Outreach to Nguiu clinic

One beautiful sunny day, I went to Nguiu for outreach clinic.

I sat on the ferry reading Joe Cinque's Consolation, which was an intriguing tale of love, death and psychosis. I kept reading till I felt like I was going to vomit from seasickness, then I went to sleep. When I woke up the ferry was perfectly still, and when I looked out the window there was a small boat speeding away from the ferry. We are sinking! was first my first thought. But no, a group of unhappy youths had burnt down the jetty on the island and the little boat was our only way to land.

Once on the beach, there seemed to be not much other than red sand and coconut trees. I was picked up by the clinic in a brand new white government-issued 4WD which looked really quite out of place, and drove a few hundred metres down the road to the dialysis centre.

My consulting room consisted of a bed, a desk with broken drawers and two broken chairs (everyone sat on the bed). The clinic assistant drove off in the 4WD to "round up" the patients from all their houses, and soon there was a queue outside my door.

It was much like any other clinic in the NT, but the Tiwi islanders are really quite sweet (always smiling, they are pretty much my favourite group of patients!). I always have the most hilarious conversations with patients in clinic, for example:

Patient: Doctor, doctor, I need you to help me.
Me: What can I do to help you?
Patient, opening mouth real wide: Can you take out this rotten tooth? It's really annoying me.
Me: I'm the kidney doctor, not the dentist.
Patient: That's ok, you look like a nice one, take it out anyway!

Patient: Doctor, now I'm on this dialysis thing, it's really affecting my life, you know.
Me: Yes, I understand it's hard to come to dialysis three times a week.
Patient: No, no, I like coming to dialysis, all my friends are here.
Me: What's bothering you then?
Patient: Well, I've got to wear shoes... I don't like wearing shoes.
Me: Well, you've got diabetes and the feeling in your feet is not so good.
Patient: Oh, but I like going walking in the mangroves without shoes.
Me: If you go walking without your shoes you might cut your feet and it might get infected.
Patient, reluctantly: Ok, I'll put my shoes on once wet season comes.
Me: What's the difference between dry and wet season for shoes??
Patient: Well I don't want to die from soil sickness (meliodosis)

(See, even patients have their priorities straight).

After we saw all the dialysis and transplant patients, we had lunch on the verandah, looking out to the sea. The dialysis centre is in a really beautiful spot, right on top of a cliff, looking out to Melville island.

In the afternoon we went to the local health clinic for our other clinic, but no-one knew we were coming so it was cancelled. We ended up roaming down the street to the art centre where I bought a Tiwi bird carved out of wood and painted using pigments from the earth. Then I went back on the ferry and read some more Joe Cinque.

It was such a relaxed day, if only I could go on outreach more often....

 The Indigenous food pyramid!

The end of the dry

A lot has happened in the last few months.

The weather has been just beautiful. Dry crisp nights, not too hot during the day, clear blue skies everyday (bar the occasional burning). Often I went to work thinking that no matter how awful things get, it's impossible to be in a bad mood in this sort of weather. It's just anti- seasonal affective disorder, and makes me wonder how I'll cope with the Sydney winter when I go home. When I was in Sydney in August it was almost unbearably cold, and I wondered how I'd lived there for so long.

Now the dry has sort of ended, and the days are starting to get muggy. The mango season has started though, so it's somewhat compensating for the lack of good weather. The nights are still tolerable but we've had a few afternoons that were a bit choking. But I get to eat a mango everyday (at least), which I'm enjoying immensely.

And from the end of my time in GM5, to relief, to 3 weeks of annual leave, I've now been in renal for 2 months. The last three months have just warped away from me and I have no idea where they went. Part of the reason time has gotten away from me was because of the uncertainty about next year. I had originally planned to take a year off to travel and work for MSF, and in fact had already applied to work for MSF and even got an interview. But somehow it was not to be. The college released a regulation update that mandated continuous uninterrupted training, and though I could apply for "special consideration", I ran the risk of being unemployed (or stuck somewhere horrible) if the special consideration was not approved.

Like the last time I faced an uncertain situation, I decided to leave it up to fate. I applied for two jobs only and decided that if I were not to get either, I would just go to Africa. One could call it a win-win situation - either I end up in a good ICU where I want to be, or in Africa where I want to be.... or one could call it a lose-lose situation - either I'm miserable back working in Sydney and actually want to be in Africa, or I drop out of the training program! True glass half-full or half-empty ness.

I felt almost nothing when I got those interview offers, and almost nothing while I was doing the RPA interview. I still felt nothing when RPA called and told me I had a job (shouldn't I have been ecstatic? bouncing off the walls? after all this is what I wanted all along..). It felt surreal, I felt detached from it all.
Even now it hasn't really sunken in. Though with the weather getting hotter (and more like the weather when I arrived in Darwin), the realisation that two thirds of my time in Darwin has gone has slightly indented in my mind. I can't imagine what will happen when I go back to Sydney, it will be the biggest culture shock!

The strange thing is, I've almost stopped dreaming. Once I dreamt I was in a patient's bladder watching the fungating tumour (with lots of flailing arms sticking out of the giant cauliflower like lesion), struggling to keep afloat in a sea of urine. Another time I dreamt I was being delivered a curry, one cube of meat at a time. But my dreams have faded somewhat and are not really very vivid. It's probably just sleep deprivation, or maybe it's too hot at night now. But I miss my dreams...