Alice Springs is named after the waterhole on the Todd River just north of the town which was the life source for those building and operating the telegraph station that connected Australia with the rest of the British empire. Kangaroos collect in the evening and dig for the water which hides below the surface of the sand. It was just one of many watery sources of life that cower in the massive ravines and gaps between the heads and tails of the caterpillar shaped mountains: Yeperenye dreaming. With the arrival of the cattle and the destruction of these waterholes, people have come to rely on bore water in these parts. Fracking is understandably very unpopular, while concern is growing that the heavy metals in some bores may be damaging kidneys.

This underground water is not all good, but without it people can die walking around here in summer. One of my registrars had a near miss climbing Mount Gillen, a nearby peak in the Western McDonalds. He was evacuated to Adelaide for an angiogram. Another doctor from the hospital died doing the same seemingly trivial exercise in the extreme desert heat. You can feel that death lives near here; whether it is in a wild flower in a patch of parched sand, or a car in a terminal state creeping along the Stuart Highway bursting with shadowy passengers. Cars often don’t make it to any normal grave and their bodies are everywhere.

Central Australia strikes me as the Centre of Palliative Care for Holden Commodores, our national iconic automobile. They come here in various but often rather morbid states and they are driven until they have nothing more to give. They usually die at home, rather than on the highway, but there are still many deaths by the road. There is, fortunately, a roaring organ donor program which operates once a senior mechanic considers that there is no useful life left in the beast. Dismantling then occurs, usually passed to friends and family members who have Commodores with some life left in them and can benefit from the transplant. Initially wheels and lights will be respectfully removed leaving the car at rest. Eventually larger organs will be required and the car turned over to remove suspension and other replaceable parts.

Organ donation does result in a genetically mixed and rather mosaic breed of Commodore. These may have one trip left in them, requiring simply that the cost of the transplant and fuel is less than any other form of transport to get where people have to go. I remember, years ago, at Mosquito Bore 300kms or so to the north east of Alice, being stunned by the massive din and cloud of dust heading towards the little outstation and collection of humpies that housed some of Australia’s premier artists at the time. As the apparition materialised, it turned into a red dust-coated white Commodore with no windows and no tyres, running on flattened metal rims. The only gleaming evidence of success was six sets of very white teeth between dusty lips that appeared from the low slung vehicle in the dimming light, all chuffed to have made it. The vehicle died right there, exhaling steam and smoke.

For some people in Alice Springs, the value of Commodores is quite different. They are symbols of Australian engineering and are to be shined and cherished and made to live until well after their life expectancy. They creep around the town and mostly slink into garages and get covered from the damaging sun. They live a lot longer but their lives are distinctly mundane and rather vain. Seeing other Commodores hurtling towards an early death, roaring over miles of corrugations and breathing thick red dust, brings tears to their eyes. They fantasise about eternal life and their descendants taking care of the beautiful automobile.

Culture has a lot to say about how we live and die. A short exciting life is of interest to many and some will invest in freezing their bodies in the hope of living forever. Mainstream urbane society is grappling with their own need to control the moment they die; all the more understandable in the face of the grotesque ability of medicine to keep us alive. For those members of our population who do not expect or wish to live forever, for whom the pace of life includes the march to death and for whom it all passes rather more quickly than we would want, the call for voluntary assisted dying does seem somewhat out of place, or even repugnant. Further, as a member of a society that has killed Aboriginal people in large numbers, and as a doctor seeking an easy death for a suffering patient, I can easily be seen as propagating this history. There are also major risks for family members openly suggesting that it is time for a loved one to die. Blame is standing, waiting with death. It gets more even more complicated. The four doctors at Congress who work in aged care (who are considering carefully our role in other people’s deaths), the palliative care specialist from the hospital and the compassion filled social worker who has worked in the field for many years are from six different cultures. None of them Aboriginal. If we combine this with the workers in the new Palliative care hospice and the nursing homes, you can multiply that many times. But zero times anything is still zero. There is an extraordinary mismatch of cultures, views, love, delight, sorrow, empathy and compassion. But almost all our clients are Aboriginal. It is unfathomable for everyone.

The Commodores provide some evidence of different attitudes and approaches to mechanical death and the value of a iconic vehicle to all sectors of the community. I have heard that the Commodore takes to the dirt roads better than other cars, that it uses less fuel than the Troopie and that parts are easy to get. I asked a wily hitchhiker coming back from the Santa Teresa Sports Festival on the weekend why Commodores were so sought after in the bush. He initially paid homage to the ubiquitous Toyota 4 wheel drive, but the answer was relatively simple. “That Commodore’s got more pipes”.