What does it all mean? – 2

The Dean encourages us students to wander the wards, to seek out patients and talk with them. I approach the bedside of a thirty-year old woman lying in her bed in the Medical Ward. I’m not hunting a diagnosis; the nurse has already given me the answer – breast cancer. Cancer! All I know of the disease is it’s a killer. Here before me lies a person of my generation who is going to die. The knowledge fills me with horror. Does she know her diagnosis? Does she realise she will not live long? How do I talk with her? I turn to sneak away, but she’s seen my approach and heaving herself to sit.

Good afternoon. I’m a student doctor. Would you mind talking with me for a while? Or would you prefer me to come back another time…?

No, doctor, we can talk.

Thank you.

My name is Howard.

I Anastasia.

Hello Anastasia.

The woman returns my smile of greeting with a weak smile of her own.

I sit.

What brought you to the hospital, Anastasia?

My breast. The woman points to the right side of her chest. Before two weeks I see the skin looks different, sort of rough, like an orange. 

At first I put moisturiser. But when I have pain I see my doctor. He sends me here. But soon is worse.

The pain?

No, the skin is break, then is bleeding, now smells bad.

A pause. My thought is all too clear: roughened skin is evidence of something growing within, tethered to the surface by fibres. The skin breaks down and bleeds

as the tumour grows. Any bad smell would indicate bacterial action on tissue that has died. You stink before you die! You live in self-disgust.

Anastasia, I cannot smell anything bad.

I put perfume, after shower, many times in day. I want smell nice when my little girl come after creche. Now I pregnant but I don’t see this baby. Is cancer, I dying. Anastasia points to her belly, which I had not noticed until now, is quite rounded. Anastasia does not look wasted, the contrary. She has plump cheeks, her hair is black and lustrous, her eyes shine. A closer look and I see her eyes shine with tears. 

Perhaps, the doctors are wrong, perhaps the diagnosis is mistaken. Anastasia looks too well. But no, beneath the scent that Anastasia has applied liberally I catch a whiff of rotting.

My mind rebels. Anastasia, they can do operations for cancer…

I stop. Anastasia doesn’t look at me. Face down, upper body shaking, she weeps quietly. She shakes her head: Is too fast, is too late.

Anastasia, you’re upset. I’m sorry I disturbed you. I’ll leave you now and let you rest.

I rise to leave as the woman weeps.

I can’t bear it. I add, I don’t think you will die. The doctors will make you better.

I leave the young woman with her knowledge and my lies.

I know the meaning but I cannot say it.

I leave her alone.

I retreat and I forsake her and I deprive her of moments when she might have sat quietly with another and shared meaning.

On the day of our encounter, that idea never enters my mind.

But fifty-four years later I feel disgusted with myself.

What does it all mean? Part 1

We’ve rushed here today, to the Operating Theatre. During this Rotation we are to follow the surgeons wherever their work takes them.
A couple of weeks ago the young surgeon whispered: Don’t rush home this evening, Howard. Something’s going to happen,
something historic. I didn’t rush home and history did happen – Australia’s first heart transplantation. A few of us stood outside Theatre and waited. Somehow it didn’t feel anticlimactic to miss the experience, to stand adjacent as history happened. We sensed the meaning.

This afternoon the call came: Emergency surgery in Theatre. Come now!
The boy on the table was riding his bike home from school when he was hit. He wasn’t too bad at first but then his blood pressure fell,
and his heart started to race. His skin colour turned to parchment and his belly began to swell. His trolley bursts into Theatre and the Surgeon’s Apprentice begins to cut into the distended belly without waiting for anaesthesia: the boy had been deeply unconscious since he arrived in the ambulance. The Chief arrives, flings on gown and gloves, no time to wash, takes over the operation. A mild man of about sixty, wise, he’s not reflective now as he slashes the belly widely open and a tide of blood pours over both surgeons, onto the floor.
Suction!
Artery forceps!
Artery forceps!
Artery forceps!
Frantic action above the table, quick mopping at the feet of the surgeons, lest they slip and fall.
The tide of blood does not abate.
No speech, nothing heard apart from fast movement of limbs as they grope and suck and search slippery viscera for the bleeder.
Artery forceps grab suspect bleeding sources but the flood does not slow.
The blood they are transfusing is insufficient.
More blood!
A second transfusion starts.
The anaesthetist’s voice says, we’ve lost the heartbeat. There’s no blood pressure.
The surgeon works by feel beneath the surface, groping, hoping, grasping at straws for the unseen splenic pedicle.
The anaesthetist injects adrenaline, massages the heart.
He looks at the boy’s pupils. They’ve dilated. He shines a light to see if the pupils will shrink by reflex. He’s searching for vitality of a brain that’s had no supply of blood – for how long?
Too long. The reflex is absent. He leans over the boy’s pale face to his colleague and taps him on the arm: He’s gone. We’ve lost him.

All this took place in 1967. I don’t remember feeling stricken. Was I numb perhaps, with horror? With self-terror? I caught the event but I missed the meaning.
The boy was twelve years old. His hair was fair and he was lightly freckled. Today he’d be old enough for the pension. I feel stricken now. Riding my bike – yes, a bike: the connection passes me by – riding to the shops this morning, I feel the enormity and my feet fail on the pedals.

(This is the first in a series in which this old doctor recalls and reflects and wonders.)