Volume 195 - Issue 8
The story of the country surgeon
Author: Katrina J R Watson
Med J Aust 2011; 195 (8): 478. || doi: 10.5694/mja11.10939
Published online: 17 October 2011
Published online: 17 October 2011
Hardworking rural doctors make an unrecognised but large difference
During my career as a city-based gastroenterologist, I was fortunate to make many trips to Victorian country towns to give educational talks. I often met inspiring people, and one of these was a senior country surgeon on the verge of retirement. This is his story.
The older surgeon and I had been chatting with a younger surgeon, new to the town. The new surgeon had proudly told us about the lovely home he had just purchased, some 2 kilometres from the local hospital. The older surgeon sighed and confided to me that he would never have been able to live so far from the hospital, but had always lived within 500 metres because he often had to get to the hospital quickly. He had taken almost no holidays in 35 years of practice because there was rarely anyone to cover his absence.
The surgeon gave me an example of his lifestyle over that time. One Easter Thursday he was having his first mouthful of dinner, thinking it was quiet and that he might even get a rest over the Easter break. The phone rang — a multiple-car crash had occurred on the Princes Highway, with a couple of fatalities and several casualties — and that was his Easter gone.
He tried to send the patients with head injuries to Melbourne. He rang four hospitals and gave the same details to four admitting officers, to be told four times that there were no beds for them. So he managed the head injuries as best he could, together with all the other injuries, and spent most of his Easter in theatre. The city folk all survived, and were eventually transferred to city hospitals. There were no thanks and no chocolates. In fact, he said he could not remember ever receiving a thankyou letter from any city-based patient.
A couple of years later, a trauma helicopter service was introduced and he was informed most decidedly, in a castigatory tone, that he must never manage any neurosurgical patient again. There was no thankyou for past services.
I knew this surgeon had an outstanding local reputation for dedicated, expert and compassionate care, but such a reputation would not have carried much weight with city doctors. He had known the limits of his expertise, and had asked for help when appropriate, but often had not received it. His story moved me profoundly.
It reminded me of an event from my distant past, when I was a first-year intern in another Victorian country town, on rotation from a city hospital. There were two of us interns, and we thought we were pretty smart. We also thought all the local general practitioners were basically hopeless — they could not read echocardiograms, knew nothing about electrolytes and prescribed old-fashioned drugs.
One Sunday morning I was in the shower about to wash my hair, having been in the wards most of the weekend, and my beeper went off. I grudgingly got out of my shower. “It’s the children’s ward; Jason doesn’t look too well; he’s had diarrhoea all weekend.” I wanted to wash my hair and knew I would not get a chance for the rest of the day, so said I’d be there shortly, and continued washing my hair. My beeper went off again: “Jason doesn’t look too well at all,” and I thought “What a nuisance, I’m not even dressed.” Jason was a thin, pale child aged about 5 years who seemed to have been in hospital for weeks, appeared to have no proper family, was always sniffly and was frequently being treated for head lice or scabies; he was none too adorable. Then a third page sounded: “You’d better come right away, Jason has collapsed.”
I hurried to the hospital and ran to discover a cold, clammy, blue Jason with a thready pulse and no detectable blood pressure. I panicked: I tried butterfly needles in his hand and in his foot, but it seemed there were no accessible veins. “Should we call Dr Jones?” asked the nurses. “Yes!” I squeaked in desperation. Fortunately, Dr Jones (one of the “hopeless” local GPs) was close by. He did a cut-down in Jason’s cubital fossa, found a vein and ran some fluid in. Jason started to pick up with a bit of saline: his blood pressure became recordable, he opened his eyes, and suddenly seemed quite adorable after all. He lived.
I learned many lessons from that episode: that I should always trust the nurses and respond quickly to their call for help; that I, in turn, must ask for help quickly when I need it; that looking after someone engenders love; and that country doctors actually do know quite a lot.
So, what of the senior country surgeon? I hope he is happy and relaxed in retirement. Many people owe their lives to him — not only country people, but city people who have been scraped off the roads into his care. I sent a summary of his life to the staff of Australian story (ABC Television), suggesting that he would be a great subject for the program. They never wrote back. Maybe they didn’t think it was much of a story after all.