Autumn Notes, IV

As I write this it’s still autumn. I need to point that out lest winter arrive before this is posted. You know how pedantic my blogmeistress can be.

Winter is lurking, waiting its moment. I left the hospital last night and walked into the dark and rain. Rather than wait in the wet for the correct tram I took another which would take me close to the station. ‘Close’ was actually a mile or two. I enjoyed a philosophical walk through the bleak, absorbing heaven-sent water through hat, jacket and leather shoes. Three jolly Chinese women sheltered in a doorway beneath bright umbrellae that flapped in the wind. Nice and damp by now, I thought of the umbrella, a found object, furled, resting in my bag. If ever I’d have an umbrella moment this would be it. I don’t like umbrellas – a prejudice from childhood dressed up as a principle. The umbrella stayed furled.

On the tram this morning three young women sat and consulted their screens. Melbourne passed by them, damp, dark, unnoticed. Their devotion was religious. One of the three wore an eskimo jacket, her face fur-framed, her free hand clutching two slices of vegemite toast. The bread looked like rye. A semicircular bite in the upper slice showed where the screen interrupted the young woman’s breakfast. Twenty minutes after boarding, eskimo-lady alighted, her neglected toast undepleted. I mention the breakfast because it looked hearty, just right for the weather.

At the hospital last night I ate the meal I brought from home, a soup described as ‘Tuscan Lentil & Grain Broth’. A woman I know found the recipe in one of the weekend magazines. The soup was new to me. Among the ingredients were carrot, celery, onion (of course), garlic (gratefully), tomatoes, lentils, barley and a green called cavolo nero. That’s Italian for kale. I saw through the disguise; I don’t eat kale, like umbrellae – a matter of prejudice. Well I ate the soup, hot and hearty. Oh what a moment! The soup warmed me and filled me so all the wet and wind and cold that followed could not dampen the love I felt for the soupmaker. I decided I wanted her to be my wife. Which, happily, she is.

The Bookshop of the Broken Hearted

Every so seldom I come upon a book to treasure. Every day I read. I inhabit a forest of books,

I sleep between towers of books, some read, some half-read, most unread. No day goes unbooked.

Some in my world of books inform or advise or enlighten. Others – not enough of them – delight or tickle me. Some inspire, some shock, others outrage and a few disgust me. Plenty bore me. But every so rarely comes a story that calls for that overused word, love. Robert Hillman’s ‘Bookshop of the Broken Hearted’ is a book to love.

What do I mean here by love? In two separate surveys carried out a decade or so ago, respondents were asked to name their most-beloved Australian novel. I saw listed many books I’d enjoyed, by authors I admire. Before reading the results I made my own nomination – Tim Winton’s ‘Cloudstreet’. I read the rankings, and there, topping both surveys, was Cloudstreet.’Just so: Winton’s characters, their stories, their rich and variegated humanness, are given to us in their fulness, given us to love. ‘Cloudstreet’ stays with the reader and is recalled with love. ‘To Kill a Mockingbird’ is another such.

Ripe for adding to that list is Hillman’s ‘Bookshop’. It broke my heart and it healed it. I laughed (my guffaws this morning alarmed a tramful of screen-trapped commuters) and I ached for the child. And for the adults who saw this child and that child torn from them I felt a distress that has visited me only once outside of a book, when the (false) report arrived that my child had a fatal malignancy.

‘Bookshop’ left me hopeful but not complacent. I will cherish the simple farmer who is the protagonist and I will tremble for him so long as memory abides.

I invite you come to Readings Bookshop in Carlton, to hear Robert Hillman in conversation with this happy blogger at 6.30 pm next Monday, May 7th.

Love and Treachery

In the movie, ‘Goodbye Christopher Robin’, the grown-up Christopher confronts his father who has commercialized the son’s persona: ‘You weren’t writing a story, you were doing research.’

A.A. Milne feels the force and truth of his son’s accusation. Lifelong the son would refuse to accept any of the vast proceeds of the stories and poems that grew from a father’s love of words and a boy.

Two years ago a friend confronted me in pain and in anger: ‘When we talked I thought we were

speaking as two friends. But you were there as a writer.’ I felt the force of his pain and the truth of my treachery. In time my friend gave me the great gift of forgiveness but a feeling of shame lingers.

My mother used to read the Christopher Robin stories to me when I was very young. Oddly I don’t recall reading them to my own children, but when my first two grandchildren were aged about three I’d push them to my mother’s house, where we four would eat cakes and pastries and I’d read aloud

the poems from ‘When We Were Very Young.’ My mother and I felt strangely moved. The children seemed to enjoy the ritual; they certainly enjoyed the cakes. The lines, Do you have a rabbit/

I do like rabbits/But they didn’t have a rabbit/Not anywhere there… always lumped up my throat.

I did not need to turn and look to know Mum’s eyes were misting as I read.

I imagine those lines will always bring back to those grandchildren some primordial sensation, some thrill or echo of my ancient loves: my love of words, my mother’s love for those words, our love of the

sharing, our love for those cake-stuffed tenderlings whom I held on my knee.

Those children are bigger now. Soon they will be grown up. And they’ll watch their grandfather the word lover as he plunders life and writes his loves, and struggles with his traitor’s heart.

Goodbye My Friend

We are saying goodbye to Mannie today.

Mannie, my friend.

Mannie, whose loved ones weep today.

Manny, one sole man, who ran and ran.

Mannie whose race is finally run.

Mannie’s roots lie in Greece.

Mannie was true to his roots.

Those roots brought forth shoots who live and grow and bear fruit. The shoots are the children of Mannie and Demitra. When the young couple named their shoots they were visited by the muses: they named their children not Lucy but Alithea; not Robert but Panayioti; not Susan but Leni. The names carry meaning, love of course, and destiny.

Mannie did not give his children easy names, Aussie names, names to hide behind. He gave them what he received – a culture, a tradition, a history of beauty and pride.

Everyone knows of the feats of Manuel Karageorgiou, Mannie, who ran the first Melbourne Marathon and the second and the third and …

Manny was one of the eight. Eight glorious souls who had lived and toiled and wrought in every Melbourne Marathon from the first to the latest. Forty consecutive marathons. Foolish.

I want to suggest to the non-runner reader what Mannie’s folly entailed. Physiologists have identified an end point of energy. And adult human can run about 32 kilometres, then energy reserves are exhausted. After that the runner faces a wall. The runner digs into a core of belief and runs a further step. There remain ten kilometres, ten thousand steps. The runner digs further, drawing on pride, on mystic need, on love, on some truth in the soul. And the runner runs on, runs through a wrecked body. The runner now is pure spirit.

And then there are the final, agonising, ecstatic one hundred and eighty steps. The runner crosses the line and then the race is run.

A few paragraphs ago I began listing Mannie’s Melbourne Marathons. I stopped after three. Were I merely to list the forty your eyes would glaze, your mind would wilt, you’d leave the track that Mannie and the Eight would not leave.

My Greek friend always dreamed of running the Athens Marathon, a homecoming profound beyond imagining. But Mannie never allowed himself to run Athens because it clashed with Melbourne. And Mannie owed the event his presence, his being. Mannie would not desert his friends of the Eight.

I’d like you to visit www.howardgoldenberg.com and look up posts that tell of three of Mannie’s marathons. You’ll find them dated October 2014, 2015, 2016. And then read https://howardgoldenberg.com/2017/10/23/its-not-how-long-youve-got-its-what-you-do-with-it/ from October 2017.

I’ll reveal here some of Mannie’s medical history, normally a forbidden act. But Mannie as we know was not a normal man:

While on an early morning training run before the Melbourne Marathon a few years ago I sensed a solid bulk of human flesh approaching in the gloom. The flesh developed a face and the face shot a me smile through the mist. Mannie recognised me first.

Here he was, I knew, fresh from his bone marrow transplant. Preposterous – Mannie understood – to run a marathon with that illness, outrageous, with those therapies. He’d visited me the previous week to talk about running again. ‘The specialist says I shouldn’t run. Howard, is he right?’

‘I suppose he must be Mannie. One fall and your bones can break, so easily.’

It was a broken rib, cancerous, we both recalled, that uncovered Mannie’s diagnosis.

Mannie looked at me. Mannie knew I was no cancer expert, just a runner. His look was a plea; he wanted a reprieve.

I said I could tell him what was the safest course. But then I told him about my mother:’Late in Mum’s life her health was shattered by strokes, but the spirit of the wanderer that had taken her to the bright and the dark ends of the globe, burned still. My sister and I were going to fly to Uluru. Mum wanted to come. She said, “If I stay at home I’ll die one day anyhow. I’d sooner go and see and find and know; and if I die doing it, I’ll have seen the rock. That would still be a good deal for me.” Mannie thanked me and left.  You know what Mannie decided.

I referred before to Mannie’s folly. I’ve seen marathons. I’ve seen and felt the interest and the indifference of spectators. I’ve seen the fellowship of running. I’ve felt the loneliness of the Malta plains. I’ve seen the splendour and I’ve seen the blackness: both were present that day in Boston. I thought I had seen it all, until I ran a marathon with Mannie. An entourage ambushed him – a son, a brother, a younger leviathan figure, a clutch of attractive young women (I wondered who they were. I learned they were girlfriends of nephews of Mannie.) This phalanx of nonrunners surrounded Mannie, they spread widely across the road. Mannie was one runner among thousands, but he alone moved in this stream of flesh aching with love. They ran and ran alongside their hero – the older man, the fat man, the glamorous girls. They tasted fatigue but they would not leave him, not until he reached the next plank in Mannie’s platform of love; and this, of course, was Demitra. ‘DEM!’, he cried, and they kissed. And Demitra held their grandbaby. Mannie stopped. He held that chubby child close and inhaled her. And then he ran on.

I have written of a human, a person. I have written of him chiefly as the operator of a pair of legs. A person is more than that. More than a disease, more than his diagnosis. But in Mannie the runner I see the human and his fate. This man faced Nemesis and outran him for year after year. And when at last – five kilometres into the fortieth marathon, after Mannie stumbled and fell, then arose bloodied – it was Demitra who stepped from the footpath, who took his hand and led him away.

“..Old age hath yet his honour and his toil;

Death closes all: but something ere the end,

Some work of noble note, may yet be done…”

Farewell, Mannie. We will not see your like again.

Mannie’s family have let it be known they don’t want floral tributes to mannie. They’d prefer us to donate to the Myeloma Foundation in his memory. And of course, in his honour.

The Continuing Silence

Paul, beloved friend,

Are you there?

Can you hear me, can you hear or feel or know the love I send?

Three weeks, four, have passed without a letter from my friend.

My friend kept me informed: he told me of the tribe of cats who lived in his caritas, his agape, his lovingkindness.  He called each of them by name.

My friend wrote of the roadrunner (likewise given a name; he kept me apprised of the rattlesnakes that swarmed in his wilderness places, as well as of the evangelist rattlesnakes on tv, and of the rattlesnakes who called by phone to extort from him in the name of righteousness.

My friend wrote of his work in the rivers of venereal pus that flowed among his captive patients in WWII. He wrote of aviation, of the sober joys and disciplines of flight. He wrote of his instructor, one Pemberton, whose memory and example he cherished.

My friend taught this doctor, a long generation younger than he, much of the medicine that had escaped him in his undergraduate days, and that eluded him until the happy day that Paul strode into his life and became a preceptor.

My friend wrote of prayer, of his habitation in the house of prayer.

My friend wrote on his bended knees as he prayed for his fracturing nation.

My friend sent me funny stories, he sent me risque stories, he sent me the news from the frontiers of science, and he sent me the news of tabloid headline that were of little science.These he derided with fine despatch.

My friend wrote often of the good people he had known, people who have long passed but whose good name and memory he kept alive with his remarkable recall and his great respect.

My friend wrote of Beverley who was the light of his life and the fire of his loins. He revered her, he missed and he yearned for her perpetually. Of her he wrote, ‘Great was the joy in heaven when she entered that kingdom’.

My friend’s body was wearying, wearing out, but his mind remained scythe-sharp.

My friend, his integrity unbending, was weakened by the cheating and the chicanery of the mendicants who plagued him. I felt Paul’s righteous being was affronted and his spirit distressed by these cheats.

My friend had standards and he never wavered.

My friend loved the human frame, the creation whose anatomy and parts he new so well. He saw in that frame the work of his Creator.

My friend wrote only weeks ago to report evidence of brain function persisting AFTER death.  What did he think of that? What now, stricken mute by stroke, does Paul think?

How are the mighty fallen.

My friend wrote to me with love. He wrote and he told me he was ready.

I am not ready.

Who, of Paul’s eighty faithful readers, can be ready?

Paul, I know nought of those awaiting your arrival above, but here on earth, great will the weeping if you leave us.

Paul, can you hear me?

Do you know our love?

Paul?

Paul?

Howard

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.