Autumn notes: Man on a Tram

Peak hour, crowded tram. Deep in my book, head down in a forest of winter clothing, I sense rather than see the form that moves in my direction. The form sits down at my side. The face that I glimpse is dark, a face of bones and wrinkles like ravines. The hair, a crown of silver curls, strewn or scattered, falls in accord with the whim of wind or gravity or inertia.

The man is short and narrow. His slim haunches scarcely fill half of the empty half seat at my side. He looks about my age, but, reckoning with an educated eye I decide he’s two decades younger. Ragged black clothing speaks of neglect. The silver hair smells of cigarette smoke. A whiff of breath speaks of last night’s grog. Surrounding him, standing or seated, commuters armed and painted for the day in the City, all in their groomed elegance, escape into screens and music. The forest towers above and about him. The man lacks all accoutrement and adornment. He sits with his stillness, the smallest adult.

The man sits with his back to me. I return to my book which absorbs me for a mile or two. A rattle of a flat voice at my side brings me back to the tram. The voice speaks a question: Alfred Hospital? Before I can compose a response the slim young woman facing the black man speaks, It’s close, I think. I’ll look it up. The young woman interrogates her phone with quick little fingers. Her hair is light brown, her face nearly pink, her glasses, large and round, giving her the look of an undergraduate continually astonished by the adult world. Her eyes are small, shiny, slanted.

Yes, she says, it’s the stop after the next one.

The man’s voice rattles: Medical appointment.

The young woman leans, points further down the track, over her shoulder: Commercial Road. The man sits as we all do, in the young woman’s face, in uninvited intimacy. Her voice is kind, her gaze at the man, steady, frank, unafraid.

The rattle again: Dunno what the doctors will tell me.

I hope you’ll be alright.

 

 

The thin man rises just as the tram lurches to a stop. He glides toward the door, correcting for the lurching with a deft swing of hip and thigh that is effortless and graceful. He dismounts and disappears.

 

A Very Difficult, Complicated, Challenging Name

As a child I read the story of Goldilocks. Gold – i – locks: three syllables. Before long I could write her name and spell it accurately. Everyone in Second Class at Leeton Public School achieved the same competence. We were pretty sharp in those days, in Leeton, New South Wales.

My name is Goldenberg. Gold-en-berg. Three syllables.

It was in the year 1972 that my childhood wish to receive letters in the mail was fulfilled. Advertisers wrote me letters, medical specialists wrote to me, insurors, charities and other mendicants all wrote to the doctor. Most of them mastered the three-syllable test that we Leeton Alumni passed in 1952.

Those who had most trouble with my three syllables were medical specialists. Lots of them wrote to Dear Dr Goldenburg. The vagrant ‘u’ looked ugly.One wrote: Dear Dr Rosenberg. I knew a few Doctors Rosenberg. Were they receiving letters addressed to Goldenberg?

I had a few letters addressed to Dr Goldstein. I feel flattered: David Goldstein, the eminent oncologist, is a remote relative by marriage, and one of Medicine’s natural intellectuals.

One distinguished colleague wrote to: DearDr Rosenstein. Stein the crows!

 

I was thrilled to be addressed as Dr Rosenkrantz. Obviously a Shakespeare enthusiast.

I’ve received lots of letters addressed to Dr Goldberg. Goldbergs are thick on the ground; we three-syllable Goldenbergs are fewer. Those thick Goldbergs – many of them lovely people – suffer syllable envy.

Last week an insurer wrote to me as follows: Dear Dr Glodenburg. Three syllables, two innovations!

Language advances, spelling evolves, we progress.

 

The Lady in Seat 22 F  

Somehow the airline separates me from my wife. They allocate Annette seat number 21 C and they give me 22 B. Arriving at Row 22 I find seat B occupied by a young mum with a baby on her lap. The baby is asleep. The young woman explains: ‘The cabin attendant switched me so my Mom and I can sit together. Do you mind?’

I don’t mind at all.

The cabin attendant appears at my elbow. ‘Seat 22 E is free. Do you mind sitting there?’

I don’t mind at all.

I take my seat between a youngish man and a younger woman. He’s a muscular nugget. His fair facial bristles catch the morning sun and glow gold; she’s slim, no whiskers, café au lait skin. The man busies himself with his keyboard. I open my paperback. The lady smiles, says, ‘Hello’. I catch an accent, try to place it. Guessing she’s a Latina I prepare some Spanish. ‘De donde estais?’

‘Not from Espain. Not from any espanish speaking country. Try to guess.’

‘Slovenia?’

The smile widens. She shakes a lot of wavy hair: ‘No.’

‘Turkey?’

More hairshaking. She’s laughing now.

‘One more try.’

Guessing wildly I try Portugal. She laughs a merry laugh. ‘No. Saudi Arabia.’

Golly. No head covering, light brown hair, pretty conventional western dress.

‘She proffers a child’s hand: ‘My name’s Amy.’

Golly.

‘Hello, Amy. I’m Howard.’

‘What is your country, Howard?’

‘Australia.’

I give her time to absorb the incredible. Then, ‘You are Muslim?’

‘Yes, of course.’

I remove my cap, lean forward, reveal my yarmulke: ‘I’m your cousin.’

The smile widens. She’s delighted: ‘You are a religious man. I pray every day five times. I am estudent.’ She names her university in Los Angeles, a name not known to me.’ When in Saudi Amy wears her head covered, ‘only my face you can see.’

Amy tells me of her two brothers and her sister who are back in Saudi Arabia, with mother and father. A second sister is studying in LA with Amy. She points to a rich head of darker hair that crowns a quite ravishing face in a nearby row,

I spend some time pondering the life of a young Saudi woman on a US campus. A woman who dresses western and prays every day five times. Pretty brave, I suspect. And incidentally, pretty easy on the eye.

‘Amy, why do you take the risk of speaking candidly like this to a strange man?’

The head lifts and she regards me, smiling a little as to one who is naive: ‘Instinct.’

Back to my paperback. The young bloke types something about a baseball match. The young woman takes out some study sheets. I sight some highlighted terms familiar to me – homeostasis, perception, adrenergic flight/fight response. The head of wavy hair bends over the notes, a child-size finger traces the lines, her lips frame the foreign words.

‘What are you studying?’

‘Clinical Psychology. And what is your profession?’

‘I’m a doctor.’

‘That’s good. Maybe you can tell me what is homeostasis.’

I tell her what I understand by that term, the neologism I encountered first in 1965, a word that widened my mind.

Amy nods gravely and thanks me.

After a while Amy sets Clinical Psychology aside. She looks at my book and asks:’ Is that a good book?’

‘I think so, yes.’

‘But you do not know?’

The book won a Pulitzer. A close friend pressed it on me, saying: ‘Read it if you want to know DR.’

Do I like it? Not much. At least not yet. The plot, yes; the characters, yes yes yes. The style, not much.

Homeostasis is simpler to explain than ‘I think it’s a good book, but I do not know if I like it.’ A deep breath and I essay some literary criticism: ‘This book won America’s top award for literature. I think it gained attention for its unusual style of writing and for telling the modern history of the Dominican Republic in the story of one unfortunate family. The writing is bright, the story is dark. The language is lively, plenty of street talk. Every third word is nigger, every fourth word is fuck.’

I pause. No shock registers on the estudent’s face.

‘The characters are vivid and their story is dramatic. So, yes, I think it is a good book, an important book. Even ‘though I do not enjoy it much. Yet.’

‘You read many books?’

‘Yes, I do.’

‘Tell me please what books are good for me to read. Books you do like.’

She couldn’t give me a pleasanter task. The flight from Los Angeles to New York takes four hours. That might suffice. I speak of my favourite of all books written in the twentieth century. This is the book I read at Amy’s age ( I’m guessing here she’s as old today as I was fifty years ago): ‘The Leopard, an Italian novel of an aging aristocrat – you know? (Amy nods) – he sees the life he has known and loved, a life of privilege, passing. He knows that life will be lost.’

Amy remarks, ‘Life in my country is also changing… Slowly.’

Next I speak of Anna Karenina. ‘This is also an old book, more than one hundred years, written by another aristocrat, Leo Tolstoy. It tells the life of a woman who disobeys the rules of her society and obeys only her passion. She loves a man who is not her husband. I like this book very much; I respect Anna’s courage but I am angry at her too. I am angry because she turns her back on her son, a small boy.

‘It is an important book, one of the earliest books to give a woman strength, courage to make choices and to follow her own path.’

I watch Amy for signs of disapproval or discomfort. No sign of either.

‘Although I don’t entirely like Anna, the character, I like the book. The author shows us life. Like Shakespeare, he knows the good and the bad, the strong and the weak. He knows them and he shows them. He is not the judge, he gives us the life.’

‘And one more. This is maybe America’s most beloved book of the Twentieth Century. I love it very much. It is called, To Kill a Mockingbird. It is written by a woman, Harper Lee. The story is told in the voice of a small girl who lives in a town in America’s south at a time when many white people showed no respect for black people. The girl’s father is a lawyer who tries to save a black man who is accused of raping a white woman. You read this book and you love the father and you love the child.’

Amy asks me to write the names of the books she should read. It dawns on me I’ve recommended three books that challenge old norms. The books subvert male dominance, they chart the passing of feudalism and ancient authority, they show the rule of equal law.

I have lots of questions. Amy answers them readily. No she doesn’t go out with men (‘I am a good Muslim’), but she had been engaged to marry a man whom she chose. That was back in her home country. Later the engagement ended, the free decision of both. No hard feelings, no honour issues. It occurs to me Amy has found in Seat 22E a Father Confessor. I wonder about her vocation: I don’t know anyone who works in mental health who enjoyed an easy childhood.

The aircraft’s engines keep up a steady hum. Conversation is hushed and most passengers sleep. As Amy sits at the side of one of my deaf ears, there’s no lip-reading and I miss some of her speech. When I ask, ‘What work does your father do?’, I miss her reply. She repeats : ‘He’s a general in the Air Force.’

Golly.

She adds, ‘My mother is a school teacher.’

‘When you finish your studies will you return to your country?’

‘I will visit. My older sister has two babies. I must see them. But my life, I think maybe here in America. And my sister Sara, she is here.’

My mind races from question to question: Is Amy the right sort of Muslim – by the lights of the current President – to be admitted to the USA? What does Daddy the General think of Amy’s choices – dress, spouse, profession, place of residence? All her choices bespeak independence but in reality she must be completely dependent on Daddy. Amy has none of the bearing of the rebel – there’s nothing defiant in her speech – yet her Americanness must challenge Saudi norms. I think too of the engagement of the Saudi’s military – especially the Air Force – in the nasty war in Yemen. A Saudi general would be a serious man.

These are questions this old man does not ask. Meanwhile the estudent has put away her study notes, buried her head in a blanket, tucked her legs beneath her and, by some miracle of youthful calisthenics, made herself comfortable enough to sleep. For the next two hours the Princess of Araby slumbers in Seat 22F. She awakens as we descend, smiles, shakes my hand and asks, ‘When will I meet you again, Howard?’

Goodbye My Friend

We are saying goodbye to Mannie today.

Mannie, my friend.

Mannie, whose loved ones weep today.

Manny, one sole man, who ran and ran.

Mannie whose race is finally run.

Mannie’s roots lie in Greece.

Mannie was true to his roots.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Death closes all: but something ere the end,

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

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

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

Summer Stories 2: Chilled Bill and the Blue Baby

At medical school in Melbourne I met a tall bloke with a hyphen in his surname. His forename was Bill. He was bigger than I and much smarter. Bill came from Tasmania. In Melbourne Bill met Sally, a nurse, also from Tasmania. Sally too had a hyphen. The two married and they hyphenated each other ever after.

My first clear memory of Bill is of finding him in shorts and a short sleeved shirt, seated at his desk one evening in his room at Farrer Hall. The window was open and Melbourne’s winter breezes fluttered the curtains and cooled the room. Bill asked if I’d like to join him in a run. I hadn’t run since schooldays but I said yes.

We ran hard and long through the cold evening. We met and climbed hills, we plunged down the further side, reckless and joyful, we saw our breath white and vaporous in the street lights. Like Falstaff and the young King Hal we heard the chimes at midnight. We ran and our chests burned, and we kept going until we had outrun all chill. From that day to this I have run. It was Bill who started it.

Bill and the hyphenated Sally started making babies. The first was a girl, Joanna. She was born blue. For a year or more Joanna stayed blue; there was hole in her heart. Bill and Sally travelled to Auckland where the reigning champion repairer of babies’ hearts fixed up Joanna’s. A second baby, Jackie, followed Joanna into the world. Jackie was pink, hale and whole.

Annette and I and our own pink baby visited the Hyphens in Auckland. I took a picture of three pink toddlers laughing themselves silly in a bathtub in Auckland.

Eighteen years later I visited northern Tasmania for the ritual removal of a foreskin. While there I visited Bill and Sally. Joanna, by now a physio student in Melbourne, was also visiting. Still pink, Joanna had become a runner. We went for a run together, Jo and I. We ran hard and long through the cold evening. We met and climbed hills, we plunged down the further side, reckless and joyful, we saw our breath white and vaporous in the street lights. Like Falstaff and the young King Hal we heard the chimes at midnight. We ran and our chests burned, and we kept going until we had outrun all chill.

Such a runner was Jo that she’d won the Burnie 10K in open company as a junior. She went on to represent Australia in the World Junior Olympics in Rumania.

Back in Tasmania recently (for medical work that endangered no foreskins) I looked up Bill and Sally. Bill’s total knee replacement surgery of two months ago has been a success. He’s about ready to go running again.

The photograph shows Bill and Sally and the author’s grandson Toby. Toby is a brave and tough runner.

Running from Office

The following verse followed me from the city and found me where I am working in remoter parts:

I had written him a letter which I had, for want of better

Knowledge, sent to where I met him down the ‘bidgee, years ago,

He was doctoring when I knew him, so I sent the letter to him,

Just `on spec’, addressed as follows, `Goldie, Doctor of The Overflown’.

And an answer came directed in a writing not unexpected,

(And for sure the same was written with that horrible doctors’ scrawl)

‘Twas his running mate who wrote it, and verbatim I will quote it:

`Goldie’s gone to Queensland doctoring, and we don’t know where he are.’

In my wild erratic fancy visions come to me of Goldie

Gone a-doctoring `down the Cooper’ where the Western doctors go;

As his flock are slowly sitting, Goldie runs past them singing,

For the bush doctor’s life has pleasures that the townsfolk never know.

And the bush hath friends to meet him, and their kindly voices greet him

In the murmur of the breezes and the river on its bars,

And he sees the vision splendid of the sunlit plains extended,

And at night the wond’rous glory of the everlasting stars.

I am sitting in my dingy little office, where a not so stingy

Ray of sunlight struggles not so much between the buildings tall,

And the foetid air and gritty of the dusty, dirty city

Through the air con floating, spreads its foulness over all

And in place of lowing cattle, I can hear the fiendish rattle

Of the tramways and the ‘buses making hurry down the street,

And the language uninviting of the gutter children fighting,

Comes fitfully and faintly through the ceaseless tramp of feet.

And the hurrying people daunt me, and their pallid faces haunt me

As they shoulder one another in their rush and nervous haste,

With their eager eyes and greedy, and their stunted forms and weedy,

For townsfolk have no time to grow, they have no time to waste.

And I somehow rather fancy that I’d like to change with Goldie,

Like to take a turn at doctoring where the seasons come and go,

While he faced the round eternal of the drafting and advising —

But I doubt he’d suit the office, Goldie, ‘Doctor of The Overflown’.

Nicholas Miller, legal practitioner and versifier, has doctored Paterson’s ‘Clancy ‘

Conversations

After I started posting some thoughts arising from the current euthanasia debates, four women whom I hold in esteem wrote in strong response. Two wrote openly on the blog, two privately. I will refer to them respectively as B, M, G, H.

B wrote: Hi Howard,

I’ve just read your maybe not rousing speech but impassioned piece on euthanasia.

If I should be dying and I should be in unbearable pain, and if through that pain I was not able to continue to relate to my loved ones other than to be overwhelmed by my pain, you would be one of the doctors I would reach out to to put an end to my pain and possibly my life.

Will you refuse me?

I first met B in 1971 when she brought about my birth as a doctor. I have not treated her since. Instead we have become colleagues and friends. B’s note shifted my thoughts from the abstract to the concrete. Here was a cry coming from deep in an ancient moment in my formation. The person who wrote is concrete. Reeling somewhat, groping for self-knowledge, I responded speculatively:

Dear B,

I cannot know…

I suspect love would defeat principle or conviction or predisposition to life.

In other words I do not know myself in abstractions but in my instinct and my sentiments.

My ancient affection for you, my strong drive to help – which surfaced in your case in c. 1971 are as likely to govern me as any personal ‘rule’ or law.

I am sure if someone came and demanded I act in any given way my instinct would be to resist.

I anticipated readers would respond with passion and with pain to my piece.

I was right…

You asked would I help you.

I know I would try.

I cannot predict what shape my help might take.

This is a heavy matter. No light answers. And for me, no right answers.

But love will govern.

B again:

From feeling like I was falling into a chasm your response came as a hand that reached out to stop me hurtling to my death. Strange metaphor given I was talking about asking you to help me to die. I am much relieved that love will play a big part in your decision making process, over and above noble and fine principles.

But the debate hypothetically may be akin to Solomon’s choice.

Let’s talk.

My friend G is another colleague, a person raised in a strong religious framework from which she emerged to find and form her own way. I suspect her hard struggle for freedom has left her with a strong respect for my right to find and form a path of my own. G asked:

Would you be comfortable referring one of your patients who met the criteria to hasten their end to another GP who you knew would agree to assist in that wish?

And if that patient asked you to be present during the event would you?

How much do you think religion affects your current view? Or are you unable to separate your religious self from your professional self?

All F’s questions arrived as text message on my phone. Like death a phone message catches one on the hop. An answer will be less considered, perhaps truer for its spontaneity. I wrote a text back:

Hello F,

I’m pretty sure my religious self is absent from this.

It’s as if something deeper and defining is at play.

I imagine that ‘something’ is what brought me into Medicine.

And that drive collides here with itself…

But on the other hand, it was religion that framed my earliest thoughts.

It is on reviewing the texts that I regret not telling F at the outset: I can’t imagine doing anything I will find comfortable. The best I can hope for is to be comforting.

But if a patient wants me there at the end, yes, of course I’ll come. I’ll want to hold her hand as she passes over to ‘that quiet land.’

F resumed by email:

I find people’s responses to this topic rather fascinating (and at times irritating). So many reactions are full of judgement and criticism when it’s a topic that requires the opposite – compassion, objectivity and an acknowledgement of all of the grey. It would appear that a single (subjective) experience of dying makes some people self-appointed experts on the topic. I am of the thought that there is no ‘truth’ in any one person’s experience. And I wonder if those who react so emotionally to the idea of not having the ‘right’ to hasten their own demise have been more traumatised/suffered by the dying of another than the person who was actually dying?

What do I know? I do know that I would prefer not to die of bowel cancer. My experience working on GI wards is that that would be a shithouse (excuse the pun) way to go. I know that until I am dying of a known cause I won’t know if I want the option to hasten my demise or not. I know that having witnessed many people dying of a known cause (some in pain, some in discomfort, some in fear) that I’m still not convinced that assisted death is the answer. But I’m not convinced that palliative care is the answer either – theoretically it should be but I doubt it will ever be financially. I know that those who have reached the palliative stage of their illness should never be admitted to an acute care ward in a hospital – I’ve witnessed far too many cases of what I can only term the neglect of those in their final days/weeks in acute care wards. And the reluctance of acute care nursing and medical staff to adequately manage final stage symptoms. I want to believe in palliative care but I’ve been waiting too long for results.

I know that if you were my GP and I had a terminal diagnosis, I would feel like I had the best GP in the world. I would know that when you asked a question you would be genuinely interested in the answer. And I would believe that you would have a moment of quiet grief when I left this world. And that would be a comfort. As a nurse I never felt any sorrow for an anticipated death of a patient – the overwhelming emotion I felt was relief. Relief that there would be no more pain, no more nausea, no more confusion, no more discomfort from lying day after day in bed waiting to be turned brusquely. But I have a feeling that you experience a moment of sorrow for each death – correct me if I’m wrong.

If I were your patient and I asked you to help me die and you indicated that you couldn’t then I believe I would want your help to find a doctor who would be willing. I would appreciate that you would feel obligated to offer alternatives but if my mind was made up and it was legal then I would want you to support my decision. You might not support assisted dying on moral and ethical grounds but having come reached a fully informed decision I would want your compassion to make that referral to a colleague who you trusted and respected. And the promise that if I changed my mind you would do everything in your power to make my end days as comfortable as possible.

Your friend, F

These words come straight from the bedside. They come from one who has stood with me at the bedside. I cannot gainsay a word of them. Yes I do sorrow for every death. Yes I sorrow for every pregnancy loss. I grieve inwardly for a miscarriage. There is something universal here and something personal. The universal is the instinct that drives all of us to struggle for life. The personal is hard for me to define or even to describe. It comes into focus most sharply for me at the birth of a child. Those moments find their mirror image in a death. The one elates me, the other deflates.

H is a writer friend, a novelist and a family historian whose earlier profession was neurology. She writes humane novels filled with unsentimental empathy. H was another friend whom I disappointed. She wrote:

I’m sorry you feel you could not give this final relief. I am a convert to assisted dying (this is not euthanasia – which implies someone else’s decision that you should die). My feeling has always been that adults who are dying should have some choice about their death, and seeing three dear relatives all the way to death, I am now utterly convinced that such choice should be available. I understand that in states in America where such choice is available, of those who take up the option only a small proportion use the drugs supplied. But, those who receive the drugs and do not use them, are much calmer and happier, for knowing that they have control and can die should they feel they have had enough.

H here echoes an experience described to me elsewhere by B, arising from her work with men diagnosed in the 1980’s with HIV-AIDS. At that time the diagnosis was a death sentence. Some of the doomed acquired the means of ending their lives painlessly, with the intention of using it at a time of their later choosing. Of those men only one availed himself of the drugs. The others lived out their natural term. Knowing they were able to die enabled them to live on.

I close here with one message of straightforward approbation. It comes from M:

Very thoughtful. And probably helpful to those who didn’t like your last post. I have put the link up on my FB page.

M often comments favourably on my blog. When she doesn’t approve she’ll keep her disapproval away from the public eye. M is of course (as she signs herself) my loving sister.