Alone and Palely Loitering

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.’

images-4

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

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.

IMG_3865.JPG

How to Widen the Gap

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

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

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

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

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.