Death Visits

Death visited last week, snatching away a lady whom we’d expected would recover. She was 87 years of age, a little disorganised in her brain, not vigorous but not too ill. We admitted her to hospital in the morning for observation and nursing care. Her elder sister had dementia too. She visited in the afternoon, escorted by her carer, a slim Asian woman.
 
 
At 3.00pm our patient enjoyed her afternoon tea. At four she took a nap. While asleep she stopped breathing. Big sister called us. Her cardiogram showed a heart attack. Her end of life instructions read: NO CPR. NO RESUSCITATION. She died. I left the dead concealed behind curtains and approached the living. I leaned and spoke clearly: ‘Your sister has just died in her sleep.’ It was the carer who fell onto the shoulder of her client, crying. The elder sister comforted her: ‘Don’t be upset. You get used to that.’ The calm features of the Asian woman twisted in grief, her face suffused. What silent sorrow of her own had been roughly torn open?
 
 
 
Meanwhile death had been stalking another two of my patients for days. I could hear his tread closing on them, unhurried, inexorable. For the younger of the two, death – release from her cancer – could not come soon enough. She begged, 'Let me die. Help me to die.' We gave her all we had, our promises of kindness, the usual feeble half-answers. She lapsed into a dull quiet, defeated by our timorousness.
 
 
The elder patient was far from ready. She had lived through the Second War in Europe, had seen much. Late at night she grasped my hand, breathlessly contriving a voice that filtered feebly through her oxygen mask. She pulled me close: ‘What will happen to me?’
I looked at her aged face, searching her: ‘Are you afraid?’
‘Yes.’
‘What are you afraid of?’
’Dying.’ She looked hard into my face.
‘You don’t need to feel afraid. When the time comes you will fall sleep. You will not suffer. You will sleep and you will not wake up. We won’t let you suffer.’
The old lady brought my hand to her chest and gripped it hard, pulling me closer. We breathed together in the darkness. No voice. Her smile said her thanks.
 
 
I went to my quarters and fell fast into sleep.  My phone rang. When the screen read ‘Unknown Caller’, I knew it would be the hospital calling. Surmise told me death had arrived for one or other of my friends. No, not yet. A third patient, more peremptory, had summonsed death by swallowing two weeks’ medications. With one hundred and forty tablets inside her she dictated to the nurse the disposition of her possessions: ‘Give my good overcoat to this one. Give the money that’s coming to me to that one.’ 
 
 
Sleep was slow to return. I lay and calculated the effects of twenty-eight strong blood pressure tablets, and an overdose of aspirin. I must have slept, for the ringing of my phone disturbed me. ‘Unknown Caller’ again. No, no-one had died. A child had a red throat.
 
 
Over the following hours of darkness ‘Unknown Caller’ rang six times. Asthma, wet lungs, fever. No death. At dawn the call hauled me from deep sleep: ‘Come now! Cardiac arrest!’ A large inert body, a small nurse pushing down hard, again and again and again. A flickering trace on the cardiac monitor, a chain of us thumping an unwilling heart, injections of adrenaline, a failed electric shock. No pulse at the wrist. I called a pause, the hopeful triangles on the monitor fell into a flat line. No breaths, no heartbeat. The husband of the inert figure stood, watching, his hand on his mouth. We tried again.
 
 
After a time I called a second halt. I listened for a heartbeat. I listened and watched for breathing. I shone a torch into pupils and found them wide with death. I walked across the room to the husband and said, ‘Your wife has died.’ A massive man, erect, he crumpled into silent weeping. His heaving trunk was enveloped instantly in the embrace of a woman I had not sighted. I spoke into the bereaved man’s free ear, ‘She didn’t suffer. She was unconscious from the instant she fell.’ The embracer’s arm groping blindly, grabbed me, held me hard in the grieving ruck.
 
 
At length I extricated myself. The small nurse from Uganda wiped his eyes. Another nurse said hoarsely, ‘I was at school with the husband.’
After certifying the death and writing my notes I left the hospital. Outside, the chill of an Alice Springs morning felt welcome on my skin. I wandered to a park and attended to my dawn prayers, delayed by a death.

Eighteen Percent

As I ate my Weet Bix this morning I read the following email sent by my sister in the United States.

Café charges men 18% 'gender tax' to highlight pay gap


This sign lays out of the policy at Handsome Her, a Melbourne, Australia café where men are invited to pay 18% more to reflect the gender pay gap.

A café in Melbourne, Australia, is giving its male customers a side of gender equity with their lattes. At Handsome Her, men are asked to pay an 18% premium to "reflect the gender pay gap." Men earn an average 17.7% more than women for full-time work in Australia, a government report found. The difference is roughly the same in the United States.

The café, which opened its doors for the first time Thursday, is hoping to shine a spotlight on the issue. "All we really wanted was to raise awareness and start conversations about the gender gap," Belle Ngien, the café's manager, told CNN. The voluntary donations are collected during one week every month and given to women's charities, Ngien said.

But it didn't take long for the Internet to go crazy over the scheme, with some calling Handsome Her's "gender tax" discriminatory. But Ngien is unfazed: "Men have their own spaces that we're not allowed in to, so why not have that space for women?"
No one has declined paying the extra 18%, she said. In fact, a few customers — men and women — have donated more. "Eighteen percent is actually not a lot. Our coffee is $4, and 18% of that is 72 cents," Ngien said.

Indeed, men have come from across town to support the cause, owner Alex O'Brien said in a Facebook post. "We've had men travel across town to visit us and pay 'the man tax' and throw some extra in the donation jar," O'Brien wrote, adding, "Guys, you're pretty neat."
In the end, Ngien said, no one is turned away based on whether they pay extra.

"Sometimes it's hard for people to change their minds," she said. "We're not in the business of changing people's minds. They are welcome to go elsewhere if they don't want to pay a voluntary donation."

So far, Handsome Her has collected a couple hundred dollars for Elizabeth Morgan House Aboriginal Women's Service. And it's definitely fueled a conversation.

No-one gets roused to passion while eating Weet Bix. I mused and meandered and then it came to me: none of  the internet responses refers to the beneficiary, an Aboriginal women’s service. No-one is less equal in this egalitarian land than a beaten Aboriginal woman.

I can affirm that: in my present posting I was asked to give evidence in the trial of the ex-partner who took to his girlfriend with baseball bat. He injured head, eye, limbs, trunk. Bones were broken. She was admitted unconscious to Intensive Care. A huge purple discoloration on the woman’s back, the size and shape of a bat, said clearly what she could not.

I forwarded the above to friends and family. A friend, Colin Hockley, wrote in response:

Once upon a time in a far away country lived a little boy. He had a big sister. 

The little boy's jobs were to feed the chooks and collect eggs, mow the lawns, work in the huge garden, chop the kindling wood, fetch coal, light the fire, walk the dog, get up in the cold, pre dawn and deliver newspapers before school, and deliver meat for a butcher on Saturday mornings. He worked on a farm through school holidays planting or picking potatoes, peas, Brussels sprouts, strawberries, raspberries, and was the chief shouter in a gang of rat catchers.  

At home his role was to peel the potatoes every day, lay the table for meals, wash dishes, and in summer, select salads from the garden. His best job was to roam across soggy fields early in the mornings, before even the farmer was up and about and find huge mushrooms laying amongst the cow poo.

The big sister cleaned house and the little boy helped with that. She also ironed, washed dishes and was very busy with homework from school. Big sisters got more pocket money because they "have to look after their hair". They don't do paper rounds in the dark, or butcher rounds, or work on a farm. This is for the boys. 

When the little boy grew up he sometimes found himself looking into an ugly pit of resentment at these differences and the bubble of pain that went with it, threatening to burst one day. Later he began to see that everyone carries weeping wounds or scar tissue and that he could transcend pain by looking at someone with greater pain. 

Like the story of the poor woman bashed with a baseball bat. 

A special tax of 18% on baseball bats should be imposed to pay for this atrocity.  
 
 

Hanky no Panky

A woman of my acquaintance declared herself ready to acquire a boyfriend. Having emerged from an emotional crash site, having brushed herself down, cheered herself up, adopted mindfulness and become a yogi, the woman confided, ‘I wouldn’t mind having a boyfriend.’ She meant me to understand ‘boy’ as a person in her own, non-juvenile age bracket. She comes, as she often reminds me, to a different – younger – generation.
 

 
The woman selected a promising candidate – fellow yogi, terrifically mindful, neither bankrupt nor lumbered with children, not a Trump supporter nor addicted. After the first date she favoured me with a report: ‘Charming fellow, good company.’ Yes, she’d see him again.
 
 
Following the second encounter I found her beaming. ‘He’s funny!  And considerate. I like him.’
 
 
The woman saw him on a third occasion. Following this
I heard no report. In due course the woman and I bumped into each other. ‘Well?’ I asked.
 
‘Well what?’
 
‘How are things with Mister Right?’
 
‘What are you talking about?’ A bit frosty. Irritated.
 
‘You know, Mister Funny, Mister Considerate, Mister…’
 
‘Him!  We’re not seeing each other. I’m over him.’
(That’s how she talks. That’s how Generation Alphabet talks.)
 
 
Nonplussed, I asked, was the matter settled, final? It was, utterly. Finally. Beyond redemption.
 
 
‘What happened?’
 
‘Nothing happened. He’s repulsive.’
 
‘Why?‘ I asked: ‘Bad breath?’
 
‘No. Something he did.’
 
‘What?’
 
‘Blew his nose.’
 
‘What’s do you prefer? Nosepicking?’
 
‘It’s not just that. He uses a hankerchief.’
 
‘What?’
 
‘He reached into his pocket, pulled out this square of folded fabric, buried his nose in it and blew.’
 
‘That’s all?’
 
‘No. After he finished, he folded up that precious bit of rag – some heirloom from his grandfather – and put it into his pocket!’
 
‘What’s the problem. His technique seems sound. Copy book, in fact. What would you suggest?’
 
 ‘A tissue.’ 'Since when did snot become so important that you need to carry a piece of material around just in case you need to blow your nose? Do you carry toilet paper in your pocket just in case you need to shit? And if you did, would you use it and then put it back in your pocket?'
 
 
This woman is not a doctor. She does not interest herself in the absorbing topic of how macrophages make their way to pathogens, how they engulf, destroy and wash them away. For her, it is not immune competence that matters, but style. Aesthetics. As a result the woman has no time for snot. I offered to enlighten her about the secret life of the albumen-born macrophage. ‘It’s not glamorous, but it is marvelous,’ I begin. She turned her face to me, sneering. From a person of her non-judging, all-accepting, mindful, universe-loving, recently renovated nature, that expression was alarming. And enlightening.
 
 
I persisted: ‘You know, we all make mucus. The membranes that line our hollow organs are named after it. That’s why they’re called ‘‘mucous membranes.’’ Their cells secrete a smoothing film of pearly fluid to keep things moving. Your nose does it, your sinuses, your eustachian tubes, your lungs, your bowel. And if you’ll forgive the expression, so too does your vagina. Snot makes the world go round.’
 
‘Not my world.’
 
“You’d be shot without snot.’
 
 ‘If you say so. I say, if you’ve got it, blow it and stow it, don’t store it.’
 
‘So, blowing your nose on a tissue is more elegant? Every tissue user knows the moist warm feeling of snot overflow drowning the tissue. Is that glamorous enough for you? Hygienic enough?’
 
‘Look, don’t give me your science. I just don’t want to be close to a man who keeps a clothful of old germs, and cold slime and green crusts in his pocket.’
 
The voice had climbed a few octaves and grown emphatic. Sober discourse and factual analysis were not what my friend was after. Aesthetics were the thing. And, as in all matters of taste, consistency is not the prize. It’s the vibe. I did not invite my friend to consider the content of the nation’s gussets, where innocent slime thickens and dries, its macrophages dying content with a job well done.
 
 
Troubled by thoughts of the man’s unfair dismissal, I appealed to proportionality, an element of justice; ‘So you deprive a person – a good person by your own description – of the sunshine of your company simply for possession of flannel and mucus?’
 
‘Certainly. I could respect him, but inwardly I’d shudder. I could never be intimate with someone like that.’

'It's also a symbol of his mindset. Who of my generation carries a hanky? Deep down he is obviously conservative, boring and predictable. The hanky says a lot about him as a person. If lunch hadn't been spicy I may not have found out about the hanky until it was too late.'
 
‘What if he treated you with tenderness and respect?’
 
‘Tenderness and respect? That’s exactly how he treats his snot. Reaches into his pocket, pulls out his damask, which he’s folded and refolded into a fussy little square, unfolds it, takes a big breath and blows. You look away, trying not to vomit. You hear the flow. He sneaks a little sideways peek at his ejaculate, tries to hide his satisfaction, folds up the hanky and pops it into his pocket.’
 
‘So?’
 
‘So, if he carries a hanky – no hanky panky!’
 

My Private Knee

After three months of physiotherapy and rest and exercises and anti-inflammatory tablets had failed to fix my injured knee, an MRI explained why: the outer cartilage was torn and the inner was tatty. I saw a surgeon last Wednesday and on Friday he repaired what was reparable and removed what was not.
 
 
The next day I sat on my couch in small pain, enjoying a liberal dose of self-pity. I had time and excuse to sit and live slowly. I read the ‘paper. A fellow citizen wrote to the editor in praise of Medicare, our universal health scheme. Her small daughter fell acutely ill and she hurried to the public hospital, where the waiting area was crowded and the public address announced the arrival of a series of ambulances. The delays would be long. However the sick child was assessed in Triage as urgent, was seen and treated expeditiously and expertly. By morning she was well enough to go home and her mother took up the pen in praise and thanksgiving. ‘How lucky we are’, she wrote, ‘to have such an excellent public health system.’
 
 
A second letter to the editor told the opposite tale. The writer suffered a limb injury and attended a public hospital. His injury was disabling and unremittingly painful. It was rapidly recognised as in need of early surgery. That was two years ago. His case is classified in the category of Most Urgent (elective). Every three months since he has returned to the hospital for routine appointments, where the diagnosis and the urgency are confirmed. His letter ends with a lament: ‘How can we kid ourselves we have a health scheme where Most Urgent can languish for years?’
 

****
 
 
The writer and I both suffered injuries. Both of us received expert advice that surgery was necessary. Mine was performed within days, while my fellow languishes for years. My injury was minor but it did not feel trivial. For three months it hurt too much to run. I turned to the bike and the knee felt worse. Soon I could not walk without pain. I watched the muscles of my thighs wither and I lamented. Those legs had been my pride. I contemplated a life without exercise and I knew I would not know myself.
 
 
How is it my leg improves by the day while a fellow citizen suffers a worse problem and waits interminably? I cannot doubt the sufferer subsists on medication which is neither curative nor safe. By now he is surely addicted to his opiates. Why the disparity? The answer is my private health insurance, which, by dint of thrift and belief, I afford. Not everyone is so fortunate.
 
 
Even an unbleeding-hearted economic rationalist would see the disparity as just that, an inequality. I believe there is a solution which is not a new idea, but a forgotten one. I recall a politician by name of Don Chipp who became Minister for Health in the Liberal Government in the days before Medicare was sanctified, beatified and became untouchable. Facing the disparity, Chipp proposed government would underwrite the private health insurance of the poor. All citizens would be insured, all would enjoy choice of surgeon and hospital, the private health sector would expand and prosper through efficiencies that Public Health can never match, investors would rejoice and the Liberals would be congratulated in the polls. Meanwhile Most Urgent Surgery (elective) would be performed within a humane frame of time.
 
 
That scheme, which bore some resemblance to Obama Care, never came to pass. Labor rejected the necessary Means Test as ideologically repugnant. Chipp moved out of his party and created a third force in politics, which soon became a chronic and disabling pain to Liberal governments. Decades later my fellow citizen, uninsured privately, suffers privately, where he could be cured.
 
 

One Grandchild, One Sickness

A contemporary told me of a rule she and her friends observe at the monthly meetings of their luncheon group: “Only one grandchild, only one medical diagnosis.”

 

 

The rule struck me as wise. My grandchildren proliferate, for which I give thanks and tell stories and show pictures. This is a picture of my latest, Sadie.

 

 

Last night I visited Sadie’s house. To my good fortune she happened to be crying. My son passed Sadie to me and I placed her against my left breast. My heart beat at its steady 46 beats per minute and over the next few minutes I patted Sadie’s back in gentle diminuendo. She stopped crying. She rooted and tried to suckle. My collar proved unnourishing. After a while Sadie gave up on fluid and slept. I held her there, on my breast, for some minutes: was it twenty? Was it only five? I never felt more deeply alive.

 

 

So much for the one grandchild. Now for the one medical condition. Like grandchildren these proliferate as we age. I have lots. Every condition generates a story of compelling interest to the sufferer, and to the sufferer alone. Today’s was a visit to the periodontist. Have you ever been treated by a periodontist? If not I congratulate you.

 

 

In reality the periodontist is a dentist. The difference is one of specialisation. This practitioner doesn’t implant, doesn’t fill cavities, doesn’t do root canals, doesn’t make bridges. Nor even, in the usual sense, do extractions. Instead the periodontist extracts scale, plaque and whatever you have saved for your retirement.

 

 

Because the periodontist is truly a dentist she has lying horizontally on a jet age bed that rises and bends and straightens in response to unseen signals from the practitioner. Behind your right ear the practitioner keeps a small table upon which lurk small pointed instruments of hardened steel. These she keeps out of your line of sight lest you seize one, and in a reflex of self defense, you plunge it deep into her eye.

 

 

In short, periodontic procedures are notoriously painful. I took my seat this morning on the dental bed. The bed lay down and so did I. I opened my mouth. A bright light shone upon my face. I closed my eyes. At this point I ceased speaking. The periodontist looked inside. She said some gloomy things: ‘Gingival recession… pockets… these front teeth are loose, might lose them…’ She fondled my gums for a good time: ’I’m applying local anaesthetic jelly’, she said. I tasted something distinctive and highly unpleasant. I recognised the taste, one I remembered from the day in the bath in 1951 when my older brother pissed in my mouth.

 

 

Perio, as I will call her for brevity, now poked a hissing instrument into my mouth. I salivated. As the instrument hissed it cooled itself with a constant spray of watery mist. Fluid accumulated somewhere near the hole through which I customarily breathe. Perio probed, the gadget hissed and misted, the fluid level rose and for a time I breathed under water. This went on for a longish time, a form of dental waterboarding during which Perio asked repeatedly, ‘Are you OK, Howard?’ Each time I lied: ‘Yes, fine.’

 

 

From behind my left ear the unseen dental nurse waved a wand that hissed and sucked. Frequently this sucking instrument missed its target and sucked at my lower lip, a strangely sensuous experience. My mouth being open and full of fluid prevented me from thanking my unseen sucking kisser.

 

 

The bed became erect: ‘Rinse’, said the Perio. I rinsed. The bed collapsed and I took the hint. My mouth fell open and so, briefly, did my eyes. I beheld before me at eye level a long thin syringe of glass and steel, moving towards my gums. I’ve seen that sort of syringe before in movies in which a figure such as Mengele carries out unspeakable acts. I closed my eyes. My trapezius muscles clenched. My gums swelled hugely, all sensation fled and the balance of my hour passed. I drowned repeatedly. I rinsed, I spat. The bed erected itself, Perio said, ‘That’s it.’

 

Happily, I paid for her next BMW. I was happy because nothing hurt. I’m sure she’s not a real periodontist.

 

Dressing up to Undress

Patients who attend a doctor in emergency come dressed in their ordinary rags and tatters. Their outer clothes vary and their undies are sundry. Those who attend, foreknowing, for their piles or their pap, wear their best undies. We all do it; we prefer to dress up to undress.
 

That’s why I’m hurrying out to purchase a toothbrush. When my regular dentist enquires I assure him I my teeth regularly – and I do – every birthday as well as at Passover and Yom Kippur. Regularly. Never fail. (I suspect my dentist’s true question goes not to regularity but to frequency. But I answered truthfully.)

 

So I do already own a tooth brush. It has served me, three times a year, for twenty years. It’s an old comrade, faithful and ragged. Today, however, I’m investing in a toothbrush of twenty-first century manufacture. I’m going to brush my teeth today. I’ve googled ‘how to brush your teeth’ and I’ll imitate the you-tube that shows how it’s done.

 

I’m preparing to visit a special dental practitioner, a periodontist. I’ve never seen a periodontist before but I am reliably advised that this professional will be a torturer with higher degrees and advanced training. So I will come prepared – with a brand-new overdraft facility from the bank and my gums sparkling after the attention of the new toothbrush.

 

Why has my faithful old dentist sent me to his colleague? Apparently my long gums are going to get longer, my wobbling teeth will all fall out, my destined dentures will never chew adequately and a gummy grin will decorate my mouth in senescence. In short my days of mastication, like life on this planet, are numbered. There’s just time to enrich a professional before it all comes to pass.

 
 

Like everyone else I’m dressing up for my own funeral.

 

 
 

Teaching an Old Dog Old Tricks

 

“Good morning, Doctor.’ The good-looking man is new to my practice. He offers a hand, shakes manfully, breaks no bones but leaves none unfirmed. His smile launches a promising relationship. ‘I’m new to Melbourne, doctor. Just moved here – for my studies.’

 

The man looks a young forty. I check his date of birth; he’s forty-nine.

‘What are you studying?’ – I ask.

‘Philosophy. Classic Philosophy, the greats, you know, Plato, Aristotle, Aquinas, Maimonides…’

He’s won me.

 

‘I used to be a lawyer. Made some money, made a family, four kids. Now it’s time for me. Time to pursue wisdom.’

‘Share it with me when you find it,’ I say.

He smiles.

 

‘Doctor, I wonder if you can help me out. Awkward situation. I’ve left my tablets in Sydney. They’ll arrive Monday next with the family. My doctor prescribed a short course of Temazepam for sleep. Exams next week and I can’t sleep. If I don’t sleep, I’ll fail. If I fail I’ll never find wisdom.’ The winning smile again.

 

 ‘What are the tablets?’

‘Temazepam, the weaker ones, the tens. I’m scared of anything stronger.’

‘Very wise. They’re habit-forming.’

The man looks shocked: ‘Habit-forming? Really? My doctor never mentioned that. I just want enough to get me through these exams. I finish in three weeks.’

 

 

The man and I spend a little time discussing Temazepam, natural remedies, his own preference for a long hard run (‘Wouldn’t you know, Doctor, my running shoes are still in Sydney?’) The man looks up at the marathon photos that cover my walls where other doctors show their degrees.

‘Are you still running, Doctor? Marathons? Really? Amazing!’

 

 

The man leaves my room with his limited prescription, leaving behind his protestations of delight, his vows he’ll be back, how lucky our paths crossed, he’s found a disciple of Maimonides, he wants me to be his new doctor.

 

 

A couple of patients later the receptionist buzzes me and pricks my balloon: ‘That new patient, do you know what he said about you, Howard?’

‘No.’

‘”What an amazing doctor! Still running marathons!” Says you are a scholar, an expert in Greek Physiology.’

 

‘You know what else he said?”

‘What?”

‘He said he left his wallet in his car. He said he’d be back in five minutes to pay. I asked him for his Medicare card, but that was in the car too. But he knew his number, he said, and I took it down. Thirty minutes and he’s not back. I rang Medicare: there’s no such number and they have no record of that name at the Sydney address he gave. I rang his mobile. “Optus advises the number you have called is incorrect or has been disconnected.”

 

 

Three years pass. Three years are not sufficient to heal a wound in trust.

Last week a new patient registers with Reception. He presents his Medicare Card, asking a series of questions:

‘What doctors are consulting today?

‘Who will I be seeing?’

‘How long has he been at this practice?’

‘I just need a prescription. I’ve lost my tablets and my wallet too. Can I pay with my credit card?’

 

 

The relatively new receptionist was not with us three years ago. She calls me: ‘Are you with a patient, Howard?

‘No.’

‘May I come in and talk with you?’

‘Certainly.’

The young woman is shaking: ’I think your next patient is lying. I think he might be the man who came here a few years ago and lied to you to get tablets.’

 

 

A phone call to the Doctor Shopping Line at Medicare. I give the Medicare number of the new patient. ‘We suspect he’s a doctor shopper’, I say. I give the new patient’s stated name. The Medicare person confirms the validity of the card and the truth of the name given. ‘We have records of that patient’s recent prescriptions. He’s had eighteen prescriptions since March first, every one of them for twenty Temazepam tablets, each prescription from a different doctor in your area. You might like to inform the patient of these facts, Doctor.’