Monthly Archives: February 2014

FOBT

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Some doctors have too much time on their hands. When you’re feeling quite well they go looking and testing for things you aren’t suffering from. They call that preventive medicine. (I call it preventative medicine.) My wife calls it meddling.

Year ago I advised my wife to have a colonoscopy. I offered to refer her to a bottom surgeon, a lovely bloke, quite exceptional in his trade. She declined.

I persisted: “Look, he’s gentle, kind…”

“I know all that. I’ve known him for longer than you have. I knew him when he was a medical student.”
“Then why not see him as a doctor?”

“No! I had the hots for him back then.”

“So? That’s not a disqualification, is it? Was he your boyfriend?”

“No.”

“Did he know you had the hots for him?”

“No.”

“So, why not see a great surgeon and a nice guy who never knew how you felt?”

“I don’t want someone looking at my bottom whom I felt that way about.”

My wife sacked me as her GP and consulted a stranger who sent her bottom to a second stranger.

What goes around comes around and bites you on the bum.

I reached the age of fifty and saw my own GP for a spot of preventative medicine. She said: “You’re Jewish aren’t you?”

I confessed I was. I had the scar to prove it.

“And you are Ashkenazi. You are in a high risk group for colon cancer. I’ll arrange a colonoscopy.”

I wasn’t keen. My wife had told me about the two-litre laxative drink that preceded the examination.

I bargained and we settled for the faecal occult blood test. She handed me a request slip that read:

Test requested: FOBT

Clinical Notes: 50 y.o. male Ashkenazi Jew.

I pictured myself lugging my specimen back to the lab in a shoebox.

I turns out they aren’t that greedy: two smudges would do.

The instructions and restrictions were detailed and grotesque. Being a doctor I didn’t read the leaflet too closely. Didn’t need to. I knew how to “produce a specimen”.

Next morning I awoke early, took my blood pressure tablets and my 100mg of aspirin and felt the urge for an early morning donation. I fought it off as I applied the Glad Wrap, discovering a happy concordance between the width of the wrap and the diameter of the bowl. (Is that cosmic chance or commercial cabal?)

I emptied my bladder elsewhere. (I don’t know what you are supposed to do if you don’t have a garden. Or if you are female.)  Finally I donated. Then I selected, daubed, closed, sealed, dated.

Then I forgot about the entire project. Three weeks later I got around to Specimen No. 2. I collected this and followed the earlier steps. With a light heart and a sense of virtuous health I delivered my daubs to Specimen Collection. Specimen Collection perused the paperwork, checked the dates. And rejected my specimens. Uncertain whether to be outraged or humiliated I asked why. “Dates too far apart.”

I never knew poo had a use-by date.

Back to the beginning. My specimens were collected in timely relationship and delivered to Specimen Reception. I waited in quiet triumph. Specimen Collection had some questions but wasn’t happy with my truthful and humbly virtuous replies. She asked: Did you eat carrot in the three days preceding each of the dates?

Certainly.

Raw?

Yes.

Did you brush your teeth the evenings prior?

Of course!

I am sorry but the lab cannot accept these specimens. Even a single violation voids the accuracy of the technique. Two violations are quite out of the question.

Look, ma’am – very politely, showing some of those teeth in a sweet smile – I am a doctor. I believe I understand the test. I’ll accept responsibility for any inaccuracy.

Sir, we are dealing here with cancer, with human life. The laboratory cannot compromise.

She handed me a new collection set. I stopped by the supermarket for more Glad Wrap and returned to my squat. Carrotless days and unbrushed evenings dawdled by. My teeth turned brown and my fibre-freed stools tore their way out. I sampled my moon rocks and I collected two specimens, a day apart. And returned to Specimen Collection.

With a lovely smile of her own Specimen Collection thanked me and said, See you next year, Doctor.

Er, thanks. Yes.

Oh, by the way, you aren’t taking aspirin are you?

 

 

Mouth to mouth

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Once a year your accredited family doctor undergoes retraining in CPR. Commanded to forget previous models she learns the latest tweak, he meets the newest gadget.

It’s pleasant, collegial, unreal.  They practise on a manikin. The plastic model lacks the saliva the pinking agonal froth. There are no dentures to yank out in a fret of haste, no sweat on the body that foretasted its death, no lips of purple grey in a face of grey.

My phone rang. It was a nurse in an outback hamlet no-one ever hears of. I know the nurse. I know her clinic.

“Howard? Thank goodness!”

A great indraft of air.

“There’s been a death. I have to report it.”

“What happened?”

“There was a fight. They’ve been rioting and fighting all week…” The nurse’s voice thinned and rose an octave. She gulped air.

“Someone raced into the clinic and called me out into the street. They said there was a man who was hit and fell and wouldn’t wake up. I looked down the street and I could see him, lying there. I ran and I asked what happened: a witness said he copped a glancing blow to the chin.  He said it wasn’t forceful.

I did CPR. I worked on him for a long while. I’m alone here. The only nurse. A copper helped me.

“Howard, I know him. It was Billy. He’s a lovely old man, gentle, you know. He was an old stockman. He always wore his old cowboy hat and his stockman’s boots. And now he’s dead!.

“Howard, we don’t have a morgue here. What do I do?”

I ran through the formalities, the bureaucracy of sudden death. There was a noise in the background, a moaning, wailing. Behind that, angry voices, shouting.

The nurse listened and took notes. Our conversation neared its end. Her work demanded and pressed but she didn’t seem ready to finish. She would be busy through the day with phone calls to the coroner, to the bush undertaker, and to the director of regional and remote nurses. There’d be the paperwork. And then she’d go home: home to her donger, the bedsitter that is really a shipping container; home to the memory of cold lips and the gentle fellow she liked and she couldn’t bring back.

“Howard, he’s lying here in the clinic. I checked him again in case I was wrong. But there’s no chest movement and I can’t hear a heartbeat. His pupils are dilated and they don’t react to the light. Is there anything else?”

There wasn’t anything else.

“Howard, Billy’s gone and now there’ll be Payback. He’s still wearing his hat and his boots.”

Ninety five years of wisdom

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My friend Dr Paul Jarret keeps his brain (and the brains of his scores
of followers) alive with his daily email transmissions. I receive an
average of four a day. Paul was a surgeon, an aviator, a morbid
anatomist (that means he cut up dead bodies to discover their cause of
death). He has a wonderful memory and a wry and tender way with words.
His brain will celebrate its 95th birthday this sunday.

Happy birthday, Paul.

May you live – and write – to a hundred and twenty.

Earlier today I received this from Paul:

Remembering the sessions I spent as a Medical student in the Surgical
Amphitheater I wonder what the Professor thought we could see from that vantage point? Surely when he was a student he sat up near the ceiling and like us was barely able to identify the incision, much less the viscera. I suspect that today’s Medical Students are shown videos down to the finest detail.

One of my classmates in the Amphitheater recognized one of the nurses down below although capped gowned and masked, by a mole on the back of her neck with which he was familiar. He obviously was not contemplating the origin of the cystic artery after recognizing that mole.

I can only imagine what it is like to be a Medical Student with computers,
modern models and all of the teaching aids available today.

In spite of such advances in teaching doctors, we still get sick an average
of 12 times in our lifetime and get well 11 times.

Medicine will become a Science when patients quit recovering to the surprise of the Physician and stop dying unexpectedly and for no apparent reason.

Between you and me and the American Trial Bar, it ain’t ‘gonna happen!

PBJ

The Price of Life in Doomadgee

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Just before noon the phone called me from the river to the hospital. The hospital held me until long past midnight.

A man with his jawbone fractured, pushed right out of alignment, said: “There was a fight. I was watching it and a man came up from behind, on my right side, and king-hit me.”

I called a plane to take Sampson to Mt Isa.

Eight thousand dollars.

 

A man came in and showed me his hand, puffed up, a boxing glove of soggy blood under the skin. Beneath the blood, the head of the metacarpal bone had snapped. I said: “You’ll need an operation. We’ll fly you to Mt. Isa.”

Eight thousand dollars.

 

On the TV Rafael Nadal struggled into night with back muscles in spasm. A chubby baby, feverish and short of breath, took me from the tennis. Over the previous day or two I had seen this baby at peace. He filled all who saw him with delight. Such abundant flesh, so well at home in grandmother’s embrace.

This was their third night visit in 48 hours. Grandma brought him in this time as previously. She nursed the weeping Buddha and comforted him. The rule in Aboriginal health says, “Three strikes and you’re in.”

I said, “He’ll have to go in. To Mt. Isa. You can go with him.”

“Grandmother said:” I can’t. I’ve got my own six-month old at home. I’m breast-feeding him.”

“What about his mum?”

“She doesn’t have him. I do.”

The letter from Child Protection said the same. So Aunty went.

 

Very late at night came an urgent call. The voice said: “A man has come in with a high temperature. He’s very old.”

The thermometer said: “39.9 degrees.”

That sort of fever says “sepsis.” In this man’s case his septicaemia arose as a complication of pneumonia.

I asked the man about symptoms. He shook his head. He had no complaints.

“What about pain?”

He said, “I think my head hurts.” He said it as if he was far from the pain. The pain was a sensation like memory; he had to summon it to name it.

The man sat bent forward, breathing quietly, speaking softly, his bushy moustache a permanent smile.

At his side sat a young woman. Her gaze never moved from the breathing old man.

I asked, “Is he your grandfather?”

She said, “Yes.”

“Will his wife come…?”

The young woman said, “No, just me. Me and my brothers.”

“He’ll need to go to Mt. Isa. Your grandfather is seriously ill.”

A sad shake of her head, She said: “I can’t go. My baby… My brother will go, one of my brothers, Ambrose.”

“How old is your Ambrose?”
“Eighteen.” Seeing the doubt on my face she said: “Ambrose will look after him properly. Us three – my brothers and me – we live with him, we look after him. We do everything.”

 

The old man’s vital signs went from worse to frightening. The sphygmomanometer said: “60/40”.

The Emergency Consultant at the Flying Doctor Base in Mt. Isa said, “The plane is on its way. Give him Adrenaline.”

We gave him adrenaline. We gave him three different intravenous antibiotics and a fourth, by mouth. Hunched forward, moving only zephyrs in and out of his chest, the old man breathed and the breath did not speak to my stethoscopic ears.

I said, “Please lie back if you can.”

He lay back, air moved in and out, the silver bush on his upper lip filled and emptied, emptied and filled, semaphoring life. The blood pressure machine said, “80/50…90/65…110/70”.

The young woman gave way to a brother. The brother, after a time, gave way to another. This was the eighteen year old, tall, thin, lightly muscled. His bearing was solemn.

The sound of an aircraft flying low overhead changed the tempo.

Quickly, quickly, gently, many hands helped the old man slide from the couch to the ambos’ trolley that he would ride to the vehicle and on to the airfield.

We pushed him towards the ambulance parked outside the front door. Lining the wall, gathering in numbers, gathering over the fretting hours of the old man’s time with us, waiting, standing quietly, were three daughters – themselves matrons – and men of all ages, boys, small kids supported on young hips and attached to slender breasts. Only minutes earlier the waiting room had been empty. All had stood outside in the dark and the heat. The chill of a hospital ward did not invite them.

All eyes now followed the old man. Hands reached for him. The ambos halted, the file flowed forward, a wave of silent care. I saw one woman, a daughter, her eyes swimming, her lips trembling. I stepped forward and said: “Your father has been desperately ill, but he seems to be turning the corner. He’s holding his own now.”

She said: ”He didn’t want to come to the hospital. He was scared. He thought you might fly him out to Mt. Isa. When they flew Mum out, she…” The voice, soft, husky, now faltered:“…Mum never came back.” 

 

I looked at the gathering and asked: “All these people – all his descendants?”

She said, “Yes, all his kids and his kids’ kids and their kids.

And there’ll be just as much family waiting for him in the hospital in town.”

 

The ambos took the old man away. The family melted away.

 

The senior nurse breathed out and said: “If I come to my final hours and I am surrounded by that much love, I will know I have lived a successful life.”

 

***

 

While the nurses tidied the Emergency Rooms, I wrote up my clinical notes. A nurse approached, apologetically. She said, “Would you mind? We have a lady here with a cut head. It might need stitching. It was a belt buckle.”

In ED an old lady sat. Seated opposite her, too long of limb to sit without sprawling, were two large men in navy blue with large guns at their hips.

I looked to the lady. She wore a patterned dress in black and white whorls. The bodice was splattered with red. Her head was a savannah of silver-black curls. I had to search for the laceration which was small and shallow. Blood had clotted in a thin line between the margins of skin. Nature had stopped the previously brisk bleeding.

There was not much to do, nothing medical.

I asked, “What happened.”

The nurse said: “Fifty dollars.”

The nurse shook her head. Was she angry? Disbelieving? Or simply busy with the wound?

She resumed: “Her husband demanded fifty dollars and when she didn’t hand it over he hit her with his belt buckle. Isn’t that right?”

The old lady spoke for the first time. She said, “Sixty.”

Unhappily, guardedly, I turned to the police officers and asked: “How can I be of help to you gentlemen?”

The taller one had blue eyes. His firm face softened. He said: “You can’t. We’re just waiting here until you’ve all finished, then we’ll drive her home. Don’t want an old lady to walk home alone. And it won’t be her home. We’ll take her somewhere else, somewhere safe.”

A crunchier cereal than usual

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While eating my breakfast cereal this morning I noticed a small brownish-black, curved item, the size and shape of a carraway seed. It didn’t taste like carraway, lacking that distinctive aroma.

As I ate I noticed more of these and removed some. The cereal I favour is GrapeNuts, manufactured in the USA by Post. It is crunchy and malty (and doubtless full of salt and sugar to enhance my hypertension and to speed the onset of diabetes.)
I really like Grape Nuts.
If you examine the packet you’ll notice the letter “K” that signifies its kosher status.
I tried to avoid eating the little brown-black crescents because, although they too were crunchy, and not without aroma, I could not be certain whether they too are kosher*,
Quite quickly I surmised that a mouse had breakfasted before I had and then used the cereal packet as his toilet. While chewing on my compound breakfast I thought of my friend’s brother who had invested all his savings in superannuation over a period of twenty years. One day the manager of his Super ran away with his life savings. My friend’s brother said: “It was only money. It was never really mine: money never is anyone’s – not permanently. It came to me from others and it went to my Super man. Now he’s spending it and it’s going to other people.” I realized that my GrapeNuts were just like that money. Made from wheat and barley, they came from the earth. They passed through my mouse and now they have entered me and will eventually make their exit and return to the earth. Like my friend’s brother’s money, the GrapeNuts were never really mine. Presently they will fertilize new wheat and fresh barley an someone else can have a turn.
Perhaps you will be next.
* Guidance from rabbis or others is sought on the kosher status of mouse droppings. As we know
a Jew may drink the milk of a non-kosher animal, so long as that animal is a human. Can we consume the ordure of another mammal?

GrapeNuts

GrapeNuts

What the Eye Will See

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A friend has published a memoir of his late father. When my own father passed away I wrote a memoir and published it.
The entire process was rewarding: I had honoured my father, I had told his story ‘that a later generation might know’. And I had managed my grief.
My friend Michael Komesaroff has achieved all those things with his memoir, “What the Eye Will See”. What stands out in the personality of Willie Komesaroff  (the author’s father) is his jealous protection of his good name, his deep to the bone integrity.
In addition to this private story the author has brought to bear the meticulous research skills that he employs as a visiting professor, consultant and journalist in his professional field, which is Asian mineral investment. The result is a small book with a big story. It is a very Australian story – the story of the Komesaroffs, a Jewish clan from the Ukraine; of their immigration to Australia during the years of the Russian Revolution at a time when Australian government policy expressly excluded migrants from that area.
How government policy was waived and how the Komesaroffs responded in the host country are the stuff of unseen greatness. This country’s gentile politicians who overcame public prejudice and government policy; the Moses figure of the Komesaroff clan who plucked his family from peril and set them up here; the manner in which that clan buckled down, worked hard, prospered, multiplied and rewarded Australia; this is the story of Australian migration success, writ large – but written as it were – in invisible ink. Such is the characteristic modesty and self-effacement of the Komesaroffs (noisy scion Michael conspicuously excepted) that although the clan is Melbourne’s biggest Jewish family and its members are giants of professions, they stay away from limelight.
“What the Eye Will See” allows us all to see and appreciate elements of the greatness of this country and the hidden greatness of some of its quieter achievers.
Michael invites my readers to the launch of the book. It will be a good afternoon.

What the Eye Will See launch invitation

What the Eye Will See launch invitation

The Birthday Card

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photo-1 photoI lent a book to a young woman I know. It was was one of those  works that tells you “How to Enrich your Life/Relationships/Soul” – books I find offputting because they presume to know me better than I do and to instruct me in a better path, the only path.

The young woman read to page forty or so and returned with my the volume and an expression of mild embarrassment. She opened the book and pulled out her bookmark.

I asked her: “How’s it going?”

“It’s quite helpful…”

I told her I never got past page forty: ”Too bloody know-it-all for me.”

But it wasn’t the book or its author that brought her back. The young woman handed me her bookmark.”This must be yours.” She blushed. ”I’m sorry, I found myself reading something personal…”

The bookmark was tiny, about two inches by three. Inches, because the card dates back to pre-metric days. It was was yellowed a little, its edges furred and thickened. On the obverse was a tiny posy of dried flowers, pressed, still intact. The date on the reverse side read January 8, 1967.

I think my mouth fell open. I recognized the handwriting – an odd and elegant hand, it looped and curled in a crisp and orderly way, warm yet somehow formal. No-one I know writes like that, not any more.

The writing was Mum’s!

The greeting was affectionate. It began, “Howard, darling…” It went on to congratulate me on my twenty-first birthday. The message spoke of my twenty one years, praising and prizing me in the way only one who had known me from birth could do.

I felt the rush and the glow of that primal love, the love that formed me. I felt deeply happy.

I looked up and faced the young woman. “Thank you.”

She averted her eyes from my face that was surely naked.

I looked down again and read the signature. It wasn’t Mum who had signed the card, but her sister, my Aunty Doreen. The handwriting so similar, the shared cuneiform of their bonded lives.

Now it was Aunty Doreen who returned to me, not displacing Mum, but present alongside her, together now as ever through their long lives. If Mum was Pollyanna, Aunty Dor saw a world in its rough reality. Orphaned early, the two turned to each other and went through their remaining scores of years love-laced and life-loving.

I held the card, soft in my hand, and thought of two women who knew me so well – better even than the author of the book I had loaned the young woman, witness to my intimate moment.

“Thank you”, I said again.

Two Doctors in Doomadgee

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Letter from Doomadgee

27 January, 2014.

 

Dear Australia,

 

Before I arrived the only thing I knew of Doomadgee was the name; that was the surname of the man who died on Palm Island. That name seemed compounded of doom and tragedy. But of the community itself I was glad to know nothing in advance of my arriving.

 

Steve the factotum drove me from the airfield. The aged street sign said:

 

Welcome to Doomadgee

Population 1200

 

Steve said: “More like 2000.”

I met the young Aboriginal doctor. He said: “More like 3000.”

 

A road sign said:

 

NT Border 103 KM.

 

The weather forecast said: Cloudy. Maximum 34 degrees.

That night the nurse said:” It felt hot so I looked at the thermometer on my verandah. The thermometer said: ‘52 degrees.’”

 

I said to the young Aboriginal doctor from Mt Isa, himself a grandson of respected elders of this community: “I’m the wrong doctor. I don’t have the language, the cultural currency…You are the right sort of doctor.”

He said: “There are nearly one hundred of us now. There were quite a few of us in my year at James Cook.”

The two of us spent most of Saturday together indoors. Between snatches of cricket and tennis on TV and poring over Murtagh’s tome on General Practice, he wanted to talk about religion (his new found Christianity, my old found Judaism), about work, about vocation. He asked me to name my favourite story from the Bible.

He told me his. I waited for a parable. Instead he said: “Jephtah and his daughter. I read that story and I put the book down and I said, ‘Lord, I need time to come to terms with this.’”

We spoke of our families and our upbringing, how he hankered for some city life while knowing his destiny lay in the country – on country – this country, this country his father had shown him and taught him and inculcated into him from early years; and I told him of my lifelong hankering for life outside the city while knowing my destiny lay there.

I said: “I wrote a book about my father – he was a country GP – and about my childhood in the country. And another book about my experiences working in remote Aboriginal communities. You can get copies of those books if you’re interested.”

He said: “No. I don’t read books. Only medical textbooks.”

I looked at him.

He conceded: “I did read two other books. My teacher said if I didn’t read them I couldn’t pass English.”

I looked at him again. I said: “I know you read. You read all the time – the Bible.”

“Yes. Yes, that’s so. I’m always reading the Bible. But books, they’re not in my background. We didn’t have books at home.”

After hours of searching conversation my colleague posed a question. He preceded it with a statement. He said: “I want my work to mean something. I want my working life to improve the lives of Aboriginal people.” He swallowed the consonants whenever he spoke that word. He softened the ‘g’ in ‘Aboriginal’ so it was like a triple ‘n’, gutturalised. He paced and paused, paced again. He said: “I want to ask you a question. You’ve been a GP for a long time; I am just starting. What should I do? I mean what should I do now, while I’m completing my training? What particular field should I try to master? What will be most useful for Aborinnnal people?”

I offered some answers, thinking aloud, feeling my way through a variety of ideas. Eventually I said: “Any answer I give will be less important than the question.”

“What do you mean?”

“I mean, you aren’t asking a casual question. This is a quest. So long as you keep asking I think the quest will lead you where you need to go.”

Then I said: “You know we whitefellas do our best but we never achieve what we set out to do. I think the answers won’t come from whitefellas alone; some of the changes have to come from blackfellas. It will be like cancer – you don’t find the cure, the single thing that wipes out the entire problem; you find an improvement here, a sectional breakthrough there. So the Pearsons and Yunipingus and Langtons and the others, they’ll come up with some initiatives; and some of those will take root and some might bear fruit.”

My friend nodded hard. He said: “Exactly!”

 

***

 

On Australia Eve, the rain belted the roof all night. Australia Day dawned bright, cooler. We went down to the river. At the spillway the Nicholson flowed a kilometre wide. Warm brown water, shallow. Steve had said: “No big crocs here. Only little snappers – freshies.”

I trusted him. I waded with the younger doctor through warm shallows down to the waterfall. Everywhere we went in those shallows Aboriginal toddlers paddled, babies sat on the laps of slender young mums. The Nicholson flowed a thin caramel around and over shiny brown bodies.

The young doctor spoke to all he met. All were, one way or another, his kin. He said: “Hello brother”, and “Hello sister.”

He said, “Hello Aunty”, and “Hello Uncle.”

He knew what to say, how to say it. He found connections with strangers.

He knew his country; he was the right doctor; he had the language.