Faith and the Flu Vaccine

Some trust in God, some trust in nature, others trust in nothing and no-one.

The roots of these feelings lie deep, too deep generally for the light to penetrate.

These feelings are almost religious: they express some faith or, occasionally, a fear of all faith.

If you try to debate feelings of this nature you’ll find them impervious to argument. They are held sacred and well away from the light of enquiry.

If you believed I held a particular faith you might consider my belief absurd. But because of your good manners you’d probably keep that view of my quaint beliefs private. You’d realise argument would not budge me and, out of kindness you’d refrain from locking horns with me.

Circumcision evokes a great example of quasi-religious positions. Whenever you hear the subject discussed you’ll recognise the intensity with which a person expresses a position. Here we find conviction, not opinion. Convictions are guarded fiercely, they are immune to fresh evidence: conviction is the opposite of scientific openness of mind. I have noticed how lay people, doctors and nurses alike defend their positions on the foreskin with religious intensity. I do not argue with the foreskin zealot.

Winter has come to Australia with promise of our regular influenza epidemic. With winter comes a rise in religious sentiment on the matter of immunisation against the flu. The government preaches immunisation, we doctors echo with our own hosannahs, the trusters in nature shriek back. We all talk at each other. We find it hard to listen when our faiths collide. Doctors trust in herd immunity. On Facebook my daughter tells ‘friends’ she trusts her doctor father. One respondent trusts in nature (“I‘ve been vegan for seven years, and I’ve never had the flu during all that time.”). Another respondent trusts no-one and nothing (“ It’s a conspiracy. Big pharma in cahoots with government.”)

I looked up some facts about influenza and vaccination. I found plenty of facts but these will change few minds. (Two thousand proven influenza deaths. Lots of people become unwell in the two weeks following vaccination. Not everyone who is vaccinated with be immunised. Not a single proven death from the vaccine.)

I had been doctor for two weeks when I saw my first influenza death. The patient caught the flu late in pregnancy. She deteriorated rapidly, developed pneumonia and was soon brain-dead. Her baby was delivered by emergency caesarean section and lived. That baby never knew her mother. Mother was twenty-four years of age. That was my own age at the time.

Last week I vaccinated my children and my grandchildren against the flu. I had the vaccine myself. I offer the same vaccines to all my patients. I answer their questions, I provide information, but I don’t enter into religious disputation.

I Feel Free

While my daughter is away I feel free…

My elder daughter and I share an understanding: I will write pieces for this blog and she alone will post them. The arrangement rests upon our secure shared knowledge of my technical incapacity to do the posting.  It rests too upon the lovingkindness of the daughter*.

That daughter is away. A small item has germinated in the deep soils of my being and it presses urgently to find the light. That trifle cannot possibly be a blog post, because, as I have mentioned, the daughter alone is blogenabled. What follows must be something different. It is the unripe fruit of my liberty.

I met a man the other day who was unwell. The man smiled a mouth of American teeth. He wore a white shirt, a dark tie with a tiepin and a name tag. The name on the tag read ELDER BLOGS**. The man was young, slim, erect in his bearing and he was bearing up despite being quite unwell. Elder Bloggs was accompanied by another young man, equally erect, endowed likewise with enviable teeth, a similar black tie, a very white shirt and a nametag of his own. This read: ELDER MAO**. Elder Mao spoke American but he was evidently Chinese.

We spoke of illness and of healing and we agreed I should try my hand at the latter. The Elders visited me again the following day. Healing was underway and we had leisure now to speak of other matters.

I asked Brother Mao: Is your family still in China?

Yes.

The American teeth appeared in affirmation.

Do they share your faith?

Yes.

Is it permitted in China?

Yes. In the family. I mean privately.

More teeth, to allay any misgiving.

Addressing both Elders I asked: Are you preaching the Gospel here in Australia?

Yes. Nodding of heads. Many teeth.

But – reverting here to Brother Mao – Is it permitted to preach the Gospel in China?

Oh no.

My eyebrow invited the Elder to elaborate.

It is against Government policy. China is atheistic.

No teeth. A worried look.

I resumed: I understand Falung Gong followers can be punished for teaching their practices. Do the same rules apply to you?

A nod. A serious look. No words: not apparently free to elaborate further.

I remembered Tiananmen Square.

I remember the times.

I remember the times of the Aboriginal man in the Channel Country who reminisced on his days as a cattleman. He looked back on those days with pride, long days that stretched into weeks on the track. Those periods of freedom punctuated the other days, days that were years on the station where he was bound, not at liberty to leave the boss’ employ. One man did and the cops hauled him back to the station where the whitefeller bosses whipped hi with iron chains. I calculated our age difference. When this man was eighteen I was ten, growing up in liberty. I learned at school of William Wilberforce and the ending of slavery. I lived in Australia. We didn’t have slavery in Australia. I remember the times.

I remember the times when we took away the children and gave them to whitefellers. I heard my parents’ friends say: They are going to good homes.

I remember when liked to wear Nike running shoes. But then I learned of child slavery in Asian factories.

I remember the times in Broken Hill when children as young as twelve were dying in the mines, of accidents, of lead poisoning.

I remember the times when my tribes lived in Judea under the Romans. They were times when great rabbis were burned alive for studying Torah.

I remember the times when we were enslaved in Egypt, times when they stole the children and drowned the baby boys.

I remember slavery in Auschwitz. If I went to the right I went into slavery. The slaves were the luckier ones.

Tonight, at home here in lucky Australia, I’ll lean back, a free man, and I’ll drink four glasses. I’ll tell my generations of the times when I was a slave.

And if they ask: were you a slave, Saba? – I’ll tell them I’ve never been to Egypt but I remember the times. I’ll tell the children I mustn’t forget the times.  If I ever forget I won’t deserve to be free.

* both daughters actually. The younger, removed geographically, is spared the call of this blog.

** I have changed the Elders’ names.

National Emergency

I should declare something at the start. This short piece is about cricket.

WordPress gives me to understand 364 persons follow my blog, a figure to humble and amaze.

I reckon about one hundred of you three hundred and sixty-four can tolerate cricket. The rest of you wish it out of existence, or at least you wish there were no broadcasts of five-day Test Matches.

I regret this post will alienate 264 friends. I do not write this lightly, however.

Perhaps thirty years ago my wife and I watched a rivetting live performance of ‘Equus’, a play by Peter Schaffer. It tells the story of a youth who attacked a number of horses, blinding them.

Towards the end of the play, a psychiatrist accuses a second character – more in sorrow than in anger – ‘You have done a thing that cannot be forgiven. You have destroyed a person’s worship.’

A memorable line which I was unable to fathom at the time. I can fathom it today. They have destroyed my worship.

Let me declare a few truths:

1. A cricket ball is a sphere, with two parallel ridged lines around its equator.

2. Australians playing cricket for our country don’t cheat. A former Captain of South Africa cheated. A number of subcontinental players have cheated.

3. Some Australian men playing cricket for our country are appalling sports in their disrespectful conduct towards opponents.

4. Our last four national captains have tolerated or fostered or led this behaviour.

5.Steve Smith does not cheat. He has suffered one episode of ‘brain fade’ as national captain that led him into breaching the Laws of the Game. But he does not cheat.

These things I have believed. I believed them long after ‘The Tour’ (of France) rotted in public; long , long after Ben Johnson destroyed my worship of men’s Olympic sprinting; long after East Germany destroyed the worship of women’s Olympic running. I knew we played fair in cricket, that is we played within the Laws. I watched our present Captain bat and bat and bat, I watched him rise and rise, I looked at his baby face:

butter wouldn’t melt in his mouth. The worldcupniks – I mean the men at the top – gave us a World Cup in Russia and will give us another in Qatar. Who can enjoy that beautiful game mired in such filth?

Russia under Putin has destroyed worship wholesale. A nation – an entire region – lived to see democracy, lived under Gorbachev, experienced the birth of belief. Putin destroyed the worship that was belief in democracy. His henchmen have destroyed the worship of sport. America has elected a taxcutter who promised to reveal his personal  taxation details – ‘later’, he said. ‘Later’ came and he promised never to reveal them.

Who in that great republic can believe that paying taxes is fair? Straight? Decent?

Overnight in Capetown, where Australia’s cricketers are engaged in a mighty contest, cameras caught a junior-ish Australian player deliberately damaging the cricket ball. The effect of such tampering is to change a perfect sphere

into an irregular object, one which will not obey the same Laws of physics that apply to a sphere. Opposing batsmen, unable to read the ball, would be dismissed easily, unfairly, inequitably. Australia’s Captain and Vice-Captain have admitted they put the younger player up to it. They have been stood down, ‘pending an investigation.’

After his earlier ‘brain fade’ I believed in Steve Smith. It offended me that others, loudest among them India’s Captain, Kohli, accused Smith of cheating. It distressed me that one of Kohli’s venerable predecessors, Sunil Gavaskar, echoed that accusation. Those men did not share my worship.

In a tale that is as famous as it is unreliable, a child fan of the Chicago White Sox confronted his idol, Shoeless Joe Jackson, who had been implicated in throwing matches: O, say it aint so! –  cried the child.

Jackson and seven others were banned from the game for, life. To understand this, know Jackson was, like Steve Smith today, the greatest batter of his era. He was stood down for life. From this day forward, whenever Smith (or Warner) will take the field for Australia we will be a nation in disgrace. Be assured our cricket bosses will see to it these two will serve terms of derisory brevity: they are, after all, our two best batters. We will sit alongside Putin’s Ministry of Sport and the bosses of the World Cup.

I am not alone. A nation has lost its worship.

The Lady in Seat 22 F  

Somehow the airline separates me from my wife. They allocate Annette seat number 21 C and they give me 22 B. Arriving at Row 22 I find seat B occupied by a young mum with a baby on her lap. The baby is asleep. The young woman explains: ‘The cabin attendant switched me so my Mom and I can sit together. Do you mind?’

I don’t mind at all.

The cabin attendant appears at my elbow. ‘Seat 22 E is free. Do you mind sitting there?’

I don’t mind at all.

I take my seat between a youngish man and a younger woman. He’s a muscular nugget. His fair facial bristles catch the morning sun and glow gold; she’s slim, no whiskers, café au lait skin. The man busies himself with his keyboard. I open my paperback. The lady smiles, says, ‘Hello’. I catch an accent, try to place it. Guessing she’s a Latina I prepare some Spanish. ‘De donde estais?’

‘Not from Espain. Not from any espanish speaking country. Try to guess.’

‘Slovenia?’

The smile widens. She shakes a lot of wavy hair: ‘No.’

‘Turkey?’

More hairshaking. She’s laughing now.

‘One more try.’

Guessing wildly I try Portugal. She laughs a merry laugh. ‘No. Saudi Arabia.’

Golly. No head covering, light brown hair, pretty conventional western dress.

‘She proffers a child’s hand: ‘My name’s Amy.’

Golly.

‘Hello, Amy. I’m Howard.’

‘What is your country, Howard?’

‘Australia.’

I give her time to absorb the incredible. Then, ‘You are Muslim?’

‘Yes, of course.’

I remove my cap, lean forward, reveal my yarmulke: ‘I’m your cousin.’

The smile widens. She’s delighted: ‘You are a religious man. I pray every day five times. I am estudent.’ She names her university in Los Angeles, a name not known to me.’ When in Saudi Amy wears her head covered, ‘only my face you can see.’

Amy tells me of her two brothers and her sister who are back in Saudi Arabia, with mother and father. A second sister is studying in LA with Amy. She points to a rich head of darker hair that crowns a quite ravishing face in a nearby row,

I spend some time pondering the life of a young Saudi woman on a US campus. A woman who dresses western and prays every day five times. Pretty brave, I suspect. And incidentally, pretty easy on the eye.

‘Amy, why do you take the risk of speaking candidly like this to a strange man?’

The head lifts and she regards me, smiling a little as to one who is naive: ‘Instinct.’

Back to my paperback. The young bloke types something about a baseball match. The young woman takes out some study sheets. I sight some highlighted terms familiar to me – homeostasis, perception, adrenergic flight/fight response. The head of wavy hair bends over the notes, a child-size finger traces the lines, her lips frame the foreign words.

‘What are you studying?’

‘Clinical Psychology. And what is your profession?’

‘I’m a doctor.’

‘That’s good. Maybe you can tell me what is homeostasis.’

I tell her what I understand by that term, the neologism I encountered first in 1965, a word that widened my mind.

Amy nods gravely and thanks me.

After a while Amy sets Clinical Psychology aside. She looks at my book and asks:’ Is that a good book?’

‘I think so, yes.’

‘But you do not know?’

The book won a Pulitzer. A close friend pressed it on me, saying: ‘Read it if you want to know DR.’

Do I like it? Not much. At least not yet. The plot, yes; the characters, yes yes yes. The style, not much.

Homeostasis is simpler to explain than ‘I think it’s a good book, but I do not know if I like it.’ A deep breath and I essay some literary criticism: ‘This book won America’s top award for literature. I think it gained attention for its unusual style of writing and for telling the modern history of the Dominican Republic in the story of one unfortunate family. The writing is bright, the story is dark. The language is lively, plenty of street talk. Every third word is nigger, every fourth word is fuck.’

I pause. No shock registers on the estudent’s face.

‘The characters are vivid and their story is dramatic. So, yes, I think it is a good book, an important book. Even ‘though I do not enjoy it much. Yet.’

‘You read many books?’

‘Yes, I do.’

‘Tell me please what books are good for me to read. Books you do like.’

She couldn’t give me a pleasanter task. The flight from Los Angeles to New York takes four hours. That might suffice. I speak of my favourite of all books written in the twentieth century. This is the book I read at Amy’s age ( I’m guessing here she’s as old today as I was fifty years ago): ‘The Leopard, an Italian novel of an aging aristocrat – you know? (Amy nods) – he sees the life he has known and loved, a life of privilege, passing. He knows that life will be lost.’

Amy remarks, ‘Life in my country is also changing… Slowly.’

Next I speak of Anna Karenina. ‘This is also an old book, more than one hundred years, written by another aristocrat, Leo Tolstoy. It tells the life of a woman who disobeys the rules of her society and obeys only her passion. She loves a man who is not her husband. I like this book very much; I respect Anna’s courage but I am angry at her too. I am angry because she turns her back on her son, a small boy.

‘It is an important book, one of the earliest books to give a woman strength, courage to make choices and to follow her own path.’

I watch Amy for signs of disapproval or discomfort. No sign of either.

‘Although I don’t entirely like Anna, the character, I like the book. The author shows us life. Like Shakespeare, he knows the good and the bad, the strong and the weak. He knows them and he shows them. He is not the judge, he gives us the life.’

‘And one more. This is maybe America’s most beloved book of the Twentieth Century. I love it very much. It is called, To Kill a Mockingbird. It is written by a woman, Harper Lee. The story is told in the voice of a small girl who lives in a town in America’s south at a time when many white people showed no respect for black people. The girl’s father is a lawyer who tries to save a black man who is accused of raping a white woman. You read this book and you love the father and you love the child.’

Amy asks me to write the names of the books she should read. It dawns on me I’ve recommended three books that challenge old norms. The books subvert male dominance, they chart the passing of feudalism and ancient authority, they show the rule of equal law.

I have lots of questions. Amy answers them readily. No she doesn’t go out with men (‘I am a good Muslim’), but she had been engaged to marry a man whom she chose. That was back in her home country. Later the engagement ended, the free decision of both. No hard feelings, no honour issues. It occurs to me Amy has found in Seat 22E a Father Confessor. I wonder about her vocation: I don’t know anyone who works in mental health who enjoyed an easy childhood.

The aircraft’s engines keep up a steady hum. Conversation is hushed and most passengers sleep. As Amy sits at the side of one of my deaf ears, there’s no lip-reading and I miss some of her speech. When I ask, ‘What work does your father do?’, I miss her reply. She repeats : ‘He’s a general in the Air Force.’

Golly.

She adds, ‘My mother is a school teacher.’

‘When you finish your studies will you return to your country?’

‘I will visit. My older sister has two babies. I must see them. But my life, I think maybe here in America. And my sister Sara, she is here.’

My mind races from question to question: Is Amy the right sort of Muslim – by the lights of the current President – to be admitted to the USA? What does Daddy the General think of Amy’s choices – dress, spouse, profession, place of residence? All her choices bespeak independence but in reality she must be completely dependent on Daddy. Amy has none of the bearing of the rebel – there’s nothing defiant in her speech – yet her Americanness must challenge Saudi norms. I think too of the engagement of the Saudi’s military – especially the Air Force – in the nasty war in Yemen. A Saudi general would be a serious man.

These are questions this old man does not ask. Meanwhile the estudent has put away her study notes, buried her head in a blanket, tucked her legs beneath her and, by some miracle of youthful calisthenics, made herself comfortable enough to sleep. For the next two hours the Princess of Araby slumbers in Seat 22F. She awakens as we descend, smiles, shakes my hand and asks, ‘When will I meet you again, Howard?’

Summer Stories: Just Dirt

Before arriving in Coober Pedy I read of The Breakaways, an accessible scenic spot of some sacred significance. Once in town I asked directions. These were simple enough to alarm me: ‘Turn right at the Stuart Highway, turn right at the signposted track and drive to the end of the road.’  And – ‘You  best get there in time for sunset or sunrise, when the colours are stronger. Other times it’s bleached by the sun.’

The Stuart bisects our continent. I’ve never found myself alone on the Stuart before. The road roars with lorries and road trains that hug the tail of your smaller vehicle at their permitted 110 kilometres an hour. But this early morning my car alone moved through the dark along the Stuart. Cloud covered the stars. The car radio was silent. A velvet cloak sat upon the earth. I knew I was alone.

The kilometres slipped behind me as I raced to catch a doubtful sunrise. A tiny signpost flashed into sight and out. Had I missed the turnoff? I laughed aloud at my famed ability to get lost. But no – a few minutes on a large sign read: THE BREAKAWAYS. So-named, I read, because chunks of the planet appear broken off from the surrounding scarp.  One or two locals, indigenous people, shrugged when I mentioned The Breakaways: ‘Never been’, said one. ‘Just dirt’, said a second.

The velvet was breaking up. Teal blues split the clouds, a lightening over my shoulder from the east, the dark surface now reddening, the black grasses greening. Earth awakening, but everywhere, silence, stillness. The dirt track shifted beneath my tyres, the car, tipsy, slid from side to side, my passage never quite controlled, not fully skidding. Up a rise, the end of the road. Once out the car the first sensation a blast of wind, night-cooled, but warming towards today’s 46 maximum.  A wooden barrier separated me from a sudden void. The earth fell away at my feet, a vast valley, roughchopped, opened before me. The wind tore up the slopes and away. Nothing else moved. No sound. No life. Stepping forward felt like sacrilege.

I stood still and gazed, astonished. Unprepared for an encounter none could prepare for, I simply stood. My eyes flew up the slopes of table-topped massifs and followed the fall of abrupt clefts. Hills of caramel pink and nude rocks of white ochre in a repeating pattern of rise and fall, fall and rise. And no sound at all. Was this the birthplace of the world? Would that scrubby shrub at the valley floor burst into unconsuming flame?

I stood for some time as one at prayer. I knew an aloneness and a silence and a stillness that must have spoken to my soul. In time I returned to time and I took up the elements of my ritual dawn prayers and I prayed and I gave thanks. I felt kin to others who have stood here over the millennia and contemplated creation. I made my poor homage.

At length a living thing came to me in the stillness, a blowfly. The fly sniffed and sipped, and finding my skin dry, it went its ways. The wind whipped my tallith which made to join the insect in flight. Alone again, no human on earth today had better access to his Creator. If a voice had called, ‘Howard, Howard’, I believe I’d have answered, Hineni.

My prayers done I walked to the display that detailed the nearby salients. The text, authorized by a local elder, hinted opaquely at their sacred significance. The place has its true name, Kangu. Behind me at a short remove was the bearded dragon, Cadney, over there was Pupa, two dogs lying down.  And in front was Kalayu, the emu, father caring for his chicks. The area is an initiation site for young boys. Its elaborated meanings are secret, forbidden. This is meet. Sufficient to be here in mystery.

A side track to Pupa beckoned and I ran. Ochreous powder cushioned my feet. The track took me down and around. Soon I was at the valley floor and the mighty forms rose up, thronging about me. This was ‘just dirt’ and I human clay, a small thing in all the greatness. I thought of the miracle of being, I thought of annihilation. So easy here, to slip, to fall, to break an ankle. In a day or two the heat would finish a crippled runner. The thoughts carried no drama, little colour. Death in this valley would be ordinary; it was living and moving that were out of the order of things.

I was alive and moving. I turned and I ran back up the hills.

Love

I realise I have written little in this blog that does not touch on death in some way or other. I have written less of love. Probably I write of death as one preparing for that moment of truth. I write myself toward it and around it as one not yet in it. The pursuit, neither morbid nor frivolous, is the necessary (if deplorable) corollary of growing up. If I write little of love it is because I dwell within it and have done all my days. But the third day of December arrives every year and it reminds me.

Here then, conceived on December 3 2017, is a love story.

My wife is married to a pleasant enough man. I’ve known him for a long time, and although I admire him generously, yet I concede he is not perfect. My wife has put up with imperfection, with hopes incompletely realised for 48 years. On December 3 this year she gave her spouse a card, upon which the following words appeared:

This is my wish for you…

 

Comfort on difficult days,

Smiles when sadness intrudes,

Rainbows to follow the clouds,

Laughter to kiss your lips,

Sunsets to warm your heart,

Hugs when spirits sag,

Beauty for your eyes to see,

Friendships to brighten your being,

Faith so you can believe,

Confidence for when you doubt,

Courage to know yourself,

Patience to accept the truth,

Love to complete your life.

 

 

Better than the average Hallmark homily, I thought. And indeed the name I read beneath these lines was Ralph Waldo Emerson.

But the platitudes of the great philosopher were not penned by my wife. I opened the card and read her handwritten message.

I won’t share those words beyond this: my wife commanded herself to love me for a further 48 years. I did a little weep for joy and for thanksgiving. And the words remained in me, resonating, lighting the damp and darkened world about me. We drove to the country to lunch as the guests of our recently widowed friend. Aged in her mid-nineties, our host prepared our meal with dogged independence and perfect accuracy. We sat in her sylvan retreat and we shared her sorrow. For the first time in our long friendship our host’s beloved was absent. Only love abided.

Outside the window the green world was soaked by unseasonable rains. Behind and above the green the world was grey. Suddenly my wife started: ‘Look!’ she said. I turned and looked and there, a glory of gold and green, sat a king parrot, nibbling the widow’s birdseed.

Love lit my night. I recited my morning prayers and read the Shema with its credo. Immediately following the words of that key formula of faith was a concrete Commandment. And the command was love.

I opened the novel* that my men’s book club will discuss tonight. The editor wrote: If the novel can be said to have one central idea, it is surely of love, the many forms love takes…’a passion neither of the mind nor of the heart… a force that comprehends them both.’

 

 

 

 

*’Stoner’, by John Williams

 

 

 

 

 

Conversations

After I started posting some thoughts arising from the current euthanasia debates, four women whom I hold in esteem wrote in strong response. Two wrote openly on the blog, two privately. I will refer to them respectively as B, M, G, H.

B wrote: Hi Howard,

I’ve just read your maybe not rousing speech but impassioned piece on euthanasia.

If I should be dying and I should be in unbearable pain, and if through that pain I was not able to continue to relate to my loved ones other than to be overwhelmed by my pain, you would be one of the doctors I would reach out to to put an end to my pain and possibly my life.

Will you refuse me?

I first met B in 1971 when she brought about my birth as a doctor. I have not treated her since. Instead we have become colleagues and friends. B’s note shifted my thoughts from the abstract to the concrete. Here was a cry coming from deep in an ancient moment in my formation. The person who wrote is concrete. Reeling somewhat, groping for self-knowledge, I responded speculatively:

Dear B,

I cannot know…

I suspect love would defeat principle or conviction or predisposition to life.

In other words I do not know myself in abstractions but in my instinct and my sentiments.

My ancient affection for you, my strong drive to help – which surfaced in your case in c. 1971 are as likely to govern me as any personal ‘rule’ or law.

I am sure if someone came and demanded I act in any given way my instinct would be to resist.

I anticipated readers would respond with passion and with pain to my piece.

I was right…

You asked would I help you.

I know I would try.

I cannot predict what shape my help might take.

This is a heavy matter. No light answers. And for me, no right answers.

But love will govern.

B again:

From feeling like I was falling into a chasm your response came as a hand that reached out to stop me hurtling to my death. Strange metaphor given I was talking about asking you to help me to die. I am much relieved that love will play a big part in your decision making process, over and above noble and fine principles.

But the debate hypothetically may be akin to Solomon’s choice.

Let’s talk.

My friend G is another colleague, a person raised in a strong religious framework from which she emerged to find and form her own way. I suspect her hard struggle for freedom has left her with a strong respect for my right to find and form a path of my own. G asked:

Would you be comfortable referring one of your patients who met the criteria to hasten their end to another GP who you knew would agree to assist in that wish?

And if that patient asked you to be present during the event would you?

How much do you think religion affects your current view? Or are you unable to separate your religious self from your professional self?

All F’s questions arrived as text message on my phone. Like death a phone message catches one on the hop. An answer will be less considered, perhaps truer for its spontaneity. I wrote a text back:

Hello F,

I’m pretty sure my religious self is absent from this.

It’s as if something deeper and defining is at play.

I imagine that ‘something’ is what brought me into Medicine.

And that drive collides here with itself…

But on the other hand, it was religion that framed my earliest thoughts.

It is on reviewing the texts that I regret not telling F at the outset: I can’t imagine doing anything I will find comfortable. The best I can hope for is to be comforting.

But if a patient wants me there at the end, yes, of course I’ll come. I’ll want to hold her hand as she passes over to ‘that quiet land.’

F resumed by email:

I find people’s responses to this topic rather fascinating (and at times irritating). So many reactions are full of judgement and criticism when it’s a topic that requires the opposite – compassion, objectivity and an acknowledgement of all of the grey. It would appear that a single (subjective) experience of dying makes some people self-appointed experts on the topic. I am of the thought that there is no ‘truth’ in any one person’s experience. And I wonder if those who react so emotionally to the idea of not having the ‘right’ to hasten their own demise have been more traumatised/suffered by the dying of another than the person who was actually dying?

What do I know? I do know that I would prefer not to die of bowel cancer. My experience working on GI wards is that that would be a shithouse (excuse the pun) way to go. I know that until I am dying of a known cause I won’t know if I want the option to hasten my demise or not. I know that having witnessed many people dying of a known cause (some in pain, some in discomfort, some in fear) that I’m still not convinced that assisted death is the answer. But I’m not convinced that palliative care is the answer either – theoretically it should be but I doubt it will ever be financially. I know that those who have reached the palliative stage of their illness should never be admitted to an acute care ward in a hospital – I’ve witnessed far too many cases of what I can only term the neglect of those in their final days/weeks in acute care wards. And the reluctance of acute care nursing and medical staff to adequately manage final stage symptoms. I want to believe in palliative care but I’ve been waiting too long for results.

I know that if you were my GP and I had a terminal diagnosis, I would feel like I had the best GP in the world. I would know that when you asked a question you would be genuinely interested in the answer. And I would believe that you would have a moment of quiet grief when I left this world. And that would be a comfort. As a nurse I never felt any sorrow for an anticipated death of a patient – the overwhelming emotion I felt was relief. Relief that there would be no more pain, no more nausea, no more confusion, no more discomfort from lying day after day in bed waiting to be turned brusquely. But I have a feeling that you experience a moment of sorrow for each death – correct me if I’m wrong.

If I were your patient and I asked you to help me die and you indicated that you couldn’t then I believe I would want your help to find a doctor who would be willing. I would appreciate that you would feel obligated to offer alternatives but if my mind was made up and it was legal then I would want you to support my decision. You might not support assisted dying on moral and ethical grounds but having come reached a fully informed decision I would want your compassion to make that referral to a colleague who you trusted and respected. And the promise that if I changed my mind you would do everything in your power to make my end days as comfortable as possible.

Your friend, F

These words come straight from the bedside. They come from one who has stood with me at the bedside. I cannot gainsay a word of them. Yes I do sorrow for every death. Yes I sorrow for every pregnancy loss. I grieve inwardly for a miscarriage. There is something universal here and something personal. The universal is the instinct that drives all of us to struggle for life. The personal is hard for me to define or even to describe. It comes into focus most sharply for me at the birth of a child. Those moments find their mirror image in a death. The one elates me, the other deflates.

H is a writer friend, a novelist and a family historian whose earlier profession was neurology. She writes humane novels filled with unsentimental empathy. H was another friend whom I disappointed. She wrote:

I’m sorry you feel you could not give this final relief. I am a convert to assisted dying (this is not euthanasia – which implies someone else’s decision that you should die). My feeling has always been that adults who are dying should have some choice about their death, and seeing three dear relatives all the way to death, I am now utterly convinced that such choice should be available. I understand that in states in America where such choice is available, of those who take up the option only a small proportion use the drugs supplied. But, those who receive the drugs and do not use them, are much calmer and happier, for knowing that they have control and can die should they feel they have had enough.

H here echoes an experience described to me elsewhere by B, arising from her work with men diagnosed in the 1980’s with HIV-AIDS. At that time the diagnosis was a death sentence. Some of the doomed acquired the means of ending their lives painlessly, with the intention of using it at a time of their later choosing. Of those men only one availed himself of the drugs. The others lived out their natural term. Knowing they were able to die enabled them to live on.

I close here with one message of straightforward approbation. It comes from M:

Very thoughtful. And probably helpful to those who didn’t like your last post. I have put the link up on my FB page.

M often comments favourably on my blog. When she doesn’t approve she’ll keep her disapproval away from the public eye. M is of course (as she signs herself) my loving sister.