Category Archives: Medical

The Wrong Doctor

By Posted in Life, Medical Tagged , , , , , , 2 Comments

 A lady older than I – all the patients seem older than I am – enters my consulting room. Tall, broad in her build, her face is oblong. If she were a horse she’d be a Clydesdale. A voice rattles and grates from the lady’s throat, the voice of a thousand cigarettes: ‘What’s your name, son?’

I tell her.

‘And you’re Frank’s locum?’

I confess I am.

‘Right. This is what I need.’ The lady pushes a scrap of paper across my desk.

I read her list: Valium, Nembudeine, Mogadon.

Diffidently I wonder aloud, ‘What conditions do you take these for?’

The lady – was her name Gloria? – it was so long ago – the lady looks at me in mild disbelief. Is the doctor a bit simple?

‘For pain of course. And nerves. And to sleep.’

I commence writing out her prescriptions. In 1970 we wrote our scripts longhand. Valium for her nerves, nembudeine, a handy concoction of narcotic and barbiturate, mogadon, another benzo.

A doctor stirs within me: ‘I should point out the risk of becoming dependent on these medications.’

‘Rubbish! You think Frank doesn’t know what he’s doing? He knows I’m not the addictive type.’

Subdued by the confidence of my neighsaying patient, I resume writing.

‘I need a smoke. Want to join me?’

The doctor within feels more secure on this ground. ‘No thanks. Smoking isn’t all that good for your health.’

‘Rubbish! A few fags can’t hurt. Frank smokes.’

‘Well, I’m not Frank’s doctor. But no-one smokes in here.’

‘Rubbish!’ The lady reaches across the desk, her broad arm brushes me as she removes the lid from a small ceramic jar, revealing a dozen or so cigarettes all standing to attention. She takes one, flips it expertly between her lips, sucking back a denture that ventured a peek at the world outside. ‘Got a light, or do I have to use Frank’s?’

 

The locum is always the wrong doctor. Gloria expected to see Frank and, doubtless, to subdue him at his point of weakness, his fondness for the occasional fag. This very young locum is composed almost entirely of weaknesses, but smoking is not one of them. He is decidedly the wrong doctor: ‘I’m afraid no-one smokes in here with me.’

‘What do you mean?’

‘I mean no-one smokes in this room while I am in it.’

Gloria gives me hard look: ‘It’s not your practice!’

‘That’s true. But you must excuse me if I step outside while you light up.’

Glowering, Gloria snatches her script and takes her leave.

 

Later, Frank chuckles: ‘Gloria always tries that out on me too. I always say no. Glad you did as well.’

 

image: envisioningtheamericandream.com

More Unnatural Medicine 

By Posted in Life, Medical, Opinion Tagged , , , , , 5 Comments

Following my recent blog post titled ‘Unnatural Medicine’ one correspondent bothered to respond thoughtfully and at considerable length. As you will see from the passage below (excerpted from his comments) he writes insightfully and with strong feeling. I quite understand that intensity; health is both a personal and a universal concern. Further, at the head of its hierarchy and ruling our fate, standing over us, exciting our awe and our resentment, are the doctors.

 …On the other hand we see leaders in western medical practice dismiss Chinese medicine, for example, as quackery and voodoo medicine. Despite clinical trials clearly demonstrating the effectiveness of acupuncture, for example, many Scientists declare that there are no such thing as “meridians” in the human body as their existence has not been clinically demonstrated. The hypothesis is dismissed despite evidence gained from the applied testing that they do. Further, many assert that all forms of Chinese medicine, sometimes including acupuncture, should not be considered “real” medicine. (This includes senior doctors advising government and insurers.) Yet this practice has 4,000 years of accumulated clinical practice, is taught in major teaching hospitals in China and practiced daily by doctors in conjunction with “modern” western practice. Numerous clinical trials of diagnostics, treatments and herbal concoctions have been conducted, which are generally dismissed in the west, often merely because they are not available in English. When they are available, the results are howled down because there is no critical mass of such research available. Yet the Chinese pharmacopeia is yielding impressive results in western labs in the treatment of everything from common infections to malaria and cancer. Why is there such resistance to the science of Chinese medicine?
With the social and economic power of the western pharmaceutical industry we continue to see western medicine practised with an emphasis on the provision of drugs as first recourse in treatment. So pervasive is this that you have written about patients who want the prescription of a drug, any drug, rather than wanting to hear a more complex story of how to achieve health and of some doctors who support this approach. We have a culture of “science” where alternatives can often be dismissed and where pharmaceuticals are pushed to the frontline of treating almost any and every condition. Incidentally, my father peddled Debendox – among many other drugs- to doctors in the 1960s and ’70s for the treatment of morning sickness and later associated with birth defects. It was given to me as a treatment for travel sickness. Hard science and its practice makes mistakes.
Please forgive my self indulgence in presenting my rant, Howard. I know your musings are often light-hearted and exploratory of deeper things. But I guess my point is this: there is an ideological spectrum in medical practice, which can be said to range from “natural” to “unnatural”. There is medical practice that works with the “natural” processes of the human, which includes an understanding of diet, exercise, psychology, history, social conditions, the environment, etc all having their effects, good and bad, on human lives. In common parlance “natural” usually refers to seeing patients as people first, human beings subject to and part of nature in never-ending cycle of birth, life, death, repeat (depending on your belief). My experience of your practice puts you in this camp. Do as little harm as possible, be cautious, be curious, respect the person, do not jump to conclusions or easy answers, respect the life process. Sometimes trauma means offering treatment (or not) that may cause damage or harm. A difficult choice.
There is also practice that does not respect the human, does not give value to patient’s experience, knowledge of their body, etc. There is a dominant (moot?) practice of prescribing western pharmaceuticals first and asking questions later in the next 15-minute consultation a week later. This well-documented practice is disease focussed and knows little of health, except as the “absence” of disease. This “unnatural” practice is characterised by a focus on the disease or condition, of which the “patient” is merely the subject. Treat the disease, not the person.
This spectrum lies at the heart of current debate and power struggles within medicine and in policy regarding human health. It has enormous implications also for all policy that focuses on the human species as somehow separate from “nature”, implicitly subject to different rules, with or without the possibility of divine intervention to protect us from ourselves.
 
I find myself highly stimulated by my correspondent’s comments. I’m bursting with an accumulation of thoughts and feelings of my own, musings and speculations. I suppose these have gathered and grown within me over a lifetime in medicine. (It has quite literally been a lifetime: born into a household that accommodated my family and my father’s medical practice, I grew up in medicine. I was weaned on milligrams and speculums.)
 
My own feelings about western medicine and doctors are as mixed as anyone else’s. I am old enough to need the services of my doctors quite frequently, while still young enough to be doling out medical services to others. Macbeth cries, ‘Throw physic (medicine) to the dogs. I’ll none of it!’ And in a few cryptic words the Talmud declares: ‘”tuv harofim le’ge’hinnom” – the best of doctors can go to hell.’
Does medicine have an ideology? If an ideology is a system of beliefs or ideals or principles, I believe medicine does have an ideology. In the practice of that ideology I see the best of medicine, and in its abuse, the worst. That worst is the exercise of power for its own sake, a petty parochialism, a readiness to denigrate what it does not understand; and, in budget season, a hypocritical piety.(“No, no, no, Mister Treasurer , you must not cut, peg or regulate our fees – or our patients will suffer.’) The best is seen in your doctor’s service of ‘scientia cum caritas’, knowledge with loving care.
For me it is the ‘scientia’ which is the hard bit. Your good doctor is a scholar: the word means ‘teacher’, ‘master’, ‘wise one.’ That scientific doctor applies himself to the evidence. He suppresses his own human hankerings, his romantic leanings, his wishful thoughts. That doctor brings to his work a rigour, an austerity, a devotion to the pursuit of demonstrable truth. When I am sick I truly need that science; and your good doctor brings that to my bedside.
Let me give you an example. While working in the Emergency Department of Alice Springs Hospital last week I watched while five doctors worked to save a man who had been found at a remote roadside, unconscious and convulsing violently. The man was tall, strongly built, apparently athletically fit. His mountain bike was found lying near him. Unable to tell us how or what or when, his powerful body defied his absent mind as it jumped and threw itself around. I stood, quietly appalled, watching a man fifteen years my junior, disconnected from mind, at the threshold of the void.
The doctors watched him for signs. Acutely attentive to which limb moved, which did not; how his pupils reacted to a pencil beam of light; whether and how strongly he responded to voice (initially he’d stir; later he did not), and to a painful stimulus. Here was a biological organism in a near agonal state. The doctors looked up to study the lines and waves and numerals on the screen. How strong is his heartbeat, how effective his circulation? How much oxygen are his lungs delivering to the circulation and – critically – how high is the blood pressure? The readings were elevated above the norm. I misgave and pointed out the elevation to the Team Leader. ‘That’s good,’ he said. He explained that the damaged brain was much more vulnerable to low blood pressure than high. The outcome, he explained, was worse when pressures were low. ‘The outcome’: two words pregnant with knowledge, with meticulously gathered and tested and scrutinised evidence. Tough minds had obeyed tough rules in the gathering of that evidence; now smart scholars would deploy this in our immediate emergency. I witnessed dry science at the service of hot blood. 
It was imperative to control the seizures and to treat pain. Surely he had pain – he’d had a fall, presumably at speed, his skin was torn from his body, gravel and mud grimed his raw wounds – and he was vomiting forcefully on arrival. He must not be allowed to vomit lest he aspirate and block his lungs.
Next the man’s respirations must be controlled. He’d be paralysed and placed on a respirator. He’d become utterly defenceless. The very doctors who would overcame his defences must become his protectors.
To all these ends, all of them critical, all of the utmost urgency, strong drugs would be used – opiates, benzodiazepines, muscle relaxant drugs, anaesthetic agents, anti-emetics. Doses must be calculated minutely, effects monitored, dosages re-calibrated. The precise numbers of milligrams and micrograms would determine whether this man would live, would walk, would think, would speak, read, laugh or love. ‘Will this man ever get back on his bike?’ All lay in the hands of these scientific doctors.
 But how to calculate dosages? Unable to weigh a stuporose man threshing his own body, the doctors had to guesstimate. Too much opiate would lower blood pressure and endanger the damaged brain. Too much anti-convulsant would do the same. And both classes of chemicals might suppress breathing. The anaesthetic drugs must be adequate to paralyse him (to allow intubation and the use of the respirator), but again these agents can defeat their own purpose.
So the doctors injected morphine, eagle eyes upon oxygen saturation and respiratory rate and blood pressure. They injected metoclopramide to prevent vomiting that morphine so readily triggers. They deployed three different anticonvulsants, in doses nicely titrated, before they were able to control the fitting. Now came the intricate business of intubation, the act of introducing a breathing tube deep into the throat in defiance of every natural reflex and physiological objection; this procedure, a pas de deux of surpassing intensity, saw all present hold their breath in unconscious imitation of the patient, now paralysed, whose breath was held from him by chemical restraint. Now the tube was guided truly, now oxygen supply was resumed, hypoxia reversed. All breathed out.
Our patient would never know how medical science saved him. How doctors had used just enough of every hero molecule, how they had threaded that narrow path between his own injuries and the potential harm of their remedies. How every drug might poison him. And of the race of his life, the literal counting of seconds where every second counted, the quietly hectic passage of time when he arrived as quivering meat and was so soon stable. Safe!
Equally deep was the pool of knowledge that detected the cause of all – no, not head injury, not brain contusion, not spinal cord injury – a heart attack had thrown this athlete, engaged in a mountain bike race in unseasonal heat, into coma and convulsion at the threshhold of death.
So, yes, western medicine has its ideology. Last week I saw that ideology save a human person. Clearly I am in awe of that sort of intellectual discipline which is so far above and beyond my suburban skills.
By way of contrast we who practise by instinct, by intuition, must tread the shallows of organic disease, even as we grope in the deeps of human suffering. You cannot afford to indulge our speculative modes of medicine when your damaged organs call out for science.
In the earliest years of my practice I felt frustrated when patients informed me of the advice they’d received from alternative practitioners. Those healers would declare to my patient her spine was out and they’d put it back; they’d looked in her eyes and found her pancreas was sick and they’d cured her with herbs. Not with drugs, no, never with drugs. Those healers prescribed detox diets for the liver, cheerfully unaware that the liver detoxifies all. They told my patient they knew what was wrong, where I knew I did not, where no doctor could – in any scientific sense – know.
I came in time to respect the achievements of these practitioners. My patients felt better for seeing them, encouraged, confident in their recovery. I wondered how this could be and it came to me that the naturopath gave the patient the gift of an unrushed, attentive hearing. The amplitude of time, the emphasis upon natural healing, the resounding vote of confidence in the forces of the natural body helped the patient materially. I realised how intuitive, how insightful, how respectful was this practitioner. I recognised in the naturopath the healer I wished to be. But there was one difference, ineradicable: I never heard a patient quote the alternative practitioner confess ignorance or impotence. Free of the shackles of constraining science, the practitioner never said three words that I need to use every day. Those three words are: I don’t know.
I am pretty confident I have by now offended some readers. This is always a risk with the trenchant expression of strong opinion, of ideology, if you like. And it is not only western doctors who hold an ideological position. I consider it natural to humans, perhaps universal, to cherish convictions about health and its care. These convictions too encompass values, traditions, emotional needs. Mine are distinctively my own. Every distinct human will differ. Expressing my full thoughts on these subjects might offend seven billion humans.
Nevertheless I propose to write a series of short pieces which might include:
Why some doctors resist and resent alternative medicine;
‘Thou shalt not kiss thy patient’ and other absurdities.
Why I recommended acupuncture for a patient whom doctors could not help.
Why doctors prescribe medicines: Big Pharma, big mamma, bad sicknesses;
My Debendox daughter.
In writing on these matters I expect to relieve myself of strong feeling, long pent. And after all that I will scarcely have responded to my correspondent’s weighty concerns.
 
One final vignette before I let you go. In 1972 I joined a rural practice where I worked happily for almost thirty years. Around that time I met a squat jolly man and his slim jolly wife. The couple had three small daughters and I became their family doctor. They were a devout family, members of a small local congregation of a church which is possibly the most widely respected by the secular majority in this country. They wore their piety tactfully – neither crucifix nor yarmulke nor hijab declared publicly their private faith.
From time to time Mother brought the little girls, slim, elfin presences with smiles that sweetened my day. They’d sit on my knee while I discussed their condition their mum. In time they grew up and left their small home town. One of the three, whom I’ll call Sarah, returned and introduced me to her fiancé, a member of Sarah’s church. The two had decided on a career as ministers to the youth in the service of their church. Soon they would marry and take positions in a distant city interstate.
 
When I saw Sarah next seven years had passed. Her father had died of complications of orthopoedic surgery. Her face shone with grief and pride as she introduced her batch of three small children to me. Slim like Sarah, all with biblical names, they played at our feet as we spoke of their grandfather, that squat jolly man, and of his passing. Sarah and her husband petitioned the church for a posting in Melbourne to be nearer the family.
They settled in an outer suburb on the far side of town and I saw nothing of them for about three years, when Sarah turned up in my waiting room. Delighted and surprised I listened as Sarah told me of the strange and slow development of her second child, a boy. ‘Jeremiah might have autism.’ We talked. I told Sarah I was no expert in that condition. She seemed to know that already. She wasn’t after diagnosis, but counsel and for that it was to her old family doctor she turned.
Years passed. Once again I was delighted one day to discover Sarah in my waiting room. She was the final patient of my morning. By chance I had no more patients to see for the next hour and a half.
‘Hello, Sarah. What brings you here?’
‘Howard, this morning in the shower I found a lump in my left breast.’
‘Does it hurt?’
‘No.’
‘Do you have chills, a fever?’
‘No, it’s not mastitis. I weaned Benjamin a year ago.’
I examined Sarah’s left breast. Her slim body habitus made the lump easy to find. It was a hard lump, a little larger than an almond. I felt the opposite breast: normal. I probed her axillae. There, in the left armpit I felt a second lump, also hard. I tried to hide the dread I felt.
Sally looked up at me, searching my face: ‘Can you feel the lump?’
‘Yes. It’s a worry. Please get dressed and we’ll talk.’
We talked for an hour. We talked of the probable cancer, of its possible spread, of treatments, of specialists – who, where, when? Sarah asked, ‘Do think I’ll be cured, Howard?’ I did not think she would. I said the signs were worrying and I feared the worst. Sarah looked down and rummaged in her handbag for her hanky. She sat quietly, tears rolling down her cheeks. She dabbed her eyes and cried some more. The hanky was a sodden ball in her hand. She blew her nose and said, ‘I’m not frightened for myself. The children… they’re so young.’ Fresh tears followed.
At length it was time to finish. I stood up. On blind instinct, driven I suppose by hard feeling, I said, ‘Sarah, stand up.’
She did so. I stepped forward, took her in my arms and hugged her. She hugged me back, hard. I dropped my arms but she hugged on. And on. At length she released me. She took a deep breath, found a small smile and said, ‘That’s what I crossed Melbourne for, Howard.’
I never saw Sarah again. Her surgeons wrote to me from time to time. Eight years after her doctor took her in his arms and breached medical ethics, Sarah died. 

On the Main Road

By Posted in First Australians, Life, Medical Tagged , , , , , , 5 Comments

Friday afternoon, the eve of the sabbath. Riding home from my shift in the Emergency Department at Alice Springs Hospital I would have missed her if I’d been abiding by the law. Luckily I was riding along the footpath when I came upon her. She looked about fifty but I reckon her true age at mid-thirties. Her large face seemed inflated, her eyelids puffy, her lips swollen, her natural flabbiness accentuated by deforming scars and oedema. The face was bronze in colour. Her gaze was inward – even when I was abreast of her, when I addressed her, I was absent to her. 

In all our minutes together we were never more than ten metres distant from people passing in cars and on foot. But in our leaden ballet we would dance alone.
She was shorter than I and a good deal heavier. The weight differential would matter when I’d struggle to lift her. I was a metre from her when I first registered her human presence. A slender tree at my right shoulder obscured her from sight. Abrupt movement caught my eye, a straining, forceful jerking of her thick neck and thorax as if she sought to escape. In fact the opposite was the case. 
The woman’s hands worked to adjust a cord that looped once around the tree then twice around her neck. I saw the cord and stopped. With all in place she suddenly slumped. Don’t! Don’t do that! – these were all the words I found. I flung my bike aside and threw myself towards the woman. She grunted but did not speak. My arms about her did not arrest her fall. The cord tightened. I remembered the knife in my lunchbox. As I groped frantically in my backpack she thudded suddenly to earth at my feet.  
A white cord floated down after her. The cord was a lengthy bootlace, the sort you pull on to tighten your running shoes. That slender tie would never support ninety kilograms of self nihilation.
Lying on the earth her silent body did not move. Was she breathing? A wave of alcoholic air reaching my nostrils answered that question. Was she conscious? I spoke. No response. I shouted. No answer. I placed my right thumb into the small bony notch above her eye and pressed hard. This truly painful stimulus evoked no movement, not a flinch. On the Glasgow Coma scale I reckoned her score at eight of a possible fifteen.
As I crouched in all my clinical perplexity an Aboriginal woman appeared at my side. Gesturing in the direction from which I’d been riding she said, The hospital is just back that way. Did I smile as I thanked her? I don’t know.
My lady was alive, breathing, intoxicated, apparently unconscious. In the long seconds since slumping she had not moved. What harm had her spinal cord suffered in that violent moment when the bracing cord arrested her fall? I could not know. My phone: where was it? Fast fingers delved and delivered from my pocket. I rang triple zero. The voice asked, Police, Fire or… Ambulance! I shouted. Ninety seconds after giving location and clinical details the siren sounded behind me. The vehicle pulled up alongside my waving, jumping body. A tall woman blonde woman alighted. She would have been in her thirties – like our patient, and unlike her. I answered her questions. A friendly smile lit her face as she said, Big shock for you, I’d imagine. This time I did smile. After a shift in Alice’s Emergency Department I’d become inured to shocks. The paramedic crouched over our patient and I heard her say: Hello girlfriend! as I mounted and headed home for the peace of Shabbat.
   

Unnatural Medicine

By Posted in Life, Medical, Opinion Tagged , , , , 8 Comments

The young woman who sat before me said she was overwhelmed. Earlier that day she had visited a woman doctor for her Pap test and to discuss contraception. The young woman (whom I have known since the evening of her birth) sat and listened to the cascade of information and advice that flowed over her. She felt she was drowning; ‘My head swam. I thought I might faint or vomit. It was too much for me.’

 

The young woman is no dimwit. A graduate in Neuroscience and Philosophy she handles ideas that make my head swim. Her doctor is a thorough and thoroughly modern practitioner. She explained the actions of oestrogens and progestogens. She detailed the various routes of administration. She canvassed the respective durations of action of the different preparations.

 

Let us give the young woman a name. She can be Lucy.

 

Lucy explained why it was now critically important that she not conceive. For pressing medical reasons pregnancy could be disastrous. Her past use of barrier contraception would no longer do. Hormonal means were required. I asked, ‘Lucy, what is it you don’t understand about the Pill or the progesterone IUD or the progesterone implant?’

‘I understand them alright’, she said, ‘I just don’t want them. None of them. They’re all unnatural.’

 

I asked Lucy to elaborate. ‘Those hormones, they all do things to you. They affect your organs. I don’t want that. I’ve never liked that.’

 

Lucy is quite correct. They all do things to you. Whether it’s a device impregnated with progesterone that is inserted into the uterus – with or without a general anaesthetic (another unnatural chemical) – or a tablet that contains both oestrogen and progesterone, or a small progesterone-impregnated rod sewn under the skin of the upper arm, all will prevent pregnancy by violating Lucy’s natural biology. It was these assaults that alarmed Lucy. She felt she’d be a traitor to her own health if she embraced any of those measures. Her audience with the doctor struck at her ideology, her beliefs.

 

I sat and listened. I know how Lucy feels. Like most of my patients I am drawn to the natural remedy. Whether it is a hot lemon drink for a sore throat or a hot salty water soak for an infected finger, I have always prescribed these for my children, knowing I have no skerrick of scientific data attesting to their value. They just feel good. And right. And natural. My children have long mocked me for my atavism. And nowadays I see them treating their own children with the same nostrums.

 

Science has no truck with ideology. Science is an unsympathetic bastard. And profoundly unsentimental. The science of pharmacology defines a drug as any substance that alters a biological system. In other words, in our retreat from such unnatural substances as drugs, we resort to our hot lemon drinks and our hot salty soaks. And we feel better. But pharmacology’s corollary declares: any chemical which alters a biological system is a drug. If my inflamed finger feels better, if my sore throat improves, the salt or the lemon is a drug. Or a placebo.

 

I love placebos. Over the many years they’ve relieved lots of my symptoms. But, as I explained to a forlorn Lucy, placebos don’t prevent pregnancy. Against an incoming tide of one hundred and fifty million sperm cells, the placebo cannot prevent penetration of her waiting egg.

 

I tried to comfort Lucy. ‘There can be no natural contraception. Nature wants your every egg to be fertilised. Only the highly unnatural (but physiologically innocent) condom or the highly unnatural act of withdrawal or the offensive intrusion of hormones will prevent conception. Those or celibacy.’

 

Lucy took this in. She had no enthusiasm for celibacy. I added my opinion that withdrawal and cyclic celibacy were the two parents of most of the babies ever born.

 

Lucy left me, taking with her a prescription for the Pill. She will violate her biology that would otherwise have seen her conceive at fifteen and again – following two years of lactation – at eighteen, and again and again every three years or so until menopause and subsequent senescence and early death.

 

Of course everything I do in my work is unnatural. I intervene when hypertension or diabetes or elevated cholesterol would otherwise hasten the onset of heart disease. I order x-rays which expose the body to cancer-causing radiation. My surgical colleagues introduce stents. My psychiatrist friends alter brain chemistry with their medications, as they struggle to control the demons in our minds of schizophrenia and bipolar disorder. Sometimes they save lives. Most unnatural. All of it, most unnatural.

 

There are two Laws I have learned.

 

FIRST LAW: There is no such thing as natural medicine.

 

SECOND LAW: There are no cures. Medical science always fails. We all die.

 

Melbourne’s Daughter

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Deep with the first dead lies London’s daughter

(Dylan Thomas)
The newspaper article was short, buried at the bottom of an inner page: Man Sought in Child Death was the headline. Ambulance officers were called to attend an infant who was not breathing. They found injuries described as Non Accidental. They detected a feathery heartbeat and commenced resuscitation and brought the baby to hospital.
Following further treatment the baby underwent scans of the brain. These demonstrated Injury Incompatible with Life. Police wished to interview a man in connection with the matter. 
Nearly forty years ago I became intimately familiar with that hospital. At the age of fifteen months our youngest child was treated there for Aplastic Anaemia. I had learned enough of this invariably fatal disease at medical school to dread it. Over three miraculous days and three intense nights nurses and doctors worked on our infant as if she were their own. Three days following her admission our baby was home again, her condition in spontaneous remission. It never recurred.
I witnessed at that time what a friend describes as the operation of ‘an edge’. He says a hospital like that is a line where the worst and the best meet and rub up against each other. The worst, he suggests, is the suffering or death or loss of a child; the best is the application of skill and care and discipline in opposing the worst. The line where the best strains against the worst is a hospital like this one. My friend describes this as ‘OUR best’. By extension the loss or suffering of the child is OUR worst. I mean we are all implicated.

 
What must we learn from those pregnant expressions: ‘Non Accidental Injury’ and ‘Injury Incompatible with Life’? Horribly intrigued I sought more news in the next day’s paper. I found nothing. For the first time in my life I went to the news on-line. I googled ‘non-accidental injury to baby’. Straight away I was sorry I had done so. Case after case, headline after headline, BABY AFTER BABY, the web told of the slaughter of our very young in Australia. RecoiIing, I quickly ungoogled. A phrase from the biblical book of Numbers came to me – ‘a land that devours its children.’
Another friend is a senior doctor at that same hospital. He is the person with whom the buck stops, it is he who has to confront the adults in whose watch a non-accidental injury has taken place. Too often the x-rays show the many non-accidental fractures that have healed or half-healed or never healed in a baby’s short tenure. He sees the scans that show the brain bruised and bleeding from multiple sites. Calmly, civilly, he must direct questions to the adults. He says, ‘Your baby has been injured in ways that cannot occur by accident. Can you explain the injury to me?’ The adult partnership fissures along one of many fault lines, the truth emerges. And the truth is braided of many rotten strands. The perpetrator – sometimes more than one perpetrator – is almost never the simple monster we like to imagine. The perpetrator too often had himself been monstered – his life fractured, his brain contused by one evil or by another or by many.
I read, over the days that followed, a scattering of further details, most of them horrible beyond my imagining. And finally, this: the injuries being incompatible with life, the parent of the child had agreed the doctors should turn off the machines. But before that, she donated the baby’s organs. Injuries incompatible abruptly became compatible with saving half a dozen young lives.

 
I described babies who are killed as OUR babies. I felt, as I read Helen Garner’s, ‘This House of Grief’ that the three murdered boys were in a real sense Garner’s children, they were mine, they were all our children. And in my moments of google horror I felt the same shock of personal responsibility.

In the small South Australian town of Penola people built and tend a park to remember their babies lost.

High Achievers

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My Principal, a man of immense self-discipline, said to me in an unexpected aside; ‘I think the fruits of that man’s loins consume too great a share of this world’s goods.’ By this my Principal meant me to understand he somehow felt such liberal procreation as an affront to his Protestant ethic. Greedy, appetitive. I thought the policeman was just a Catholic who, after a long day of fining speedsters and charging car purloiners, liked to come home and enjoy a conjugal root.
 

 

I received a letter today from a doctor whom I have not met. The doctor wrote to inform me of the specialist obstetric practice he has set up. The description made my mouth water, if that is not an incorrect metaphor to apply to a birthing service. The doctor offers every thoughtful amenity for babies and mothers and extends a warm collegial hand to all referring general practitioners. How exemplary, I thought. Impressive too was the doctor’s post-graduate training at the Mayo Clinic and Harvard.

 

 

At the foot of the doctor’s well-crafted letter was a lengthy postscript. It was a list of her – his? – qualifications. Let me list them for you:

MBBS, B Med Sci (Hons), LLB, LLM, PDLP, FACLM, FFLM,(RCP, Lon), MHSM, FRANZCOG, FFCFM, (RCPA), MAICD

 

 

Golly, I thought. If each post-graduate qualification required only one year of study – and I do know that MBBS takes six years; and FRANZCOG takes another six or so, and the two degrees in Law would take another handful of years – this doctor must be starting private practice after twenty years of study. I marvelled at the doctor’s scholarship and academic thirst.

 

 

Some study, some copulate. As one who has trod only the shallows of learning and of reproducing, I am in awe of their stamina

 

How to Recruit an Ordinary Australian, How to Torment Her, How to Drive her to madness 

By Posted in Asylum Seekers, In Detention, Life, Medical, Opinion, Reviews, Work by Others Tagged , , , , , 5 Comments

Sitting watching Eva Orner’s movie, ‘Chasing Asylum’, I fully expected to be appalled. I anticipated I’d feel the old outrage. I feared I’d see things that would shock me.What took me unprepared was the vision of Australian workers on Manus and Nauru as they disintegrated before the camera. Three in particular found the courage to expose themselves before the slow, careful camera of Eva Orner. Two of the three were young women. The camera never revealed them full face, their names were not mentioned. Like their charges who subsist behind Boat Numbers, these are humans without names. Their voices told us what was happening to the people seeking asylum; but it was their hands that gave them away. Nail-bitten fingers worked continually. A writhing was seen, a slow dance of agony. Voices hesitated, speech fell away as the young women spoke. I watched these young people as they struggled to shed a burden that will never leave them. The third beanspiller was not young. A former prison guard, he was a man in his fifties, a man surely innured by his past experience. He spoke to the camera of what he saw. He recounted carefully and precisely his attempts to bring about change from within the system. How he spoke to superiors, how he complained of wrongdoing, how anonymous threats to ‘shut up’ mounted, until he feared for his life. Finally he fled his island. He returned home and lay low. For some time he did not speak of what he’d seen, what had happened to his detained charges, how he had been threatened and lived alone in fear. Finally he decided he could keep silent no longer: “I was brought up to know right from wrong. I couldn’t live in silence.” The man’s face worked as he spoke. He struggled for composure but grief and pain defeated him as he wept his honest tears.    

Elsewhere in my life I have a colleague, a mental health worker, who has been engaged in the repair of a wounded offshore worker damaged deeply by trying to protect and support detained refugees. Hired by the government, that worker can never safely return to the work that is his vocation, which is to care for vulnerable people. He is now counted among the vulnerable. Innocent casualties, these, like the mates of the former detention worker who told me of two fellow guards who attempted suicide, one successfully.

What are we doing? What have we done.? What price do we demand of our own people? How we disgust ourselves!

When, at some time in the next century, I become leader of this nation I will do some things urgently. Apart from what ever I do to abate our present cruelty, apart from preparing for the Next National Apology, apart from prosecuting the Prime Ministers and their Border Control Ministers for crimes against humanity – apart from all these necessary steps, I will seek out these whistle blowers and offer them honours in the highest echelon of the Order of Australia. But I will not be surprised if they decline any honour offered in the name of a nation that betrayed itself. 
Chasing Asylum is screening now. See it and learn where our taxes are going and what is being done in our name. 

http://www.chasingasylum.com.au/

Health is not a Human Right

By Posted in Life, Medical, Opinion Tagged , , , , , 6 Comments

I am about to make some shocking suggestions: 

Health is not a human right.

The Morrison-Turnbull budget cuts to Medicare Rebates are not completely bad.
Running in the dark this morning, I noticed the illuminated sign outside the local hospital. It read:

PRIVATE HOSPITAL.

 

I felt unhappy reading that. A hospital is a place where human beings help other human beings with their health. The meaning of a hospital cannot be realised with that label. ‘Private’ tells the reader that some humans will be admitted and others turned away. Privacy as a personal property might well have been eclipsed by the internet, but ‘private’ survives with this message, unkind to some, saying ‘keep out.’

 

If health were a right we’d need to outlaw Down’s Syndrome, premature death and disability. We would legislate and make ourselves ridiculous. The error of language here betrays an error of thinking. We cannot assert a right to health, but we can create a right to equal access.

 

I am a private doctor. I am a public doctor. The public is composed of private persons. I treat one person at a time, privately. That is, personally, confidentially; two humans together, doing what every human does in a lifetime: ordinary transactions of care.

 

Doctors generally share a number of characteristics. We are serious, careful, committed and proud. We are defensive of our liberties, self-righteous and voracious of cures. We are expensive; I mean someone, somewhere, always pays for cures. In its new budget the government has pegged Medicare rebates. This skewers doctors and patients: either the doctor loses or the patient loses. There is nothing new in this.

 

When Hayden-Whitlam introduced Medicare I bulk-billed everybody. I thought it was a wonderful thing that a person, be she rich or poor, might consult a doctor equally. I thought so then and I think so still. To assure doctors they would not lose, the Hayden-Whitlam Government set up a referee who increased the rebate in pace with the rising costs of practice. This was costly. So the government told the referee to stop indexing rebates. And I stopped bulk billing. Often patients found themselves facing a choice – see the costly doctor or feed the family. When this occurred all doctors I know abated their fees so the patient might afford both cure and food.

 

What a government does in tightening benefits is to create the need for a new force to operate in care. The force is not one of rights but of grace. The doctor and the patient gaze upon each other as we did through all history, unmediated by refunds and rebates, freer now of the obscuring presence of the insurer. Two humans in a situation of human need.

 

The words ‘Private Hospital’ jolt me. They remind me that health is not merely a matter of economics or of civil rights, but of civil opportunity.

 

A Downtown Medical Professional

By Posted in Books, Life, Medical Tagged , , , , , , , 2 Comments

 As I walked past the couturier’s shop in Collins Street, peering in as a beggar at a feast, I sighted a chic young lady within. She looked at me and beckoned. I looked at myself. I saw myself, dressed for my work, in all the formality and  

the finery of a downtown medical professional. And I bethought myself: I do not look chic. I will not look right within those bright halls. I shook my head, but the chic one persisted. She nodded emphatically. I approached the crystal doors and the chic one emerged. ‘How good to see you, Howard! Come in! Come in!’
I came in. A large man dressed in tails stood on the threshold. He bowed and smiled a welcome. He finished his smiling and remained where he stood, large and decorative and solid.

  

My friend looked really happy to see me. I looked about me. I was the only person present who was not a member of staff. Perhaps I should be a customer. I looked at the goods on display. I sighted handbags. In a discreet undertone I remarked to my friend: ‘I am glad I am not wealthy enough to buy this one’ – indicating an overdecorated number in a shade of steatorrhoea. My friend looked at me searchingly: ‘What do you mean?’

‘I mean this probably costs the earth and it’s grotesque.’

My friend gasped. I must be joking.
We crossed to the sunglasses. I wear sunglasses about as often as I wear a handbag. I asked: ‘Can you show me your most expensive pair?’

Good naturedly my friend indicated a pair of sunglasses resting in a box labelled ‘First Edition.’ I asked, ‘How much?’

‘One thousand, nine hundred.’

I thought of my First Editions at home. Patrick White’s first novel was published in a limited print run. He came to judge the novel, ‘Happy Valley’, an embarrassing failure. He forbade reprint. As a result, copies of that First Edition are extremely rare and quite costly. The purchase price of my copy was less than the price of the couturier’s sunglasses. 

I decided I would not buy that pair. I sighted another pair whose convex lenses shone golden in those halls of light. I tried them on and admired myself in a mirror. ‘How much?’ ‘Seven hundred.’ I put the glasses down carefully. 
My friend and I surveyed the shop. ‘Nice shop’, I said. My friend smiled, ‘Yes, we like our boutique.’

Before us, seven young ladies and one nearly young, gazed at us, smiling warmly. I find it pleasant when young ladies smile at me. I smiled back, revealing the broken paling fence of my front teeth. ‘This is my friend Howard,’ said my friend. The smiles shone, still warm. ‘He’s a doctor,’ said my friend. 

‘What sort of doctor?’, asked the nearly young one. She looked truly interested. She rested a friendly hand upon my forearm.

‘A GP’, said my friend.

‘Oh.’
I looked around. Seven young ladies, one nearly young, one old friend and one large man keeping station at the threshold. My eyes feasted on their finery. ‘I think I’m the only customer, ‘ I said. My friend gasped. ‘Shhhh’, she said. I shushed. I made my farewells and I stepped out into the autumn.

Rembrandt’s ‘Return of the Prodigal Son’

By Posted in Life, Medical Tagged , , , , , 1 Comment

In the course of conversation today a man said, ‘My doctor showed me a painting by Rembrandt. It was the Prodigal Son. Do you know it?”

I didn’t know it. 
I pulled Mister Google from my pocket as the man continued: ‘My doctor showed me the painting. I looked at the painting, wondering. I looked back at my doctor. He was looking at the painting and I saw his eyes in a sea of tears.’

It was my turn to gaze at the painting. I was right: I’d never seen the image before. My own eyes stung.