The River Runs Dry

Photo of the Todd river bed at Alice Springs

I walked home from the public swimming pool, having swum my mandatory forty laps. Thinking-time in the pool helped wash away my nights on call, if only to refresh me for the next. The clay path skirted the Todd’s dry riverbed, where I knew many of my Aboriginal patients camped—not that they were visible, except for the flicker of a campfire at night. They’d told me the coarse sand stayed warm, and with a few blankets and some grog onboard, the cold was not so bad. I hadn’t yet ventured into the riverbed; I felt threatened by the camp dogs and my fear of snakes.

Living in Alice, I missed the sight of water. On all the maps, the Todd River appeared as a great blue serpent winding its way through town and between the ranges. The reality was an expanse of dusty beige sand, lined by stands of river red gums. It was merely a promise of water that could not be quenched.

On a stinking hot afternoon, I had no objections to working in the emergency department; at least the hospital was air- conditioned. I would follow up all the patients whom the junior doctors had called me about overnight—a local bitten by a snake (he only went out to collect his washing); some youths ejected at high speed from a car near Tennant Creek; a young mother assaulted with a star picket; a child with an infected dog bite to her hand.

I was in the office when one of the nurses, Dianne, thrust an ECG before me. The heart tracing was perilously slow and deranged. ‘Whose is this?’ I asked her.

‘It’s Bundy’s.’ Dianne motioned with her thumb to the resuscitation bay.

Bundy Morgan had been brought in from a different riverbed, a community some 500 kilometres away. I walked over

to his bedside, where Dianne fussed around, connecting him to the monitoring equipment. I saw on the chart that Bundy was only fifty-five years old, but he looked eighty. He appeared to be semi-conscious, lying on the trolley in dirty rolled-up moleskins and no shirt.

I watched him for a few moments. He looked dry. His black skin was coated in red dust, reminding me of one of those fancy chocolate truffles. His grey hair and beard were matted. An ammoniacal odour rose from his body. His eyes were closed and I gently rested my hand on his shoulder. ‘How’s it going, Bundy?’

Bundy opened his eyes, glanced up, then quickly looked away. ‘No good,’ he slurred. His brown teeth were coated and slimy. The whites of his eyes were yellowed and bloodshot around the dark centres.

‘I’m the doctor.’
He nodded. His eyelids drifted down and closed again. ‘Your heart’s no good at the moment. That’s why

you’re not feeling well. We need to do some tests.’ ‘Fuck that,’ he grumbled.

Dianne wrote all her observations on his chart at the foot of the trolley. ‘You been drinking, Bundy?’ She grabbed his hand for a fingerprick glucose test.

‘I wish,’ he chuckled. ‘Not today.’
‘Hmm … sugar’s normal,’ Dianne informed me. There was a sudden ruckus breaking out at the triage

desk. A woman screamed ‘Let me in!’ and I heard something smash. Dianne rushed with the other staff to the front desk to help, and a security call blared over the hospital’s PA.

‘That’s my wife.’ Bundy tipped his head back in a wheezy laugh. His abdominal muscles heaved up and down.

I was gathering the equipment to take his blood: swabs, tourniquet, needles and tubes. ‘What’s she so mad about?’ I asked.

‘I dunno. She’s just mad at me.’
I picked up my tourniquet. ‘Which arm?’

He did not respond.

I applied it to one of his arms, then the other, examining them closely. His limbs felt as light as driftwood, his veins were impossible to pick through the coating of red dust. ‘You’ll need a wash before I can find your veins.’

A small angry woman, no doubt Bundy’s wife, suddenly stormed through the department. Barefoot and equally red- dusted, she scuttled to the bedside and punched Bundy in the upper arm.

Dianne had chased her inside. ‘Ay, ay, ay … Christa, lay off him.’

‘Why’d you do that?’ Bundy moaned at his wife.

‘You haven’t been home for days!’ Christa lunged again, but Dianne managed to intercept the punch. She gripped the small woman by the wrist.

Christa spat at Dianne, only narrowly missing her face.

I tried to intervene. ‘I’m sorry, Mrs Morgan, you’ll have to wait outside if you’re going to be like that.’ I took a deep breath, in and out, and spoke calmly. ‘Your husband is very sick. It’s his heart.’

‘I don’t care. He’s been lovin’ someone else,’ Christa hissed.

Three hospital security officers arrived at the bedside. ‘Come with us,’ one of them said, prying Christa from Dianne’s grip.

‘Christa, we need to look after Bundy now,’ I said. At least she didn’t spit at me. The security officer led her to the waiting room, his large hand guiding her back as she stumbled across the department.

I returned to studying Bundy’s ECG. I realised that he had very high blood potassium, the result of kidney failure. ‘We’d better get some urgent bloods,’ I told Dianne. ‘He’s in renal failure.’

Dianne nodded and started to sponge down Bundy’s sinewy neck, bony shoulders and gaunt arms. I looked at his arms again to see if any veins were visible. Nothing. We’d have

to look at his legs instead.
Dianne cleaned Bundy’s legs while I fastened the

tourniquet around his thigh. I felt something under his dirty moleskins and rolled them up higher. There was a plastic catheter, caked in the red dust, implanted in a large vein of his thigh.

‘Look at this,’ I showed the catheter to Dianne. ‘It’s his dialysis catheter. He’s a renal patient.’

‘It’s a wonder he’s not septic from that line.’ Dianne shook her head and began swabbing the tubing with antiseptic.

‘Let’s clean it up and see if we can get blood out of it.’ I picked up Bundy’s medical file and found a letter from the renal team, intended for his family doctor. It stated Bundy had ‘end- stage renal failure secondary to type II diabetes’, but the renal team considered him to be ‘non-compliant’ with their management.

The letter was blunt. ‘Mr Morgan does not accept his illness and refuses to comply with haemo-dialysis. We cannot offer him any further treatment.’ They’d given up on him but the intravenous line remained in his thigh.

Dianne ran a bedside blood test and handed me the result on a slip of paper. ‘His potassium’s through the roof.’

Just as I’d suspected. ‘We’ll have to treat it and I’ll talk to the renal team about admitting him.’ I wrote up a barrage of potassium-lowering medications.

‘Hey, Doc,’ said Bundy, his voice low and scratchy. I returned to his bedside.
‘I wanna go home.’
‘I’ve got to give you some medicine first.’

‘Aw, Doc, I don’t need whitefella medicine.’

‘You might not make it home if you don’t have some treatment. Your heart’s not so good.’

He shrugged. ‘Time I go back to my mother. Mother Earth, you know?’

‘Wouldn’t you like to stay a bit longer—for your family?’

Bundy stared up to the high translucent windows, his only portal to the outside world. ‘In my Country, I never walk alone. I got the land with me, Mother Earth.’

I felt his sadness, but he was philosophical and resolute.

‘You docs think I should live here in Alice. I don’t wanna live here, in the town camp. You tell my wife … I wanna go home.’

The thought of him going home with Christa troubled me. ‘Not sure that’s a good idea, Bundy.’

‘Doc, I wanna go home.’ He continued to stare at the window .

I sighed. ‘How will you get there?’
‘My sons, nephews, they’ll come pick me up.’
I folded my arms across my chest. ‘I need to make

some calls. Stay here, I’ll be back soon.’ He nodded and closed his eyes.

I went to the doctor’s office to page the renal team, and as I waited for them to call back, I wondered whether I was doing Bundy a service or a disservice by keeping him.

Dianne tapped on the door. She was carrying a kidney- shaped dish full of medications drawn up in syringes. ‘Seems Bundy’s left.’

‘What do you mean, he’s left?’ It had only been about ten minutes.

‘Well he’s not in resus anymore.’

I jumped up and pushed past her. The resuscitation bay was empty. The only trace of Bundy was a rumpled, red-dusted sheet. It seemed no one had noticed the critically ill man get up, disconnect himself from the monitors and walk out.

‘He’s done a runner,’ said one of the junior nurses. ‘Gone walkabout,’ sneered another.
‘Why didn’t you stop him?’ I asked.
They stared at me, wide-eyed.

I rushed to the waiting room. All the sick and disparate souls, who had been waiting for hours, looked up in the hope it was their turn to be seen.

‘Anyone seen Christa?’ I asked.

‘She’s gone,’ said a woman with an infant sleeping across her lap. ‘See me next, Doc?’

‘Not yet, sorry.’ I headed for the door and emerged into the heat of the late afternoon. I scanned the hospital forecourt for Bundy or Christa, but couldn’t see anyone resembling them. Most days, many of the Aboriginal patients and their relatives congregated outside. They didn’t seem to like the sterile confines of the hospital. It was too cold—its climate-controlled atmosphere, its synthetic linear surfaces, its racial division. Outside the air was hot and dry and tinged with eucalyptus, not so different from the air in the communities they came from.

A number of folk watched me search the forecourt. I asked them if they knew Bundy or Christa, if they’d seen them. I saw heads shake and one voice piped up.

‘They gone home.’

I looked up and down Gap Road, where the jacarandas had dropped carpets of mauve petals, along with their heavenly scent. Bundy had vanished. I stood on the side of the road searching, but all I could see was the heat shimmer off the bitumen and the imposing MacDonnell Ranges beyond. Their palette of reds and ochres was enhanced against the bright blue of the sky and the afternoon’s long light.

My hospital phone bleeped.
‘It’s David from the renal team. Did you page me?’ ‘Yes, I did, but never mind … the patient’s gone.’ ‘Another absconder? Good-o, I’ve got enough work

already.’
Pressing the End button on a hand-held phone was

definitely not as satisfying as slamming down an old-style telephone receiver.

Bundy’s plaintive situation left me feeling hollow. Deep down, my ethical self knew my patient was right, but it rallied against my medical instincts. Dialysis may have prolonged his life, but I wondered—for what? For what, if he was not in his Country, among his people? At least this way he was returning

home. His terms, his Country.

The next day I walked to the Todd riverbed. The river’s channels were shaded. Galahs and corellas trilled among the treetops and I could make out a small group of people congregating around a campfire. I removed my shoes, took my first steps into its sandy expanse and felt the land envelop my feet. It was warm and welcoming.

 

This story appeared in Breach. Visible Ink Anthology Vol.28
(Clover Press November 2016)

Into the Swim (part 3)

This piece was published in slightly shorter form (titled ‘I can probably help’) in the book ‘Emergency: Real Stories from Australia’s ED doctors’, edited by Simon Judkins, Penguin 2015

Into the Swim (Part 3)

photo of Urquhart's bluff and beach victoria

A yellow rescue helicopter hovers menacingly just beyond the break. Its downdraft carves a white-fringed crater on the sea’s surface. A rescuer descends on a rope. Soon after a body rises, limp and curved over the sling of the rope. The chopper swings toward the beach, depositing them onto the sand. An ambulance arrives in the carpark. I watch the paramedics run to the body.

I start walking. I’m conscious of being in my swimsuit.

The paramedics are performing CPR. Someone asks me to move aside.

‘I’m an emergency doctor, I can probably help,’ I say.

A paramedic looks up. ‘Are you a doctor? Can you try tubing her?’ He waves the tube and motions for me to join them.

I’m on my knees in the wet sand, leaning over a woman younger than me. She’s clothed in jeans and a t-shirt that’s pulled down exposing her chest. She is cold and grey. Her eyes stare, pupils huge and cloudy. My impression is she’s dead.

I insert the airway tube and frothy pink water gushes out of her windpipe. She has no pulse. We strip off her wet clothes trying to let the sun warm her.

She was dragged out by the rip. The guy next to me saw it happen. He is a surfer and a nurse. He saw her jump off the rock platform after her son. He tried to rescue them, but she was unconscious. Her son was floundering. The nurse chose to rescue the son first because he was still conscious.

We try, but we can’t revive her.

A retrieval helicopter descends to land on the beach. Its downdraft sandblasts us. Two paramedics in navy jumpsuits emerge. I give them a brief run down. I have my doubts she’ll survive; it’s been too long and I think she had drowned before she was pulled from the water.

The paramedics continue CPR as she is carried to the helicopter. The engine powers up and in a moment the helicopter is airborne and away.

When I look up, I realise the beach is empty. No one approaches me. I go to the water’s edge to wash my hands in the sea.

It’s the lead story on the news that night. She didn’t survive. My heart bleeds for her young boy.

I return to the beach a week later. It’s been deserted, labelled treacherous. The people who know what happened feel the need to swim between the flags for a while.

I walk along the expanse of sand and imagine I see her face reflected in the sheen of water left by each wave. Although this is still my favourite place to run my dog and dig mermaid pools with my daughter, it has changed for me forever. I pay my respects both to her and the sea, leaving flowers on the sand.

The Eagle

Wedgetailed eagle flying 
She finds an eagle on a highway verge—a wedge-tailed eagle. It lies with its eyes open next to a stinking kangaroo carcass. It has been struck by a vehicle; must have been recent as every other predator and scavenger, including its own kind, haven’t yet discovered it. Such is life in the outback—cannibalism is an accepted form of survival.

Continue reading The Eagle