Finding Hope

Seven years. It took seven years for her to open up. Seven years to start to tell her story. Seven years of repeat medications. Seven years of small talk. Seven years of watching her twist as her back pain took hold. Seven years of hearing snippets about how insecure she felt in her job. Seven years.

And then came an event so devastating that there was no one else to tell. So devastating that it ripped the scab off her wounds and left her deeply, deeply pain-ridden, damaged inner self exposed and vulnerable. So devastating that the only logical response was to contemplate suicide.
Merciless devastation.

“Please stay.”

I don’t remember what else I said that day, but I do remember saying “Please stay”.
I remember because she remembers.

Traumatised, abused, misunderstood, labelled. Navigating the world through shrapnel. Nowhere is safe. Systems that failed. Carers who didn’t care. Helplines who didn’t help. Professionals who walked away, no risk of attachment issues because there was no one who stayed around long enough to attach to.

Months and months of slowly, cautiously discussing the abuse. The betrayals. Those who looked the other ways. Small, infrequent acts of kindness. Achievements not seen as such as the endless reel of negativity plays over and over and over and over in her head.

And yet. Writing. Powerful poetry, excellent essays
Desperately reaching forward, communicating, educating
Increasing my understanding, the understanding of others
Bridge building
Generous. Kind. Compassionate

Beaten, berated but not broken

A little light in the darkness. Journey not completed, but underway
A glimmer — did I really see it?
Did I imagine it?
No, there it is again!
A glimmer of hope
A sense of purpose

Hope, rising from the ashes

“Drench yourself in words unspoken
Live your life with arms wide open
Today is where your book begins
The rest is still unwritten“ Unwritten, Natasha Bedingfield

Dr Adele Victoria
January 14, 2020

The cancer journey

Too often, I hear the phrase that someone has "lost their battle" with cancer
This makes me angry - this is not a war with bayonets, bombs and bullets

Cancer does not
shatter hope
corrode faith
destroy peace
suppress memories
silence courage
invade the soul
kill friendships
or conquer the spirit

Cancer does not cripple love

These people precious to me have not "lost"

They have lived, endured, loved, been angry, cried but continued to live, until the very end.

Dr Gretchen Hitchins 
December 18, 2017
With thanks and acknowledgement to those who work in palliative care and to others whose writing is similar
First published on the private Facebook group, GPs Down Under Dec 2017

It's quiet

Usually in summer we hear sirens, jet skis and illegal fireworks, brought on by the influx of Sydney tourists, but this summer I can only hear the relentless wash of the waves on Collingwood Beach.
It’s almost a relief, until I remember why. 

Relentlessness is what characterizes this summer’s fire emergency.

It’s not a single event where the plane has crashed, the waters have risen, and you can be pretty comfortable that the recovery phase is what comes next.
A month ago during our regular treatment trips to Children’s Hospital Westmead, the ward was full of smoke.
On New Years Eve I was on a pontoon boat with my husband and daughter getting home to our other daughter, because the Princes Highway was closed at South Nowra.
This time last weekend I was setting up our little room at St George’s Basin Country Club evacuation centre.
On Thursday I was prepping in case it happened again.
Last night the southerly buster threatened to push more fires up to us. 

So far in Jervis Bay?

Nothing

The embers were defended by the unsurpassable New South Wales Rural Fire Service at Sussex Inlet, Basin View and Tomerong.
Our trees are standing, our kangaroos with joeys happily grazing on my green front lawn, our roads are open.
But here’s the thing - we have fires to our North, South and West.
We have dense bush that hasn’t been burned since 2001.
We have 2 months left of the longest, scariest bushfire season we have ever experienced.

We watch, in a bizarre mix of survivor guilt and vicarious trauma, while our friends and colleagues around us burn and struggle.

And we wait, hoping we will get through unscathed.

Dr Kate Mandelson, GP
January 11, 2020 #AustralianBushfires
First published on the private Facebook page, GPs Down Under

Sitting in the darkness

As I lay in bed at 4 am this morning, reflecting on the difficult life journey of a colleague, the following thoughts came to me and I hope you don't mind me sharing them.

Perhaps the most profound thing any of us do, as fellow humans, is to sit in the darkness with another. 
No magic wands
No silver bullets
Just to sit and to be
Some pains run so deep there are no words

For those of you in the darkness, please know that you are not alone.

For those of us privileged to sit awhile with another, never let us forget how important this can be. How simple things, like an appropriate touch, can make a difference.

Stay safe. Be kind to yourself and to others.

Merry Christmas

Follow up: Following on from this morning's musings and mindful of a reflection about (not) "feeling the need to switch on the light" I thought I'd share the following words. I have always been taken by the last two sentences, especially when "all" you seem to be doing is sitting in the darkness.

"Every bit of light, every small gesture is needed. It is not our task to judge the worthiness of our own light or even to know if it is seen. We are too quick to measure our lives by dramatic moments, too ready to minimize the light that we shine into the small darkness of everyday life. It is not given to us to know who is lost in the darkness that surrounds us. We can only know that against even the smallest lights, darkness cannot stand. A sailor lost at sea can be guided home by a single candle. A person lost in the wood can be led to safety by a flickering flame. It is not an issue of quality or intensity or purity. It is simply an issue of the presence of light."

-- Kent Nerburn –

Dr Wendy Burton
Christmas Day, 2016
Originally published on the private Facebook group, GPs Down Under

I’m emotionally exhausted

I need to debrief and I am only too aware that I am so so so much luckier than some of my colleagues and many of my patients

I work in the Southern Highlands of NSW, Australia. I was unable to get in on Saturday because of the fire (road closure and evacuation orders), worked an extra shift yesterday and back again today
I was fully booked days ago

100% of my patients are fire affected
80% cried
50% had no home or didn’t know if they had a home to go home to
20-30% were fit ins as they were having trouble breathing, had chest pain, were people I will always fit in (pregnant, kids, cancer diagnosis, palliative care or just on my “must fit in list”)
10-20% Rural Fire Service, Fire NSW or State Emergency Service seeking help for acute injuries sustained yesterday

I’m keeping my kids close tonight as they sleep and looking for my knitting and a glass of wine….

I feel so privileged being safe and home

Dr Bek Hoffman
January 6, 2020 #AustralianBushfires
First published on the private Facebook page, GPs Down Under

Photo: Sir Ivan Fire Feb 2017

Emergency response

It is January 2020 and Australia is on fire. The following is a story from a GP on the front line who seized the initiative to safety net her community.

My colleague Dr Lee Simes and I have put together a medical room at the St George’s Basin Country Club evacuation centre, and have a list of 5 local GPs and 8 local nurses who are ready to come in as needed. We decided to offer our services because we expected our community might be isolated by fires for days, possibly without power. The evacuation centre team welcomed us with open arms, and our conversations since then have been about “why don’t we have General Practice embedded within our emergency and evacuation plans?”

Calling an ambulance or driving to the hospital are absolutely the right thing to do for the right patient at the right time, but when there are embers and dense smoke closing our roads, maybe having patients seen by GPs and community pharmacists - with the right equipment, training and experience, working with NSW Health and St John Ambulance volunteers - ought to be an option included in the emergency plan, and not just something that the local on-call doc and pharmacist put together on their own. The experiences from our GP and pharmacist colleagues further south demonstrate the value and importance of the primary care team when the ambulance and hospital are simply not available. 

I’m looking forward to meeting with the right people in leadership positions to make sure this can be done for when the next (inevitable) fire emergency comes around. For now, I’m just looking forward to packing up my gear, blissfully unused I hope, a few days from now .... fingers crossed!

Dr Kate Manderson
GP from Nowra on the NSW South Coast
January 4, 2020

The pocketknife clinic

It was the year 2000 and I was running the GP and worksite medical services for a construction site in Matola, Mozambique.

The site was very busy but I had been struck down by my third bout of malaria and I had to follow my own rules and stay away from work for five days until the medication had a chance to work.

Then disaster struck – a massive flood hit Mozambique and large parts of the country were inundated with water.

Slowly international aid started arriving, but it was patchy and there was great need. I could stay at home and feel sorry for myself while recuperating or I could make myself useful – I chose the latter and hitched a ride in the back of a transport chopper to one of the relief camps 300km to the North.

The camp was extremely basic – half of it had a foot of water over it and the Puma could not even land – we had to jump the last metre to the ground – it was rather unnerving to see the snake slither away just as I hit the water.

The refugees were housed in lean-tos made with tarpaulins and branches and they were desperate. Our only supplies were in a marque tent manned by a small group of volunteers who all looked like they had barely left school. My medical supplies consisted of my personal tools and a few boxes of supplies sent from charities abroad, mostly from Australia.

My first challenge was to find a place to work in. I had a tarpaulin, crepe bandages and my Swiss army knife. So that afternoon, I built a clinic. 

The next morning I looked out and there was a line of people stretching over a 100m, waiting to be seen.

It turned out that there had been no medical services of any sort in that area for nearly 30 years.

In a country ravaged by nature and civil war they thought this one GP with his stethoscope and a few boxes of basic supplies could cure them of anything from heart failure to cancer.

I tried my best over the next three days, then I had to leave. I had a worksite with 10, 000 construction workers that depended on my expertise to keep them safe from malaria, cholera and work injuries.

Did I make a difference?
I would like to think so, but how do we ever know?

Dr Thinus van Rensburg

Pennies for umbilical hernias only

After my parents died, I was cleaning out their medical equipment and I came upon this tin with "Pennies for umbilical hernias only" written in my mother's neat hand. Inside was, indeed, a collection of pennies. 

My dad in particular was a man of science. A straight up and down widely-read, show me the evidence or else fellow with an incredible memory. Mum was more flexible in her approach but neither were out there on the fringe. Both were country GPs.

So, did they believe this worked?

Was this a placebo? So parents would feel something was being done while nature took its course?

I never asked, so I'll never know, but I keep this tin with its pennies in my consulting room.

It reminds me to hold knowledge lightly.

My hands

My hands have tried to save lives

I never really liked them when I was growing up. I felt they were always a bit too big, the veins too prominent. My nails were never shaped neatly but always slightly ragged and cut hastily, a bit too short. I look down at them today, despite my efforts to touch-type, and notice that, still, the nails are a bit too short; the skin dried out by hand washing and now also a bit wrinkly. But now I take less notice of their outward flaws, as I remember what they have done as the tools of my trade for the last 13 years.

My hands have brought life into the world. They have been the first hands to touch brand new, warm, slippery, vernix covered skin. The first hands to write new names on tiny wrist bands. To stretch yellow knitted hats over tiny heads.

My hands have tried to save lives. Shaken as they applied the pads or paddles and pressed ‘shock’. Tapped to find a vein. Tightened a tourniquet. Tapped again. Trembled as the cannula pierced flesh. Hoped. Interlocked and compressed. Felt the rhythmic bounce of the sternum underneath them.

They had to stop their compressions; instead fold together, poised, beneath a bowed head. Touch a colleague’s shoulder to signal that their hands should also stop. They have felt cold flesh under their fingertips and drawn up the hospital sheet to cover the indignities of resuscitation. They have written in black ink to confirm the finality of a life passed. And paused to wonder what those hands had done in that life, what hands had held that person dear.

My hands have communicated as they helped me listen to stories. Stories of all things human - joy, anger, fear, grief, trauma, addictions. My hands have passed tissues, rested on other hands, arms, shoulders. My hands have embraced, because, sometimes, that is all that can be done.

My hands have prevented influenza, pneumonia, shingles, HPV, measles, meningitis, hepatitis, and more. How many deltoids, old and young, have they exposed and how many vaccinations have they administered? Applied band-aids and stuck stickers on sweaters. Tousled brave heads and signed green books.

And how many times have my hands pulled the curtains around the examination couch, palpated abdomens, pelvic organs, found elusive cervixes? Swabbed and smeared. Inserted IUDs, ring pessaries, contraceptive implants. Prevented and detected cervical cancers; imparted contraceptive choice.

I think about how my hands have managed acute and chronic diseases. Checked blood pressures, oxygen saturations, peak flow readings, dipped urine samples. Felt for a pulse: regular, irregular, too fast, too slow, thready, bounding or quickly collapsing. Feeling again. Necks, wrists, feet, knees, groins. Auscultated and percussed lungs and abdomens. Pricked fingers and toes; swung tendon hammers. Squeezed skin nodules, held dermoscopes, ophthalmoscopes and otoscopes; checked temperatures of hot foreheads, swollen shins, sore knees.

My hands have helped me explain anatomy, diagnoses and treatment plans. They have drawn pictures: diverticulae, enlarged prostates, vertebrae, mostly it seems (from an unofficial audit). They have written and typed notes, referral letters, medical forms, Centrelink reports, radiology requests; checked interactions, issued prescriptions. They have written instructions. And re-written them, more clearly.

My hands have been the tools for teaching medical students and GP registrars their trade too; passing on skills and experience etched in mine to hands that are less wrinkled.

And my hands have made mistakes. They have written the wrong doses of drugs, missed an important clinical sign. My hands have held my head in dark, lonely on-call rooms, blown my nose, wiped away my tears-and those of colleagues.

These are my tools-my hands, the hands of a GP.

Dr Claire Denness

First published on the RACGP History page, under Tales from the Tools

My stethoscopes

My stethoscopes. I had several. They were special, awe inspiring tools and badges of my new life and identity. I inscribed them with my name and learned to care for them - by trial and error. My first stethoscope – a gift from my proud parents - was usually crammed into a pocket of the short white coat I wore around the wards. One day, the tubing split. I learned the most durable way to wear it was draped around my neck.

I slowly and progressively learned to use it - to keep it clean, to not transfer infection and how to wield it without mutual embarrassment to the patient’s benefit. I built up a library of sounds in my own head and developed a sense of what was normal, what was not normal but not pathological and what was definitely pathological.

What episodes stick in your mind?

I remember when it did not work. When I could not get a BP reading because the BP was too low for Korotkoff Sounds, because I was in the back of an ambulance going lights and sirens to hospital, when I was attending to a patient in dire peril and the pounding of blood in my ears blocked out any other sound.

I listened and no noise came from one side of the chest.
I took a slow deep breath and eventually learned to focus on the needs of the patient - my fear served no function except as a distraction.
I heard the wheeze of asthma, the rales and crepitations of infection and the pleural and pericardial rubs, the hollow echoes of cavitated TB. There were things absent that should have been present and vice versa. I heard the unilateral wheeze of a stone in the right bronchus, of a compressive cancer. Far too often, I heard nothing and having heard nothing I turned to the nearest table and completed the Death Certificate.

I remember the roadside trauma, the cricothyroidotomies I had to do. I recall the anaesthetics. Did I really do all that?

I remember all the techniques I was taught by those who had seen it all, done it all and were only too glad to have an eager pair of ears to finally tell. They had so many stories bound up in medical confidentiality that they could not share with family or intimates. Finally, as my teacher they could unload. Their passion imprinted their stories into my consciousness – I can see them still. May they rest in peace. In spite of my encouragement, they never wrote their life stories, which is probably why I have become a researcher, a teacher and now RACGP Victoria Historian - to see that they are remembered. They learned their craft by the trial and error of everyday practice. They had paid a high price for their knowledge - if I or any other doctor could be spared by their experience, they will rest happy. “Chris, experience is what is left when you survive your errors.”

Dr Chris Hogan

First published on the RACGP History page, under Tales from the Tools