to be her normal eye and a unilateral

proptosis that , under other

circumstances , would have been

suitable for a presentation of signs

in grand rounds .

Then she said : “ I have to go to

the toilet .”

I struggled to see the way . She

was holding her head to the side as

she moved with what I was able to

discover was a complete homonymous

hemianopia .

The story slowly came through

from her husband and more rapidly

from my examination . The disinhibition

and frontal lobe signs suggested

a potential space-occupying

lesion .

Things moved quickly then .

There was an urgent admission for

a CT scan and then a consult with

a neurosurgeon arranged within a

couple of hours .

Ellen was a 48-year-old woman ,

severely compromised with a

sinonasal undifferentiated carcinoma

perforating through her cribriform

plate .

What followed in the coming

days was classic general practice .

Care by our staff of a person

through chemotherapy and surgery , care of a family in great distress at the changes to their mum , then the regular updates and translations of the letters from

London medical schools , where women were not allowed to wear trousers and the language was very formal . I was Dr Chappel , for instance , and the patients were known only by Mr or Mrs .

specialists . We were also there for the celebrations of the small

Kuranda , Queensland

So when my first patient in the Land Down Under entered my room , I said : “ Hello , Mrs

improvements and the follow-up

Smith . How can I help you ?”

home visit for actual mental health

“ G ’ day , Liz ,” she replied . “ I ’ ve come for my tits

support .

IT was my very first day working in rural Aus-

and fanny check .”

Like all patients whose world

tralia , having arrived fresh from England .

That was the moment I fell in love with Aus-

was being thrown upside down ,

I had been trained within the formalities of

tralian medicine .

Ellen wanted to make sense of

what had occurred .

What made all this the best day

in general practice for me ?

“ She ’ s four . My wife was besot-

The wonderful community

ted with her , but now she ’ s strug-

capacity of a well-resourced and

gling to look after her .” “ How long for ?” “ About two months .” We climbed the stairs — more photos , more dust and a slight

well-trained general practice team ; the willingness to go where others cannot — into homes where you can see the small signs that show the serious changes in a person ’ s

sense of an unkept house . We GPs know about these places because

life even in the minutes prior to seeing the patient themselves .

Perth , WA

our own homes are often like this .

Then there was the clinical

We reached a light-filled bedroom at the back of the home , and I was ushered in by Bill . “ Ellen , the doctor ’ s here .” I looked to my left , and my mind went back to my medical school days about 25 years ago . Ellen ’ s face and habitus reminded me of a patient we once saw in the professorial surgical unit .

Pattern here ? It is ‘ Big Sick ’, as one of my colleagues in general practice would say .

‘ Big Sick ’ for Ellen was a strangely euphoric , “ Hello , fancy having a doctor visit ,” said in a singsong tone by a cachectic-looking woman . Her complexion was sallow , and she was sitting up against the pillows .

training necessary for high-level diagnosis within a system that was actually there to serve our patients in the way medicine should .

But even more than this , it was the phone call at the end of the day from the ED colleague amazed at what had unfolded .

I was able to say to him that it was not hard . It was keeping my eyes open to see what was in front of me .

He spoke about how he and the staff at the ED had missed the incredibly deforming look of this woman ’ s proptosis .

But the main thing was this — we ended up agreeing to support each other more and more . We both wanted to do what we had

IT must have been 2am . I was working at the hospital covering the wards .

Hoping for an uneventful evening , I cruised the wards and did the needful : catheters , cannulas , patient reviews , as well as monitoring an elderly man who was being palliated . I had spent a while speaking with him over a few shifts . He was accepting of what was coming .

I had not seen my wife for a few weeks as she was working overseas , but I would occasionally get a call on night shift if she needed some reassurance during late-night loneliness .

I happened to receive one of those late-night calls while I was chatting to the dying man . “ I ’ m pregnant ,” she said . I was shocked , ecstatic , scared , delighted . I said nothing , but my face apparently said it all . “ That looks and sounds like major news ,” he said to me .

Dr Kia Alizadeh with his two-month-old baby , Zia , in 2015 .

I told him , and he smiled and coughed . He shook my hand and said how he was glad to witness some joy .

He was gone by morning .

She was also turning her head

been trained to do : high-quality

to look at me with what appeared

medicine .