One Grandchild, One Sickness

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

 

 

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

 

 

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

 

 

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

 

 

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

 

 

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

 

 

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

 

 

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

 

 

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

 

 

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

 

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

 

Melbourne’s Daughter

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.

Do You Have Children? 

She was the first patient in my day.
She was sent to this city in North Queensland by the foreign mining giant that employs her. 
I had never met her before. We introduced ourselves.
 She said: ‘I was woken by awful pain in my bladder. It’s an infection, I’ve had them before. I couldn’t sleep for the pain. It was four in the morning, but I got up and went out and walked the streets until I found a 7- eleven. I bought some Nurofen tablets for the pain.’
‘Did they help?’
‘A little.’
Her urinalysis was positive.
‘I think you’ll need an antibiotic. Antibiotics famously render the oral contraceptive pill inoperative. Maybe. So during this cycle you shouldn’t trust the pill… unless you want a baby.’
A smile and a shake of the head. The smile is not that smile that says, ‘Tread with care.’ She is a mature woman at peace with herself. Excepting for her hostile bladder. The smile licensed me:
‘Do you have children?’
‘No.’
Another smile as she sat and formulated a response to my silence.
‘I never thought I would. Now I realise I really have to decide – this month in fact. You see I’ll turn thirty-nine next month. I wouldn’t want to have a baby after forty.’
‘Why the late uncertainty?’
‘It hit me I might come to regret never experiencing that.’
 

She talked about childbearing and childraising, describing the contrasting experiences of her sisters. I agreed it was a momentous question. We talked about bladders and we parted.

 At home I asked myself how I’d describe my own experiences. I’d be unable to resist describing – at clear risk of malicious misinterpretation – the intense pleasures of bathing or changing soft bodies, the satiny skin, the small weightiness in arms or lap.
I thought about my feelings and the word that came was ‘intensity.’ Had she asked I might have said, ‘Becoming a parent deepened me. I believed I was tender towards children, but my firstborn taught me how I had tiptoed through mere shallows.’
I recalled an early piece of Martin Flanagan in the Melbourne ‘Age’. He described nursing his small daughter through a night of torrid fevers. From memory, I recall him writing, ‘I know I will never feel closer to this child than I have this night.’
I might have quoted an early patient who became an enduring friend. Her asthmatic sons struggled night after night for breath. She told me how she’d walked the floors, holding them, counting breaths, weighing ambulance against a dash in her own car.
Inevitably I was visited by verse.
I have walked and prayed for this young child an hour
And heard the sea-wind scream upon the tower,
And under the arches of the bridge, and scream
In the elms above the flooded stream….

(W B Yeats, ‘A Prayer for My Daughter’)

I might have described the common and uncommon thrill of feeling a newborn curling her fingers – by reflex – around the finger that I rest on her palm. I might have said, ‘The unearned trust of my child makes me know – as I have never known before – I am significant.
 

I might have said, ‘My children gave me a clarity that was visceral: I knew through them my task, the meaning of my being alive. I knew I would give my labour without question or measure or thought of recompense.

I could never have dreamed the reward that would follow – grandchildren. And of course, with grandchildren comes the renewal of mission, of labour, of redemption of my aging. Feeling anew that deep significance I stride towards my latter end with head high.’

 

Had she asked, that’s what I might have said. But of course we will not see each other again.
Postscript: But we did see each other again – the next morning. With her consent I read aloud the words you just read. I looked up. Her face was suffused, on her lips the widest smile, from her eyes a flow of tears.
She thanked me and in answer to my question she said, ‘Sure, you can publish that.’

Watching Women Drowning their Babies

London, heart of anglophone civilisation, cradle of British culture? ‘For british’ read ‘brutish’.

See below. This is a true story.

This morning I watched a group of six young mothers and their babies, aged six to fifteen months, in an indoor pool in London. The pool was heated: they’re very considerate here when they set out to torture their young. The mothers undressed their babies and clad them in little wet suits. Entering the water they held the babies close to their perfidious breasts, murmuring the tender endearments that loving mothers do. They walked backwards in a circle, bouncing their babes in the water, hoisting them high, beaming, beaming all the time. Choreographed by Nicola – that’s the name of the licensed water torturer – the same cooing, smiling mothers all splashed water into the faces of their young. Spluttering, the babes looked up, discomfited. Their mothers chorused “hooray!”, made loving whisper and song, reassured the children that what had passed was not real, then splashed them again. After half a dozen such passes it was time for holding on. Holding on is taught by placing the babe, until now an entirely earthbound being, facing a horizontal railing just inside the margin of the pool. The mothers all sang “Hold on! Hold On!” Nicola sang the same. A sweeter chorus you never heard. Then the mothers let go of the slippery bodies, singing gaily as the newborn of their flesh slipped below the surface. Here the babies enhanced their education by breathing in water. After a little bit of this, desperate bodies surfaced, flailing arms found the railing, and most survived. None looked happy, but the mothers beamed and sang and cried “Hooray!”

I looked at my watch. We had been going for only seven minutes of the thirty that the mothers had paid for. I braced myself.

Now came swimming. Swimming is done by having your face pushed beneath the surface and held there for two seconds. To condition you for this submersion your mother calls your name, once, twice, then drowns you briefly, smiling withal. Mother Malvolio brings you to the surface, cuddles and coos. When you are a year old or a little more or a little less, you still can recall those aqueous moments of birth, when you suffered anoxia, your first near-life experience. Here, during the your seconds underwater you go through it all again. You’ve been flatlining: you never felt so thoroughly alive.

Throughout your thirty minute session of education you drink a good deal of pool water, chlorinated for your safety (and to foster your eczema). When you have drunk all your small tummy can hold, you pee, re-warming the water for the next baby to drink. The mothers never drink, their faces held above water level as befits members of an air-breathing species. Instead the adult female bodies shed their dribs and their drabs of belly button fluff and sundry fluids, augmenting the brew drunk by their young.

After too long the session is at an end. Money passes to Nicola. Stunned babies, shuddering, shivering as the cooler air hits them, blue of lip, mute with disbelief and moral shock, nestle in mothers’ arms. Those adults smile at each other in congratulation of their depredations.
Scot-free they’ll congregate here again next Thursday and do it all again.

Loss

My friend Paul Jarrett is a retired surgeon.  He lives in Phoenix, Arizona. A wise and humane man, Paul is now in his mid-nineties. Every day he sends a volley of emails that entertain, edify and enlighten me. Visited by a spark of memory, he writes:

A Moment in Time

There was a girl in our class at Phoenix Jr. College whose last name I could not recall until Catherine  McComb reminded me. 

She was remarkable in many ways, lovely, tall, brunette, bright and friendly, but pleased to help any of us duller students with our physics, chemistry or biology studies.  She was a lady of beauty, charm and talent.

Over time she married, became a columnist for the local newspaper and wrote under her married name.

I lost track of her during the war, but after return when I was in practice, I ran into her at St. Luke’s while making rounds.  She recognized me, gave me a hug and a kiss, broke into tears and left, crying, without saying a word.  I do not usually have that effect on girls.

I have no idea what that was about.  I wish I did.  She died some time later and I finally concluded that she must have just received some bad news about her condition prior to seeing and recognizing me.  I do not know to this day what burden she bore however silently.

The memory of an experience like this remains over a lifetime and although names may be forgotten, emotional experiences are not.  Whatever was hurting her, she did not deserve and I was powerless to help.  The scene flashes in my memory once in a while.  I am pleased that Pete provided me with her last name, but disturbed when I recall that last recognition and meeting.  Had she spoken to me, probably all I could have done was help her cry, and she did not want that.

This sparked something. I wrote back.

Dear Paul,

Your story moved me. It disturbed a memory of my own of an event that took place about twenty years ago. It is something I think about infrequently, but when I do so, it affects me still.

It’s nearly lunchtime and I’m running thirty minutes behind time. I collect the last patient from the waiting room. To my delight it’s Lucy. I haven’t seen her for seven years or so.

Ten years ago Lucy and her young husband moved interstate to serve their church full time as youth chaplains. She bobbed up a few years later seeking my help:  I have a problem no-one in South Australia can diagnose. So I’ve come back to Melbourne to see you. Lucy’s problem turned out to be an ectopic e. And she prayed for babies.

The babies, a boy and a girl, arrived soon after. And now Lucy is here today.

In this country practice the doctor treats the whole family. I was the family doctor. I knew Lucy’s father parents, a broad man with deep dimples in his wide face. He’d smile readily and his loose features would collapse inwards in genial embrace of whatever passed. He was the first of my patients to undergo hip replacement surgery.  He died in hospital of an infection. I looked after her sorrowing mother and the four girls. I treated Lucy’s younger sister for the fatigue illness that followed Dad’s death. Lucy was the eldest. She married and moved to a parish on the farthest edge of the metropolitan area, but when she was troubled she’d drive across the city and come back to the doctor of her childhood.

Then she and her husband Christian moved interstate and created a family and I haven’t seen them since. And here she is…

Hello Lucy, how lovely to see you.

Hello Howard. It’s good to be here.

Something is missing from Lucy’s face. The wide smile that always raced across her fine features like a flash of brightening is a small pinched effort today. Something’s up.

What’s wrong, Lucy?

I have a lump in my breast.

Lucy is petite, still slim after the babies. The lump in her right breast is easy to find and hard. My anxious fingers check under her arms. There is an enlarged lymph node in her right armpit. The same side.

Can you feel it, Howard?

Yes, I can.

Lucy looks up from the couch at her old doctor. Her small face looks terribly young, her little body swims beneath the white sheet. She looks to the old doctor, that old look from the time when doctor would make everything alright. Doctor feels suddenly too young, or too old, or too something for this news.

My hesitation tells Lucy everything. Her face speaks. She knows. She understands. Her voice is steady, calm: what will we do, Howard?

I’ll let you get dressed, then we’ll talk.

The things we will do are much easier than the things we must think, the things we must say or must not say.

I arrange an immediate mammogram and an ultrasound. I request a fine needle biopsy of the lumps. And I secure an appointment for Lucy to see a breast surgeon within days.

These phone calls consume the minutes. Today Lucy and I have ninety minutes; by a mistaken stroke of a receptionist’s cursor my lunch hour has doubled. There is time to describe the nature of a mammogram, its discomforts, its austere indignities, its impersonal delays and interruptions. There is time to describe the relative painlessness of a fine needle biopsy. A result will take up to a week.

We sit quietly for a while, thinking our thoughts. More precisely, Lucy thinks and I guess what at she must think: What will I say to Michael? What will we tell the children? How will I tell Mum? And my sisters? They’ve had enough of loss?  I think that I know that none of Lucy’s thoughts will be for herself, for the support that she will need.

I notice Lucy glancing at her watch: Have I made you late for something, Lucy? Your children?

A shake of her head: No, the kids are with Mum.

Tears gather, tremble, fall.

My children…

How old are they now, Lucy?

Michael is six, Hetty is four.

A pause. Lucy mops her face, blows her nose, a long unselfconscious, snotty blow. Then more tears: They might not even remember their mother. At least I had Dad until I was twelve…

Lucy, I think it is cancer. If so, it is serious. But we don’t actually know. We don’t know anything at this stage. I promise I’ll tell you everything that I know as soon as I know it.

Lucy gets to her feet and tidies her face again for the world outside. She thanks me and turns to go. She stops before my door, turns back and reaches, draws me into a hug. I hug back. Hard.

I have finished my hug and let go. But Lucy holds on. Her body is shaking. She is crying again, she will not let go. My arms are gentle around her. After long minutes, Lucy has finished. She steps back, looks up and says: That hug, that’s what I crossed Melbourne for.

Paul, I never saw Lucy again. Her specialist kept me informed. The imaging showed a tumour, the biopsies confirmed cancer that had spread to the lymph node. Lucy underwent mastectomy followed by chemotherapy.  Eight years later Lucy died. Her boy, Michael, was fourteen, her little girl was twelve. Old enough to remember, old enough to grieve.

Some time after Lucy’s last visit a routine letter arrived from the Medical Registration Board. It warned all practitioners against any contact with a patient beyond that necessary for their clinical management. I thought about Lucy. Paul, that hug was as intimate as it was chaste. It was important.

I told my wife about it at the time. And last week when I received your letter I spoke about it with Annette again. As I did so tears gathered in my own eyes and my voice thickened. I felt the pain more keenly than before. And Annette understood and she comforted me. Continue reading

A Baby’s Bottom in Buenos Aires

View of the northern portion of Plaza Francia.I

I

The baby awakens and suckles. The man comes to consciousness in the quiet and dark of the bedroom and hears the regular soft sounds of his wife and his child. Suck, suck, swallow. A pause. Suck, suck, swallow; then the sound of a breath, a breath in two phases – a shorter one high in pitch and a slower one, deeper: the sounds of an ardent drinker and a sleepy feeder. The sounds of the flesh of his flesh.
The man leans on his arm and watches and sees something new. The baby has stopped in mid-suck. He looks up to his mother’s sleeping face and his mouth falls open. He smiles at her, then his arm reaches up and touches her face, plays with her hair. Milk spills from his smile. At the baby’s touch, the mother stirs and sees the smile, reaches for the camera of memory. She wants to capture this moment and to preserve it.
They arrived here in Buenos Aires the day before yesterday. They flew across the world and arrived, excited and anxious and dog tired. The father returning to the city of his birth, the mother with her chick to a  different nest. But the baby has not travelled at all. He is at home in this world which is his mother – his locality are her smells, the feel and the sound and the taste of her.
Father is up early, putting on his work suit, dressing and grooming himself fussily. He wants to present himself well for the  culture of vanity here.
He is dressed and ready early, anxious to make a start, to make a favourable impression. But he is anxious too about leaving. He wants to protect his wife and child: DON’T WEAR JEWELLERY IF YOU GO OUT, DON’T WEAR YOUR EXPENSIVE CLOTHES, DON’T TAKE THAT PRAM – WEAR THE BABY IN THE SLING, DON’T TALK TO STRANGERS, DON’T GO ON THE SUBWAY, DON’T TAKE ANY CAB ON THE STREET – CALL UP AND ORDER ON THE HOTEL PHONE….

The list of don’ts is long. The wife has heard them all before. The peso has fallen, the government has fallen, people are hungry, they have nothing, this isn’t Melbourne, people are desperate, you don’t understand. He’s right – she doesn’t. Continue reading