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.

Imagine a World

Imagine a world without i-phones.

Imagine we lost our i-phones.

 

Imagine a world in which the President of the United States of America lost his i-phone.

Such a state of affairs might easily be.

Just imagine the President decided last week to cosy up to the Jews.

Such a thing might easily be: the previous week it was the anti-Semites.

So the Pres attends a Rosh Hashanah meal.

At that meal everyone is given a slice of apple.

All hold the apple in their hand and dip the apple in honey.

All intone: ‘may it be your will that you renew unto us a good year and a sweet one.’

 

The Pres watches and follows suit. The honey pot passes to him and he dips his Apple well and truly in the honey.

As is the wont of the incumbent of the White House he decides then to send off a tweet. Just as he did after meeting the Saudi king, declaring he had overcome Islamist terrorism, he now purposes to tell the world he’s given the Jews a good and sweet year.

 

But the thing with Apple is their device no longer works after a honey dipping.

The Apple Warranty states explicitly: ‘Apple Corp offers no warrant of service if the device be dipped into any fluid extruded from the rear of a bee.’

 

In the untweeting silence America is lost. For her

president cannot tweet.

 

The Pres finds himself impotent to provoke North Korea.

The Pres cannot encourage racists.

He cannot insult patriots.

He cannot communicate ill will.

He is powerless to wedge.

He cannot wage war against the climate of our planet.

 

The President remains, of course, incapable of coherent argument; and incapable sustaining any argument longer than 40 abusive characters.

 

A world in which our President presides without his i-phone is a different world.

It is a better world in which we can look forward to a good and a sweet year.

 

 

In an Age of Nausea, Auguries of Sweetness

A year or so ago the news was full of the globe-wide threat to honey bees

The threat was not confined to the buzzing, stinging insect but to all vegetal life: no bees, no pollination, no animal life

A simple silence, the end, good night, no tomorrow, no new year, no honey

It didn’t transpire – at least it hasn’t yet

We still have bees, pollen, honey

I recall a patient of mine, not Jewish, who always knew, well in advance, of the approach of Rosh Hashanah

He’d wish me the greetings of the season

He knew about our new year through his work: he was an apiarist who would visit all the Jewish schools and kindergartens with honey and stories of honey bees, and bee raising and honey making and honey collecting

He’d bring honey to the children

I write this letter in the same spirit: I wish, I wish us all, a year sweetened, a year of blessing

howard

Magnified and Sanctified

It’s been ten years, Den, and only now do I feel I can say goodbye to you.

You were sixty three, I was sixty one. You died on Friday night. Your son brought the news to us at our shabbat table.

We buried you on the Sunday. We laid you to rest at an odd corner of the Jewish burial ground, beneath a young gum tree. I looked at the tree at that time and I remembered Dad’s fear of falling gums. I thought, here you are again, going against Dad’s prudent judgement. And I smiled.

You lie now, beyond the judgement of humans. Many were the people who judged you, fewer were those who tried to walk a mile in your shoes. They were big shoes.  Like everything about you, very big. Magnified, sanctified… People who did understand loved you extravagantly, in proportion to your extravagant life.

And now I can let you go. From the time of our final conversation I dreamed of you. The dreams were dreams of helplessness. You could not help yourself, I needed to help, I tried to help, but in those dreams, I could not. You called me that last time. The phone woke me from a dreamless sleep. Your speech rustled and crackled, the sweetness of your voice ruined by seven days with the breathing tube. You had rallied, they’d removed the tube; now, with your breathing failing, they needed to replace it. Your voice crackled: ‘Doff, they want to put the tube back. What should I say?’

I heard your breathing, a rasping, gasping sound. ‘Do as they say Den.’

‘Is it my best chance?’

‘Den, it’s your only chance.’

They returned you to your coma and they replaced the tube. Three days later you breathed your last.

At the cemetery we said, magnified and sanctified be the holy name.

One evening during the week of shiva my son led the prayers in honour of his uncle. He loved you Den. We loved you.

For ten years I dreamed of you, restless dreams, frantic. I was unable to help. Then I started writing about you and the dreams stopped. Now I sleep without the dreams. Sleep in peace beneath your gum tree, Den.

From the Heart 3

 
0600. The rock squats, silent, a massive cupcake among the grasses. Moment by moment the light changes: dark gives way to deep blues, to a steel blue, now to a primrose glimmering. All is quiet, still. Life suspended, the plain broods, foreknowing sunrise.
 
0621.The rock as image is too familiar. The rock as concrete reality forbids familiarity. I emerge from my small car, and regard the great terracotta thing before me: after all these years its immensity, everfresh, astonishes me. My car winds its way to the carpark. At every bend the rock changes; every aspect surprises and evokes the overpowering question: what immortal hand or eye? My question and the custodians’ questions are the same as Blake’s. The very greatness demands a myth.
I glance at the steep wall at my side and the slope flings my gaze up, up, upward beyond my range of cervical extension. The human neck cannot accommodate the reality; only if I lie on my back can I take it in. The human ant needs a postcard.
 
0623. Time to start: I am alone, the sole ant. The base walk used to be nine kilometres in length. Now it’s 10.6 kilometres. The rock hasn’t grown but the people who manage the Park have decided to keep us at a distance. And I need to finish my circuit by 0730: time to start.
 
Every one of my years finds voice and protests in my lower back as I shamble into movement. I intended to run but for now this hobbling is the best I can do. The gravel path underfoot is soft and red. It cushions and retards. Slower going and harder. But with only a hundred metres behind me slow going and aching back are forgotten. The rock compels, demands all attention, with its folds and bends, its clefts and pits, its elegant curves, its sweep and breach, its sudden secret shades and sulci.
That face – those many faces – prefigure every expression of humanity. The rock gazes down with idle incuriosity, here it is a pockmarked teenager, here a gaunt pensioner, now a lady, elegant in her long dress that falls and sweeps and moves gracefully in concert with my passing. The rock shows the many faces that are human faces: here is calm, here inscrutability, here obduracy.
Three great gouges side by side at great height, these are eye sockets, empty: what is this sight that sears her eyeballs?  The rock gazes out at our killing fields, at Crusades and Inquisition, at Babi Yar, Rwanda, Cambodia, at Holocaust, at the Armenian Genocide. The rock’s eyeless sockets see all. She has no tears. No mouth here, no words.
 
0630. Right on time the sun comes up, shining, burning directly in my eyes as the rockface heads me due east. The wind comes up too, blowing hot hard warnings of today’s forty degrees: you step outside from your cooled habitat, you breathe, your palate dries and you gasp. The second breath confirms the first impression.
For now the hot headwind is welcome: an early headwind promises a following wind in the later stages when I’ll head west and home.
But the sun, this sun, this blaze, this interrogator’s light right in my eyes: son of man, why have you come?
My innocent run is no longer blameless.
Son of man, what business have you here?
What? Why? What do I seek – peace? Innocence?
The light glares: What gift do you bring?
Consciousness. It is all I have.
The bright light relents, winking now, filtered by thin foliage, broken by gentle rises and bends. 
At this point the run might become a chore; the vista is relatively unremarkable, the rock radiating yesterday’s stored heat, the glare, the difficult going underfoot, the headwind – all might sap a runner. Instead the mechanical affair of placing one foot before another feels charged, significant. Plod, plod, breathe, breathe, the ordinary is transmuted. It is said of William Blake that he took a visitor outside, directed him to look at the midsummer sun and report what he saw. “Bright sunshine”, said the visitor. Said Blake, “I see hosts of fiery angels surrounding the Throne, singing Holy, Holy, Holy.”
 
Fires in my throat. I sip my iced water. But first I recite the customary blessing over the water, an act in which this mortal congratulates his Maker on His good idea in creating and providing the mortal with water. Water never tasted better. Like everything here it is charged, touched with the sublime.
 
I have passed twenty minutes alone in the company of Uluru, an uncommon privilege. At my left, hidden in the scrub, is the village of Mutitjulu. Its people live in the lee of immensity. Daily they awaken to the view of deep terracotta that earlier was mine. At sunset, fire flames from the rock’s margins, the rock purples. Echoes follow me – another place, another colour scheme:
And I shall have some peace there, for peace comes dropping slow,
Dropping from the veils of the morning to where the cricket sings;
There midnight’s all a glimmer, and noon a purple glow,
And evening full of the linnet’s wings.
 
 
Around the bend now, heading south, the greens and greys relieve the eye. I can’t complain of sameness. More faces in the rock, caves that grimace, bluffs that lower, red rock that slopes down towards my feet, down, down, a slow, shy approach. The rock is within a metre of my shod foot. To step on it a profanation. I do not walk this rock. Not now.
 
Around another bend and another, tracing waving folds, the rock shapes here are emphatically, anatomically feminine. Inescapably feminine. Curves that flow, flow, ineffably graceful, to deepening clefts, soft in the gentling light. These mother forms beckon, embrace, call me home.
 
My old legs move fluently, easily. They swallow the miles. My mouth burns, it sends messages – drink, drink – messages you receive only when it’s too late. Above me rockmouths gape toothlessly, vast, cavernous, inaccessible. My eye searches the sheer face; only a mountaineer equipped with hammer, piton and ropes could reach those high hollows. But in their depths ochreous markings, patterns, declare themselves; these impossible deeps are painting sites.  No white foot might imaginably intrude. Good!
 
Nearing the beginning of the end, here is the Mutijulu pool, a cool, shaded dell between three high surrounding walls. Its waters are permanent. But no, not so today, not in this heat. I gaze amazed at naked sands. Even dry they keep their cool, concealing water close to the surface. This dryness is a mirage; at all hands the growth is green, tender, silvan.
 
0715. Nearer the end and I am not alone. Cars pass on the bitumen that runs unseen, parallel to my path. Above me the rock has mouths with calcific projections, teeth that do not smile at what passes below. I look ahead: there, formicating on the slope, scores, hundreds of whitefellas climb hand over hand along a chain that will take them to the top. They will climb Uluru, they will conquer, they’ll be able to tell everyone.
At the top they’ll see the pits and gullies, the moonscape no-one below imagines, the scales and plaques of red; and the smallness of humans below.
I know what they see. I know the climbers haven’t seen or haven’t understood or haven’t cared what the owners write on the notice: Anangu do not want you to climb the rock.
I am not happy to see them climbing. It seems disrespectful. I feel it as if it were a personal sIight. I know and I care about it because I too have climbed the rock. A quarter of a century ago, I drove up, leaped from my car and ran up the slope. I did not see the notice. Hubris sped my feet: I would conquer Uluru; I would do it at the run, I would not stop.
Of course I did stop – after only fifteen metres – stopped and gasped, ran again, stopped, fought a breathlessness I had not known before. I made it to the top, saw how small we are and descended. I do not climb now.
 
 
 

From the Heart 1

Warily opening the newspaper I came upon the following passage, quoted in an essay authored by Aboriginal leaders. I found it unusual.

 

“What Aboriginal people ask is that the modern world now makes the sacrifices necessary to give us a real future. To relax its grip on us. To let us breathe, to let us be free of the determined control exerted on us to make us like you. And you should take that a step further and recognise us for who we are – Aboriginal people in a modern world – and be proud of us. Acknowledge that we have survived the worst the past has thrown at us, and we are here with our songs, our ceremonies, our land, our language and our people – our full identity. What a gift this is that we can give you, if you choose to accept us in a meaningful way.”

 

 

This cri de coeur from the pen of former Australian of the Year, Galarwuy Yunupingu, distils the Letter from the Heart, which is the statement of Aboriginal consensus on their future. There’s a Jewish saying, words that come out from the heart (will) enter the heart.