Tag Archives: Cancer

Writing as Healing

By Posted in Life, Love, Medical, Opinion, Work by Others, writing Tagged , , , , , , , , 2 Comments

The mother of identical twin boys sent me this story by Ranjava Srivastava.

 

“Losing my twin baby boys for ever changed the way I treat my patients.

I will never know the kind of doctor I would have become without the searing experience of being a patient, but I like to think my loss wasn’t in vain.

‘My obstetrician’s tears stunned me but also provided immediate comfort. They normalised the mad grief that had begun to set inside me.’
Around this time 10 years ago, I was poised to start my first job as an oncologist when personal tragedy visited in a way that would forever change the way I would practice medicine.

I had returned from my Fulbright year at the University of Chicago, blessed with only the joys and none of the irritations of being pregnant with twins. Landing in Melbourne, I went for a routine ultrasound as a beaming, expectant parent. I came out a grieving patient. The twins were dying in utero, unsuspectedly and unobtrusively, from some rare condition that I had never heard of. Two days later, I was induced into labour to deliver the two little boys whom we would never see grow. Then I went home.

If all this sounds a little detached it is because 10 years later I still have no words to describe the total bewilderment, the depth of sorrow and the intensity of loss that I experienced during those days. Some days, I really thought my heart would break into pieces. Ten years later, the din of happy children fills our house. But what I have found myself frequently reflecting on is how the behaviour of my doctors in those days profoundly altered the way in which I would treat my patients.

An experienced obstetrician was performing my ultrasound that morning. Everything was going well and we chatted away about my new job until he frowned. Then he grimaced, pushed and prodded with the probe, and rushed out before I could utter a word. He then took me into his office and offered me his comfortable seat. Not too many pregnant women need a consultation at a routine ultrasound.

“I am afraid I have bad news,” he said before sketching a picture to describe the extent of the trouble. I thought for a fleeting moment that my medical brain would kick in and I would present him with sophisticated questions to test his assertion that the twins were gravely ill. But of course, I was like every other patient, simultaneously bursting with questions while rendered mute by shock.

I was well aware that doctors sometimes sidestepped the truth, usually with the intent of protecting the patient. I knew he could easily get away with not telling me any more until he had more information but I also knew that he knew. I read it in his face and I desperately wanted him to tell me.

I asked the only question that mattered.

“Will they die?” 

“Yes,” he said, simply holding my gaze until his tears started.

As I took in the framed photos of children around his office he probably wished he could hide them all away.

“I don’t know what to say,” he murmured, his eyes still wet. 

Until then, in 13 years of medical training, I had never seen a doctor cry. I had participated in every drama that life in bustling public hospitals offers but never once had I seen a doctor cry.

My obstetrician’s tears stunned me but also provided immediate comfort. They normalised the mad grief that had begun to set inside me. Yes, the doctor’s expression said, this is truly awful and I feel sad too.

“You are sure?”

“There is a faint chance that one lives but if you ask me, things look bad. You know I will do everything I can to confirm this,” he said.

The obstetrician had told the unflinching truth and in doing so almost surgically displaced uncertainty with the knowledge that I needed to prepare myself for what lay ahead. I had test after test that day, each specialist confirming the worst. I think I coped better because the first doctor had told the truth.

Two other notable things happened that week. Among the wishes that flowed, another doctor wrote me an atypical condolence note. His letter began with the various tragedies that had taken place that week, some on home soil and others involving complete strangers. “I ask myself why,” he wrote, “and of course there is no answer to why anyone must suffer.”

Until then, everyone had commiserated only at my loss – and I was enormously grateful – but here was someone gently reminding me that in life we are all visited by tragedy. All the support and love in the world won’t make you immune to misfortune, he was saying, but it will help ease the pain.

Finally, there was the grieving. I lost count of the pamphlets that were left at our door to attend support groups, counselling sessions and bereavement seminars but we were resolutely having none of it. My midwife called me out of the blue – it was a moving exchange that taught me how deeply nurses are affected too. But I didn’t need counselling, I needed time. I valued the offers but I knew that my catharsis lay in writing. I wrote myself out of suffocating grief, which eventually turned to deep sadness and then a hollow pain, which eventually receded enough to allow me to take up my job as a brand new oncologist. How I would interpret the needs of my patients was fundamentally altered now that I had been one myself.

Cancer patients are very particular about how much truth they want to know and when. I don’t decide for them but if they ask me I always tell the truth. A wife brings in her husband and his horrendous scans trigger a gasp of astonishment among even the non-oncologists.

“Doctor, will he die from this?” she asks me.

“I am afraid so,” I answer gently, “but I will do everything in my power to keep him well for as long as I can.” 

It is the only truthful promise I can make and although she is distressed she returns to thank me for giving her clarity. Sometimes honesty backfires, when the patient or family later say they wanted to talk but not really hear bad news. I find these encounters particularly upsetting but they are rare and I don’t let them sway me from telling the truth.

Oncology is emotionally charged and I have never been afraid of admitting this to the very people who imbue my work with emotion. I don’t cry easily in front of patients but I have had my share of tears and tissues in clinic and contrary to my fears, this has been an odd source of comfort to patients. In his Christmas card, a widower wrote that when my voice broke at the news that his wife had died he felt consoled that the world shared his heartbreak.

It can be tricky but I try to put my patients’ grief into perspective without being insensitive. It’s extraordinary how many of them really appreciate knowing that I, and others, have seen thousands of people who are frightened, sad, philosophical, resigned, angry, brave and puzzled, sometimes all together, just like them. It doesn’t diminish their own suffering but helps them peek into the library of human experiences that are catalogued by oncologists. It prompts many patients to say that they are lucky to feel as well as they do despite a life-threatening illness, which is a positive and helpful way of viewing the world.

I will never know what kind of a doctor I might have become without the searing experience of being a patient. The twins would have been 10 soon. As I usher the next patient into my room to deliver bad news, I like to think that my loss was not entirely in vain.” 

……… 

I read this story with alarm. It made me feel anxious because I have and love a pair of identical twin boys. I felt involved because, like the writer’s doctor, I am a doctor who cries; and like the writer, Dr Srivastava, I am a doctor who writes. Finally we two are products of the same medical school (Monash) – Dr Srivastava graduated at the top of her class, in the present century, I graduated at the opposite end of my class, in antiquity (1969).

A final point of commonality was her reassuring remark that ten years after her doctor wept her home is full of the noise of happy living children.

I found the piece helpful. Dr Srivastava identifies and untangles the strands of her experiences with surgical deftness. Her doctor weeps, her colleagues show support and care and empathy and she heals. As a trained observer, the writer dissects her experience of grief, lays out its anatomy and reflects upon its organs and parts.

Like the writer, I find relief and understanding in the act of writing. I suspect that a part of this relief results from word search. The writer is obliged to seek the precise word for the experience. In my case this forces me to test and taste a number of words. Perhaps a dozen words might work more or less passably, but the acts of searching, of choosing, of trialling, help me to clarify what my feelings were not quite like. I mean I discover what I mean. Perhaps this functions as a working through, a self-conversation, something between analysis of an experience and re-imagining it. In my case too, the pleasure of words is an aesthetic joy that comforts me.

Medicine is a pursuit conducted with the living in the shadow of death. It is a pursuit packed with anxious questions: what is wrong with me, will I die, what can be done, will it hurt, how much, how will I know the answers, when will I know? This crying doctor feels the patient’s fear and his own and has to know the border that divides the two. My fears are for the patient, of the patient, of failure, of failing a person of flesh and feeling. My fears include the terror that strikes me when I see my patient slipping away, the knowledge of my mortal inadequacy.

The writer who lost her twins precisely names the elements in her emotional experience. With remarkable poise she traces the costs and the benefits of the loss. So coherent are her reflections I could feel myself learning as I read. I learned about her life and her work, how the two are not the same but never severable. I learned more of how a doctor feels, who she is, who I am.

Alone and Palely Loitering

By Posted in Family, Life, Opinion Tagged , , , , , , , , 4 Comments

You walk past them at lunchtimes and at smoko, you see them sheltering under eaves in foul weather, you see them in their outcast clusters, you see them and you avert your gaze for fear your concern will offend.

They are many, these persons of all ages, members of an underclass. If they were to unite as voters they’d overthrow governments. If they were to become radicalised we’d tremble in our beds. But no, they do nought to us and all to themselves. These human persons harvest leaves and dry them and chop the dried leaves finely then wrap the product in a cylinder of paper. Carefully, accurately, with practised fingers, they burn the leaves, then hungrily, deeply inhale.

Alone in the animal kingdom these sentient creatures do not flee from smoke.

I see them, I see my friends, who meet my gaze and smile in confession – and I am sorry to see – in embarrassment.

A long time ago my father in law was dismayed when advised by his tobacconist (yes, he saw a specialist, no mere candy vendor) that Chesterfields would no longer be imported to Australia. The tobacconist asked: ‘How many do you smoke a day?’

My father in law told him.

The tobacconist responded: ‘You are a very special customer; we’ll make sure you stay supplied.’

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The very special customer became too breathless to read a bedtime story to his grandchildren. Soon he developed a cough. Suspecting cancer he stopped smoking.

Not long after, the very special customer died of his disease and my children lost their very special grandfather.

Manufacturer Phillip Morris continues to accommodate its special customers. My friends huddle and shelter while I shudder. And I direct my superannuation to alternative investments.

Manny the Marathon Man

By Posted in Faith, Family, Life, Running Tagged , , , , 2 Comments

Manny Karageorgiou ran 42.2 kilometres yesterday, racing his oldest foe. At 58 years, Manny is the youngest of the Glorious Ten who have competed in and completed every single Melbourne Marathon. ‘Forty two kilometres’ – it rolls off the eye easily, but it’s a long way to travel on foot. My car gets tired over that distance.

Manny ran with the most reluctant consent of his oncologist. He delayed his stem cell transplant so he could keep faith with the Ten. This GP consented more readily despite the rib that fractured as it filled with tumour, despite the remaining bones waiting for fracture in the merest trip, bones brittle and chalky from the medicines and radiation. The GP consented; who could say ‘no’ to that beautiful face, a child’s face, appealing, smiling through the pain and fear, gentle, mild even before the cancer, tenderer than ever since the rib broke, as Manny sought to comfort his fearful wife and his children.

They came around, the family. They ran the late kilometres with him, the bitter second half of the marathon, they ran, a caravanserai of love and hope and tearful joy, along the endless steppes of St Kilda Road. Manny’s son ran the whole distance at his side. Pana, as Manny calls him is a strapping footballer, vigorous and fearless. Afterwards he would say, ‘I don’t know how anyone could run another marathon after experiencing the pain of the first.’ But Manny has run the Melbourne Marathons thirty seven times. He has outrun the Reaper. So far.

Why does he run?

He runs for faith, he runs for pride, he runs to be humbled, he runs for the self-glory of mortifying his flesh. He runs because he lives. He runs for all of us.

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How to Widen the Gap

By Posted in Books, Carrots and Jaffas, First Australians, Howard's published work, Life, Medical Tagged , , , , , , , , , 2 Comments

In my novel “Carrots and Jaffas” a whitefella doctor working in an outback Aboriginal community has a recurring daydream. The doctor’s dreaming is of a pathway into a healthier unobese, normotensive, undiabetic, heartwell community. That pathway is the path of a sugarless past, a path followed by gatherers and hunters, who are not fast and fizzy food consumers.

That dreaming, a sort of longing for escape from the simple carbs that destroy his flock, that widen the Gap, is born from the reality the Doc sees at the checkout in the community’s foodshop. The local people stock their trolleys, proceed to the checkout, proffer their paycards and wait. The cost of the foods frequently exceeds the funds in the card. The customer removes this food, that food, the next – until the tally equals the funds. First to go are milk, vegies, fruit. Then meat. Finally the customer is left with white bread and brown fizzy cola.

The Doc reels at the choices, at the grip on appetite and taste of these poisons: “more harmful – because more widespread  – than alcohol”. The Doc, an old utopian, dreams of a switch to the Zero option, the sugarless drinks that will please the taste for sweet and the pull of caffeine…The Doc does not fear the scaremongering over artificial sweeteners; thirty years ago these were going to cause cancer. Thirty years on he is still waiting for those cancers. Meanwhile sugar’s harm is here, everywhere…

The experience of that old doc is my experience precisely. In fifty communities, over twenty five years, I have seen these carbs at work on babes in arms, on youths and matrons, on aunties and uncles. In go those carbs and the gap widens that we are successfully closing elsewhere.

The Surgeon

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

This is an everyday story. We all know stories like this one.

“My friend never smoked but she had a cough. Her doctor said, “ Better have a chest x-ray.” The chest x-ray showed a shadow on her lung. The GP sent her to a respiratory physician. That doctor spoke with my friend, listing the possible diagnoses and explaining the process that would define the cause of her cough. She asked some questions. She was pretty scared, but she doubted she could have cancer: she had never smoked.

“My friend was sent to a chest surgeon for a bronchoscopy. She saw the surgeon in the operating theatre just as the needle was inserted into her vein for the injection that sent her to sleep. After the procedure she felt sleepy. She came home with a memory, or perhaps it was an idea she daydreamed, that the surgeon said: ‘Visit my rooms next week for your results.’ It seemed the sort of thing someone would have said.

“My friend’s husband telephoned the surgeon’s rooms and made an appointment. He accompanied his wife – who was still coughing – to her appointment. The surgeon appeared right on time, at 10.00 am, precisely. (The husband is himself a precise man. He notices things like that.) The surgeon gave them the diagnosis. They left the surgeon’s rooms at 10.02 am. My friend believes the surgeon said: ‘The biopsy confirms you have lung cancer. You need an operation.’ My friend’s husband confirms the duration of the visit and his wife’s recollection of the surgeon’s words.

“The next time my friend and her surgeon met they were once again in the operating room. While a nurse gowned and gloved the surgeon he gave instructions to a second nurse about instruments and the overhead lights. The surgeon had no time for conversation with my friend before she was anaesthetised.

“The morning following the operation the surgeon visited my friend and told her she was well and the operation had been successful. Three days of coughing and three nights of agonising pain followed. Morphine and Endone did not relieve her pain. On the fourth day the surgeon visited a second time and said, ‘You can go home.’ In fact she could not; she could not walk unsupported and every breath was followed by a wince and a gasp she had to stifle. A nurse arranged for my friend to convalesce in aftercare. Ten days later, still with her original cough that now shook her chest wound violently, my friend went home. Six weeks after the operation she was still coughing. It was time to see the surgeon again.

“My friend’s husband attended – her chest hurt too much to drive. He sat in the waiting room and timed his wife’s visit to the surgeon. He told me later: ‘Mr. S. beat his previous record. She returned to the waiting room in 30 seconds.’

“That afternoon I delivered some food my wife had cooked for our friend. She told me, ‘The surgeon said the cancer’s gone.’

‘Good’, qouth I. ‘ Great! Will you need chemo?’

‘He didn’t say.’

‘Will you have radiation treatment?’

She shook her head: ‘He never said.’

‘What’s next?’

“I don’t know.’”

As I said, an everyday story in this age of miracles and wonder. An everyday surgical miracle worker, himself a wonder of brutish mutism. What we do not read of is any disciplinary action taken by the authorities against the surgeon for his brutism.

Why not ? – I wonder.

The Twin Bond

By Posted in Family, friendship, Life, Medical Tagged , , , , , , , , 3 Comments

He’s a big bloke in all directions, tall and broad. His face is round and it smiles widely as he enters the Doc’s consulting room. He has an open gaze.

The Doc makes room for the big man to pass.

“Thanks Doc.” He offers a large hand. Doc’s hand disappears inside his patient’s. The grip is manly firm, manly gentle.

“My name’s Alexander, Doc. Call me Alex.”

“Good to meet you, Alex.”

“I’ve got hypertension. Need a repeat of my tablets.” He smiles, his jowls rise and shine and recede. He tells the Doc he is sixty six. He is a man who invites conversation.

The Doc asks Alex where he lives.

“Port Augusta. Been there forever. Born there. Father met mother there, in primary school.

They’re long gone.

I’ve got a sister, a good bit older.

I had a brother – we were twins…”

The glow on Alex’s large face gives way to something deeper as the man slows his flow. Something is happening. Homage? Damage?

The Doc wants to know: “Were you identical?”

Alex nods. “And close.”

He clears his throat.

“What happened to your twin?”

“Cancer.”

In Alex’s mouth, the word is a sentence.

“You know we only saw each other three times in the last thirty years, but we were close.”

The Doc looks at him.

“Very close…Thirty years back he went to New Zealand for a fortnight and he stayed. He came back to see me, stopped with me here, for 12 months. Here we are together.” Alex fishes in his wallet and pulls out an old colour photo. Two large round men in their thirties sit in a small fishing boat and smile goofily into the sun. The light bleaches their faces and sets fire to their red hair. One of the men rests his hand on the other’s shoulder.

“After that year he went back to N.Z. To his friends and his life.

Then he got sick and died. Cancer.”

“It was tough?”

The serious face recedes inward for a moment. The Doc is forgotten. Alex is alone with memory of the feeling, with feeling returned.

He looks out at the younger man: “Knocked me around something terrible.” He stops, shakes his head.

“People used to ask us: ‘What’s it like being twins?’

We’d ask each other: ‘What’s it like not being a twin?’”

The Doc looks away while the other man composes himself. At length he resumes. His face is earnest now as he searches for words to carry feeling: “You know, I lost my son. Suicide.

My wife and I only ever had the one son… Terrible…

I wouldn’t wish it on anyone.

But it’s my brother I think of. Half of me is gone.”

The old man’s eyes are wet. “It’s been seven years…”

A pause as he searches for dates…“Seven years and one day.

There wouldn’t be a single day when I don’t think of my brother.

The large man takes his prescription and shakes the Doc’s hand. He conjures a smile for the Doc and he leaves.

FOBT

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

Some doctors have too much time on their hands. When you’re feeling quite well they go looking and testing for things you aren’t suffering from. They call that preventive medicine. (I call it preventative medicine.) My wife calls it meddling.

Year ago I advised my wife to have a colonoscopy. I offered to refer her to a bottom surgeon, a lovely bloke, quite exceptional in his trade. She declined.

I persisted: “Look, he’s gentle, kind…”

“I know all that. I’ve known him for longer than you have. I knew him when he was a medical student.”
“Then why not see him as a doctor?”

“No! I had the hots for him back then.”

“So? That’s not a disqualification, is it? Was he your boyfriend?”

“No.”

“Did he know you had the hots for him?”

“No.”

“So, why not see a great surgeon and a nice guy who never knew how you felt?”

“I don’t want someone looking at my bottom whom I felt that way about.”

My wife sacked me as her GP and consulted a stranger who sent her bottom to a second stranger.

What goes around comes around and bites you on the bum.

I reached the age of fifty and saw my own GP for a spot of preventative medicine. She said: “You’re Jewish aren’t you?”

I confessed I was. I had the scar to prove it.

“And you are Ashkenazi. You are in a high risk group for colon cancer. I’ll arrange a colonoscopy.”

I wasn’t keen. My wife had told me about the two-litre laxative drink that preceded the examination.

I bargained and we settled for the faecal occult blood test. She handed me a request slip that read:

Test requested: FOBT

Clinical Notes: 50 y.o. male Ashkenazi Jew.

I pictured myself lugging my specimen back to the lab in a shoebox.

I turns out they aren’t that greedy: two smudges would do.

The instructions and restrictions were detailed and grotesque. Being a doctor I didn’t read the leaflet too closely. Didn’t need to. I knew how to “produce a specimen”.

Next morning I awoke early, took my blood pressure tablets and my 100mg of aspirin and felt the urge for an early morning donation. I fought it off as I applied the Glad Wrap, discovering a happy concordance between the width of the wrap and the diameter of the bowl. (Is that cosmic chance or commercial cabal?)

I emptied my bladder elsewhere. (I don’t know what you are supposed to do if you don’t have a garden. Or if you are female.)  Finally I donated. Then I selected, daubed, closed, sealed, dated.

Then I forgot about the entire project. Three weeks later I got around to Specimen No. 2. I collected this and followed the earlier steps. With a light heart and a sense of virtuous health I delivered my daubs to Specimen Collection. Specimen Collection perused the paperwork, checked the dates. And rejected my specimens. Uncertain whether to be outraged or humiliated I asked why. “Dates too far apart.”

I never knew poo had a use-by date.

Back to the beginning. My specimens were collected in timely relationship and delivered to Specimen Reception. I waited in quiet triumph. Specimen Collection had some questions but wasn’t happy with my truthful and humbly virtuous replies. She asked: Did you eat carrot in the three days preceding each of the dates?

Certainly.

Raw?

Yes.

Did you brush your teeth the evenings prior?

Of course!

I am sorry but the lab cannot accept these specimens. Even a single violation voids the accuracy of the technique. Two violations are quite out of the question.

Look, ma’am – very politely, showing some of those teeth in a sweet smile – I am a doctor. I believe I understand the test. I’ll accept responsibility for any inaccuracy.

Sir, we are dealing here with cancer, with human life. The laboratory cannot compromise.

She handed me a new collection set. I stopped by the supermarket for more Glad Wrap and returned to my squat. Carrotless days and unbrushed evenings dawdled by. My teeth turned brown and my fibre-freed stools tore their way out. I sampled my moon rocks and I collected two specimens, a day apart. And returned to Specimen Collection.

With a lovely smile of her own Specimen Collection thanked me and said, See you next year, Doctor.

Er, thanks. Yes.

Oh, by the way, you aren’t taking aspirin are you?

 

 

How to Persecute a Smoker

By Posted in Life, Medical Tagged , , , , , 3 Comments

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.

Loss

By Posted in Life, Medical Tagged , , , , , , , , , , , 4 Comments

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 →

My Doctor My Self – A Fiction

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A very old doctor?

A very old doctor? (Photo credit: revger)

Washing myself in the shower, it suddenly registers that I haven’t farted this morning. Straight away I know I am in trouble. A tummy ache is a commonplace, tummy aches come and go, but this one is different. My bowel has fallen silent. No wind music. Big news, bad news.

I dry myself, lie down and palpate my abdomen.

Is it distended?

Hard to tell.

Is it tender?

Decidedly.

Listening with the stethoscope, I hear nothing.

I listen harder, longer.

Silence. A clamorous silence, speaking in clinical tongues of bowel obstruction, of an absence of vomiting, of a pain that has been colicky in nature, and is worsening.

I am 64.

A person of that age with a large bowel obstruction most probably has bowel cancer.

That can’t be me. I don’t do cancer. I eat, I run, I work, I fart, I tell fart jokes.

I am large with life, I don’t have cancer.

And yet I hear myself observe that this patient is an Ashkenazic Jew. He has no comforting past history, of diverticular disease, of ulcerative colitis, of Crohn’s Disease.  And his aged mother had a pre-cancerous bowel polyp.

This old bloke, this rationalising self-deceiver has bowel cancer.

I feel a surprising, deep calm. I have cancer, I have ignored two decades of advice to undergo colonoscopy, and now I have bowel cancer.

I will die. Continue reading →