Lessons from a summer placement

Final year medical student Madeline Coles certainly gained a higher education through her Royal Flying Doctor Service elective placement in Port Hedland over the summer. 

The two-week experience was funded by a Rural Health West scholarship and coordinated by the Rural Clinical School of WA. 

In this testimonial, Madeline reflects on lessons learnt and her ambition to practice rurally…

The Royal Flying Doctor Service (RFDS) has always appealed to me, long before I began my medicine journey. Combining medicine with travel and adventure seemed like a dream role.

Fast forward to May 2023, where I excitedly wrote my letter of application after learning that I could do anything for my MD3 summer placement. I proudly typed out that I considered myself an asset to the team because I could confidently put in cannulas (with a grim strike rate) and use clinical judgement (after one year of rotations). Fortunately for everyone involved, my cannula skills were not required, and my knowledge was used as a teaching point only.

Lesson 1 - REJECTION

I was told that the RFDS spots were already full, and I was on the waitlist.

Lesson 2 - PATIENCE

A place became available in September, and I was heading to Port Hedland in January.

As I drove to my accommodation in my incredibly expensive rental car (I was warned that everything in Hedland was more expensive), my initial impression of the town was how inhospitable it seemed. Flat red land was all I could see. I thought of Lisa Holland-McNair’s book ‘Red dust in her veins’ and thought it should be called ‘Red dust in her lungs’ because my goodness, the wind!

I began orientation the evening I arrived with a passionate doctor telling me so much about plane mechanics that I thought she may be the pilot too. The love and pride in her career were palpable and I knew immediately that I made the right choice for placement. The instructions for my role were clear - be ready for the phone to ring between 6am and 6pm. Having never been on-call, I was excited at the thought of emergency and the unknown.

Lesson 3 - PATIENCE

Being on-call when you have no real purpose being there other than self-development feels like a glamorous waste of time.

I sat in my rental, dressed in scrubs, too scared to leave for grocery shopping in case I got the call. Then 6pm rolled around and no call. This continued for a few days with the doctors and nurses running simulations with me and taking me out for coffee apologetically. They referred to this quiet week as a "Q period", as if saying that bad word would bring on an unrelenting workload of STEMIs and strokes.

After five days and only one necrotic ankle wound, I eagerly signed up for the weekend shifts. And that was when the trip changed from reading novels in my scrubs and doing online Pilates on my bedroom floor, to a real flying doctor experience.

My first call came just after 6am, saying to meet the team at Hedland Hospital for a patient with severe asthma needing to go to a tertiary hospital. Considering he was already intubated, I thought we'd be in and out. Incorrect.

Image: Madeline Coles ready for take off.

Lesson 4 - PATIENCE

Transferring a patient takes hours.

All the machines, tubes and pipes had to be transferred to RFDS equipment - a process equal parts meticulous and nerve wracking. Sliding an intubated patient across to a St John stretcher is also an art, requiring eight people (the medical student was useful here!).

We climbed on to the PC-12 (yes, I’m an aviation girl now) and jetted to Jandakot. The patient was stable so the doctor spent the 3.5 hour flight quizzing me on anaesthetics and pharmacology - both subjects I know embarrassingly little about.

I was once told that the best quality of a medical student is their ability to entertain (or at the very least, not annoy). I hit him back with my own questions, such as “If I were to drink the syringe of Propofol I was drawing up, would I vomit it up or just pass out?” He called me an “idiot for considering it.” Apparently, he doesn’t get intrusive thoughts the way I do, but at least I entertained the other members of the team.

The days that followed were an incredible mix of well and unwell patients, psychotic episodes, chest pains and sepsis galore. There was something so magical about flying home at sunset, the views making me reflect on what an incredible opportunity this experience was. I wouldn’t have a HECS debt if I had a dollar for every time I thought 'pinch me'.

For something different, I asked the RFDS general practitioner if I could attend the flying GP clinic where three times a week a doctor would fly to a rural community to see patients. This was one of the more eye-opening components of my trip. The first stop was Marble Bar where I met the kindest nurse, who eagerly showed off his bee hives and gave me a jar of fresh honey to take home.

During my few hours there, I was also gifted a fruit cake. There really is something to be said for country hospitality. The second clinic was the even more remote Nullagine. This was my first time going to a remote Aboriginal community and I learnt so much about the culture and healthcare of these areas.

We went to pick a patient up from their house, only to learn from cousins that they had gone. Another patient skipped their appointment to hunt goannas. I was able to appreciate the difference in cultures and how they need to be integrated - with a lot of compromise - to deliver effective healthcare.

Takeaways from these clinics were firstly how poor health literacy is. A large portion of the patients did not know what diabetes was and why they were taking Metformin. Secondly, I appreciate the importance of establishing rapport and having a clinical yarn. The GP did this effortlessly and I learnt so much by listening to these consultations.

My two weeks with RFDS was enlightening, exciting, and motivating. I look forward to getting my five years of medical experience so I can return there as an employee. My love for rural health and the rural lifestyle grew by being there, and despite the heat, wind and dirt, the incredible people made it very liveable indeed.

Information on the Rural Clinical Elective Placement Program can be found on the RCSWA Medical Students webpage.