The latest chapter in my locum journey has taken me back up to the warm northern parts of Australia, this time for a three week sojourn to Derby where my infatuation with the Kimberley has grown into a genuine love-affair.
I expected that this would be another tough challenge for me. Derby is the smallest and most remote town I’ve encountered on my locum travels so far, with a population of 3500-ish and falling into the RA-5 category of remoteness according to the ASGC classification. It boasts the most extreme tides in Australia and is surrounded by tidal mudflats on two sides and the waters of the King Sound on a third. There’s a picturesque jetty, a couple of supermarkets, lots of boab trees, a horde of grey nomads, a couple of pubs and not much else! An even bigger step outside of the comfort zone for a latte-sipping, sushi-loving city girl like me.
After an eventful start to the trip, I arrived at the hospital just in time to get a hand-over from the departing locum specialist obstetrician. I immediately questioned the sanity of my decision to come to such an isolated town when he flew off into the sunset and left me as the only obstetric doctor within a 200km radius, with a 39 week multigravida patient with a baby in the breech position lurking somewhere in the community. “Oh, you’re happy to do a vaginal breech delivery, right?” Ummm… Well, technically I’d never done one, hadn’t ever even seen one and certainly wasn’t credentialled to do it. A quick call to the regional obstetrician yielded a pep-talk and the very useful advice “Penny, you are in Derby and you’re on your own. It doesn’t matter what you’re credentialled for, you will just have to manage whatever comes through the door. It’ll either go completely fine or it will turn to absolute shit. Good luck!”
Riiiiiiight… Welcome to remote medicine!
The next few weeks had me thinking “I’m really not qualified to do this,” on many occasions, particularly during my week as the doctor responsible for the adult inpatient ward. I was looking after patients with chest pain, heart failure, COPD, renal failure, antibiotic-resistant septicaemia, resistant neuropathic pain syndromes, massive TB pleural effusions, acute peritonism secondary to pica and many other weird and wonderful things. Previously in my career I had managed to avoid ever working as a medical registrar precisely because I find sick patients with co-morbidities difficult and scary. Luckily, my time in Albany and Kununurra had prepared me reasonably well, and in the end, giving a damn about the patients is more important than knowing all the answers. With the help of the smart physicians on the other end of the phone, I think I managed to do a pretty good job while also gaining a heap of new knowledge, a few new skills and only a couple of grey hairs.
Another thing that struck me while I was working on the wards was how, as a rural hospital doctor, you not only need to be able to work across just about every medical specialty, but also every level of the medical hierarchy. Not only was I working at various times as the emergency doctor, GP, obstetrician, physician, paediatrician and psychiatrist, I was also having to be the intern, resident, registrar and consultant! As well as making the management decisions for the patients, I was also responsible for writing the medication charts, writing ward round notes, requesting and chasing investigations, liaising with other health professionals and writing up discharge summaries. It’s been a few years since I’ve had to pull out all of my best junior doctor organisational skills and it made me grateful that (for the most part) I’ve moved on from those days. For those of you who work with junior doctors on your team, lucky you! I hope you appreciate them.
Thankfully, I got to periodically retreat to the comfort of the maternity ward, and also got to flex my neglected obstetric muscles with a couple of elective caesarean sections. Managing complicated antenatal patients gave me a taste of the difference between remote and urban obstetrics practice as I grappled with decision-making processes surrounding transfer vs local management.
As much as I enjoyed the work in Derby, the town’s appeal extended well beyond the walls of the hospital. What it lacks in size and amenities it makes up for in spirit. The feeling of community is really quite amazing and I felt immediately welcomed by the locals. I was fortunate enough to be in town at a great time of year and got to go to the Derby Cup, the annual Long Table Dinner and the Derby Art Auction and found familiar faces every time. When there’s not much going on, people come together to make their own entertainment; cheese and wine on the marsh, Sunday drinks on the jetty, do-it-yourself fitness bootcamp or just sharing yet another magnificent sunset.
The tight-knit community does come at the price of anonymity, and this was highlighted to me one evening when I ducked out for a sneaky take-away dinner and was sprung by one of the ED nurses I had met just that same day. Thankfully, the warm climate prevents the always awkward ugg-boots-in-public scenario, but in general you really can’t get away with anything without hearing all about it the next day. However, as fellow rural GP Dave Chessor points out in his post on the topic, the privilege of living and working in such a small community has much to recommend it.
So all in all I had a great time in Derby and was actually quite sad to leave. I’m not sure if I liked it so much because of the nature of the work, the welcoming community or the great people I met; probably a combination of everything. It certainly helped having an old friend in town to show me around and keep me company and I think it would be easy to make new friends given a bit of time. After concluding in Kununurra that the Kimberley DMO lifestyle wasn’t for me, I’m a little bit surprised to now be seriously thinking about going back to Derby, if not for ever, then maybe for 6 or 12 months initially and then see what happens.
In any case, it’s great to feel like I’ve found a couple of different places that I could happily settle in once I reach the end of the locum road, each with its own unique charms and challenges. For a complete change of scenery, I’m heading to South Australia for my next few locum jobs, so who knows what new adventures are waiting just around the corner.