What Does it All Mean? – V The Final Act

‘TRIGGER WARNING’

The following post may distress some readers. Before reading, please ensure you have any supports you might need.

This hurts the most. 

If only, if only…

It happens and it hurts and the hurt can’t be helped; it can’t be talked away; it can’t be redeemed.

And when you lose the next one in this way, it finds you again unprepared, defenceless, bewildered.  

When I count those lost to me by their own hand, I find the tally low: three, three in over fifty years. These three, and two more who tried and who fell, falling, astonished into my outstretched arms.

The wound is not to my pride. The wound goes deeper. Petty pride stings at slights, but this is not slight. This one trusted me, that one looked to me, they stood before me in their naked grief and I tried to clothe them in my regard: You matter. Your life has value. Your unique being has meaning. 

I have been talking, I discover, to those who are beyond hearing. My words vibrate and pass, and unclothed and alone, the three take their leave. 

The first died for beauty. Believing herself dysphorically to be disfigured, she could not see the beauty all others could see in the photos her despairing husband took and showed her. Beauty cannot keep her lustrous eyes. She takes her leave, she takes her life. Her husband cannot take my calls.

The second died for lovelessness. Born a late child into a family already too full of children, born whole into a constellation deformed by the severe deformity of an elder brother, this one was never deemed to have needs. He called out for notice: Mum, I’ll be good! Mum, I topped the class! Dad, I was best and fairest! Mum, Dad they made me School Captain! Mum… Dad…

They never noticed. All their time, all their energy they spent on the other one, the one who couldn’t run, who would never read. Mum and Dad had no love to waste. The unloved one made himself lovable. I never met a more winning man. I noticed him, I regarded him. He won me. But mine was not the love he lacked.

Being lovable, being good, being the one who’d always try the hardest, he tried all I suggested; he took the medication, and the next medication. He accepted the referral to a psychiatrist, he engaged with the therapist, he accepted admission to hospital. He convinced the specialist he was recovering. He left hospital and he kept his appointment with me. He spoke to me in warm appreciation. He took his leave and, leaving me in false assurance, he took his life.

Twenty years pass and still I shake my head in bewilderment. So vital his being, so warm his blood, so much greater than both, his pain.

Of the last I write least. Two years on it remains too raw. Another who died for beauty. Ugly only in her own eyes, ‘unworthy’ of the lavished love of her parents. Unable to bear the hope with which I’d inoculate her, she separated herself from me in her final months. She died by her own hand. She died alone.

My feelings are not of guilt. Not being family to any of the three, I feel none of the woundof kin, none of that stab of accusation or anger. I cared for all three. They took from their scant stores of trust and they invested in me. I tried my best. It was not enough. We all lost.

What Does it all Mean? – IV

Warm Skin and Broad Shoulders

For my first twenty years in general practice, I worked in partnership with a famous man who happened also to be a great man. I’d heard of him before we met. His name was Donald Cordner, famed as the sole doctor ever to win a Brownlow Medal in Australian football. I learned you win the Brownlow for being the fairest and best player. Those two adjectives epitomise the man.

Donald happened to be, in his time, the tallest player in the League. Together with that height he was broad in proportion. On my first morning with him, Donald performed a tonsillectomy on a child of eight. Disdaining a trolley, he hoisted the patient in his arms and carried her to the Operating Theatre before surgery, then carried her back to the ward afterward. Donald personified two valuable characteristics in a doctor – the personal touch and broad shoulders.

At about five feet and seven inches I could only look up to this very tall man. My initial awe gave way quickly to admiration, for I saw in Donald a quality I’d seen at close quarters through the previous twenty-six years as the son of another GP. That quality was the courage to feel the pain of another, to share it willingly, to shoulder it and to carry on with calm. 

I saw Dad and Donald as they brought life into the world and as, inevitably, they walked closely with others to their final exit. They did this kindly and bravely. Every birth builds us, every death diminishes us. John Donne was right:

Therefore send not to know

For whom the bell tolls,

It tolls for thee.

Seated in close consultation with a young mother one morning in the village of Diamond Creek, I was interrupted by the insistent ringing of the telephone: Would I come urgently to the Treatment Room?

For the next thirty minutes Donald and I worked frantically to revive a six-month old baby who hadn’t cried that morning. Her anxious mother found her child inert, unresponsive, not breathing. We tried all we knew but the baby would not breathe. All through this time the mother stood at our side, fully, dreadfully aware. Through it all, the baby felt warm to my touch. That warmth was to haunt me.

I returned to my patient and took up our earlier conversation: Jen, how did you feel when he spoke to you…

My patient cut across me: Howard, you’ve just been attending to something terrible in the other room. You can’t just walk back in here and carry on as if nothing has happened. You have to give yourself some time.

Jen (not her real name) was right. Nobody had ever suggested a doctor too might need care. 

Over the following twenty years the bereaved mother brought her surviving children to Donald and me. We shared our unbearable, unspoken knowledge.

Another young mother, Julie, became my patient around that time. Over the next decade I delivered her babies and looked after her children. I tried to help her when she became depressed following her final childbirth, and again when she came to me for help through her divorce. Julie was a dynamo whose many ailments frequently led to surgery, and few of her numerous operations went smoothly.

Julie saw in me capacities that I could not recognise. When she brought a problem to me she did so with inordinate trust in my powers. Howard would know. That trust must have generated the power she imagined. She demanded I become a better doctor, and her faith or some species of love brought that doctor into being. 

When I left Diamond Creek she followed me to the city, travelling an hour each way to see me for her many incurable conditions. When Julie moved to a  more distant country town the trip to see her trusted doctor took two hours each way. Her ailments were many and her visits not few. She’d seek my counsel in her wilful mother’s decline. She shared the joy of new grandchildren. Her bones began to crumble and she looked to me for guidance about the medication that should strengthen bone, but weren’t there cases where the jaw would abruptly crack?

When aged about sixty, Julie developed intractable abdominal pain. Specialists failed to find the cause and I struggled to relieve her pain. Through all of this Julie looked to me with that unwavering trust.

Belatedly we found the small malignancy that was the cause of Julie’s pain. Cure by surgery was not possible. Supported by her brave husband, Julie endured the full ordeal of chemotherapy. To the end Julie chased a cure: she would not give up her precious life. To the end she trusted her old doctor. I was humbled by her faith.

Julie died.

Over fifty-one years I’ve seen death undo so many. Not all deaths were tragic, some were a release. Inevitably, though, some die in cruel suffering. I remember Robbie (not his name), a tender soul, a deeply spiritual man who’d survived a harsh childhood, and who emerged with a love that overflowed. Robbie and I shared a love of literature. He’d hunt out books he knew I’d enjoy and gift them to me, inscribing every volume with a message full of feeling. To this day I’ll pick up an old postcard, a cherished book suffering neglect, and instantly, Robbie’s handwriting, the curved lettering, bring him back; his love visible in ink.

One day I rode with Robbie as he drove his teenage kids to school. He kissed his daughter as she left the car, then he kissed his blushing son. As I followed, rather than allow me to feel neglected, Robbie kissed me too.

Robbie worked in Student Services at a university, later as a chaplain in ICU at a major hospital. He would see forty percent of his patients die.

Robbie knew his own heart would eventually fail. Numerous surgeons had opened his heart and repaired or replaced valves, not all successfully. Robbie’s cardiologist assured him his passing would be smoothed: he would not suffer. This GP reinforced this advice. Robbie and his devoted wife trusted our words.

When his time came, Robbie exited life in a prolonged and desperate struggle for breath. He died at home with his wife at his side. Years later Robbie’s widow – herself my beloved friend – continues to suffer grief born of betrayal.

In the end that must come, all we doctors can offer our patients is our warm skin and our broad shoulders.

What Does it All Mean – III

Crossing a Bridge

It is late in the third year of medical school that we watch a screening of a live birth. Until this point in my life, film was always smaller than life, an image, a series of images, fictive or documentary, but extracted, never fully real or fully human, let alone monumental. But this was a video of the eruption of life. I might have been witnessing the Big Bang so enormous was this, the advent of a human.

I remember feeling electrified, thrilled, struck and struck again by a cascade of philosophic thoughts, intense joy, a sense of being a guiltless voyeur upon the utterly intimate that was utterly universal. I was witness, by invitation, to creation. I remember too, my naive amazement that a woman would allow a camera (that shockingly lacked any sense of modesty) to show her fully naked self in this way. I looked around with a wild surmise. But my friends, more worldly, more mature? – showed no shock.

It is only a year or so later that I will deliver a baby. Between the videotape and that event, my father decides I’m ready to go to Labour Ward with him. This entails walking out the back door of our house, past the rhubarb growing in the back garden, to the side gate that opens onto the lane. Dad would hasten across the lane with me at his heels. Through a second gate and we are in the grounds of the Oakleigh Community Hospital. Here Dad frequently invites me along, to watch as he performs surgery, administers General Anaesthetics, treats heart attack and pneumonia and fracture. Dad’s patients welcome me: Dad is their idol, his son would be a godling. Today my presence will demand inordinate trust on the part of a woman of her doctor. What I will share is a series of events, of unmediated sensory experiences – the rich colour of placenta and the same colour in a woman’s face, the odour of amniotic liquor, the sounds and lack of sound, of wordless breathtaking, grunting, pushing, the sight of a calm and immensely calming doctor, his movements graceful as ballet, his stillness, his attention, his kindness and his firmness – and the huge feelings of a new mother, the joy reflected on the faces of nurses, and my own sensations, intense and too many, crammed into climactic moments, and I unable yet to unpack them and describe them calmly. For now I know only awe and thankfulness.

Perhaps a year later, I stand at the side of a young woman through hours that become a full day, during which she approaches a bridge in her life. Today I’ll cross a bridge of my own. Surrounded by calming midwives, veterans in this arena, I watch as the woman pushes. The woman pushes hard, pushes long, gasps, pushes again. Her face reddens deeply, now a beetroot, now a plum. I peer hard: is that hair? Is that scalp we’re seeing? I move into place to catch a baby.

The Delivery Room encloses the birthing mother, a couple of midwives and a nervous medical student. This room, this world comprises all animal humanity as a life spills free into air. Our air, cold upon wet skin, evokes a gasp, a cry. The cry tells a young woman she has crossed the bridge. The student gropes, grabs a slippery cord, which yet dances and writhes. He applies a clamp which slips and falls to the floor. The baby cries, the mother cries; I suppose I’m tearless, but I know I have crossed too. This is one meaning that I catch instantly.

Six weeks later I travel, as directed, to a Victorian terrace house situated next to a rail crossing in Brunswick. In the house a new mother and her young husband live with their baby. The idea of the visit is for a student to learn the consequence of those climactic events six weeks earlier; that consequence is the fact of parenthood. The mother welcomes me, the stranger who crossed with her, the intimate male who usurped the father. That father welcomes me, thanks me! It occurs to none of us three that he should have been there in my stead. A bond exists, forged in the sweat and blood and urine and shit of birth giving, in the gasping and the heaving of giving birth, in the shock and the cry of being born, in the spreading flood of love for a human child.

I never visit the family again. I would not recognise the mother today. Yet every time I drive past the terrace – which happens to stand on my preferred route to the airport – whenever I pass, I remember, through all the decades that follow. I remember that day, I feel that bond.

The birth leaves me changed. I feel called.

For the first thirty years of my working life I deliver babies. It never stales. Nothing else in a life in Medicine will rock me with that astonished joy as I witness the advent of a human. When suburban GP Obstetrics eventually dies, a part of my own life is extinguished.

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.)

The MRI

Two Sundays ago I underwent magnetic resonance scanning of my prostate. I was feeling well, I just had old man waterworks, nothing out of the ordinary. But there was a rise in the prostate antigen. MRI is an ominous sign: generally when a doctor orders an MRI she’s looking for a cancer.

My GP said, I don’t think this is cancer.

My specialist said, It’s probably benign.’

My medical self thought, I don’t think this patient has cancer.

So far, so unconvincing. When the appointments person said, There’ll be no charge. Medicare covers this scan… I really misgave.

Medicare means the Government. Governments are not sentimental, not famously charitable, excepting when it comes to cancer. When it comes to cancer the Government says, No charge, Howard. On the house, old fellow. Sorry for your news.

Cancer evokes awe. When someone says, So and So has cancer, we say, Oh.

Silence follows, we experience awe. True awe, not the cheapened article as in awesome Uber ride. This is the real thing: we stand, hushed; we feel a chill, we’re in the shadow of the absolute.

***

I turned up at the hospital which was a place of silence. I gave my name, I gave my phone number, I gave my excuses for being there. The man looked at me suspiciously and asked for my Driver’s License. He held it in a gloved hand as far away from his face as his short arms allowed. He photographed the document, grunted and returned it to me. The man sanitised me and allowed me to enter. I walked the empty corridors, climbed abandoned flights of stairs, got lost, retraced my steps and tried again. In the bowels of the building I found MRI. The young woman behind the perspex screen read through the lengthy pre-admission affidavit I’d completed. She read my thirty-three responses to questions: full name, date of birth, did I have dentures, did I have implants, were my hips natural, how about my knees, had I ever had an MRI before, why was I having this examination, how was my health, did I have coronary stents, ureteric stents, urethral stents, was I wearing hearing aids, did I believe in God, did God believe in me, did I have a next of kin, whom did I want notified in case of emergency, had my name changed in the last ten years, and had there been any change in my date of birth. The young woman ticked all my responses. All satisfactory, all correct. Then she noted the date of my document: ten days earlier. Sorry, Howard, I’ll have to ask you to fill out this questionnaire once again. It’s ten days old. We can’t accept it over a week. I filled out the form: same questions, same answers.

A nurse, gowned, masked, gloved, came and claimed me. What’s your full name? Date of birth? By nowI knew the answers by heart. I told him. Here, he said, passing me a small plastic tube, this is your micro-enema. The prostate is radiologically remote, hard to visualise. We can’t have any waste matter obscuring the view. 

Waste matter? Perish the thought.

The nurse, probably male, probably forty, but who knows? – led the way. He indicated a door. Here’s your bathroom. Go in there and insert the tube.  I entered and looked around. I saw no bath. I sat down above a porcelain bowl. There were only two openings for the tube. I chose the back one and inserted the tube, a novel sensation. I awaited the arrival and departure of waste. Nothing happened. I emerged and the nurse claimed me again. He lay me down, inserted an IV into an arm vein, asked my full name, and what was my date of birth.He recorded the responses and took me into the MRI chamber. I clambered into a mechanical vault whose walls were of mausoleum white. I lay down on a narrow board. A machine propelled me and the narrow board backwards into the mausoleum. Nurse placed earphones over my ears. What music do you like? I answered and he (My name’s Brian) turned a dial to ABC Classic FM. Some musicians performed some fretful baroque sounds which were free of melody. The nurse placed a gadget in my right palm: Press this button if you need to get out urgently. I’m going to inject contrast. What’s your full name and date of birth? He recorded my responses. Okay, we’ll get under way now. You’ll be in there for 40 minutes or so.

I said, there’s something I ought to tell you.

What’s that?

I haven’t discharged any waste.

Oh!

Now the board slid me feet-first out of the tomb. Back in the bathroom I sat down again. I did my honest best. My output was modest. I returned to the MRI chamber, purged and waste-free. Earphones back on, I heard mechanical sounds of the end of the world, mercifully drowning the Baroque. I napped. Brian tapped me on the shoulder, told me I was free to go. Contact your doctor tomorrow for the report.

***

I called the next day. I said I was the referring doctor – which was not entirely untrue. I gave my full name as referring doctor. I gave my full name and date of birth as patient. I waited. I don’t think the radiologist will have reported the scan yet, said the pleasant young lady. I’ll just check… Yes, I do have a report. Howard Jonathan Goldenberg?

Yes.

Born January 8, 1946?

Yes.

Normal scan. No sign of malignancy.

Once, on a cold day in Melbourne

Someone called the Clinic the other day and left this message: ‘Alexa Rosa wanted to speak to the doctor who treated her mother a long time ago. And she wanted to buy your book.’ Did I know an Alexa Rosa? I thought somehow I should. A scene came back to me: a cold winter’s day in Melbourne, a young family in a front room, a sick mother, her worried husband, their adult daughter.

If this truly was my Alexa, then her story was strong and bright in my recall. I could never forget it. It was the winter of 1971. I had a new marriage, a new licence
to practise medicine outside of the hospital and a brother about to marry
in the United Kingdom. In order to raise the fares to the wedding I moonlighted as a radio locum. A radio locum installed a two-way
radio in his car and travelled, like a taxi driver, to wherever the job
called. On this occasion the call came to the Migrant Hostel in Kororoit Creek Road Altona. My bride, an able map reader, sat at my side and navigated.


Kororoit Creek Road in Atona was a long drive from everywhere else. When we arrived and parked in a vast car park, Annette (the bride) repeated the Controller’s directions, “Building 19, apartment 5.” I stepped outside.
Here, at Melbourne’s western edge, you could see the setting sun
disappearing beneath the horizon and the world darkening.

I didn’t feel happy leaving Annette there in the dark. I looked beyond the carpark toward the distant buildings. Would Annette be any safer in that lowering mass? Annette said, “I’ll be alright here. Just go.” Troubled, I went. How would I find building Nineteen where someone needed a doctor, someone who was suffering from something, possibly something serious? Having now reached the first of the buildings I could see my search was hopeless. The buildings were all great bulky cuboids of concrete. All were unli. And the dark was cold. I wandered and looked for numbers. No number nineteen anywhere, no five. I knocked on a door to enquire. The door opened, I asked, Can you direct me to Flat Five? A hand flew to the heart. The head shook: I not English. I sorry.

I felt sorry too. I turned dully away. Of course no English, everyone here newly arrived, everyone indoors, appalled, like me, by the cold. Movement in the shadow on
my left. I hailed the shadow: Excuse me, do you speak English? The head
shook no, while the face smiled a wide yes. The shadow, a young man,
beckoned, and signed me to follow. I followed. He moved swiftly along cement paths, in and out between buildings, along corridors, until abruptly he stopped in his tracks, pointing and nodding furiously. The shadow knocked on a door, turning to me, smiling. Pointing towards the door, the shadow said, English! The door opened and a voice spoke: Good evening. How can I help you?
Did you send for a doctor?
No.
Is this Apartment Five?
No. This is seven.
Is this Building Nineteen?
No but I’ll take you to Number Five..

This was someone not lost in language nor in space. Feeling found, I followed. A building or two or three later, my guide stopped and knocked on a door. I noted a large numeral 5 next to the doorway and felt almost
hopeful. The door opened and a pretty young woman appeared. Behind her stood a man, older than she; behind him a couple of small children, curious and fearful, clutched at the man’s legs and peeked. The young woman saw my
medical bag. She told me her name and said, Come in Doctor. Thank you for coming. My mother is sick.

Mother lay on a couch. She did not look well. Her daughter explained: We arrived just today from Spain. During the flight Mother started to cough and it was hard for her to breathe. Now she has a fever. We didn’t know how to call a doctor. Thank you for coming.

I examined the lady. I thought I heard altered breathing sounds in one
lung. I bent and listened hard. The air struggled into one side of the chest, it rattled and squeaked.This was bronchopneumonia. Ordinarily a hospital matter, this called for X-RAY, possibly intravenous treatment as an inpatient. How would this lady get to hospital? Would Medicare cover a new arrival? Would the ambulance take her? Was there another way?

I straightened and addressed the  man through his adult daughter. Mother is sick. She has an infection in her chest. She needs strong antibiotic medicine, she might need to go into  hospital. If you wish I can start some treatment here, now. And with luck she will improve quickly.

The daughter translated for her father. The two spoke with the mother, the three nodded. They had decided. The daughter spoke. Thank you doctor, yes, we would like you to treat her. Thank you doctor…we don’t want hospital.  I fished out some  penicillin – no, mother is not allergic – and gave the lady a hefty dose by injection. I wrote out a prescription for oral penicillin to commence the next day. 

Leaving detailed instructions for a range of eventualities I prepared to take my troubled leave. I wished the lady well, I wished the whole family good health in Australia. The daughter reached for a purse. How much do we pay you, Doctor? I did not want payment. A doctor who deserted his sick patient didn’t deserve payment. I said something like, There is no charge. To myself I said, You have paid me, you’ve paid off my guilt. The young woman protested, No Doctor, we must pay you. We don’t know who sent you. How did you know we needed you? I didn’t know. Once again I wished them well and I left, my ears burning with blessings I could not accept.

Back in the car, I found Annette unharmed. I said, I couldn’t find my patient. And I told her the story.

***

It might have been six months later when I was called to the Delivery Suite for the birth of a baby. Birth was not expected for some weeks. Labour was well advanced when they called me and birth was imminent. I needed the mother to help. ‘Push, hard, push! The mother didn’t speak English. A masked figure at her side coached her, translating my words: Big, long push. Push….The mother pushed, her face turning deep red, the veins standing out on her forehead. Stop pushing now! Don’t push! Breathe, breathe…The mother breathed and with each breath the head advanced. The mother breathed her baby into this life, accompanied by fluids, red and clear and mucoid, and followed by the placenta and cries from the baby and crying from the mother. I counted fingers and toes and other parts and placed the baby on the mother’s chest and wished the new family joy. I pulled off my mask and thanked the person whose interpreting had made the birth smoother. I extended a hand, My name’s Howard. We have met, she said, removing her mask. I am Alexa.

***

Alexa explained she had come to visit her friend, now a new mother, in her ward. Abruptly, labour started and accelerated. The hospital discovered there was no-one to interpret for a Spanish speaker so Alexa volunteered. We chatted. She told me her own mother was well, recovery had gone smoothly. She, Alexa, was working as a wardsperson in this hospital. She told me she hoped to study nursing.

I said, I don’t know if you realised I had been called by an entirely different person on the day you arrived from Spain. I never found that person. I never discovered how I fund your Mum. I know, said Alexa. God sent you.

A few weeks later my father told me a new family had started seeing him as their local doctor. They’re from Spain, he said. They tell me you treated the mother for pneumonia.

***

Forty-nine years passed. Locked down, I’m doing Telehealth from home. A message arrived for me, asking me to contact an Alexa whom I had know years before. I rang the number. Alexa speaking, said a voice. The voice sounded Aussie. I told Alexa who I was. She asked, Do you remember us? If you arrived from Spain in 1971, then yes I do. How could I forget? We did. It was 1971. I guess you were about nineteen then. Exactly. So you’re sixty-eight now? Yes. And I did do nursing. I’m still nursing. We talked for a while. Mum is still alive. She’s ninety-three now. Dad only died last year. Do you remember what you said when you left us that night? What did I say? You said, I wish you health and happiness in this country. You blessed us and your words came true. I reminded Alexa of her words to me in the Delivery suite. You said, ‘God sent you.’ That’s right. God did send you. It’s the only explanation. That was the night I became a believer. I found God in the Hostel.

***

In the few days that have passed since Alexa opened the closed door on half a century, I’ve felt excitement and perturbation. I’m excited that Alexa and I will ‘meet’ again, that I’ll ‘see’ my pneumonia patient again, spry and vital; that I’ll meet the children and their father, that I’ll learn their stories. At the same time, some different, powerful feeling operates and unsettles me. It’s the thought of the power of a word, the reverberation of a small act. Alexa sees the hand of the Divine. Does that make me somehow an instrument in a plan? I cannot begin to recognise anything so lofty. I dismiss any idea of some special mission I might have; I find that sort of belief a burden, an embarrassment; it makes me want to run away.

But I’ve been moved to tears thinking how a simple act might lodge in memory, might germinate as a seed, might influence a life; that somehow, quite without intent or thought or awareness, a simple act could take root, help, lift, encourage, perhaps inspire. That thought brings with it a glow, the sense I have done as I know my father did before me – many times – some act of unwitting goodness that lived on afterwards. I’ve felt overcome with a feeling of blessing, perhaps of being a small link in a long chain that might continue on, in lives undreamed…

Mercedes, aged 92 years
Alexa and son

The Hero

My father was a doctor. In his small town where we lived he was adored. As a boy I saw Dad as a hero, standing against illness, repairing broken bodies, relieving suffering. One morning a grownup came to the front door, his hand wrapped in a bloody towel. His horse had bit his hand. I looked up and I saw the blood dripping. I called Dad, who took the man into the Surgery and closed the door. After a while the man walked out, his hand in a spotless white bandage. Dad had repaired him. Dad, the hero.
Fourteen years later I entered the Oratory Competition at my city school. I spoke about doctors and I called them ‘society’s noblest sons.’ My father read my speech and said, ‘Darling, I’m afraid that’s not true. Doctors aren’t so noble.’
I had been reading ‘The Story of San Michele’, the memoir of a Swedish doctor who worked in fin de siecle France. A cholera outbreak in Naples saw the young doctor leave the safety of Paris to work among the Naples poor. In the plague hospital the doctor worked alongside a nurse. The nurse was young, beautiful, a nun. With death all about them, the two young people felt the call of their vital flesh. I read the old doctor’s account, modest, intense and arousing. I saw the two walking with eyes open, day after day, into the valley of death. How could I not see them as heroes? I did not alter those words. My speech convinced the judges and I won the contest.
Today the plague rages about us. At the outset, before contagion struck down the many, the principal of my clinic offered to release from duty any clinician who feared catching the virus. I felt shocked. We had worked through AIDS, when any pinprick might mean death. (I did in fact suffer a needlestick injury at the hands of one of my infected patients.) We had worked though the Swine Flu and through SARS. That was our job, our calling. How could I leave and sit it out at home?
Today I sit at home. I have closed the door, closed myself and my wife in, closed the world out. I feel like Noah might have, as, closed in his Ark, he saw the waters rise upon those locked out.
Meanwhile my younger colleagues work on. They all have spouses, aged parents, small children, whom they might infect. With eyes open they work on.
Friends and relatives send me emails, congratulating me, thanking me, for taking good care of myself. My children thank me. Each letter, every approbation for my prudent (read, ‘cowardly’) retreat heaps burning coals upon my head. Praise appals when you know it to be false. No hero, I know heroes when I see them. If in these days of plague, you consult a doctor, if you are treated by a nurse, you will know them too.

Letter to an Old Friend

Friend,

I write to you from quarantine. My wife and I have been ordered to isolate ourselves. 

Old friend, you and I are old. We have passed the threescore and ten years of the Psalmist. A short time ago we were heading confidently full steam ahead for one hundred. So we proposed. So life seemed to promise. But now, this virus.  

Man proposes, Virus disposes. The virus has disposed of thousands. In Spain overnight, three hundred. Overnight in Italy, 800. I’ll write that more plainly. Three hundred persons. Eight hundred persons.At the start of the year all eleven hundred would have been steaming ahead. I imagine them looking confidently to the future as recently as the start of the month of March. By the close of the equinox all were dead. Few will be those who follow their caskets to their burial.

While going about my work in the past weeks I’ve found the most worried people have been those with the least to fear. Young parents have been terrified for their young children. Truly that suffering has been unnecessary. For most people younger than forty, COVID-19 is a milder illness than the ‘flu. I have heard of no deaths of children anywhere in the world. That should bring blessed relief, but although those facts are widely known, the fear for their young extinguishes parents’ peace of mind.

Curiously, we old ones need fear not so much for our young, as from them. The theory runs that children are unhygienic creatures that act as vectors for this novel virus (they certainly do that service for the influenza viruses), and they endanger and infect us older, more vulnerable subjects. That is why I am writing.

If you are over seventy, go inside now, close the door. Shun your children, ban the grandchildren. Ours is the age group in which most of those hundred of persons died. Ours is the sector at greatest risk of the pneumonia that fulminates and kills. Ours is the group who will not receive respirator treatment and Intensive Care when those services are rationed.

This is cautious advice that might later be seen to be over-cautious. As the W.H.O. Chief of the Ebola response advises, ‘Go early, go hard’ when it comes to responding to pandemic. There will be no second chances for us once we catch this catchiest of germs.

My wife and I passed a weekend of grotesque denial of the love between us and our grandchildren. Encounters were fleeting, spatial remoteness was enforced, no-one kissed, no-one cuddled. Time and again, puzzled children approached instinctively, loud voices repulsed them. Astonished, the children felt every instinct of love denied; and the deniers were precisely those wrinkled figures who ever doted and dandled. Suddenly loving behaviour was wrong.

My resolve wavered. My wife, the softest being in our family constellation, commanded austerity. One of my children has a newborn; we cannot visit, cannot cuddle, cannot relieve exhausted parents at 2.00 in any morning. Our daughters, both recovering from surgery, wait on us, rather than the reverse. The fibres of parenthood are warped and strained by fear of a new virus. And it is precisely those deprived adult children who direct us: go inside, stay inside, keep the world away. ‘‘We’d sooner miss out on you both for weeks or months than miss you forever.”

Old friend, I won’t be with you this Friday for lunch. We won’t see each other at the coffee shop in the mornings. Our house of worship is forbidden to us. Seeing each other as faces on a screen is a cold change after years, after decades of warm touch. I don’t know when we’ll be together in those old ways again. I reckon our best chance of those old pleasures again, some day on the far side of this fear and horror, is cold resolve today.

Until then, old friend, until then,

Yours at a distance,  

Howard

Something Old, Something New

Two epidemics: Covid-19 and Community Panic Disorder.

We are feeling our way. This is new territory for all. The last time was in 1919, when the epidemic of Spanish Flu came, burned itself out and left scarsin memory. It’s those same scars, and earlier ones, back to the Black Death and beyond, that we are feeling now. In 1919 we needed someone to blame: that time it was the Spanish, this time the Chinese.


New experiences every day, new government edicts, new behaviours. Our governments are leading, not following public opinion. This blog has never before found anything kind to say about our governments. (I missed an opportunity to praise our leaders for the National Disability Insurance Scheme.) I offer praise now. According to the experts in public health, those appointed to advise government, no-one in power is playing politics with their advice. Government offices send daily bulletins to doctors, bringing us up to date. We are segregating corona suspects from non-contagious patients.We’re doing this methodically and with sensitivity. Contingency planning for various crisis scenarios is advanced. The planning has been rapid, decisive, bold. The War on Drugs has not made us safe; the War on Terror has made us less free; but the War against COVID-19 makes sense to me.

What have we learned? The Coronavirus numbers suggest the following: Infectivity is high, mortality is low. COVID-19 is easily caught and generally safely survived. If you are old your risks are higher.If you are a child or a baby your chances seem better. This is unexpected and so far unexplained.We can expect the numbers of infected persons in our community to mount and to mount further. So far Australians are far, far likelier to encounter a person with influenza than coronavirus infection.

What follows?

I think it’s a numbers game.

Think before you travel.

Don’t go to Iran (corona) or to Syria (bombs).

If your immune system is poor or if you are old, avoid peak hour public transport, avoid mass gatherings, including at your house of worship.

Work from home if you can.

If you develop a fever or flu symptoms, CALL UP YOUR LOCAL DOCTOR before arriving. Don’t just lob.

Don’t read the newspapers. Yesterday the national broadsheet called it the Killer Virus. That is unhelpful and misleading. And of course, irresponsible.

Trust the advice of the Chief Medical Officer.


Be thoughtful about contact with your touching professionals.These are your barber, your manicurist, your physiotherapist, myotherapist, osteopath, chiropractor and sex worker. And your doctor.We professional of touch take the greatest risks and are potentially the most dangerous to you.


Finally, kissing is a high-risk act. Do it only in emergency. Handshaking is forbidden in NSW. Various alternatives have been suggested. One is the mutual forearm grip, where your palm rests on the inside of your shakee’s elbow. Now that we are urging everyone to cough into the elbow recess, this grip offers you the best chance of a handful of fresh snot.