My previous posts have been relatively up beat, however here I would like to share one of my more sobering experiences in Bairnsdale hospital.

A 72-year-old woman presented to the emergency department with 12 hours of acute severe cramping abdominal pain and profuse foul smelling diarrhoea. Morphine infusions barely scratched the surface. The emergency room struggled to gain a clear medical history between groans, but a quick phone call to her GP revealed that he was in fact anaesthetist on duty in theatre that day. He had treated her for years and described a complex history of heart, lung and neurological disease and chain smoking in a retired nurse. He recommended high dependency level care immediately.

Subsequent fast tracked investigations put ischemic bowel at the top of the list. Her condition required ICU level care, yet the retrieval service refused to accept her, stating that if she is that sick she needs surgery before transfer.

The theatre in Bairnsdale was not confident of her outcome, however the surgery was arranged, and she consented along with her family. Sadly 90% of her bowel was necrotic so surgery was abandoned. Worse still she never recovered from her anaesthetic.

The team involved in her final surgery involved her family’s GP of 12 years as well as 2 nurses that had trained under her. Everyone in theatre except the locum surgeon and knew about her work around Bairnsdale. The intimacy made ethical alarms ring in my head, but at the time it certainly felt right. The family was clearly relieved to have a familiar and trusted face to deliver the news.

I wonder if this same presentation would have ended differently in a place like Queenstown’s hospital; a similarly isolated hospital in New Zealand without surgical facilities. She would likely have been immediately transferred to base hospital in Invercargill or Dunedin to receive the same surgery. Except this surgery would be delivered by ‘pure’ specialist surgeons and anaesthetists 200 odd kilometres from her home, her family’s support networks and her friends. The anaesthetist may have been more experienced, however I cannot imagine it making any difference in this case.

From my point of view, I would have been happy if my grandmother had received this care. The staff take great pride in their ability to care for their own local community and it shows in the level of care that they provide. They realise the value of their rural service and are determined to make it work effectively. It is the ultimate follow up for the family also, when the GP who was intimately involved through to the end of their grandmother’s care can be in clinic the next day to continue dealing with the family on a day to day basis, through the good times and the bad.