbo to Cobar was long and drowsy, the roads terribly straight and with almost nothing to distract one from the monotony of driving straight. I forced myself to look at the kilometre countdown numbers as we drove along, pinching myself to stay awake.

View at lunch near Dubbo

Eventually we got to Cobar and felt a great sense of achievement that we survived our first day. There wasn’t much to see in Cobar, other than an old mine across the road from the motel. It was like an artificially dug out lake which had dried, but with tall fences all around, which makes one wonder what they actually did mine there. On the main street there are a few old fashioned pubs, some more than a century old. There are also a few quaint shops, including a quilt shop and a tea room! Too bad pretty much everything was closed on a Sunday except the petrol station.

Main street, Cobar

First crazy dream in Darwin

Well, the insane dreams never stop, this is the first one since arriving in Darwin.

So I'm standing out on Shoalhaven St just in front of the hospital, and get in my car to go back to my Nowra house. Suddenly I receive a phone call from Bec going "Where are you? Rodney's coming around to sell our house, and I need you here for moral support!"

So I hop in the car and start driving down the street, and soon I realise there are different signs up now, and I thought "that's weird, they've changed all the signs since I was at work today". One sign was a picture of kangaroos like the ones in the bush, and another one was of potholes. The landscape was different too, much like the flat terrain outside Coober Pedy (so called "Moon plains").

In the middle of the desert stood our good old Nowra house, as if all the other houses around it just disappeared. I go inside and Rodney's dressed up in a suit showing a tiny little Asian girl around the house. He says to her "this is the closest accommodation to the hospital, only 10km walk!". She doesn't look impressed as she looks inside our bedrooms.

Then she goes into the kitchen and exclaims "he..llllloo handsome!" and I thought "handsome? there's no-one handsome in our house!" It turns out Baz is making spring rolls in our kitchen, and is rummaging in our cupboards for a pot to fry them in. I said to Baz "you can't pour that much oil into a wok, it'll explode!" and he said "oh well, then we can all just have coffee for dinner".

The little Asian girl says "I'll make the coffee!" and takes out a giant stainless steel coffee machine from under the microwave, which obviously doesn't exist in real life. As she turns on the coffee machine, cream comes out of the drip part, followed by a few raspberries which plop into the cream.

Then she turns to me, presents me the plate with cream and raspberries in it, and says, "I saw this patient today, he had an erosion off his R main bronchus from some food he inhaled, so the moral of the story is that we should all stay on fluids and have no solids coz it could go down the wrong way!"

As I thought "huh?" in the dream, I woke up.

Monsoonal rain

On my 5th day in Darwin, I finally realised how crazy the rain is.

So far I've been sort of lucky, the rain only really coming during the night. All I've heard of it has been the sloshing sound of buckets of water falling on my rooftop, and when I get up in the morning everything is soggy. Today I came out of the hospital and looked up to see a dark and ominous sky, but since I only live across the road, I started out for home.

Within 30 seconds the rain started. Big fat raindrops that pelted down with ferocious force. Within another 30 seconds the rain reached such a velocity that my face was totally covered in water and I couldn't open my eyes. By the time I ran home (possibly only another 30 seconds later), I was completely soaked to the bone and could wring water out of even my shoes. But by the time I had a shower and opened the door again to hang out my clothes, the sun was out again!

My arrival in Darwin has been a mixed bag of feelings. On one hand the hospital is like a pre war dungeon and reminds me solidly of Hornsby, on another the patients are absolutely fascinating. I think I really am up for a year of developing world medicine in a developed hospital, which will be fantastic. However, the hospital has elected me to start on nights, something that I feel anxious about. I am filled with so many unanswered questions - a giant adventure lays ahead of me.