tyranny of distance, part 3

in the bush, there is just not enough of some things.

what a horrible weekend: the hospital was so full that they had to open up day procedures to put patients in so that more people could come into emergency; our list pushed out to three pages for the first time this rotation; i was still doing my inpatient ward round at 5:30pm in the afternoon. the bed coordinator cajoled and threatened but there is nothing i can do! look at the bloody list:

- a third of the patients are oldies admitted from nursing homes because there are not enough general practitioners in town, such that the ones that are left are either overworked and dont have time to deal with anything more than a six minute consult; or they simply don't know and don't care;

- another third of the patients are oldies waiting for allied health input before they can go home or be placed: physios to improve their mobility, occupational therapists to set them up at home, speech therapists to work on their swallow, dieticians to buff up their nutrition, neuropsychologists to prove that they are incompetent, aged care assessment to tick that box - and even after that, they wait for a bed to be emptied from one of three facilities in town. waiting in hospital to go somewhere else to wait to die. what a lovely thought.

- the final third of the patients seem to comprise entirely of patients bouncing back with a medical problem that cant be fixed (eg end-stage copd), they wont let me fix (eg alcohol abuse) or i cant fix (eg fulminant hepatitis and malaena but no gastroenterologists in town).

so we did the best we could: patched up the oldies so they could go back to their nursing homes; kept the others in hospital so they received adequate nursing care; and provided band-aid solutions or palliative care to those who are simply broken, before they went back into the community or up to heaven.

why would anyone want to live in the bush? and... why do i want to live in the bush?