Flying to Wadeye

I: FLYING TO WADEYE

I am flying to Wadeye with wary curiosity. They say it’s a community that lives in fear of its kids; and there are whispers of an uprising by childbearing women. 

I want to see for myself.

 II: HEY, MISTER MANDARINE MAN

At the airport, we are forty or fifty people waiting for the light plane to Wadeye. Aboard there is seating for sixteen. 

The gate lounge is a shed with one of its four walls missing. The missing wall would have faced the tarmac. An airconditioner fights noisily to cool the eight seated ‘inside’. The remainder sit near the tarmac, in intimate relation with the sun and the heat and the noises and smells of light aviation.

Coming from the southern winter, I am unprepared for the heat. I choose to sit inside. Seated along a second wall, two school-aged girls, an aged lady, and a pair of older men – all Aboriginal – share the cool with me. A Whitefella man and woman in their late twenties sit separately.

It is the aged lady who first takes my eye. She has a rich snowfall of hair, the caramel skin that would have seen her stolen in childhood as a ‘half-breed’, and an upright deportment that speaks of grace and authority. She looks just like my hero ladies, the Strong Women of Galiwin’ku. She is in fact, very good-looking, a judgement not diminished by the snowy bristle on her chin.

The old lady is cradling a newborn baby in its swaddling. The baby is quiet in her arms. The two teenagers next to her whisper busily to each other, drink Coke, send text messages and chew their gum. One girl wears cheap-looking Carlton Football Club merchandise, the other is a Brisbane Lion. I am trying to decide who is the baby’s mother. It is not easy: the girls seem too young, too slight, too innocently childlike; the old lady looks old.

The blokes are tall and thin, not young. One of them is a well-made man with long arms hanging loosely from his muscled shoulders. With his reach, he’d have made a formidable boxer. The man has abundant hair, great waves of charcoal, grey and white, falling in wild harmony about his head. He carries himself as a personage.

He rises and crosses the room in my direction. His gait is abnormal. He rolls as one on a ship’s deck, steadying himself against a tricky ocean swell; a step forward and another, a pause to sway and regain balance, then another flurry of quick steps, before checking his progress and regaining equilibrium. It’s a short passage of ballet, rhythmic, distinctive, somehow dignified. It is a neurological consequence of a toxin, possibly alcohol, possibly petrol.

In all his human wreckage, this man is arrestingly good looking. He sits down a metre from me and says: “Hello”. The voice is a rich, rattling baritone with echoes of tobacco.

My mouth is full of the fruit I’m eating. I return a fruity hello and proffer my bag of citrus. He accepts a piece of fruit, extends his neck and looks it over, then asks: ”What’s this?” 

I tell him, “A mandarine”.

The old man – I guess he’s fifty – gets up and flows into movement, negotiates the dance floor between me and the women and the baby and sits down. Wordlessly, he passes the mandarine to the Brisbane Lion, she passes him one of the cigarettes she’s been rolling, and the girls and the man step outside and have a smoke. Then they come strolling and waltzing back inside. The three sit down and my small mandarine is shared between themselves and my Strong Woman.   

***

A thin voice from outside calls us for the flight. Twenty-four people step forward to the cyclone wire gate. The pilots (I’m glad to see we have two) are young white men in pilot regalia – white shirts with the stripes, pilots’ hats. The aircraft they command is small. They could easily be ridiculous, but their informality and friendliness belie all pretension. They look smart.

We are to pass through the gateway only when we hear our names called. The younger pilot calls eight names, eight of us pass through to the tarmac and the promise of a seat. The first eight  are all Whitefellas. Why us?

More names are called and we are joined by another eight, including the girl in the Carlton shirt and the mandarine man. The Strong Woman and the Brisbane Lion are not among us. The Carlton girl cradles the baby. 

We climb aboard and choose seats at random. I have an aisle seat, immediately behind the young mother and the mandarine man. Deftly, gently, the old bloke threads the baby’s seat belting around the swaddling. We take off and for forty minutes I study one of Australia’s newest citizens in the sole care of one of our newest mums.

The baby has round black cheeks, pursed dark cherry lips, outlined by traces of drying breast milk.  The baby is a winning miniature of the mother, who wears his rounded features in leaner, linear form. Forty minutes is not too long a time to look at the baby.

The aircraft is not pressurized. We ascend and descend and the baby never stirs. The mother’s face is inches from the baby, her eyes fixed on the small face. When the brilliant sunlight shines onto him, Carlton girl shades his eyes with her small hand. At intervals, the mother’s slender fingers caress the air over the baby’s cheeks. The urge to touch the exquisite flesh wrestles with the wish to preserve his perfect rest.

We land and walk across the tarmac to the cyclone wire gate. The pilots heap our luggage onto a trailer. Passengers identify their belongings, and reach over and wrestle them free from encumbering cartons, packages, swags and suitcases. 

A young Aboriginal couple disembarks and claims a couple of packages. He’d be in his early twenties, she looks about eighteen. The two stand near the trailer with their packages and hand luggage.  A policeman is in conversation with them. The officer is one of two, both tall and thin, both wearing serious German pistols in their belts.

The officer addresses the pair quietly: ”You understand that we’ll take you and your bags up town with us to the station and we’ll unpack and examine the contents there.” The girl does not respond. The young man nods slightly.

We are well past the wet season but Wadeye is still cut off by flood waters from outside. A ‘dry’ community, Wadeye has been drier than usual over the long wet, with smugglers of drugs and grog disabled by roads still under water. Some people resort to flying in their own supplies.  By the look of today’s targeted interview, the officer is ‘acting upon information received’. Did the tip-off originate from a member of a rival tribe?  

*** 

The ‘Women’s Uprising’ is my own term for the quiet subversion of modern obstetric arrangements by outback women. Time and again I have dispatched Flying Doctors to remote locations to retrieve women in obstetric emergency. 

They are all supposed to deliver in larger centres, regional hospitals, where mothers and babies are safer. But time and again, the woman whom I flew out to the hospital last Monday is back home  today, Thursday; and there, in deepest Woop-Woop, she comes into labour, at great risk to herself and her baby. She has returned from a foreign place to give birth in her own place. But when I receive the call she or her baby is in danger.

The insurrection against obstetric policy is a phenomenon of the humble and the disempowered: teenage girls and mature women alike sneak back home to give birth. It is in Wadeye that the phenomenon has occurred frequently enough to be described and published in academic papers.  

***

Many Whitefellas have read of Wadeye but not many recognize the name when they hear it. It looks like “Wad-eye”, but it’s pronounced “Wad-air.” Its colonial name is Port Keats.

Port Keats was founded in 1934 by Father Richard Docherty. Despatched by the regional bishop, he arrived with Indigenous guides, looked around and chose a site for a mission. Promising locals he’d return and build the mission, he left. His parting gift was flour and tobacco.

Much of the fate of Wadeye is the unintended legacy of the Whitefella gifts of Catholicism, refined starches and tobacco. Seventy-five years after the arrival of Father Docherty, diabetes and heart disease occupy a huge clinic and a large tribe of nurses and doctors. I am one of the latter.

The Church built a school and taught an early generation to read, write and enter the twentieth century. The school continues to function under Church auspices and within its large campus resides Wadeye’s hope for the future. 

Whitefellas who have heard of Wadeye have read of the gang warfare on its streets at night. Youngsters in their teens gather with their weapons – generally sticks, palings, pickets – and posture at their enemies. Sometimes these real weapons are wielded to effect real bodily harm.

On the aircraft, I find myself seated next to a psychiatry registrar based in the Territory. I point out the headline on the front page of today’s newspaper. It reads: “MOZZIE KILLS TOURIST.”

My companion says: ”The press reporting about the Territory is not nuanced. They claim that Alice Springs has the highest stabbing rate in the world. Do you know Hermannsburg?”

I do.

“The stabbing rate there is four times higher than in Alice. They have only four hundred and eighty five people living in Hermannsburg, but they need a clinic with a fulltime doctor and a staff of twenty seven.”

Down south, the broadsheets read like tabloids: “Mayhem in Wadeye!” The papers explain that the different gangs are playing out ancient clan grievances in a sort of ritualized payback.  

Port Keats was a settlement in which twenty nine or so separate tribal groups were aggregated. With the collocation of groups that had always been mutually hostile, every Montagu found a variety of Capulets, Capulets found Montagus of all stripes; and all parties obliged the colonists with Payback without end.

The ‘papers describe a community whose elders have failed. Ruined by alcohol and disappointment, they have lost all self-respect and have failed to gain the respect of the young. The town abides in paralysis, terrorized by its teenagers. 

That is the story down I read down south.

Before I commence my term in Wadeye the Remote Health Service treats me to a session of Cultural Orientation. The doctor, a veteran of outback indigenous health, explains the gang warfare differently: “What happens in Wadeye is nothing like Payback. In communities as traditional as Wadeye, Payback is determined by due process, which is quite exhaustive. What happens on the streets of Port Keats is emphatically different. The Wadeye stuff is imitative of gang life, in the style of American movies.”  

Indeed, I read that the gangs in Wadeye style themselves Judas Priestand Warriors, and more latterly, German Punk.

My mentor adds: “These kids are out at night because there is no room for them in their houses. There might be thirty people in a three-bedroom house, with three sleeping shifts around the clock.  The teenagers grab some sleep during the day. Then there they are at night, awake, energized and presently homeless. They join gangs for something to do. An outlet for testosterone, a need to belong when they don’t belong at home.”     

***

The local doctor meets me at the airport and takes me to his house, which will be my house while he is away.

It is enclosed in a cage among a cluster of cages. We members of the aviary are the Whitefellas, our cages are residences with barred windows and enclosed verandahs. We cluster, I gather, for safety. The idea is that a worker – often a nurse or a teacher, often young and female – should be safe and should feel safe. 

I feel too safe for comfort. 

Appreciation comes later: towards evening and in the early mornings the stout wooden palings create a delicate sculpture of light and shade in my verandah; the penitentiary space of concrete and wooden bars becomes a resort, a place of serenity. In the mornings and before sunset I come out into this dappled light to recite my prayers – shacharit and mincha – in unexpected tranquillity. 

III: A SACRED SITE  

I haven’t been here long – in fact I haven’t yet reported for duty – when a banging and a thumping on my bars and the roaring of a voice disturb my Sunday quiet. The voice calls: ”Howard! Howard! Are you there?” 

I am. It is my boss, the clinic chief. He has a lot of hair, a shaggy leonine face and a warm handclasp. ”Howard, can you come to the clinic, now? We’ve got a woman about to give birth. There are complications.

I’m Stuart, by the way.”

“Howard. Good to meet you.”

It’s a short drive from cage to clinic, but long enough to learn that our patient is about to deliver, she has received no antenatal care at all and she is anaemic. The air medical service promised to send a doctor and a nurse, but only the latter has materialized.

We jump from the ute. Standing before me on a plinth, arms outstretched in welcome, is the outsized form of a tall bearded man with a beautiful face. He wears a robe and an expression of ineffable love. 

Do the Brothers still run the clinic, I wonder?

We enter the modern building, a monster. Passing rapidly through deserted rooms we head for the Emergency Room. I will find this clinic building to be the largest I have worked in – anywhere in the world. (I sense here the fruit of some spasm of Whitefella reaction; has some politician, embarrassed by reporting of disgraceful neglect, promised largely and spent wildly?)  

In Aboriginal Australia it is preferred that a man should not attend a woman in childbirth. It is women’s business; its private and secret nature transcends coyness but includes shame.

I stand at the rear of the room, the patient sheltered from my view (and from my assistance) by curtains pulled around her. A wrinkled white face atop a small frame smiles across the room at me and the lady identifies herself as Holly, the clinic midwife.  “I’m glad you are here. Her haemoglobin is only sixty percent. We don’t want a bleed.”

Between curtain cracks I witness the expert delivery of a baby that bawls its own birth announcement. I examine her. She is chubby, mature, perfect.

Meanwhile, her mother is haemorrhaging. The placenta is stuck and we must wait. A nurse brings me a mask, gown, gloves in preparation for an emergency procedure called Manual Removal of the Placenta. This, of course, is a manual removal of all dignity and privacy, invasive and painful; and it carries its own dangers. 

Highly competent Holly pulls patiently and gently on the cord. Nothing budges. Blood flows; how much of the mother’s sixty percent remains?

Her vital signs remain stable. We wait as the blood pools.

Presently, Holly’s patient traction is rewarded with the arrival of a complete and healthy placenta. The bleeding slows, then stops.

Soon a flying doctor arrives and takes mum and baby back to the city hospital, where mum will receive a couple of pints of blood.

I have witnessed one skirmish in the Uprising.  No-one lost. Did anyone win?  Certainly, the clinic, ostensibly a non-obstetric facility, functioned very well in an obstetric emergency.

All the equipment you might need for midwifery is here, stored discreetly away from public gaze. The clinic is not supposed to be delivering babies, but, in circumstances of familiar ambiguity, reality contends with policy. Half supported –there is no blood here for transfusion – stoic 

nurses quietly do their heroic best.  

IV: STRONG WOMEN

Night falls at the end of my first day here. My neighbour in Wadeye, a white lady who has worked here for years, calls me: “Don’t leave your vehicle parked outside overnight. The kids congregate for fighting quite close by. Your car will be a great temptation, an alternative to a fight for bored kids”.

Then she adds: “Come over to my place and meet the neighbours.”

I spend pleasant hours in the company of a couple of schoolteachers, a bloke who cooks for the kids at the school, some nurses and the woman who runs the Women’s Centre. As far as I can see, no married couples. The outback is hard on marriage.

At a large outdoor table, a large hospitality prevails. Liberal amounts of food and bonhomie, affectionate in-jokes, laughter and conversation relieve a difficult reality. We are gathered here, behind prudent fences, and not quite within the community we serve. The gathering is not dry.  

Conversation flows, shedding snippets of difficult reality: “cheeky dogs”; “school, hunger, houses”; “the Take Away”; “women, safety, fighting”.

“How long will you be with us, Howard?”

The question is prompted by need. I dash any hope with the truth: ”Five minutes.”

So, you’re not going to replace the doctor when he leaves us for good?”

“No, I’m just a locum.”

“That’s a shame. It’s hard to attract doctors to Wadeye. What made you come here?”

“I met a midwife in the Kimberley, named Rachel. She used to work here in Wadeye. She told me about the fifty babies born safely here. I didn’t know whether to feel excited or alarmed, so I came to see for myself.”

I tell them about the childbirth that I witnessed this afternoon, the calm teamwork, the expertise, the anaemic mother giving birth for the fourth time. 

“She had had no antenatal care at all.” 

This statement is received with a shaking of knowing heads. Fourth time around, a mother

would understand something of the risk. She’d have hidden herself from notice, determined to give birth in her own country.

I remark: “If Rachel is right, we could run a safe midwifery service out here for selected patients who had normal pregnancies.”

This provokes a passionate response from the midwife seated next to me. “I’m sorry – Rachel’s a lovely girl – but her paper is dangerous! Women will believe they can stay away from hospitals because it was safe for those others. But it’s not safe. Excepting for low risk pregnancies. And very few of them are low-risk!”   

This is one of a number of strongly felt views that I hear at my neighbours’. The strong opiners are all women. Wadeye is a place where I will encounter forthright opinions delivered by a number of strong women. Unfortunately, this cadre of Strong Women in Wadeye is all white.

I do come across one exception. Outside the store, I pass an aged lady. The lady has long white hair that falls to her shoulders like a nun’s wimple. Her face is a map of desert country, her spine is bent forward and to her left. As a result her gait is slow and spidery, her legs propelling her forward while her head and body face left. In the old measure, she’d be well under five foot tall.

It is not her physiognomy that strikes me so much as her expression of obdurate resolution: she knows what needs to be done and she will do it.

She leans on a stick as she walks and she holds the hand of a very small child, leading her, pulling her past the store with its blandishments, through the thronging idlers and smokers and the cool teens with attitude. All these make way for the old lady and her charge. The two proceed in the direction of the Women’s Centre. 

The Women’s Centre is a revelation. Here, women weave mats and baskets in traditional materials and paint and print in gloriously untraditional media. Beneath soaring rooves of galvanized iron, vast sheets of bold printed cloth hang from beams. Prints of great beauty hang on the walls.

All of this is the work of local women, some of whom are away at present, in residence at Bachelor College, where they are learning advanced printing and silk painting techniques.

The work takes me by surprise, its beauty and its ambition and – it’s not too much to say, its grandeur – all belie the sheer ordinariness of the building’s exterior. It is a tin shed. And it is a treasure house.

“But, some of the artists are too scared to come here” – thus the director, my neighbour of last night – “sometimes their menfolk are jealous and keep them away.”

“Why would they be jealous?”

“Their women gain confidence and independence here. They keep fifty percent of any sales. Some men resent that. They keep their women away through fear.” 

***

V: COLA

My house is the residence of the local doctor, whom I’m covering while he takes a short break. He’s been here for two years. Before leaving for his holiday, he speaks about the outstations here: “The people in these small outlying family clusters are an Aboriginal aristocracy. They are traditional owners – T.O.’s they’re called – with unchallengeable land rights. They choose to go and live in ‘cultural purity’, untainted by the corruption of the town.”  

He speaks softly, choosing words carefully, using them sparingly. He looks into the middle distance as he speaks, a small smile playing about his mouth as if he knows that any interlocutor is likely to jump to refute or trump him. Two years out here have prepared him for the cauldron of ‘expert’ opinion that prevails on everything indigenous. 

The doctor makes his observation. He smiles his smile and says: ”Pardon my cynicism.” In fact he is not cynical but the opposite – he keeps open eyes and an open mind.

Wadeye is said to be the largest Aboriginal town in the Territory. There are three thousand people here – some say more than that – of whom two hundred are Whitefellas. Three thousand people is a sizable population. I’ve lived in much smaller towns than this. And it is growing, the average age is young; soon they will number four thousand.

In the sunlit streets, there is a general dawdling. No-one over the age of five moves with alacrity. The elderly and infirm move slowly, so too the able-bodied, adult and child alike. No-one is in a hurry. What is more, no-one is going anywhere.

In this young town, kids are everywhere, the small ones skinny of limb, round of face, the teenagers tall and lean, all in AFL uniform. The uniform is footy club merchandise – hats worn back to front, oversized sleeveless shirts – all in shabby synthetics. The apparel of the teenagers of Wadeye is made of the cheapest materials out of China. The fabric is mean stuff, no cottons, no wool, every stitch of it authentic synthetic.

Hawthorn club colours are prevalent here. (Someone, I am sure, some sad and sour spirit must have woken from a bad dream and come up with the Hawthorn colours of drab yellow and drear brown. That someone – probably a Richmond supporter – imposed the colours on the club he most disliked.) 

I digress here for a purpose: the mournful autumn colours, powdered in red-brown dust, bespeak a state of desiccation, of life attenuated, of the draining away of sap. In Wadeye even the most vivid of footy shirts, the scarlet on white of the Swans, is dusty and spiritless.

Although we are in school hours, hundreds of children linger around the entrances of the supermarket and the takeaway. While school is open, children are not admitted to the shops. But they appear answerable to no-one for their absence from school. 

There is an abiding passivity. Three thousand people live here. I locate the hairdresser’s shop. It has closed down. The gym is barred closed. The town has no taxi, no drycleaner, no internet café, no café of any sort. In this verdant coastal  wetland no-one  markets or processes fish, no-one runs an orchard or a market garden. 

In two weeks in the community, I fail to identify a single Indigenous enterprise. 

A spasm of energy on the main street. Two teenage boys and a younger brother erupt in a flurry of activity. A splash of rainbow colours moves up, down, sideways between their stomping feet. A parrot, its plumage glorious in its emeralds and turquoise and ruby, is desperately trying to evade three young hunters. Six quick feet, six fast hands, contend with two flashing wings. A foot stamps, feathers float to the footpath, the bird takes flight, but winged, it circles into the hand of one of the bigger boys. 

What will follow? I lack the stomach to watch. I look away.

Above me, a pair of parrots, swooping and swerving towards a high tree, scream the news to the congregation of parrots. Ruby, turquoise, emerald, flash and squawk vividly. 

A moment passes and torpor descends upon the street once more.

I walk the sad streets and the passivity overtakes me. I am in the slough of despond. After three days, I call my brother back in the city, down south. I tell him what I see. He catches the pain in my voice. Desperate, he shouts into the phone: “Why don’t they fix it?” 

I explain, wearily, almost apologetically, that they try, that we try; that none of us knows how to “fix it”, that we cannot fix it; and that we do not know how to desist from trying.

My brother sounds sorry. He has caught the sound of a pain that is not really my own, but which I have appropriated.

***

VI: HUNGER

I am taken by the body habitus of the locals. No-one is fat. The small children delight the eye. Human miniatures, everything about them is small excepting for large smiles and abundant hair. Their adolescent siblings are slender and erect. They flow in movement, poetic, delicate. 

It is difficult to behold the young of Wadeye without a shock of delight. But a cruel reality hides behind the beauty.

In the shops people line up at the checkout. At the checkout they set down their groceries – frozen meat (the coast is close but no fish is sold here), bags of white bread, packets of chips, bags of white flour, bags of sugar, bottles of drink. While I wait I count the cola buyers: five out of every six customers buy cola drinks. The store sells all types of sugary soft drinks as well as diet drinks. But the full sugar cola, the authentic one in its classic livery, remains the overwhelming favourite.

Frequently the customer’s plastic card lacks the funds to pay for all the goods. The purchaser then returns items one by one until the card can accommodate the total on the tab. I stand in line behind her and watch as a mother sets aside staples – bread, meat – but not the cola. Never the cola.

Why then are the people so slim? How can this community achieve such enviable body shape? Despite the sugary drink from America, Wadeye people are skinny.

The answer is infant starvation.

This is not my opinion. In fact it is no-one’s opinion. It is declared as manifest fact by nurses, by teachers, by community workers – all of them women – all angered by starvation on our own shores. They speak of a literal food chain where children do not sit high. 

A senior teacher explains: “Some of these kids get no reliable feeding except at school. We feed them breakfast, morning tea and a cooked lunch. That’s the main reason school attendance here is so high.”
“How high is it?”

“Thirty percent. Nine hundred kids are enrolled and on any given day three hundred come to school.”

Food for thought. On these figures the majority misses school. But thirty-three percent attend ‘on any given day’. 

(For some reason the bible story of Sodom and Gomorrah comes to my mind. In the story, Abraham pleads with God to spare the wicked city of Sodom for the sake of its few righteous people. God will save the city if there be as few as ten righteous there.  

Could it be that Wadeye will be saved by its thirty-three percent?)

“Who comes to school? What age groups?”

“All ages – from five to twenty-one. Some will come one day, some another. One will come for an entire week, then disappear for weeks. Sometimes I’ll notice that one of my regular girls hasn’t been here for a while and I’ll enquire, ‘Where’s Josie?’ And her friends will say: ‘Josie has a boyfriend.’  From that I am to understand that Josie’s schooling is over. The girls stop coming to school as soon as they have a boyfriend.”

VII: AT THE SCHOOL

I arrange to visit the school. I want to see what happens at a school where the way to a person’s mind is through his stomach. It is the senior children whose lunchtime I witness. These children are 12 to 15 years old, not yet married, not yet matriculated into a couple or to coupling. 

The food looks nourishing and appetizing. The kids line up, each holding a bowl. Cooked white rice is dolloped into the bowl, then a lashing of chicken curry. Every child receives starch, fat, protein and flavour. After this they eat sliced orange segments. 

There is order here. Children wait their turn, they line up, many are coaxed into saying ‘thankyou’ audibly. According to Teacher Betty, a forthright idealist, this is one of the longer sentences in English she’ll hear from her students.

I ask Betty: ”How many of your senior class can converse in English?”

“None. Perhaps one. Sentences are one word.”

After lunch every student scrapes waste into the bin. A monitor, selected for the task for some recent infraction, washes the dishes while another delinquent wipes down the tables with studied accuracy. All this takes place under the hard, clear eye of Magdalena, who might be the Vice Principal. Magdalena says she is fifty percent Serbian and fifty percent Scottish. I watch her in action: she is one hundred percent tough love.

Magdalena informs me that I am to return tomorrow to give the senior boys and the senior girls a health talk. Separately.

I will comply.

Next day, when I arrive in the boys’ classroom an AFL footballer is talking to them. ”Now if you write down your sentence about footy on the entry form, you’ll go into the draw for a brand new Sherrin. That’s worth a lot of money.” 

He talks on a little. The kids talk across him. He is a detail. The pupils and the athlete do not meet. 

If a real genuine footballer from Richmond doesn’t get through, I don’t expect I’ll do better.

Magdalena wants me to teach them about sexual health. The rivers of venereal pus flow deep and broad up here (as they do back in the whitefella south). If one-word sentences are to be the go here, that one word would be condom.

I walk to the front of the class. The Whitefella teacher introduces me. The boys take no notice: Pandemonium fights with Apathy. Apathy wins. One boy, seated immediately beneath my nose, keeps his back to me. I am getting the John Howard treatment. Is it because of my name?

The teacher retreats and returns with reinforcements. His reinforcers are two Aboriginal men, one in his forties, the other in his fifties. They stand at opposite sides of the class and berate the boys. And berate them. And berate them again.

During a lull in the berating, I make to start. More roaring from the berators; I’ve jumped the gun. I wait, and after fully fifteen minutes of laying down the law, the older man nods. I may begin.

What should I tell them? I decide to ask them what they want to know. “What do you want to know about sex?”

Silence.

I ask the question in sign language. This is a hit. I have chosen a sign that bridges the seven languages of Wadeye and trounces the Queen’s English. 

Uproar. Pandemonium beats Apathy pants down.

The berators quieten the class.

The school is called OLSH. I decode this. It means “Our Lady of the Sacred Heart.” It is against school policy, it seems, to use the word condom. From my bag I draw a banana. I have a condom from the clinic supply. The condom is black. I produce a banana, purchased by means of a Personal Loan. I have their attention now. I apply the condom to the banana. I do not speak of contraception, not of respect for women, nor of responsibility. Instead I say: ”This one” (indicating the condom) “keeps this one” (indicating the central part of the front of my pants) “strong. When you put on this one (pointing again to the condom), that one (pointing at my pants front) doesn’t get germs.  Stays strong.” 

Now I pull out a red can of cola and a bottle of water. “Which one is the healthy one?”

“Water!” – in one voice.

“What’s wrong with the red one?” – I ask.

“Sugar!”

To which I add: “If you drink the red one every day, you can get diabetes. If you get diabetes, one day, this one (indicating the same area at the front of my pants) is not strong. Doesn’t work. No sex. Never – no sex.”

A pause for dramatic effect. 

“Too much red one – no sex.”

A voice from one of the bigger boys, addressing the body of the class, not the guest: “I drink the red one. Do plenty sex.”

So much for my attempt to improve sexual health among the boys who will be men in Wadeye. 

“Without a change in male behaviour, women will contract their men’s diseases endlessly.” Thus the women’s health doctor, a tall tawny lady like a great dane, who pulls no punches, takes no prisoners, especially not from this southern pipsqueak. I ask a question – “What if a woman were to say ‘If it’s not on, it’s not on’”? 

This isn’t an assertion, not an opinion, just a diffident question – and the doctor jabs the air at me as she gives me THE FACTS. “Women here are completely objectified. They could never demand that their partner use a condom. They mightn’t even be asked for consent. They have no power. It is the men who have to change!”

Back at the school, I visit the girls’ senior class. The girls sit in ladylike stillness, a larger group than the boys, all attentive. They too are copping a double-barrelled berating. Teacher Betty is giving it to her class for being so rude as to keep their guest (Doctor Howard) waiting. Magdalena is foaming about the girls teasing a schizophrenic man who wanders onto the campus in search of girls. This is a tricky one.

After the berations it is my turn. I anticipate that the girls will not want to hear from me – a male, a Whitefella, and old – about sexual health. Instead I produce four bottles – one of water, one of orange juice, one of full-sugar cola, the last a sugar-free cola.

I ask them to grade the bottles for goodness. Perfect silence from the young ladies. I reiterate the question, breaking it down to its elements. No response.

They are not talking; I have their attention. But they are shy.

So I tell them that the sugary drink is bad. “This one is a death drink.” I am careful not to use the language of a previous doctor who called sugary cola “Black Death.”

He was asked to leave the community.

Of course, I believe he was right in fact and right in imagery: sugar kills far more people here than alcohol; and far more insidiously than death in custody. He spoke up, spoke too bluntly.

That doctor has gone. People in Wadeye still queue daily for their prized sugary drinks. What will it take, I wonder, for the community elders to ban them? To replace them with the sugar-substitute drinks? The same people who banned alcohol from Wadeye acted then with courage and resolution. Why not ban sugary drinks?

People would still be able to feed their caffeine habit; diabetes might decline. Life expectancy might soar above the figure (forty seven years) I was quoted when I arrived. 

I want to leave the girls with something useful, something that can help them when they matriculate to boyfriends. Magdalena passes me a piece of paper on which she has written: NO CONDOMS!!!

This is OLSH. I am forbidden here to talk about contraception. Bananas and condoms are out of the question. What will I talk about? Then it hits me – sex is secret. It is secrets that I must talk about. Standing next to me is Roxanne, the Sexual Health Nurse, who has come with me from the clinic. 

I start: “A woman’s body is her secret. I cannot talk about that secret. The nurse – pointing to Roxanne – can talk about it. She knows secret things. She can see you alone, at the clinic, with the door closed. She will keep your secrets.”

The girls seem to be listening. I want to talk about sex, about consent, about feelings, and of course I cannot.

I continue: “Sometimes a boy wants sex with a girl and she doesn’t want it. Maybe he does it anyway. He makes her do sex. Then that girl can see the nurse about those secret things. 

Maybe a boy hurts a girl, maybe she gets sick in her woman’s parts, inside her body. The nurse knows about all those secret things. 

If a woman wants a baby, the nurse can help. If she doesn’t want a baby yet – maybe she is too young – the nurse can help her. 

At the clinic. 

All that secret business.”

I’ve finished. Three women are nodding emphatically, meaningfully.  The three are Teacher Betty, Magdalena and Lucy, the activities officer. The schoolgirls have been polite and attentive. I cannot know whether I have been useful or just another old Whitefella who comes, speaks incomprehensibly and goes away.

VIII: THE LAST COMING HOME

The oldest nurse is a lady named Wendy. She addresses her workmates in our clinic: ”Lesley is flying back to the community tomorrow. She’s coming home to die.” 

The nurse’s face is soft and round and sad, but you can see the daughter of a smile at its edges. It is a face that doesn’t show the years. 

Wendy knows that there are worse things than dying. She knows her job, which is to gentle Lesley’s passing.

This oldest nurse is a veteran. She has worked in remote places all around the country, often long stints, frequently as director of nursing. 

Our patient, Lesley, is well known to this remote clinic. She has a long, long love affair with alcohol. She has loved the grog and the life in the long grass, loved the commonwealth of drinkers, the open air, loved the grasses that concealed and sheltered and welcomed her.

Nurse Wendy tells me: “You can lie in that long grass and it will form a canopy over you, shading you and keeping the strong winds off.”

When Lesley’s kidneys failed some years ago, the hospital doctors explained that a dialysis machine would do the job her kidneys could no longer do. The machine would keep her alive. She would need to visit the hospital three times a week.

This suited Lesley well. She’d visit the city for dialysis, and between treatments she’d return to her long grass friends and to her lover, the bottle.  

She’d often miss her dialysis treatments. Then fluid would build up in her body and make her sick. Fluid would fill her feet and legs first, then her abdomen, finally her lungs. At some stage in the rising tide, Lesley would surface, sometimes at the hospital, other times back in the community, and the doctors and the nurses would race to her rescue with their kidney machine and save her from drowning. 

It got to the point where they’d fly Lesley in from Wadeye to the city for her familiar emergency, and she’d get off the plane, bypass the hospital and go straight to the long grass. 

Lesley’s community decided to go dry: no alcohol. Home didn’t suit her anymore, so she spent less and less time in her own country and more and more in town with the grog. Instead of routine dialysis three times a week, Lesley would turn up at the Renal Unit once in a few weeks, sometimes only once a month.

At the Unit, the nurses and doctors were frustrated and amazed. With her tiny surviving kidney function, Lesley should have been dead. Many times she nearly was dead. Sometimes they thought she’d die right there, on the end of the needle, through which they were injecting lasix and rizonium and other hero molecules, with all their anxious, exacting care.

Nurse Wendy resumes: “The hospital phoned today. I spoke for a long time to Lesley’s kidney doctor. She said the Unit decided last week they would not treat Lesley again, not until and unless she’d attend a family meeting. And Lesley and her family would have to commit to dialysis.

“Apparently that meeting never took place last week, not until today. Lesley came in again last night, near-dead. This time she has kidney failure and heart failure and pneumonia and a septic infection in her blood.

So the family and Lesley and the hospital people had their meeting earlier today.”

“The meeting included me as well as family in Darwin and her relatives back in the community. We did it by teleconference. There were sixty people in the meeting, some leaving, others coming in. More than sixty people close to Lesley listened and spoke.

The meeting was all ready to start when Lesley said she wanted a smoke. She struggled to her feet and took tiny frail steps to the wheelchair. They took her outside and she smoked her fag. She loves a smoke.”

“Back inside again, Lesley spoke. On the screen you could see how swollen she was with fluid, rattling and gasping her few words before taking a long time to catch her breath and talk again. 

But she was quite clear in her mind. When the doctor told her she was critically ill and that she could not be cured, she said she understood. 

The doctor said only she, Lesley, could save herself. Lesley knew she was not going to change. 

She understands this means she is going to die.

She is ready. She accepts the decision. In reality the decision was hers. 

At the end of the meeting, family members in the hospital room came and stood close. Most touched her. Young mothers lifted toddlers to kiss Lesley’s lips.”

“In the last year or so, Lesley has been more peaceable. Before that she’d fight us. She’d spit and shout. Now she’s calm.”

The nurse’s face glows with feeling, with reconciliation. She sees before her the dying of an old struggle that became a partnership and ends as a friendship.  

The nurse lifts her face, and looks at her workmates for a few moments. She is composing her thoughts, separating them from her feelings. There are practical steps she will have to take, things which we all need to know. 

“Lesley is coming home. She needs to be home, among her people. Her husband Gerald says he’s prepared to look after her. The hospital has explained to him what he’ll be facing. He understands what it will be like.

The hospital has chartered a plane to bring her home. The family have morphine mixture for Lesley’s pain and for the feeling of panic when she can’t breathe.”

”The kidney doctor thinks we won’t have to wait for kidney failure to kill Lesley. She thinks the toxins from her blood infection will take her first. Maybe within a day or two. 

The daughter of a smile on Nurse Wendy’s face is is now full grown: ”Then again, Lesley being Lesley, she might live for a week or longer.”

***

The next morning, Lesley’s plane arrives. During the afternoon Nurse Wendy and I visit Lesley at home. I’m familiar with the clamorous grieving of Aboriginal families, but I cannot imagine what a house will be like with sixty close relatives waiting for a death.

We walk down the slope to a house of contemporary design. Curious angles, plenty of shade, interesting colours, a house fabricated of metal. Nothing here speaks of welfare housing, nothing organic either. Nothing grows in the grounds: no-one is raising a garden here. Cheeky dogs stir and follow us, sniffing.

I follow Nurse Wendy inside. The front room is quiet, nearly empty. On our right as we enter is a low, narrow bunk. On our left there is a small flat-screen TV that speaks in incessant banal English to a near empty room. Lesley lies quietly on the bunk. She does not move. Is she alive? 

A silent toddler plays here, attempting to assassinate a cardboard carton. A portly grand-daughter, perhaps fifteen years of age, possibly the mother of the toddler, glides into the room as we enter. She carries the bottle of morphine mixture and confers with Nurse Wendy about dosage. 

Of the husband Gerald who ‘will care for Lesley’ there is no sign.   

Lesley stirs. She recognizes Wendy, wants to converse with her, pulls the nurse’s mouth close to her deaf ears. Lesley’s grasp is vigorous. She props herself into half-sitting, a difficult posture. She breathes normally, no crackling or frothing of lung fluid. Lesley conducts a negotiation with me: she wants the complicated central venous line removed from the great vein in her chest. This, the hospital had previously refused to do, reckoning it to offer nought but the chance of uncontrollable bleeding. I am not Lesley’s regular doctor; I temporize, speaking words that are not strictly untrue; but my intention is to deceive: “Lesley, Doctor Morton will be back in a few days. He knows your case. You should ask him about this.” 

Lesley’s mind, although narcotized beyond fear, remains clear enough to accept the compromise. Does she see through my lie? 

The weekend is here; Lesley has been home three days. I will see her next week. She looks far from an imminent death. 

The weekend passes but Lesley does not.

When I visit again it is her fifth day out of hospital, her fifth in the care of the young woman I saw last week. 

We approach the house solemnly, ready for Death’s preliminaries, the coma, the rattling of final jerky breaths, the terrible look of a face that does not know itself, a body struggling without a mind, the last battle before the final peace. 

Cheeky dogs lying in the shade do not stir. Not cheeky today. We cross the threshold into the quiet room. As we enter, a young woman with a babe at the breast slides silently away. Another enters, stands at Lesley’s bedside, face turned to the old nurse.

Wendy takes Lesley’s wrist in her hand. The arm is slender, still shapely for all its withered flesh. Wendy is feeling for the volume of the pulse, its rate and rhythm, the warmth of the limb, the tone of her muscles. And she is giving her touch, that intimacy of woman to woman, so much the story of Wendy’s forty years as a nurse.

Wendy speaks into Lesley’s hard ear. “Are you comfortable, Lesley?” No words from Lesley, but her head lifts and she gazes long into the nurse’s face. What will pass between the women?  

I am glad for the nurse’s confident intimacy. The proximity of death calls for something in those professionals who come close, a something that I always fear I will lack.

After some moments Lesley’s gaze empties, becomes drained of intent. Lesley had roused herself to register Wendy’s presence. The effort has exhausted her strength and she sinks back now into Death’s antechamber. No fighting for breath, no fever, no cough.

Gerald has materialized at Lesley’s side. His face is opaque, his bearing gentle. He stands at his woman’s side, erect, silent, stationary, a rock or a tree in Wendy’s country.

Wendy has outlasted her pneumonia and outwitted her sepsis. Her ‘dead’ kidneys have made a trickle of urine that looks like gravy.

We came here for a death. It has not been admitted. Death must await its day.

Death, be not proud, though some have called thee/ Mighty and dreadful, for thou art not so.

IX: COUNTRY 

It is Sunday and the clinic is closed. Early in the morning, Jonathan and I go for a run. Jonathan is a fit fifty year old Englishman, responsible for maintenance at the school. He certainly maintains himself in working order. He leads me on quiet tracks out of town, away from the pack dogs. The red dirt is firm but yielding underfoot. The forest is green around us. Leaf meal and sticks lie everywhere. They crunch with our footfalls, setting to flight feeding wallabies. Some stand about a metre tall, on their toes. Others are diminutive. In the light of early morning their skin is grey with a hint of green. “Agile Wallabies”, says Jonathan. Little taller than chickens, they are the most graceful movers I’ve seen in the bush.

We turn a bend and a noisy languorous flapping overhead makes us look up. A body length from us, an eagle takes reluctantly to the air.

The sense of privilege, the feeling of blessed good fortune is intense. Among all Australia’s twenty-plus millions, this beauty, this pristine harmonious forest, is ours alone.

We run on and on, now up and up. We reach Airforce Hill and climb to the peak. Here a wartime radar station protected northern Australia from attack. No harmony then. The view rewards us. Three hundred and sixty degrees of forest, sea, sky. Of isolation.

In its isolation Wadeye is paradoxically a hopeful place. Just as in the incapacity of its young people with English there resides the germ of a cultural vitality.

The less English, the better local languages can survive. The greater the isolation, the less the cultural contamination. In all its backwardness, might not Wadeye hold on better to its culture?

I try, without success, to take the cultural pulse in Wadeye. Sometimes at the bedside of a patient I’ll feel for a pulse and be unable to locate it. I move my finger higher up the wrist, then lower; I press down a little softer, a mite harder. No pulse. On the opposite wrist, I grope without success. But the patient is smiling at me, talking, manifestly alive.

Just so with the pulse of culture. As Nicolas Rothwell confides:” You might look about for ceremony and find none. That might mean there is none, or it might mean the opposite.”

I realise that the seers and the men of degree and the healers of Wadeye are not rushing to show themselves to me, to share their secrets. Why should they? What have I done to earn that trust, that honour? Rothwell assures me that Wadeye is richly, intensely alive with intact spiritual practice. He concedes that the community’s backwardness could be its salvation. In the spiritual sense.

I recall the papers down south, declaring, “The elders have lost all respect”. Really? 

We want to visit the beach. At every hand, everyone we ask – Whitefellas and Blackfellas alike – all say, “You better ask permission. Find Leon and ask him. He’s the owner of that beach.”

The clinic staff want to initiate new community health policies. “We’ll need to talk to Boniface. It’s his land.”

I’ve been here for twelve days and twelve nights. On the third night, I heard a lot of wild boy noise, but next day we treated no-one for injuries. By the time my twelve days have passed, I realize that I have not seen or treated a single person for human-inflicted injury. And I haven’t seen a single intoxicated person. 

In a community of three thousand or so, it’s un-Australian.

It is the ‘disrespected, disempowered’ elders who have negotiated the prolonged armistice between the gangs, just as it was they who decided that Wadeye would be a dry community.

***

On the Sunday, I follow directions given by my running companion. I drive with some colleagues and my guest for the weekend – a rabbi who wants to learn his country – to ‘the waterfall’. I look down from the vehicle to the meagre stream that meanders in shallows between rocks, beneath and beyond the bridge. We park and beat back bushes on a narrow track that winds down to the falls.  The ‘falls’ look unimposing. Was ever a smaller flow of water dignified with the title ’waterfall’?

Thinking wary crocodile thoughts, we regard the plunge pool beneath the falls. I decide I will not swim. But crocodiles do not inhabit waterfalls, so someone told me. So I climb back up the track and descend into the falling water. 

There are any number of footholds and handholds within the falls and the water plays around my neck and shoulders, over my head, and on to my stiff old runner’s spine, and I am receiving a massage in nature’s Jaccuzzi.

The waters are clean and gloriously warm, carrying heat that they absorbed from the rocks that they caressed, as they meandered towards the falls.

All five of us find niches and luxuriate in the falling water.

A feeling overtakes me of extreme pleasure. 

Ambushed by this delight, in this secret place of humble, simple pleasures, I splash and move aging joints against the small torrent. 

I recognize this joy. I am like my newborn grandson as he splashes and kicks and squeals in his bath. 

At sundown my friends and I return to the peak of Airforce Hill. As the light mellows, the leaves dance in the gentle air, now emerald, now light green, now golden, ever aflutter. Far below, below the canopy of honey-green, lean tree trunks reach down, down to their foothold in the sloping earth. 

The distant sea is flat, pale, a misty mirror. An inlet winds its silvery way inland to a landing stage far below. The wetlands stretch out and glow with abundance. The living land and the living waters are still. The sun bleeds into the horizon, staining the ever-smoky air in spectacular blood reds.

There is quiet. My companions and I are visited by a deep peacefulness. 

The rabbi and I recite our afternoon prayer and give thanks.

We five hail from different corners of the world, from Nigeria, from Zimbabwe, from Adelaide and Leeton. We are guests here. Soon we will leave. Little is our understanding of Wadeye, but today we learn one big true thing, that this land, this swamp, is rich and beautiful, a place of treasure, a sacred place. 

We five are foreign, here at the pleasure of the owners.

X: UNTIL DEATH

Outback Australia is the Land of Marriage’s End.

All over the outback, I work with veteran nurses and doctors and community workers, people who devote careers to Indigenous wellbeing. Few of them are there with spouses. Most are dismarried, half-married or never yet married. I wonder at the personal cost of their work.

For some, of course, remote work is not the cause but the remedy for a lost marriage. One of these tells me: ”I came outback to recover myself. I needed work and quiet. I needed to find a purpose. I did and ten years later, I’m still here.”

There are intact couples, most of them younger. They will never dismarry, if only because they are ‘partners’, not spouses. Most of the young ones are tasting outback life for a few months, perhaps a year. They will leave in time, before their union corrodes. 

Love might wither, relationships crumble, but I see no sign that motivation wears out. My outback colleagues, perhaps alone among Whitefella Australians, somehow create an enduring marriage of perfect realism to constant respect for the first people of the country.

XI: ONE BIG TRUE THING

It is my final morning. I go for a run before work. I take the dogfree trail leading out of town into the bush. The track winds between the trees. Ancient vehicles lie half-hidden, wheels upward, like so many dead cockroaches, rusting in the enveloping green. 

I round the bend of last weekend’s Agile Wallabies. There they are again, bouncing into air, bounding silkily away, weaving untraceable paths in the undergrowth. Now the eagle flaps into flight, does a lazy circuit and allows me to pass. 

I am the guest of this country, a happy and blessed visitor. I turn and run back.

My visit has been brief. Apathy, endemic, assailled me, but the circumambient life redeems me. 

The children at school radiate energy. Even the  Fight Club congregation carries its energy, all curled up, held latent: I fight,therefore I am.

The land, its waters, its gleaming flora, the leap and soar of animal and bird, these leave me uplifted.

And its people who know One Big True Thing, live here and know their own land.


I Don’t Belong Anymore

My medical defence insurer wants to protect me from myself. The insurer invites me to attend a webinar titled, Keeping Professional Boundaries. I entered medical practice as I entered life: I wanted to break down the barriers that kept people apart. “Only connect” was the motto of the great E M Forster. It was my motto too.

In recent years, AHPRA has been writing to me, warning me to maintain necessary distance from patients. I should avoid initiating any physical touch of a patient, other than when clinically necessary. I must not treat friends, I must not treat family members, I should not meet a patient for coffee or a drink or a date, nor for a dalliance nor for a sexual relationship. Realising that the world has changed I register for the webinar.  

The webinar began with a playacted scenario of a young male doctor’s consultation with a youngish woman. The doctor is a good-looking male, personable and competent. His patient is an attractive young woman, perhaps slightly older than the doctor. At the conclusion of their consultation the patient asks, “Do you have any more victims today?”

The doctor hesitates and the patient clarifies: “Am I your last patient today?”

“Yes, as it happens.”

“Would you like to go somewhere and have a coffee together?”

At this point the youtube stops and the watcher is presented with three possible responses the doctor might make. One only is deemed correct.

1. The doctor assents. It’s innocent enough. Sharing a single cup of coffee is not improper.

2. The doctor informs the patient politely that he cannot accept. Further, he states the professional relationship has broken down and he must not see her again as her doctor, but must arrange for her future medical care with another doctor.

3. The doctor informs the patient politely that he cannot accept. He states, ‘We have professional guidelines which we must follow.’

To me the answer seemed simple. But the scenario made me think over the past 52 years of being alone with people of all genders and trusted by them. Form more than half a century I’ve tried to remove barriers. None of my patients, however, invited me for coffee, so I had no practical experience of the scenario.

I recalled an event that occurred perhaps a dozen years ago. I received a phone call from a previous patient whom I first met when she was one week old. She remained my patient through childhood to adulthood. I treated her father for his rare disease, which eventually killed him.

The young woman studied Medicine and when she graduated, she invited me to attend her graduation ceremony, I supposed, in loco parentis. She became engaged and she invited my wife and me to attend her wedding. She trained as a GP and started practice in the country. I didn’t see her for some years. Now she rang me, asking if she could consult me professionally. She was unsure how to approach a possible problem affecting her little boy.

I offered her the first appointment of the next convenient day. The young woman accepted. Then I said, ‘If you can come half an hour earlier, we can meet for a cuppa beforehand.’ My patient accepted enthusiastically. At the café, delighted to see each other again, we embraced, sat down, drank coffee, talked about our work and our widowed mothers then crossed the road for our consultation.

The same day I opened a letter from AHPRA which arrived in the mail. The letter warned against socialising with patients, specifying the dangers and the power imbalance that prevailed even in meeting for coffee. The same letter emphasised the need to avoid non-clinical touch. I thought about the hug with which my patient and I had greeted each other that morning.

This brought to mind another occasion in which I had transgressed. A religiously devout young woman whom I treated through childhood and adolescence moved interstate to train for the ministry. Her parents had been my patients before her. Her father was the first patient I referred for total knee joint replacement. The operation was a success but he developed an infection and died a week later, of septicaemia. His daughter was then a teenager.  

The young woman studied theology, married and served a flock in a distant city and I did not see her for quite some years. She returned once to Melbourne to seek my help with infertility. She was married happily to her first boyfriend, himself a minister in the same community. I asked some questions then placed some calls and referred her to my favourite genius. Years after that she turned up again at my country practice on the outskirts of Melbourne. I was delighted to see her. We sat down and I asked her about her life. The couple had been blessed with two small children.

The conversation turned to her health. She said, “I found a lump in my breast.” I examined her and felt the lump readily. It was hard, a bad sign; it was not mobile, another bad sign; the overlying skin was puckered, a further sinister sign.

After she had dressed, we talked. I answered her questions: Yes, it was worrying. Yes, it was probably cancer. We talked about treatment, about biopsy and tests, about choice of specialists. She asked me about the prognosis. I answered as well as I could. I asked her about the age of her children.

I placed some phone calls and wrote a referral letter. We spent well over an hour together, the visit spilling falling at the end of my morning’s work.

I felt shattered.

The young woman stood to leave. I took her in my arms and held her a moment then released her. But she held me for some time, her head resting against my shoulder, her body heaving with sobs. At length she wiped her eyes and said, “That’s what I crossed the country for.”

Looking back at that encounter I realise that this was the first time I had initiated such conduct. I had acted on an impulse, in response to which my patient had told me how much it meant to her.

I have socialised with patients, I have drunk coffee with them (and in one case, eaten pancakes with an ex-patient’s at her invitation). I have treated close friends and, apprehensively, I continue to do so. I have walked the primrose path toward the eternal bonfire.

In recent decades lawyers, teachers, nurses, ministers of religion, therapists and doctors have all been guilty of extremely harmful acts. In response to those wrongs all professionals have been warned to protect those who are vulnerable. Power resides with the professional. Power corrupts some. As a result, society is wary of abuse. And all of us in professions have been trained to mistrust ourselves.

I think about my Dad in his years practising as a GP in a country town. His patients were his friends. His friends were his patients. After we moved from the country to the city some of those friends drove hundreds of miles to consult him. I think of the many doctors living and working today in small communities. The AHPRA rules (or ”guidelines”) would, if followed, socially strangle a doctor and in preventing great harms to patients, do much harm to practice.

My insuror’s webinar gave clear and absolute guidance to members. We would be obliged to decline the coffee, and we must bring an end to the relationship forthwith.

I am guilty of great error: I still trust myself.

I no longer belong in a role which has long been my home.

The Miner


 

He’s a tall man, slim. He wears clothing of dark gray. When he gives his surname, I nominatecorrectly his country of origin in Northern Europe. It’s only after we’ve parted that it occurs to me his name translates to Big Son. He might well descendfrom a line of big sons.

Even though he’s past retirement age, I ask him what he does for a living. Out here the farmers and the miners never quite give it up. I’m a miner, he says – a shrug, a wry smile. The lure of the big find is too strong for some to stop.

– Where do you live?

– Out along the Seven Mile. I’ll take you and show you if you like. You can see the diggings.

– OK, I have your address. I’ll drive out.

– You can’t. You’ll get lost.

This rings true. The town is peopled by those who don’t wish to be found, persons escaping the Lawor vendetta or drug dealers or the tax man or the former spouse, or a life of persecution in the old country. Nobody really knows the population. The town boasts fifty-four ethnic groups. As you drive into town a sign welcomes the visitor. A little further on a sign reads: “POPULATION ?”

The 2016 census lists 2016 persons, a neat match, probably too neat. No one really knows. It’s though a further 3000-odd are hidden away in the hills, where they live in disused trams or railway carriages, huts and caves. In the past, the local Police designated a discrete patch of earth behind the shopping strip where scamps and scally wags were allowed to park when they came into town for supplies. Certain back roads were allotted to these folk. The Police would ask no questions so long as the miners did not bring themselves to their attention.

Big Son instructs me to meet him outside the front of the clinic after I finish work: you can follow me out along the Seven Mile. At 5.00 precisely I step out into bright sunshine where Big Son looks at my white hire car and says, Get into my vehicle. Yours is too pretty to take out bush. I jump in to a large, hard-working 4-wheel drive and we drive out of town.

The further we drive the thicker the marks of the digger. Low structures of tin and timber alternate with mullock heaps of pale stone and earth and random bit of rusted machinery. We’ve left the bitumen behind us, dirt tracks branch off and wind off in all directions into thin scrub. I’ve lost my bearings. My companion keeps up a commentary: that claim there belongs to a friend…over here you can see cabins…the people over on the right run a really good tourist operation.

Before I came to this country I moved to Roma – I had a girlfriend there, the usual story, you know – in Roma I set up a photographic studio.

Photography was my trade. 

The narrating voice has taken on a note of pride.

I didn’t speak the language, but I taught myself by watching videos in Italian. I succeeded as a linguist but I struggled in my photography business. No network.

I visited Australia – curiosity, you know?  Back in Roma I applied for a visa to settle in Australia. It was for adventure. I came out here and started to dig. I married once, had a couple of daughters. The marriage ended. Married again, my wife is an artist, an art teacher. We fostered a little child. He was murdered. My wife went mad. I sold up, sold all this – by now we’re at his claim and we’ve pulled up – I had to sell and take her to the city for treatment…

The young bloke who lived over the hill there, a loner, a misfit, killed the little one. He lived there, a recluse, a neighbour. No one knew anything about him until he committed murder. Of a child.

CARRIAGE HOME

My wife got better and we came back. I got a new claim just by my old one. This is it. ‘This’ is a patch of elevated stony ground with holes in it. Disparate bits of metalwork rise above the surface and disappear below. I peer down a hole walled by a cylinder of galvanised iron. The hole is a mine, about one and a half metres in diameter. My host says, it goes down eighteen metres. I consider the dark and the deep. Obviously you don’t suffer claustrophobia…

I do, to a degree. I think anyone with imagination must.

Spiral staircase for a mine

Bright blue steel steps disappear into the depth of another circular hole. Big Son says, a friend invented that spiral staircase. The friend sells them to diggers and small miners across the country. This machine here he points to a steel contraption – I built. I invented it and patented it. I’ve sold a few of them, but most diggers can’t afford $18,000…

The digging machine invention

The machine that my host devised is a complicated structure of thick steel, encasing steel cables, an electric motor and meters with dials and numbers. It stands, grey, substantial and sophisticated on the primal earth. There’s not a speck of rust. It’s a machine for digging a mine. I gaze at the device in awe. Inventor and invention alike stand solid and impressive, gunmetal grey, erect in the unforgiving sun.

Who trained you in engineering?

No one. I always liked machines, devices, gadgets. I pulled things apart, curious you know?

What does a digger do who can’t afford a mechanical digger? Pick and shovel?

Yes. If they can’t scavenge bits of old machinery. Maybe fix it up, get it working.

I consider pick and shovel work in the digital age. Out here summer temperatures reach fifty in the shade and stay there for days. But I do know why a digger might stick at it. On the way out of town Big Son pointed out a jewellery showroom: Very honest people there, prices very reasonable. They’ve got a gem there that I dug up, very valuable. They paid ten thousand for it. They’ll sell it for forty thousand, but they might have to hold it for years.

Another person, obese, not old, walking on a stick, hobbled and rolled picturesquely into the clinic this morning. Both her florid gait and her words told a story that stretched the truth in support of her quest for a medical certificate for welfare benefits.

We moved onto other subjects. 

What’s your work – when you’re able to do it?

I’m a miner, she said. I’ve got forty thousand worth of raw gems in this bag. 

In this town that outlandish statement might just be simple truth.

Here, gemstone is currency that doesn’t leave records. Bankers, accountants, the taxman need not know.

My tall host looks around his claim. He says, There’s always theft. You can’t make your property safe from thieves.

I ask, Do people arm themselves?

Some do, they have guns… shootings aren’t rare out here.

This here is my blower – Big Son points to a large hollow, elevated structure of steel and rust, that rises above the claim, shaped like one of those concrete mixers you see on trucks at building sites. This towers above us. It does something with mullock that I don’t really understand, but it sounds like winnowing. My host tries to explain: You see that motor there? I found it in a derelict street sweeper. It’s a three-cylinder diesel. I adapted it. It’s noisy. The miner turns a switch. A battery turns the motor over, it fires then clamour, brutal and immediate, drowns conversation. The thick steel platform vibrates beneath our feet. 

Come this way, into the house. Twenty metres from the claim, just down a small slope and hidden from sight at the claim, stands an elegant modern building of steel and timber. Yes, this too was designed and built by my host. It stands on leasehold land. The house lease is separate from the mine lease: You get a home lease for twenty-five years. You renew it every twenty-five years.

We pause at the threshold. Big son points: these stones everywhere, that’s gemstone waste, that’s potch. My host leans a long way down and picks up a pebble. Here take this, a little souvenir. I look at the little grey pebble. Its centre glows with blue and green fire.

Inside, all is dark. A woman of middle age materialises and speaks in a florid French accent.

We stand in the dark room until electric light reveals walls hung with artworks in oils that startle with their mute emotional power. The artist steps from the shadow and speaks with shy pride about the paintings.

– You see that brown shading? Do you know what I use for pigment? 

I regard the glowing brown and shake my head.

– Coffee. Nescafe. I’ve tried other instant coffee. Nescafe gives that fire in the brown.

We come to a bathroom whose walls are a menagerie of megafauna: emu, koala, kangaroo, in their greys and browns move across bright panels of white and lime. My hostess explains: We sit on the toilet and instead of blank walls, we gaze at animals, bounding across the walls, alive.

We pass a small portrait, the only watercolour. The painter passes it by. Big Son pauses. We regard a bright portrait of a little boy with a face full of life andwild, straw-coloured hair. He radiates light. Big Son says quietly, this is our little one.

Deploring


Deploring has long been a favourite sport of mine.

Bankers, paedophiles, turners of blind eyes have all earned my opprobrium. I’ve deplored racists and people who speak or act violently, and in common with many others, I’ve greatly enjoyed deploring politicians. I’ve deplored climate change deniers and I’ve deplored people who criminalise asylum seekers. A good deplore always left me feeling righteous. As my wife points out I’m particularly good at seeing myself as righteous.

In recent times deploring has lost some of its gloss. It’s become like tenesmus, which is the medical term for the condition of dissatisfied defaecation. The instinct is blameless, the urge is strong, but the act feels somehow incomplete.

Hillary deplored deplorables to her cost. It turns out the deplorable are not few and they live next door or across the street, or among your friends.  

Covid has seen an outbreak of deplorables and of deploration, both in epidemic proportion. Anti-vaxxers, rioters who confront police, those who piss on the Shrine and expose the many to the risk of contagion; attenders (not attendees – no-one forced them to attend) at an illicit engagement party, worshippers at a proscribed religious service likewise incur my white-hot rage.

But my rage no longer satisfies. Why? Firstly, I have to distinguish between the act which I deplore and the actor. Further, I need to recognise that the deplorables are people, and what’s more they are people in the plural. They are my fellow citizens, these hundred who congregate to pray, thesethousands who block streets and provoke police officers. I can’t help wondering who these people are and reflecting on the honest thoughts and the genuine fears that prompt many of them to act in these harmful or misguided ways.

In my work I meet plenty who declare their certainty of conspiracy (big pharma, the government, George Soros – which means – wink, wink, nudge, nudge – the Jews). Others teach me the science; this week a seventeen-year old girl told me, ‘I know Pfizer impairs female fertility. I know I want to have children but I want to be safe from Covid too.’ (I told her I too had heard that report, but only here in Lightning Ridge, where I’m presently working, had I heard it. The remainder of female humanity doesn’t know what this child knew – and now unknows.) How can I deplore her for the primal fear of childlessness? What profit is there in contradicting those convictions that are religious in their depth?

The common theme among my patients is fear. It’s honest, sincere fear, invariably magnified and feeding on itself and its cesspool of ‘information’. How can we help frightened people by name-calling?

I have no respect for those people who decline vaccination and cry Apartheid! Their thinking is sloppy and they enjoy playing the victim. Less innocent too are those who behave lawlessly. But with the exceptions of the clearly malevolent minority (I include here members of bikie gangs, violent anarchists, Nazis earnestly working towards overturning democracy and restoring Whitest Australia), no-one gets up in the morning and asks, How can I do the most harm today? What is the most foolish trending opinion I can embrace?

Rather I see people who embrace such folly as attracted to the ‘glamour’ of free thinking, the ‘heroism’ of rebellion, the ‘courage’ of free speech. They evoke in me feelings that range from compassion (in my consulting room) to outright condescension (like the people of biblical Ninivehthey know not their right hand from their left).

But we are divided. We do discriminate between the vaccine-willing and the others. We grant freedoms to some and deny them to others. I can see no other choice, but I can see no long-term future in this discrimination. There is a limit to people’s acceptance of curtailment of their liberties. The fabric of community is only as strong as our leaders’ capacity to inspire.

Where are the inspiring leaders? They do exist. At the outset of the pandemic I held great fears for the most vulnerable communities in Australia. Even more than residents in Aged Care, I feared for outback indigenous communities. People who obeyed an ancient cultural imperative to wander through ancestral lands would surely catch and succumb to the virus, as they did in early colonial times to smallpox. But this did not eventuate. The traditional leaders, elders, listened to respectful advice that was appropriately conveyed. They became convinced and they carried conviction with their people. People listened, followed and were safe.

My friend Colin begs to differ. I’m pleased to oblige:

Howard. G’day and thank you for sharing.

To “deplore” is surely the most respectful way to demonstrate that one differs from another’s point of view.

 

Deplore – to express or feel deep grief in regard to.

 

In certain quarters this word came to be reviled after it was used to register dismay at public political rallies. The rallies became places where lies, insults, routine mocking of opponents and outrageous motivation of crowds chanting “lock her up” in respect of a political opponent who 5 years later has not been charged with anything. There was no crime.  This from a man who now has 16 Civil legal cases underway against him and a further 16 Criminal cases underway. A man who has instigated or influenced 60 appeals against an election result, all of the appeals dismissed, sometimes with a Judge’s comment, “don’t waste the court’s time, there is no evidence”. 

 

History teaches us such “leadership” emboldens ill informed and bigoted people to behave inhumanely. Seeing ill informed led astray, firstly to chant insults and later to attack the seat of Government leaves me weary, bewildered, numbstruck and sighing with grief. Politicising a virus is a masterstroke of machiavellianism.

 

It’s deplorable.

If we see a small child randomly pull blooms off flowers, or hurt a small brother, or for good measure swing the cat about by its tail and then tell lies, we rightly deplore it. And try to correct it. If in the process “our rage no longer satisfies” maybe it’s because we think our voice no longer counts and have given way to misinformation or that no one is listening. There are voices the misguided listen to. They are not by any stretch “reflecting on honest thoughts”. Rather they reflect on dishonesty of a spectacular nature. If these thoughts and actions are “religious in their depth” this is called heresy, not that I’d suggest burning at the stake. But failure to act in a firm manner gives leeway for deplorable behavior such as pissing on a shrine.  

Relying on people getting the correct message via the frightful spectacle of seeing grandma, a friend, neighbour or workmate suffocate to death with covid is not enough. Mandating compliance saves any argument(s). 

No jab, no footy. 

No jab, no coffee.

No jab, no Bali. 

No jab, no work. 

 

Doing so doesn’t mean “we grant freedoms to some and deny to others”. It’s not unlike the freedom to drive a car once learned and tested. And when that’s achieved other layers are added, such as wear a seat belt, don’t speed, and for heaven’s sake get off your phone while driving at 60kph and if you’re 15m aloft fixing the tiles put up a safety harness. Please. For a variety of reasons, one being it’s cheaper for society to do that than pay for a lifetime of care for a paralysed worker. This is not “discrimination” but boundaries for the greater good.

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.