December Seventh

As I left my house this morning, my hand drifted up, as it often does on my leaving home, to touch the mezuzah on the doorpost. I kissed my fingers, as I often do, but this time quite consciously. I was visited by unexpected thoughts: I hope this house is still here when I return. Will I find my loved ones safe and well this evening?

 

 

Musing, I walked to the tram.

 

 

It’s December seventh today. Indelible date. A baby in my arms, born three months ago, named Aviva for the season. Small, pink, warm, her lips a rosebud. We return from a week in the wilderness, wife, the two older children and the baby, two days ago. Back at home the hot water tap runs cold. And stays cold. We call the plumber, he calls the electrician, he replaces the thermostat.

 

 

December seven I am up first. I go to wash for the dawn prayers; a clanking in the pipes, steam issuing from the hot tap. I think little of it. Back in the bedroom I remove the wedding ring that bears Annette’s inscription: ‘Howard, with love, Annette. I enfold myself in ritual gear and recite sleepy prayers. The family is up now. Annette sits in an armchair, breastfeeding springtime baby, while the three-year old and the five-year old sit and wait for Sesame Street. Kisses goodbye and I am off to work, leaving my wedding ring on the dressing table. The hands on the bedside clock point to 0745. 

 

 

Work is busy, absorbing. Quickly I slip into country doctoring. Families, wives, children, snot, cut legs, bruised feelings, breaking hearts, then a phone call from our neighbour: ‘Howard, I think you’d better come up home. There’s been a small explosion.’ I know the neighbour, an excitable person. There’s no rush. I see a few more patients before a voice says ‘go home’. I do so.

 

 

It’s sunny and pleasant. The warmth beguiles me as I drive up the unmade road that twists and turns on the way to number 43, Deering Street.

 

 

I turn into the steep driveway. Ahead I see the carport, tall, stout, ugly. The carport is empty. To the left I see the brick walls of our home lying flat on the rough grass. Grey oblong bricks, Besser Bricks, they call them, I don’t know why. The wooden house frame hangs drunkenly, the roof sits skew-whiff above the frame. A moment of amazement. Then a warming, a drenching flood of relief. The carport is empty. No-one is home. Annette, the kids, they’re safe. We have lost a house but I have lost nothing.

 

 

In the hours that follow I trace Annette to her sister’s house and tell her. She has to drive, to arrive, to look, to sift through rubble before she understands the import of the excitable neighbour’s ‘small explosion.’ A mother has lost her children’s nest. Our son loses speech for the next six months. One goldfish has lost its life, the second survives in the millimetre of water that covers the floor next to the shattered fishbowl.

 

In the bedroom the bedside table is a shatter of toothpicks. Of my wedding ring, no trace. Ever.

The Price of Life in Doomadgee

Just before noon the phone called me from the river to the hospital. The hospital held me until long past midnight.

A man with his jawbone fractured, pushed right out of alignment, said: “There was a fight. I was watching it and a man came up from behind, on my right side, and king-hit me.”

I called a plane to take Sampson to Mt Isa.

Eight thousand dollars.

 

A man came in and showed me his hand, puffed up, a boxing glove of soggy blood under the skin. Beneath the blood, the head of the metacarpal bone had snapped. I said: “You’ll need an operation. We’ll fly you to Mt. Isa.”

Eight thousand dollars.

 

On the TV Rafael Nadal struggled into night with back muscles in spasm. A chubby baby, feverish and short of breath, took me from the tennis. Over the previous day or two I had seen this baby at peace. He filled all who saw him with delight. Such abundant flesh, so well at home in grandmother’s embrace.

This was their third night visit in 48 hours. Grandma brought him in this time as previously. She nursed the weeping Buddha and comforted him. The rule in Aboriginal health says, “Three strikes and you’re in.”

I said, “He’ll have to go in. To Mt. Isa. You can go with him.”

“Grandmother said:” I can’t. I’ve got my own six-month old at home. I’m breast-feeding him.”

“What about his mum?”

“She doesn’t have him. I do.”

The letter from Child Protection said the same. So Aunty went.

 

Very late at night came an urgent call. The voice said: “A man has come in with a high temperature. He’s very old.”

The thermometer said: “39.9 degrees.”

That sort of fever says “sepsis.” In this man’s case his septicaemia arose as a complication of pneumonia.

I asked the man about symptoms. He shook his head. He had no complaints.

“What about pain?”

He said, “I think my head hurts.” He said it as if he was far from the pain. The pain was a sensation like memory; he had to summon it to name it.

The man sat bent forward, breathing quietly, speaking softly, his bushy moustache a permanent smile.

At his side sat a young woman. Her gaze never moved from the breathing old man.

I asked, “Is he your grandfather?”

She said, “Yes.”

“Will his wife come…?”

The young woman said, “No, just me. Me and my brothers.”

“He’ll need to go to Mt. Isa. Your grandfather is seriously ill.”

A sad shake of her head, She said: “I can’t go. My baby… My brother will go, one of my brothers, Ambrose.”

“How old is your Ambrose?”
“Eighteen.” Seeing the doubt on my face she said: “Ambrose will look after him 
properly. Us three – my brothers and me – we live with him, we look after him. We do everything.”

 

The old man’s vital signs went from worse to frightening. The sphygmomanometer said: “60/40”.

The Emergency Consultant at the Flying Doctor Base in Mt. Isa said, “The plane is on its way. Give him Adrenaline.”

We gave him adrenaline. We gave him three different intravenous antibiotics and a fourth, by mouth. Hunched forward, moving only zephyrs in and out of his chest, the old man breathed and the breath did not speak to my stethoscopic ears.

I said, “Please lie back if you can.”

He lay back, air moved in and out, the silver bush on his upper lip filled and emptied, emptied and filled, semaphoring life. The blood pressure machine said, “80/50…90/65…110/70”.

The young woman gave way to a brother. The brother, after a time, gave way to another. This was the eighteen year old, tall, thin, lightly muscled. His bearing was solemn.

The sound of an aircraft flying low overhead changed the tempo.

Quickly, quickly, gently, many hands helped the old man slide from the couch to the ambos’ trolley that he would ride to the vehicle and on to the airfield.

We pushed him towards the ambulance parked outside the front door. Lining the wall, gathering in numbers, gathering over the fretting hours of the old man’s time with us, waiting, standing quietly, were three daughters – themselves matrons – and men of all ages, boys, small kids supported on young hips and attached to slender breasts. Only minutes earlier the waiting room had been empty. All had stood outside in the dark and the heat. The chill of a hospital ward did not invite them.

All eyes now followed the old man. Hands reached for him. The ambos halted, the file flowed forward, a wave of silent care. I saw one woman, a daughter, her eyes swimming, her lips trembling. I stepped forward and said: “Your father has been desperately ill, but he seems to be turning the corner. He’s holding his own now.”

She said: ”He didn’t want to come to the hospital. He was scared. He thought you might fly him out to Mt. Isa. When they flew Mum out, she…” The voice, soft, husky, now faltered:“…Mum never came back.” 

 

I looked at the gathering and asked: “All these people – all his descendants?”

She said, “Yes, all his kids and his kids’ kids and their kids.

And there’ll be just as much family waiting for him in the hospital in town.”

 

The ambos took the old man away. The family melted away.

 

The senior nurse breathed out and said: “If I come to my final hours and I am surrounded by that much love, I will know I have lived a successful life.”

 

***

 

While the nurses tidied the Emergency Rooms, I wrote up my clinical notes. A nurse approached, apologetically. She said, “Would you mind? We have a lady here with a cut head. It might need stitching. It was a belt buckle.”

In ED an old lady sat. Seated opposite her, too long of limb to sit without sprawling, were two large men in navy blue with large guns at their hips.

I looked to the lady. She wore a patterned dress in black and white whorls. The bodice was splattered with red. Her head was a savannah of silver-black curls. I had to search for the laceration which was small and shallow. Blood had clotted in a thin line between the margins of skin. Nature had stopped the previously brisk bleeding.

There was not much to do, nothing medical.

I asked, “What happened.”

The nurse said: “Fifty dollars.”

The nurse shook her head. Was she angry? Disbelieving? Or simply busy with the wound?

She resumed: “Her husband demanded fifty dollars and when she didn’t hand it over he hit her with his belt buckle. Isn’t that right?”

The old lady spoke for the first time. She said, “Sixty.”

Unhappily, guardedly, I turned to the police officers and asked: “How can I be of help to you gentlemen?”

The taller one had blue eyes. His firm face softened. He said: “You can’t. We’re just waiting here until you’ve all finished, then we’ll drive her home. Don’t want an old lady to walk home alone. And it won’t be her home. We’ll take her somewhere else, somewhere safe.”

Doctor and Suer

I ate breakfast with a sixty-year old doctor who told me he’d retired from doctoring. He is a paediatrician, a member of that special tribe of doctors whose hallmark is kindness.

I congratulated him on his courage. It takes courage to walk away from a mistress as beautiful – or as possessive – as Medicine.

‘Oh no, I wasn’t brave; the opposite. I was sued.’

‘Really?’

Why was I surprised? Even in his quiet state of Tasmania we Aussies follow America in so much.

I wondered what he’d done.

‘Nothing. I wasn’t accused of doing anything wrong. That was the problem: rather I was accused of not doing something right; I didn’t detect a cancer that was diagnosed years later. By the time the cancer was found it had spread and could not be cured.’

My friend told me the story: how the woman consulted him for breastfeeding advice when her new baby was four days old for breast pain that went away over the following week. Two years later an aggressive breast cancer was discovered.

The woman visited my friend only once. By the time the case came to court the unfortunate patient had no memory of my friend.

America’s doyenne of breast feeding, a distinguished doctor, still acute in her nineties, travelled to testify what any doctor – or any mother – would know: breast pain is universal in the early days of lactation; that transient soreness of that sort is not caused by cancer but by engorgement; and when engorgement settles the pain disappeared. That is what happened in this case too; the eventual cancer was permanent but its supposed symptom was temporary.

This did not deter the counsel for the plaintiff from bullying my friend and decrying his knowledge and skill. In open court, on the public record.

The jury found for the doctor. He was exonerated. And, following two years of legal proceedings in which he lost sleep, lost weight and felt shame, he decided to stop seeing patients. ‘If I can be sued for practising properly, then I can never feel safe. I could be humiliated and publicly insulted in that way at any turn.’

A family with two small children will lose a mother. That mother will suffer and die. My friend loses his good name. A community loses the service of a person who turned his back on Medicine’s monied paths to work humbly for children. How many children of the future will never know his wisdom and skill? How many mothers might have found comfort in his counsel?

I marvelled that this person of exemplary quietude could be shamed publicly. I marvelled at the shamelessness of that lawyer, operating for a contingency fee. In pursuit of mere money that lawyer sought to take from my friend his good name. Now the lawyer has lodged notice of appeal. More grief, more tension for the accidental doctor, the human who helped another human in the elemental enterprise of physical mothering.

More tension and uncertainty, more grief for the mother who will die.

I attended a tribunal hearing once of a different type. Here there was no suit for damages. Instead the licensing authority heard an accusation against an older doctor by a patient that he’d carried out an improper examination of her chest.

The tribunal – consisting of two doctors (one female), a former police detective and a social worker – heard the patient’s evidence in a closed room. The woman was allowed the presence of a support person. The doctor and his support person were excluded. As a result the complainant was given an opportunity to present intimate evidence before a small number of persons who questioned her with respect and tact.

The lady and her supporter were then excused and shown to a private room to await the outcome.

Subsequently the doctor was called on to explain himself before that same nuclear group. He detailed a systematic mode of examination which was thorough, an examination he was taught at his medical school in the days when doctoring was painstaking and x-rays were a late resort. It transpired the patient had never before been examined with such thoroughness. She felt it improper.

The older doctor had practised in this manner for sixty-five years without any complaint against him. He took quiet pride in his meticulous methods. He knew no other way. And now those virtues had found him out.

I imagined the woman had to summon her courage and her resolve to make her complaint. But in the course of these proceedings she was not made to feel that she was on trial for her own truthfulness.

The panel – comprised of doctors and non-doctors – exonerated the doctor. The female chair said the panel found his work exemplary. She added, ‘This tribunal wishes you many more years of such careful practice.’ She then excused the doctor.

After the doctor’s departure from the premises the complainant was recalled. The tribunal explained that no finding was made against the doctor’s practice nor against the patient’s truthfulness.

Here again two innocent persons endured painful proceedings, but neither was humiliated in open court. A careful enquiry was conducted, uncontaminated by lure of money; here there was no blood sport.