Death Visits

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

Two Recipes for a Long Life

Recipe One
(Yvonne Mayer Goldenberg, 8 June, 1917- 7 June, 2009)

  
Eat only foods rich in butter and cream. Avoid any food that requires chewing, especially vegetables. (My mother was frightened by a vegetable as a child and never came near one again.)

Relax. Do not rush. Shun punctuality.

A lady who possesses the skill of changing a flat tyre should conceal such knowledge. ‘Why deprive some gentleman of the opportunity to behave chivalrously?’
(Mum believed in chivalry. As a child when instructed by her teacher to use the word ‘frugal’ in a sentence, Mum understood ‘frugal’ to mean one who saves. She wrote: ‘A lady was walking by the sea. A strong wind lifted her up and flung her into the waves. She could not swim. She saw a man on a white horse: “Frugal me! Frugal me!”, she cried. So the man leapt into the waves and frugalled her. And they lived happily ever after.’)

Rejoice in your kin; they are life’s benison to you. You will not have them forever. (Mum’s parents died in her childhood. Left with her younger sister in the care of her beloved grandmother, Mum cherished all her descendants with promiscuous undiscrimination.)

Smile. Nothing is so serious that it should furrow your brow – unless it hurt your little ones.

Talk to strangers, visit their countries. Walk the earth without fear. People are good.

Forgive your children their naughtiness. Indulge your adolescent children in their self-absorbtion. They owe you nothing; they give you all.

What you cannot cure you must endure – with a smile. (Mum’s hip was shattered in her twenties. For forty years she walked in pain, with a marked limp. She did not think to complain. Pain did not interest her. Likewise the disabling strokes she suffered in her last decades. ‘A stroke is boring’, she said.)

Decorate your life. Eat every day from your best china; use the good cutlery. (Which day will be better than today? Who better than the family to enjoy these things?)

Raise your boys to help. (‘Why should I be your kitchen slave? There is no pride in being a parasite.’)

Sex is good, sexual pleasure very good. Never boast of your conquests. Use a condom. (These last two dicta were delivered to her sons before the age of nine.)

Feminism is a mistaken impulse. (It arises from the absurd notion held by some that a woman could possibly be inferior to a man in any particular.)

Never open someone else’s mail.

Read. Meet new words. Look up every one in the dictionary. Read everything – the classics, the junk mail, the cornflakes packet.

Don’t fear death. Speak of it freely. (‘Death is a part of life, darling.’)

Do not fear harm. Fate is kind. Clothe your young in love but do not over-wrap them. Harm probably won’t befall them. Entrust them to the care of the universe.

Do not fear at all.

Recipe Two
(Myer Goldenberg, 5 December, 1909 – 10 September, 2003)

  
Fear everything. (Dad witnessed his friend die of electrocution when the stays of his yacht struck power lines. He operated on trauma patients without number. These events made him warn his children of the injuries that result from inattention or lack of care. One warning would never suffice. No number of warnings could suffice.)

Do everything. But take care. Sail, drive, use power tools. Never wave a knife around. Safety first. Safety last.

Fear nothing and no-one. No task is beyond you, no skill too hard to master, no knowledge beyond your reach, no person to be feared.

Eat vegetables. Overboil them first.

Be firm with children. Demand they meet your own high standards. Don’t coddle them in their minor ills. But if real harm come near, cross the country to protect or repair them.

Don’t let your children off lightly. But protect them ferociously from attack by an outsider.

Cherish your kin. Honour your parents. Honour your ancestry.

Honour your work.

Work hard. Keep going. Do not weaken.

Do not run marathons.

Be worthy. (Dad idolised his parents, particularly his father. Through his long life Dad wished always ‘to be worthy’. He meant worthy of his own father. Even in his eighties Dad fretted he was not worthy. I ached when I heard him speak so.)

Forgive. Never hold a grudge. Speak your anger then reconcile.

Never forget or forgive one who hurts your young.

Keep your words clean. Do not say ‘bum’, never say ‘bloody’. Forget ‘dick’. When you belt your thumb with a hammer, allow yourself ‘YOU BITCH!’

Exercise. Where you could drive, choose to walk. Walk fast. Your children can run to keep pace.

People are good. Life is good, health a blessing. Protect it with injections.

Do not fret about germs. They build resistance.

Breast feed. (‘They’re not just there to fill jumpers’).

Cuddle your children. Kiss them – the boys too. And not just in private.

Pass on your faith. Drill your young in ancient ritual and practice.

Tell the children Bible stories. Read those stories with passion and conviction. Pass on your heritage with love and pride.

Be proud. You are as good as anyone else. And no better.

Be authentic. Do not fear being different. Respect yourself and others will respect you.

Love your children. Succour them in your old age as you did lifelong when the need was real.

Show tenderness. A man can be soft and still be strong.

Tell the truth. Demand the truth. Nothing is more sacred than your word. Nothing nourishes better than trust.

Don’t arrive on time. Arrive early.

Never open someone else’s mail.

Work hard. Save for a rainy day. (Dad worked very hard. He practised medicine to the age for ninety-two and a half. To the end of his life he saved for a rainy day, never feeling the heavy rain upon him, never knowing the time had come to take shelter.)

Sing. Sing loudly. Sing with your children. Sing table hymns with your children on Shabbat; sing loudly in synagogue; sing sea shanties, sing nonsense songs. Opera is grand but Gilbert and Sullivan are brighter, more fun.

The compass needle on your boat flickers; at the poles the compass fails. Know your own True North. Follow it.

Embrace the sea. Sail, fish, and sing. Travel by boat at night, navigating by stars, chart and compass. Do not fear the sea. Never take it for granted.

Be vigilant. Experience the rapture of your mastery of an alien element.

Do not fear. Relax. Never relax your vigilance.

See the beauty, smell the ozone, relish this given world.

Thrill to the cresting wave, the heeling sailboat.

Surrender to the windless calm. Experience tranquillity.
Feel the caress of the sun, the bracing breeze. Both are good.

Give thanks. Be thankful.

Love your kin. Nourish them, work for them protect them, nurture them. Demand resilience.

Be brave. Be true.

When all is said remember the love.

The Faithful Fibroblast

Late last October the Boston Athletic Association sent me an email which read:

‘Dear Pheidipides Goldenberg*,

Kindly advise us of your postal address forthwith so we can forward the race package for your entry to the 2015 Boston Marathon.’

I sent my details forthwith and equally forthwith I began to train for the great event. Now, my alert reader might recall the sincerity and warmth with which I wallowed in self-pity in my incapacity last (southern) winter. I posted a piece titled ‘Farewell’ https://howardgoldenberg.com/2014/07/28/farewell-farewell/, a lament for injuries that would permanently prevent running. I indulged in a prolonged period of warming sorrow, recalling better times. After three decades of running that were halcyon my winter of 2014 was halcyoff.

I know well not to expect an injured and abused skeleton, aged in its late sixties, to heal. My forty-four marathons had smashed knee joints and mashed vertebrae. Sciatica taunted my left thigh with every footfall. I stopped running and I rode a weasel bike. This morally feeble substitute served until osteoarthritis screamed from my left knee whenever I pushed down on the pedal. I stopped all exercise and sulked and nursed that achilles’ limb.

Sulking did me good. After a team of physiotherapists rubbed and probed and pressed sore spots until I squealed; and having found those sorest spots they pressed harder and I squealed the more; and after they prescribed exercises too intricate for me to conceive, to be repeated thirty times a day; and after I tried each exercise once before giving it away; after all this I sulked. And in my sulking I enlisted the faithful fibroblast and it is to that unglamorous cell that I owe thanks.

I last met the fibroblast in my second year of medical school. That was in 1965. I learned then of that industrious cell, of its role in building connective tissues. The fibroblast is the humble builder’s labourer of the foetus. It creates the neonatal skeleton and muscles. Once the human – so intricate, so cunning, so elegant in design, so glorious in execution – has been built the fibroblast might deservedly rest on its laurels. But it does not. Instead it lurks and waits for any damage it might be called upon to repair.

Sprain an ankle and fibroblasts swarm to the site, building, building, building. They create a fibrous scaffolding which, together with nests of new capillaries, is appreciated as a hot swelling at the site of the tear in the ligament. Slowly, thanklessly, this busy little cell knits new fibres to replace the old. Slowly the damaged dancer or skier or hockey player rises and flies again.
But that leaper or runner or slider is fifteen or thirty. Chockers with fibroblasts, at those ages she is indestructible.

Then the day arrives that she turns fifty, when her collagen sags, her ovaries shrink, her mood sours and she sweats her nights through and celebrates the menopause ‘and all the daughters of song are brought low.’

Her man is even more pathetic when ‘desire fails and man goeth to his long home and the mourners go about the streets.’

On the other (more cheerful) hand the poet John Donne wrote:
‘… from rest and sleep
Which but thy pictures be
Much pleasure…’

My spine had rest and my knee slept. June came and passed and with it passed the marathon in Traralgon. August came and for the first time in ages I missed the marathon in Alice Springs. In October Melbourne ran its annual marathon without Pheidipides Goldenberg.

Then Boston sent me that email.

And together with Johnny Donne my knee sang and my spine caroled: ‘Death, thou shalt die,’ as I rose and ran. Since October I have tested the knees on the rocky slopes at Wilson’s Promontory. I have tried but failed to provoke the sciatic nerve in Central Queensland and in outback NSW. I have thrashed the skeleton in Pittsburgh, in New York and in Boston where, three weeks ago I ran the slopes of Heartbreak Hill. I froze but I felt no pain. The next week I ran fast up the length of London’s Muswell Hill to the top, then I turned around and galloped down. This short run constitutes a brutal abuse of synovial membrane, of articular cartilage, ligament and tendon.

I listened for protests from the body. But neither degenerate hip nor spinal nerve made any murmur. Incredulous, I gave thanks to the long ignored, sadly neglected, ever-faithful fibroblast.

One of my favourite poems for sulking is Ecclesiastes, 12. With language like this it’s a pleasure to be sad. Here’s a fuller portion for your enjoyment. You don’t need to run a marathon or injure your body:

1 Remember now thy Creator in the days of thy youth, while the evil days come not, nor the years draw nigh, when thou shalt say, I have no pleasure in them;

2 While the sun, or the light, or the moon, or the stars, be not darkened, nor the clouds return after the rain:

3 In the day when the keepers of the house shall tremble, and the strong men shall bow themselves, and the grinders cease because they are few, and those that look out of the windows be darkened,

4 And the doors shall be shut in the streets, when the sound of the grinding is low, and he shall rise up at the voice of the bird, and all the daughters of musick shall be brought low;

5 Also when they shall be afraid of that which is high, and fears shall be in the way, and the almond tree shall flourish, and the grasshopper shall be a burden, and desire shall fail: because man goeth to his long home, and the mourners go about the streets:

6 Or ever the silver cord be loosed, or the golden bowl be broken, or the pitcher be broken at the fountain, or the wheel broken at the cistern.

7 Then shall the dust return to the earth as it was: and the spirit shall return unto God who gave it.

8 Vanity of vanities, saith the preacher; all is vanity.

*My running name

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More Mother’s Day Thoughts

After my experience last Sunday I’ve decided I like Mothers Day. I enjoyed sharing vignettes of my old Mum. One of the first that I ever published, appeared in my first book, a memoir which I called “My Father’s Compass”. The vignette, a story about my 92 year old father battling the extinguishment of his great powers, and my mother battling nothing and accepting all, was titled: Falling gums.

“The phone rings at midnight. I walk towards the answering machine and listen for an urgent message. I do not pick up the receiver because it is Friday night, my Sabbath – Shabbat – when my soul visits paradise. When I am in paradise I do not answer the phone. There is no message.

Though puzzled – who would want to speak to me at midnight if it were not an emergency? – I begin to relax, then the phone rings again. Once again my machine offers to take a message, once again the caller is mute. I grab the phone. Dad’s voice says, ‘Mum is on the floor …’

‘I’ll come now,’ I say, and hang up. Dad and I have responded to the situation with the least possible desecration of the Sabbath.

Minutes later I let myself into my parents’ house. There, on the bedroom floor, in a tangle of limbs, is my mother. ‘Hello darling,’ she says. She looks up at me and gives me a grin. Recently, Mum’s front teeth have begun to desert her. Those teeth that remain are a picket fence, stained and in disrepair. Mum’s former serene smile has given way to a seven-year-old’s grin – all mischief and careless abandon.

I peer down at Mum’s legs. They are thin, too thin, except for her ruined knee which is swollen and misshapen. In the half light her skin is ivory. I crouch and put my hand on her leg and feel its cool and its smoothness. I touch my mother’s skin and I am her small child again.

A short time passes. ‘Does any thing hurt, Mum?’

‘No darling.’

‘Can you move your limbs, Mum?’

Dad’s voice breaks in: ‘Mum’s not hurt – she didn’t fall. She was reaching for the commode chair and she pushed it away instead of holding it still … she just slid gently onto the floor … I couldn’t stop her falling …’

Dad’s voice subsides. He sits on his bed and holds his head in his hands.

Mum speaks: ‘I’m quite comfortable, darling. It’s quite a nice floor, really.’ Another grin. I look at my mother. Her limbs are splayed and folded beneath and before her like so many pick-up-sticks. I wonder how I will pick them up.

‘If you like it on the floor, Mum, would you prefer to stay there until the morning?’

‘If you wish, darling.’ She extends a hand and pats my face.

I bend and begin to take her weight, my hands beneath her arms. Dad gets up to help but I knock him back because his heart is worn out and failing.

He recoils, recedes and sits down opposite me, his face wrought of grief and care. I feel a pang for my abruptness.

An in-drawing of breath, a grunt and Mum is aloft, her legs a pair of white flags hanging limply beneath her. Her arms are around my neck and we are locked in our accustomed embrace that has become so familiar since she began to suffer a series of strokes.

We know this moment well; each of us knows the sweetness of this slow dance. Neither of us would readily trade it, not even to make Mum whole again.

A moment later Mum is in her bed, covered up, wheezing, speaking breathily, her voice ravaged by stroke and by time: ‘Thank you, darling, what a treat!’ – and beaming with the simple pleasure of ­being tucked into her bed.

Dad, contrite, distressed, is saying, ‘I am sorry, darling. I hate to disturb you.’ And I am saying how pleased I am to come, and how come he didn’t speak into the machine when he rang. And Dad says, ‘I don’t know.’

‘Shabbat Shalom,’ I say, kiss them both goodnight, and go home.

Back home, but not yet in paradise, I sit a while and recall a conversation my friend Lionel reported to me. While driving with my father in the Flinders Ranges, Lionel asks this indestructible old man a singular question: ‘What are you afraid of in this life, Myer?’

My dreadnought father has fought all his sixty-seven years as a doctor against illness and injury. Of all diseases, I know that cancer and stroke fill him with terror beyond naming. And I recall, too, Dad confiding to me his fears for Mum: ‘I am grateful for every single day that I have her; and I am so frightened of the day that …’ He falls silent, his voice drowning in the grief of his imagining.

When Lionel asks his question, Dad looks up and out and away from inside him, and he sees those silent, massive and beauteous living things, so inviting in the outdoors and so treacherous. He answers, ‘Falling gum trees.’

The day after the ‘fall’ Mum and I are alone in the kitchen when she begins to laugh. The sound has a gasping quality. You have to pay close attention to discover whether she is choking again, or simply amused. She laughs louder then tries to speak at the same time.

Her voice is a concerto for bagpipes and windstorm. I lean close, into the teeth of the storm, and Mum says, ‘When I was on the floor last night, and I couldn’t get up, I started to laugh, and I couldn’t stop … and Daddy was furious!’”

Why did the old lady cross the road?

Noon on a sunny winter’s day. As the traffic slows for a red light, an old lady advances a single step onto the roadway. She is preceded by a man who is older than she. The man steps well out into the path of my car, raising a gesturing hand for me to give way. He steps with shaky determination. His hair is grey, his face is grey, his jumper is the same. He has a soft shapelessness.
The elderly lady for whom he acts as traffic controller pushes a walker, a wheeled gadget that supports her while her good right leg drags the stroke-affected left leg forward.

The lady lacks the relative speed and vigour of her man. He gait is an adaggio – a stride and a drag, a stride and a drag. The lights turn green. The old lady has advanced one quarter of the way across this narrow road.

The old bloke looks up at me anxiously, sees I am waiting, plants himself in mid-road and waits.

The green lights signal to oncoming traffic to come on. They do. The old man stands where the plantation would be – if there were one – and waits. The old lady strides-drags, strides-drags her way to her man’s side. Together they wait, he alert, a sentinel, she fully engaged in the labour of remaining upright. There they stand in their island of unsafety, waiting for the tide of traffic to turn again.

Their passage across a narrow street will encompass five minutes of time and all their resources.

Heroes both, with no dream or thought of their heroism, they are everyman’s dad, everyone’s mum.

Are they you, are they me, in time to come?

Where will I find their courage and resolve?

On Quietly Going Deaf

IMG_1696 IMG_1646 IMG_1046“What?”

“What did you say?”
My family is sick of my hardness of hearing. It seems that hearing hardens and arteries harden at just the time that other things soften.
One of my body’s pumps has softened noticeably. I refer to the one with the ventricles.
What human heart can stand firm against the arrival of grandchildren?
This happy, happy stage of life where our children use their sexual organs for the pleasure of us, their parents!
Technological Man has invented old age. Nature, blind and base, has no use for us once our litters have matured and reproduced. We are supposed to wither quickly and politely die. But doctors have intervened and prolonged the moments of aging into an epoch. From fifty to ninety we live on, noting the failing function of joints and arteries, of ears and eyes. Our teeth desert us, our balance fails, our uteri prolapse, our prostates swell, our bladders leak and we dare not trust a fart.
But we have grandchildren. I can hold a newborn on my knee and croon off key and she will not object. I can hold the toddler in my arms and tell him a thousand stories, long after my eyesight darkens, for just as long as memory holds strong. And when memory fails, I can confabulate.
Who needs hearing aids, dentures, titanium hips, dental implants? We have grandchildren.IMG_0009 IMG_1603 IMG_0482