The doctor who parked his ambulance on the top of the cliff
The other day, Dr Tom Mulholland was giving a talk to some men employed by a concrete pipe company, so he tailored his metaphors to fit.
"Guys," he said, "you've got to look after your pipes!"
He showed them some pictures of blocked arteries to drive the point home, and explained how they needed to watch their blood pressure, and get the blood tests that give an early warning of looming diabetes, and seek treatment if they suffers from depression.
If just 10 of those pipe-company guys followed one of these bits of advice, says Mulholland, "I'll have had way more effect than just sitting there waiting for them to come to me."
Mulholland was a GP once, but now he's something rather different – part gypsy, part doctor, part motivational speaker, part public health activist.
There are a few days a month, when he's working as an emergency department doctor at Auckland City Hospital, that he waits for the sick people to come to him, but most of the time he's out and about, nabbing the not-yet sick off the street and pointing them in the right direction.
He calls himself, and his website "Dr Tom on a Mission". He drives about in a old Chevrolet V8 ambulance that features a grinning cartoon rendering of himself on the back, and he sets up health-check stations outside supermarkets or The Warehouse, or in the Invercargill council offices, or in a Masterton hotel full of local farmers. He is, you might think, a little unusual.
But ask him what he's up to, and it starts to make some sort of sense.
Mulholland is 54. He was born in Lower Hutt, son of a ship's engineer and a nurse, and announced at the age of five that he wanted to be a brain surgeon. After school he got distracted by the great outdoors and did a forestry degree, but when he tired of pines he went back to uni, graduating from Otago medical school at the age of 29.
He never quite became a surgeon, instead working as a doctor and raising a family in Taranaki.
Then around 2000 life got complicated. He'd started a computer-based health records business and had just raised a large chunk of venture capital to expand, when his marriage fell apart.
"I got depressed basically, and this was before John Kirwan. I was suicidal. I was doctor for the Taranaki rugby team. I was on the district health board, chairman of the school board of trustees, but my whole life changed overnight."
He's a fast talker, and this is just a quick background chat before he heads out for a stint with the Chevy at Henderson Pak'nSave, so perhaps he's skimming over the finer details, but the way Mulholland describes it, his response to his depression was basically this: "I was put on pills, but I thought there's got to be more to it than this. I thought if I'm this miserable there must be other people in the world who are miserable, so I developed some tools and techniques to help change your mindset. I discovered what I call 'Healthy Thinking'.
"The business plan was write a book, get some corporate clients, do some stand up comedy. So I went from being clinically depressed and suicidal to doing comedy at the Classic in about eight weeks."
He indeed wrote a book, Healthy Living, which sold well, and other books followed. He didn't do the stand up for long, but it helped hone the skills he now uses in his corporate speaking.
After a few years out of practising medicine though, he was missing it, and once again rejuggled his work life.
He now lives on a houseboat in Auckland's Westhaven Marina, works a few days a month in the emergency department, does some volunteer work and a bit of corporate speaking, and for the past two years he's been getting around the country in his ambulance, funded by rolling contracts with organisations such as the government's "Healthy Families" initiative or the Mental Health Foundation's ""Farmstrong" scheme, which aims to encourage farmers to take better care of themselves better physically and mentally.
Yet all disparate bits and pieces all point in the same direction: prevention not cure, wellness rather than sickness. He's parked his cartoon-bedaubed, self-aggrandising Chevy V8 ambulance right at the top of the cliff.
"It's just tragic seeing what's preventable. People say it must be awesome working in an emergency department and saving people's lives, but the reality is we don't save very many.
"We might extend your life by four minutes, or four hours, or four days or, if you're lucky, four years. But usually most of the damage has been done, with things like high blood pressure that's led to a stroke.
"Doing my corporate stuff, I see how low healthy literacy is. People don't know you should be getting your blood pressure checked."
Just yesterday, says Mulholland, he was out in West Auckland and a person's blood pressure was 240 over 140 and they had a parent who'd just had a stroke.
"That's ambulance material. There are tens of thousands of people walking around who've never been to a doctor, have really high blood pressure, and are half an hour away from having a stroke."
THE PAK'NSAVE CLINIC
Out in Henderson, west Auckland, the Chevy is already parked in front of Pak'nSave. Mulholland's ambulance manager (and fiancee) Meleane Bourke has already set up a rudimentary clinic in the supermarket's foyer.
It's exactly like a GP's surgery, except there are no reception, or crying babies, or bored people reading magazines, and there's a guy lugging in long trains of supermarket trollies every few minutes, and the clinic consists of trestle tables, a few chairs and a row of small but high-tech diagnostic machines.
All right, it's really nothing like a GP's surgery. And that's how Mulholland wants it. He's hoping to grab the ordinary folk who don't get around to seeing their GP, or can't afford it, or only go when they're properly sick. He wants to talk to them while they're still well.
"The days of patients going to sit in a crowded waiting room getting coughed and sneezed on by unwell patients when they want a wellness check, only to get their blood pressure taken on an old machine, are gone," says Mulholland. "We need to go and see the people."
Josephine Kapua, 26, is happy to take 10 minutes out of her supermarket time for a free checkup from a guy with a cheerfully painted ambulance.
Like most of her family, she's a smoker, so Mulholland asks her to blow into a a lung-capacity meter. She passes with flying colours, but Mulholland's not letting her off that easily.
"Your lungs haven't been damaged very much – yet. If you stop smoking now, you're not going to have much damage. Have you ever tried to stop?"
Yes, she stopped smoking when pregnant but has started again since.
She takes a pre-diabetes check: Bourke takes a pinprick of blood and transfers it into biscuit-sized plastic disks that go into centrifuges the size of a large shoebox. The disks cost $30 a pop, the price of spitting out results in a couple of minutes rather than taking days via a diagnostic laboratory. Mulholland sits with Kupua to discuss what the numbers show and what they mean.
Later Kapua says she stopped at Dr Tom's stall because she has a family history of diabetes and stroke and heart disease. Her tests showed everything was OK except her cholesterol was a bit high, so Dr Tom suggested she cut back on drinking the fizzies. She's also going to have a go at stopping smoking. The clinic collects the contacts of people who've got tested, and follow up to see if they've taken action.
"He's going to help me."
There are curious looks from shoppers entering and leaving Pak'nSave and no shortage of takers for a free checkup. Kupua's cousin Tania Vano blows into the lung tester and submits to the finger-prick. A elderly but fit-looking woman with a Dutch accent chats as her blood pressure is taken. It seems a little high so Mulholland takes it again.
"Think of tulips," he says.
She's not been to the GP for a couple of years, but feels pretty fit. Mulholland suggests two years is probably a bit too long between visits, and that it would be good to get the blood pressure under control if she wants to remain as independent as she clearly is now.
Mulholland has been on this peripatetic mission for two years now. The Healthy Families scheme is currently focussing on 10 high-need areas, including poorer districts within Auckland, but also the Far North, East Cape, Rotorua and Invercargill, so he really gets around. He's taken his ambulance to d'Urville Island in the Marlborough Sounds. He's off to the Chathams in December.
"There are times when it's tough, when it snowing or raining or you're in traffic or the ambulance's starter motor goes. But it's like any roadtrip – you wake up the next day and drive to a new place."
He's seeing the country, and some of what's wrong with the country.
"There's a divide. Look at the life expectancy of Remuera versus, say, the East Coast. It's like two different countries. That's why we're going there."
If he can keep tapping the right funding, he'd like to do this for another five years, and then he's got a new plan. By then he'll be nearly 60, and he'd like to get on a boat and keep doing the same thing, only this time around the Pacific.
"It's a privilege to be able to have fun and enjoy seeing the planet and meet great people and make a difference. What else would I do? There's no reason to stop."
* Dr Tom Mulholland's new column for Fairfax Life&Style launches on Sunday, October 23 and will, he promises, be about "the simple things and tools you need to live to 100 and stay out of the emergency department".
- Sunday Star Times