‘In non-doctor speak, the patient is f***ed’: a GP’s story

After leaving Sydney, GP Dr Sonia Henry confronted the reality of 'desert medicine'.
Dr Sonia Henry
Dr Sonia Henry.

GP and writer Dr Sonia Henry put jolts through the medical profession when she published an anonymous opinion piece in 2017 about medicine’s “shameful and disgusting open secret” — doctors were dying by suicide.

Her writing reverberated with doctors, being a rare break in a culture of silence.

Years later, after revealing she was the anonymous author, and writing a novel called Going Under, Dr Henry has published a memoir: Put Your Feet In The Dirt, Girl.

With her frank and uncompromising style, she describes swapping a harsh hospital culture in Sydney for a solo GP job in remote WA, which brought its own confrontations.

Here is an excerpt.

The phone wakes me up and I feel a sense of immediate dread when I realise what the sound is.

I look at the digital clock next to the bed: 1.28 am.

There are three big mines surrounding Desert Town, and the sites operate 24/7.

There are hundreds of people working there with very heavy machinery, including loaders, saws, and bombs for drill blasts.

But from the patients I’ve seen the last few months — a lot of them with high cholesterol and fatty livers — what the 1.30am call really tells me is: HEART ATTACK. SICK PERSON. VERY SICK PERSON. IN THE MIDDLE OF FUCKING NOWHERE.

I stare at my ringing phone for a moment, willing it to stop.

It doesn’t.

“Hello?” I say, the dread already starting to kick in.

It’s Nurse Lime. She’s panicked, I can hear it in her voice.

She is saying things like “chest pain” and “strange heart rhythm”.

It is clearly as bad as I’d feared, but she’s speaking so quickly I can barely understand her.

“Just tell me the name of the patient, their age, and what the problem is,” I finally interrupt.

“It’s Wolff Parkinson White Syndrome,” she says.

“The patient has known Wolff Parkinson White?”

I try to stay very calm. It’s Colm. The patient is Colm.

At that moment, a memory of studying for my fellowship exams with ‘heartdoc_82’ embeds itself in my brain.

We are studying over FaceTime, covering unusual and dangerous cardiac arrhythmias.

I can hear his voice, as if he is right next to me.

“What’s the main thing to remember about Wolff Parkinson White Syndrome?”

“The delta wave on the ECG?”

“No, like, the main complication.”

“I don’t know. Dizziness? Fainting?”

I feel defensive, the way I usually do when we study together.

“Sometimes, the main complication of Wolff Parkinson White Syndrome, Sunny,” he says, saying my nickname in the way only he says it, “Can be death.”

“Geez, no need to take it there!”

“No, I mean it,” he says seriously.

“It’s rare, but it happens, and you don’t want it to happen in front of you.”

Then we are laughing and he is telling me that helping me study actually isn’t as bad as he’d thought; now all we needed was the ultimate study lubricant, wine, to make it easier … he says that my laughter is his favourite thing to hear in the world, and that making me happy is all he wants, because it makes him so happy too …


I snap out of the memory immediately.

I am not studying, and I am not in Sydney, and I am not laughing.

I am in a town 5000km from home, and I am the only doctor for miles and miles and miles, with nothing to help me except red dirt and a seriously under-resourced Royal Flying Doctor Service that usually takes at least five hours to get anywhere.

It is 1.29am and, medically speaking, I am it.

I feel sick.

“Death,” is all I can hear. “The main complication of Wolff Parkinson White Syndrome can be death.”

“It’s rare, but it happens, and you don’t want it to happen in front of you.”

Nurse Lime doesn’t offer much more information aside from the fact the patient isn’t too well, an ECG has already been done and they’ve sent it to the mining company doctor in Perth, who has instructed us to get the patient to the clinic immediately.

“Who’s the patient?” I ask Nurse Lime, already knowing the answer but hoping to hear something else.

“Colm Calhoon,” she says, after a split-second of hesitation, which I experience as an abyss of dread.

I mumble that I’ll get dressed and head into the clinic.

My stomach feels like it’s inside my head, and then my throat.

I take deep breaths.

I need help, I think to myself. I need help.

I am desperate.

My hands do what my brain is screaming at me not to do, and text the person who, deep down, I blame for this entire situation.

If it wasn’t for heartdoc-fucking-82 and all his filthy lies I wouldn’t even be here.

I wouldn’t know and like Colm Calhoon, I wouldn’t be close friends with his damn wife, and I wouldn’t be the person who everyone is relying on to save the day.

I text him, and he doesn’t reply.

I call him, and he doesn’t answer.

I hear his voice again, one of the last things he said to me.

I’ll always help you when you need it. Doesn’t matter what time of the day or night. I’ll always answer the phone if you need help. Always. I know you don’t believe anything I say, and I get it. But Sunny, I promise you.

I call him again. It rings out.

I get dressed and walk out of Q Block.

I look up at the stars. They are bright and clear as I stand there under that big sky.

And for a moment, for the first time since I think I was a child, I pray.

It’s dark when I get to the medical clinic.

They must still be coming from the mine site.

I go to the crash trolley and check that everything is there in case — I try not to think about it too deeply — he arrests.

I walk into the emergency section of the pharmacy.

Adenosine. Amiodarone. Hmm.

There’s no point calling the flying doctors or Royal Perth until I have the patient in front of me, so I try, once more, from the clinic phone, to call heartdoc_82.

No joy.

I harden myself to the situation and ring Roy, who thankfully is on a night shift.

Roy did a year of intensive care and anaesthetics and is calm and collected.

Just hearing his voice soothes me.

“Do you have a blood gas machine out there? Telemetry?” he asks.

“No blood gas machine, and everything else is pretty basic,” I say.

Roy sighs.

“Fuck. Okay, well, you can only do what you can do. Just do what we’d normally do. Bang in a cannula, pull some bloods.”

“The bloods take three days to even be processed,” I tell him.

“Whatever, just do it, it’ll get the ball rolling. Then try the vagal manoeuvres. Put the defib on him. Draw up some adrenaline. Worst case is he arrests.”

I agree.

“You can call the flying doctors, right?”

“Yeah,” I say. “But they take ages. If they’re busy with something else they might not be here until morning, at the very earliest.”


Roy sounds reflective.

“It sounds like you’ve got nothing. Call me anytime, not that I can do much.”

“I’ll call the cardio in Perth as soon as the patient comes in,” I say.

“Although I doubt they’re going to say much different.”

“Good luck, mate,” Roy says, sounding sorry for me.

I hear a pager going off and for a moment, crazily, I think it’s mine.

Then I realise I’m hearing it over the phone, as Roy is called by a nurse.

“Gotta go,” he says. “Just stay calm.You can only do your best.”

True friendship, that. A call to arms from 5000km away.

I might fail and the patient might die but I am in no doubt as to the solidity of my friendship with Roy.

Sometimes, at the worst of times, even doctors just need the backup of a bloody good mate.

Colm is brought in on a stretcher.

His heart rate is through the roof, close to 200 and his blood pressure is hovering on the cusp of too low.

He keeps saying he doesn’t have chest pain but his slight grimace makes me think otherwise.

The volunteers hand me the ECG strip, which looks like a dog’s breakfast.

“Colm.” I speak urgently, walking quickly alongside him as he’s wheeled into the little emergency department.

“This must have happened before. You told me you knew you had this — what do you normally do?”

He looks at me. “It normally stops on its own.”

“Do you ever hold your nose and blow out your cheeks?”

I’m referring to vagal manoeuvres, the series of tricks that can cause a nerve reflex to slow the heart rate.

These tricks include things like blowing hard against resistance (like with your mouth and nose closed), or using a facial ice pack.

“Maybe once? I can’t remember. Anyway, I’ll try.” He holds his nose and fills his cheeks with air but nothing seems to change. “It doesn’t work. That’s why I called the first aid guys.”

Colm is tough as nails, so the fact that he called for help is a very bad sign.

He works as a drill blaster, on his own, about a half an hour’s drive from the buildings on the mine site, which is half an hour again from the medical clinic.

So he’s been in this heart rhythm for at least an hour already, with no change.

“What about the cardiologist you saw the last time you were in hospital? What did he say? Surely he would have sent you for an ablation if you needed one? Or told you what to do if this happened?”

He looks, if possible, even worse.

“I never went to the appointment,” he finally says. “He was too expensive.”

Something in me kicks in and I go straight into autopilot.

Cannula, bloods, fluids, is there any magnesium lying around?

I tell Nurse Lime to get another ECG, and, just in case, put the defib pads on Colm and draw up some adrenaline.

I call the flying doctors.

The bloke on the other end of the phone sounds strangely cheerful as he explains there are no planes and the best they can do is 6am.

“What should I do, do you reckon?” I ask instead, my tone blunt.

I can almost hear his shrug on the other end of the line.

“Try some amiodarone,” he says. “Or if he’s unstable, just shock him.”

I feel like rolling my eyes: as if ‘just’ shocking him is as easy as giving him some Panadol.

“Sorry to say it,” he says, sounding only vaguely apologetic. “But you’re on your own.”

“Thanks,” I say.

“I just spoke to the cardio AT in Perth,” he says. “He’s awake, and he’s pretty all right. I’d give him a call.”

I call the cardio AT.

He asks for the ECG. I send him photo after photo, none of which is that clear because our ECG machine isn’t that crash-hot, but from the pause as he considers the images I know things aren’t good.

“Is he stable?” he asks.

I look at Colm; he’s covered in sweat.

“His blood pressure is hanging on, and his oxygen sats and stuff are okay,” I say, motioning at Nurse Lime to squeeze another bag of fluid through his IV, as fast as she can.

“But his heart rate is so high, and he doesn’t look very good. I thought I might give the vagal manoeuvres a go.”

The cardio AT starts speaking quite fast, saying words like “the ECG isn’t very clear” and “pre-excitation” and “this isn’t a standard supraventricular tachycardia, you’ve got to be careful you don’t throw him into AF”.

This is all ringing a bell from my Advanced Life Support 2 course.

With this exact scenario, I suddenly remember, the advice was to ‘seek expert cardiologist opinion’.

If a patient is experiencing AF in the context of Wolff Parkinson White, and in a place like this, they’re essentially — in non-doctor speak — fucked.

“So what should I do then?” I ask the AT.

The panic is sitting in my gut, slowly rising.

I can’t believe how steady my voice sounds.

“Like I said, the flying doctor guy said to give amiodarone.”

“Amiodarone can send him into VF,” he says gloomily. “You don’t want that. Especially not out there, with no support, no ICU.”

“So all the drugs that work, I shouldn’t give him?”

I hear the desperation in my voice, and the start of something even more concerning. Resignation.

“Yeah. If he becomes unstable, you’re going to have to shock him.”

“I don’t have, um, much here,” I finally say. “No way of checking his electrolytes, no good cardiac monitoring. I mean, yeah, there’s a defib.”

“I feel really sorry for you,” the AT says, quite kindly.

There’s noise behind him, loud voices and beeps, and he says he has to go.

“Something’s come up,’ he says hurriedly. “I’ll call you back. Give me your number.”

I quickly tell him my mobile, and his voice, my only source of comfort, vanishes.

Don’t go! I want to shout. Don’t leave me!

Never before have I understood extreme isolation so well.

Colm doesn’t look good at all.

The way he’s got his arms tightly folded over his chest belies the “no” he gives to my repeated question of: “Do you have chest pain?”

I watch Nurse Lime nervously pat down on one of the defib pads.

I know D-Day is coming.

If his heart continues like this, he’s probably going to go into VF and arrest anyway.

I stare at the ECG. Is it AF?

By now I’m so panicked my thoughts are becoming jumbled. Is it something else?

Maybe I could just try the amiodarone? But he said that might make it worse.

The vagal manoeuvres? I know that one type of arrythmia means the manoeuvres could be a good idea, while another means they could be a really bad idea, and I can’t tell the difference: the ECG is so all over the place that it’s difficult to make sense of it.

Nurse Lime takes Colm’s blood pressure.

It’s not terrible but it’s also not really, I admit, that magical word: stable.

As if reading my mind, Colm closes his eyes and says, “You can save me, right doc?”

I don’t respond.

My brain is trying to organise itself.

If he gets worse, I’m going to have to shock him, which may or may not work.

How old is the defib? Has it ever been serviced?

If it doesn’t work, he might go into VF. Then he’ll arrest. Then I’m going to have to try adrenaline, and the whole shebang of the Advanced Life Support protocol.

I can’t tube him, so even if he somehow survives all of this, we’re going to have to insert a half-baked airway and just keep calling the flying doctors in the hope they can somehow get here earlier.

I feel like I am driving a car at around 300km an hour into a wall with an airbag that may or may not work, and it’s all going in slow motion.

It’s like a bad medical TV show only it’s actually happening.

How am I going to tell Holly?

That’s when it happens.

The image of Holly sitting in her backyard with her kids as Colm serves up smoked fish does something to me.

His blood pressure is still okay and the registrar didn’t say not to try the vagal manoeuvres.

I make a decision.

“Mate.” I clear my throat, addressing Colm as I look at his pale face. “I’m going to get you a very cold tub of water, and I want you to put your face into it.”

“If that doesn’t work I’m going to get you to do the weird cheek-blowing thing again, as hard as you can, and I’m going to very firmly massage your neck.

“All of these things stimulate a nerve in your body that, if done in the right way, can throw your heart back into its normal rhythm.”

Or throw you into full-blown atrial fibrillation then ventricular fibrillation that will kill you, I add silently.

“And if that fails and you get worse, I’ll have to shock you with these pads. Okay?”

Colm looks terrified but manages half a laugh.

Nurse Lime brings over the freezing water and I start massaging Colm’s neck.

He blows his cheeks out.

And then, after what feels like decades, I see his face change.

“I think it’s stopped,” he says, looking up at me, almost childlike.

Nurse Lime does another ECG.

She hands me the printout, wordlessly. Sinus Rhythm. Normal.

Somewhere in the green hills of Tipperary, a group of leprechauns is standing up with their pints of Guinness and cheering.

Maybe Colm was saved by the stimulation of the vagus nerve coursing through him that night, throwing his heart back into a stable rhythm, giving his cells and brain and soul oxygen and life.

Or maybe the underlying arrythmia wasn’t as bad as we thought and there was always a chance it would revert — who knows?

Whatever it was, the leprechauns and I are both celebrating the grace of blind luck.

Because in a place like the Pilbara, sometimes that’s all you have.

From the relative safety of a giant hospital, it’s easy to say it wasn’t that bad.

But when you’re alone, and far from help, all your brain can think is: what if it gets worse, or I make it worse, and I can’t fix it?

My phone rings. It’s my friend, the cardiology AT from Royal Perth.

“He’s reverted,” I say.

“Okay, great.” He’s all business. “But still get him down here.”

“We’ll accept care.”

“Colm,” I say when I hang up. “You’re going to see the fucking cardiologist.”

“If you don’t get on that plane when it arrives, I’ll kill you.”

When Colm is less grey in the face, and three more ECGs look normal, I call Holly, who races into the clinic.

As she is scolding him for not going to the cardiologist and drinking too much, and crying and thanking me, I slip out the back door.

The lights are dim, but I can just make out the flat tabletops of the mountains in the distance.

Soon it will be daylight, and the plane will be here to take Colm to the safety and civilisation of a big teaching hospital.

By the time heartdoc_82 texts me back, Colm is well on his way to the city and I’m in bed, trying to sleep.

Sorry—missed this. Wolff Parkinson White, that’s a really tough one. Love to hear about it.

Part of me wants to feel infuriated at the casual throwaway tone, at the lack of care from someone who promised me they would never let me down.

But all I feel is really tired and really old.

This is an edited extract from Put Your Feet in the Dirt, Girl by Sonia Henry (Allen & Unwin, $34.99), available now.

If this news story has raised issues for you, or you are concerned about someone you know, you can call the following support services 24 hours a day, seven days a week:

State- and territory-based doctors’ health services

  • ACT: 1300 374 377
  • NSW: 02 9437 6552
  • NT: 08 8366 0250
  • Queensland: 07 3833 4352
  • SA: 08 8366 0250
  • Tasmania: 1300 374 377             
  • Victoria: 03 9280 8712
  • WA: 08 9321 3098

Mental Health Support Line (Telepsychology)

  • 1300 374 377 (Dr4Drs)

Other services 

Lifeline: 13 11 14 

Beyond Blue: 1300 22 4636  

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