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.’

 

 

The Wrong Doctor

 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

Two Flies on a Wall and Darky Harris

fliesWhen I was a boy I came across cultural truisms like, “Aussies will bet on anything; they’ll bet on two flies walking up a wall.” What I heard was something to celebrate, a playfulness in the Australian spirit. When I inherited from a great uncle a curious little plank with two identical circular depressions, someone had to explain this relic of “two-up”, a national pastime. It spoke to me of the irrepressible Aussies of  “Songs of a Sentimental Bloke”. As a more than commonly sentimental bloke myself, I was not disposed to judge or diagnose any malady.

In 1972 I met Darkie Harris. I was the new GP in an ethnically homogenous semi-rural community, an oddity in a skullcap. Somehow the community embraced and included me while excluding the pig-raising Maltese and my only co-religionists ‘the Jews on the hill’.
Darkie Harris differed from everyone and in ways solely his own. Unprepossessing, short, stocky, swarthy, with a face marked by scars and improved by large purpling lips and a vocal tone that ranged from a growl to a bark, he looked older than his fifty-four years and fiercer than anyone so old (I was then exactly half his age) had a right to look.
Darkie distinguished himself by a sort of verbal pugilism. By word and facial expression, and yes, by facial complexion, Darkie dared everyone he encountered to fight him.

What was it that Darkie wanted to fight against? One thing, one thing only. Racism: I don’t care if you’re a chinaman or an abo or a white man. If I cut you, you’re blood’s the same colour as mine.* Darkie was the only person in the town who saw this Jewcomer doctor as undifferent. In equal parts alarmed and charmed, I found I liked him. To most in town I seemed exotic, to some a too shiny exception (‘you’re not like the others’), to some an emblem of a nobility I never earned.

Darkie was retired by the time I met him. He’d take up his position on a bench outside the Chinese café and the fish and chip shop run by a pair of Maltese brothers. He’d sit and glower, softening into a winning chivalry towards women (a sweep of the hat, a flash of gaptoothed smile, “Good morning, Ladies”) and to engage toddlers in amiable conversation while uncertain mothers tried to hide their nervousness and drag their children away.
Darkie sat on his bench and kept vigil. He was waiting for the unguarded comment, any reference he could take exception to, any sneer at the immigrants he championed.
Young hoons and would-be thugs about town learned to shy away from Darkie. As he informed me on a number of occasions, I’d sooner have a fight than a feed. Darkie was referring to his younger self in the Depression days when he was a runner for an illegal bookie, a risky position in a volatile industry. But in 1972 his interlocutor would take Darkie at his word as he’d rise and stride, frothing, barking menacingly to confront the casual bigot.

Darkie never gambled. Those were not the risks he’d take. He described his working life as an honest buccaneer. He served his boss – some degree of criminal – honourably. He’d take the blows and deliver his own and he’d return home and hand his earnings to Joyce, his leathery wife, who subsisted in a cloud of tobacco. Before Joyce Darkie would humble himself, confess his escapades and worship.

The stories of Darkie and flies on a wall and two-up created the sketchy image I had of gambling in Australia. We must have had gambling addiction but I never knowingly met one. I knew dimly of the ancient rabbinic edict that disqualified a gambler as a witness in court proceedings because an addict could neither trust himself or be trusted by others.

In 1976 I went for an early morning run in Launceston, pausing to poke a curious nose into the local casino, a gruesome cellar where women in curlers and moccasins sat mechanically before fruit machines from six in the morning.
Shaken, I ran away.
For some years in the late nineties my younger daughter, a psychologist, worked as a therapist at Gambler’s Help. Her stories of human wreckage at our dinner table opened my eyes. In 2000 I met Alan, a shining youth who became my patient. He starred at hockey, graduated from his elite school, studied business, was recruited by a leading financial institution that trained him as a currency dealer. Two years ago Alan married his golden girl Helen, a primary teacher. They bought a house together in the regional city were she grew up. Neither Alan nor Helen yet realised the bank Alan worked for had trained him as one of their corps of gamblers.
A year ago doctors in the city’s ICU worked on Alan through a Saturday night and all the next day and night. At 27 years of age, Alan’s life seemed at its end, his blood pressure unrecordable, his breathing and heartbeat negligible. It must have been his hockey that saved Alan, his underlying fitness, that brought him back from where his overdose had taken him. After gambling away the contents of the joint bank account, Alan punted on the marital home and lost it. On a weekend when Helen was out of town for a friend’s hen’s night, Alan wrote a note and swallowed the tablets that were to end his self-loathing and his shame. Only Helen’s dog, locked out of the house all Friday night and Saturday, raised the ire of neighbours with her barking.

The marriage died and was buried in a divorce. In the settlement there was little to apportion: Helen took her dog, Alan his shame. His need, his comfort, his fateful hoping – I mean his urge to gamble – survives. It is a daily battle which Alan does not always win.

I turn on the TV to watch sport. Sport still has the power to inspire me, to express nobility, to create wonder, to delight, to unite and uplift. Before and after and between plays, the gambling industry shouts its messages of slim hope, seducing, reducing the game to mere exchange. It is not possible for a child to watch sport on TV without seeing gambling ads. I turn off and prowl my bitter old mind and think of Alan.

In these wrinkled years the past glows, the present moulders, the future threatens. We need someone to blame. That’s why we elect governments – there are some things you just can’t blame on your wife. In the matter of our gambling pandemic I blame governments. Governments bankrupt of funds fall hard for the revenue that streams from gambling. Soon the treasury is addicted to gambling. A few budgets later, we have a government bankrupt of judgement and ultimately of morality. In their lonely amorality, our representatives fall into bad company, the Gambling Lobby. Governments collude with the industry to prevent and foil the simplest attempts to ameliorate our national malaise.

Over two decades I have witnessed the card games in remote Aboriginal communities. Large numbers, women usually outnumbering men, sit on the ground beneath huge trees and gamble from first light to nightfall. Darkness falls and the players shift to the bitumen and sit on the roadway and play through the night.
In Arnhem Land once a nurse and I battled through a long day to save an underweight, undersized infant with life-threatening pneumonia, the child starved because his mother had no money for food. After the necessities – I mean cigarettes and Coca Cola – the young mother consumed the family income at the card games.

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How to Persecute a Smoker

You do not have to try very hard to make the smoker feel miserable. I know, having persecuted smokers for forty five years with all the zeal of the reformed addict. I gave up smoking in 1952 on medical advice. The doctor said I would suffer if I continued to smoke. Although he spoke of chronic lung disease the suffering I feared was a spanking. The doctor in question was my father.

I heeded his advice although it wasn’t easy. Every afternoon on our return from school my older brother and I encountered warm cigarette butts dropped onto the paved area where Dad’s smoking patients smoked until Dad called them in and started to persecute them for smoking. Dennis and I liked to pick up the butts, still gleaming with warm saliva, and take a little puff. Addictive stuff.

Once I was a medical student I could commence practice in my own right. I did so with a will. Never more sincere is the doctor than when battling against smoking: the cigarette and the doctor, precisely opposed, work to antithetical ends: the doctor needs to save, the cigarette needs to sell the next cigarette. In the end death defeats both doctor and cigarette. In the grave no-one sees a doctor and no-one smokes – hell might be different – and both Phillip Morris and Doctors Goldenberg have lost a customer, an addict, a slave.

Over the course of my initial decade as a doctor I grilled every patient capable of holding a cigarette about smoking. It didn’t matter what prompted your visit – the common cold, halitosis from any orifice, bleeding gums or malformed toes – I asked: “Are you a smoker?”

If the answer came, “Yes”, I was off. I informed, I warned, I hectored, I described the coils of cancer and told you smokers stank and as a result they got less sex. I lied. Of course I lied. For the greater good – we do that – we, the militant non-addicted.

I was good at my job. The confessed smoker (Yes Doctor, I did smoke half a cigarette… last month… it was my fourteenth birthday) sits arraigned before me. Relentlessly virtuous, like Senator Joe Mc Carthy, I pursued her.

After a decade I conducted an audit: of 50,000 patients I knew of two who ceased smoking on my advice. Both were ladies well into their eighties. The remainder? They listened to my advice, my graphic predictions, they quivered, shivered, trembled, and – crests fallen – they hurried outside and lit up a comforting fag. Some, too far gone in their degraded state, far beyond fear, felt simple shame. In their misery, they paid, they left, they lit up.

I am sure part of the secret of my success was my sincerity. My purity. I’d ask, not “Do you smoke?” but, “Are you a smoker?” No longer a person but a type, the confessed malefactor sat among the categories, the undesirables: rapists, stabbers, mother rapists…

They’d confess: “Yes, I blow up buses, yes I molest small children, yes” – whispering now – “I smoke.”

We see her, the smoker, in her degraded state. Huddled with others in winter doorways, banished from indoors, she shivers just as she smokes her entrails. Ragged, condemned, outside, outside of the good.

History of course tells us that one day she will rise. Her time will come. Gathering others who are disrespected – the homeless, the mentally ill, global warming deniers, real estate agents, politicians, clergy, boat people, Muslims, Zionists – she and all those we have persecuted will agglomerate and strike. Blowing cigarette smoke in our faces, the smoker will have her day.