Tag Archives: death

The District Medical Officer’s Logbook

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Hg is a district medical officer in remote australia

The DMO takes phone calls from the remotest places in Australia

The cases he describes are typical and fictional. And true:

2100 hours – a large man screaming in pain from his twisted testis.

2105 – given morphine intravenously

2110 – still screaming; more morphine

2115 – in agony; crying; more morph

2118 – no better; given a fourth dose; settles; given an oral opiate for continued effect

2120 -2150 – called Flying Doctor, arranged retrieval to the Base Hospital, briefed Flight Nurse, briefed Emergency Dept at the hospital.

Plane will take off at 2235, pick up patient at 2355, ETA at hospital 0045 hours. He has six times the normal dose of opiate aboard his large body. He will undergo urgent ultrasound to confirm the diagnosis. If confirmed surgery will follow to save the testis.

Meanwhile the phone has not cooled in the DMO’s hand:

2107 hours – a doctor in an Aboriginal community some 2 flying hours away calls seeking retrieval of a 79 year old Aboriginal man, normally active, sociable, a traditional healer, a man of high degree who has suddenly fallen ill. His urine tests positive for infection and his high fever and racing heart and falling blood pressure register a likely septicaemia.

Air retrieval is urgent. DMO makes a further six phone calls to the parties to this retrieval. The plane will not arrive for a further three hours, leaving the remote nurse and the remote doctor with a failing treasure.

2204 – A triple zero call to the ambulance alerts all services to a rollover 20 kilometres from the nearest settlement, about 130 kms from the Base Hospital. Two grey nomads have hit their heads and walked away from the wrecked vehicle. They will be treated as fractured necks until a CT scan proves otherwise: a vehicle that overturns while travelling at 100 kph belts a neck with sudden brutality. Persons walking away from the car might never walk again.

2224 – An unconfirmed and unclear report of a third person trapped in the wreckage. Ambulances set out from the small community driven by remote nurses who handle everything from births to deaths to attempted hangings. None of those tonight, thankfully. So far.

2241 – Six hundred kms distant from the septicaemic old man another goes down with a similar illness. This man, aged sixty, looks eighty. We send a plane, knowing that the flight will not commence until 0300. Aviation hazard statistics show that risk is highest after 3.00 am. This retrieval will end at some time from 0600 to 0800, when the crew will be at their lowest ebb. More phone calls – at least six per evacuation, sometimes as many as twenty.

The DMO’s shoulders and neck tighten during the 13 hours of the night shift. The bladder calls but calls in vain.

2300 – a baby has bronchiolitis, needs oxygen, is supported capably in a clinic 350 kms from the nearest hospital. The planes are both out. Two nurses pack up babe, mother and all their gear into the ambulance and commence the 8-9 hour return trip. The nurses will be on call tomorrow night too.

2340 – a bloke has a headache. His head has ached for the last six days, ever since the rock chucked at him hit him on the head. He looks well enough, his vital signs are alright, but who knows which little artery bleeds quietly away, building, building a pressure on the brain that might bring a stop to respiration?

The DMO arranges this man’s evacuation for first thing in the morning. Meanwhile the man sleeps. He will probably wake up. The plane that retrieves him will also bring the station hand whose ovaries, tubes and womb are on fire with the infection that her man gave her before abandoning her 15 months ago.

Midnight and the calls come less frequently. The DMO climbs onto the couch by his desk and waits for oblivion. He yawns great, jawcracking yawns. He falls asleep. The phone rings at 0040: the nurse in the most remote community calls about a woman whose labour has started. The baby was expected in 13 days. Mother-to-be is nineteen and this is her first baby. Her English is poor, she is shy – or scared mute. The nurse – “I am not a midwife, doctor” – reckons the contractions are infrequent and brief. The waters have not broken. There is no blood. There will be no aircraft until 0930 at the earliest. The non-midwife will be alone in a room with a ticking womb through the remainder of this long night. Telephone calls proliferate – from DMO to obstetrician , to RFDS, to Emergency Department, to the flight nurse, and – repeatedly – to the solitary nurse in the clinic in Deepest Woop-Woop. Drugs are ordered to halt labour. Observations are taken, reported, discussed: Nessun Dorma.

The DMO keeps notes, trying to enter them in real time into the computer whose softwear has an inbuilt stuttering tendency, suddenly freezing in mid-sentence, then as abruptly thawing. From time to time the computer does its programmed unbooting. The DMO is old, computers are new and the NBN cannot come fast enough. The DMO swears a lot at the softwear while reserving the most supportive and encouraging words for his allies, the nurses, with their patients in their far and lonely posts.

The labouring lady sleeps. The non-midwife checks an inscrutable belly for contractions, peeks furtively at a pad for liquor or blood, listens to the baby’s heartbeat, monitors blood pressure,

The DMO wants to sleep. He lies down, looks balefully at the phone – silent for now – and delivers a little speech to himself: The phone will ring. It will wake me. That’s what I signed up for. That’s my job – no phone, no job. Don’t complain. The DMO finds this speech inspiring: he will fight on the beaches, he will fight in the streets, he will never, never… The phone rings. It is the flight nurse, reporting on the safe arrival of the old seer with sepsis. She needs the current observations on the second bloke. More telephony. More self-conversations about sleep, work, the meaning of life.

0350 – the ambulance service rings. A triple zero call has come in of a man, raging, threatening harm to himself and to others. The call came from a clinic 80 kms distant. The caller says the patient lives in House No. 174. Police have been called.

The DMO calls the clinic in that community, disturbs the sleep of a nurse who must go out into the dark to find a patient who hasn’t called her and who is quite unpredictable. DMO enlists her help but commands her to keep her distance until the Police arrive. Once she can safely assess the patient she is to call back and the DMO will face the mutually demeaning task of certifying another human insane. The nurse goes out into the cold – it is minus two centigrade. In the event she searches with the Police, fruitlessly. The harmer is not found.

0600 – the DMO briefs the flight nurse on the first of the day shift aircraft. Before this he answers phone calls from nurses supplying the latest observations and reports on their charges.

It is 0635. The shift will end at 0800 – give or take the handover to the day shift DMO, and the paperwork, and the catch-up note-keeping on the flukey computer.

The DMO decides to make a cuppa. Night will soon be over.

Further Deaths and a Birth in the High Arts

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Peter de Vries is dead. This is sad but it is not news: he has been dead since 1993. It appears he will remain extinct. What is sadder is that none of his books is in print. You cannot buy any current edition of the works of this pre-eminent American humourist of the early post-war decades. From 1940 to 1986, he chronicled the full comedy of the full human tragedy.

De Vries found plenty of material for dark jokes in his war time military service, in his Calvinistic upbringing in the Dutch Reformed Church and in the death of his daughter from leukaemia. He transmuted grief into sobering mirth and we laughed ourselves silly. Now his books are no more.

Life is just as funny today as it was in De Vries’ lifetime. We have the media, the markets, religious institutions to entertain us. Our politicians are a joke. The pestilence that is our species still despoils the planet, continues to kill, it maims and lies still – and records its glory in the daily newspapers. The papers are on the way out, and soon or sooner the planet appears likely to kick us out too.

Meanwhile a distinctive genre of off-beat humorous fiction for which Australia was once famed has died, unlamented and unsung. I refer to the Annual Income Tax Return. In the 1970’s and 1980’s creative accountants and millionaires and gifted liars combined to create songs from the bottom of the harbour and paid no tax. How they laughed.

Nowadays the accountant is effectively a secret agent of the ATO. She shows no interest in creative fiction, steering me instead along the narrow and straitened path of maximum taxation. The tax return she creates is deadly non-fiction. She then charges me and – for all I know – receives a commission from the Tax Office. This would make her a double agent. We have here the makings of a spy story. Would that the story were fiction.

The news is not all grim. This new genre in literature, the Tax Spy story, incubates in a silence disturbed only by the sound of calculating machines at the ATO.

 

Monanism

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English: MONA - Hobart, Tasmania

English: MONA – Hobart, Tasmania (Photo credit: Wikipedia)

MONA is the Museum of New and Old Art in Hobart.  All of its promotional materials are written with tongue lodged firmly in cheek. One such refers to Monanism, a play on Onanism. This in turn is named for Onan, a figure in Genesis whose wife had suffered bad luck with her previous husband: he went and died on her. Onan decided to prevent pregnancy. He did this by spilling his seed on the ground, at once giving rise to the eponym and leading to the naming, some three millennia later, of a parrot in the USA. (Onan the parrot belonged to Dorothy Parker, who named him thus because the bird too “spilled his seed upon the ground.”)

MONA is remarkable. Submerged in a hillside it is a museum without windows. Visitors are entombed for the duration of their visit. Dominant themes of the artworks are sex and death. All this might warn off a visitor, suggesting a visit will be a dark or morbid experience. This in turn is the museum’s little joke at its own expense, an instance of Monanism at play.

Cynics who view Hobart as Australia’s petrified forest – views that are themselves stale and petrified – simply feed into the joke and the pleasant surprise that is MONA.

We* visited MONA yesterday. It is fabulous. The entire experience is exciting, playful and confronting. To remark that the collection is eclectic is to discover how inadequate and weary is that term for artworks that range in date from antiquity to today, to tomorrow. And to some time well beyond tomorrow.

My two favourites are Arthur Boyd’s “Melbourne Burning” and another work, commissioned for MONA and titled “Untitled”. This looks like a giant spud; it’s about the size and shape of a Morris Minor motor car, and like that vehicle, it has small windows through which you can peer into the interior. Here, red apples fall vertiginously from the grip of finger-like branches at eye level towards small wells, or open cupolas, containing water. The effect is enchanting, both magical and charming. And mysterious. I looked and felt as Moses might from a mountain peak in Moab: I could see but never hold a view of endless allure and promise.

(It should be obvious that I cannot recall the name of the artist; it’s an Armenian name. Like his work, he remains untitled…)

Boyd’s “Melbourne Burning” recalls a work by Breughel the Elder. It expresses the artist’s mixed up, unnamable and profoundly distressed reactions to WWII. In the painting life both destroys itself and asserts itself in grotesque and cruel ways. I have not been moved so strongly by a work about war since viewing Picasso’s “Guernica” in MOMA (no relation to MONA).

My mind exercised itself throughout the visit. Tracey Moffatt’s mixed painted and photographic work is as brilliant as anything there. This Aussie artist (of mixed extraction, including Aboriginal) stands as a peer alongside any of the ambiguists and tricksters at MONA. Her work, “Something More”, seeks to confuse meanings – particularly of cultural identity – by emphasizing its own ‘fakeness’. (Wikipedia)

In my experience, culture is very hard on the feet: a trip to an art museum always leaves me footscore. Not so at MONA.  The experience set my mind to dancing. But my feet feel fine. [Unlike old Onan, who, soon after his marriage, left his bride a widow once again.  (See Genesis, 38, vv 1-10).]

*This blog has a spouse who accompanied me to MONA.

What I Have Been Doing With Your Donated (and Undonated) Monies

By Posted in Life, Running, Travel, Uncategorized Tagged , , , , , , , , , , 2 Comments

Late Training Notes from the Bristol Downs.

I promised to report on your Unusual Investment. (If, as you read this, you don’t know about that Investment, please visit these links http://hopkintonrespite.com or
http://www.youtube.com/user/HopkintonRespiteTV
It is not too late for your dollars to join the nearly-four thousand dollars that preceded yours, whose donor investors will never see them again.)
Since I first wrote to you the grass has not grown beneath my feet. A certain amount of tinea has, but this is inevitable: I have been training hard. The Boston Marathon will be run on Monday 15 April and investors in my little Scheme are helping the Michael Lisson Memorial Respite Centre.
Michael’s mother, who created the Centre, wrote one week ago, reminding me that Michael died on the day of the 100th running. I ran that day, unknowing. Now I know and marathon running feels like a small matter.

They ought to call the Downs the Ups, these vast, everlasting, uptwisting hills. Or the Steeps. From one end of the Downs you can’t see the other for distance. And even if you could, you couldn’t – because of the mists. In spring, season of mists and frosts.

My father, not a lewd man nor crude, told few risqué jokes. However this semi-liquid air brings to mind one of Dad’s one-liners: Did you hear about the man who took his girlfriend out into the night air and mist?

Enough complaining. Hilly Bristol, like coastal Israel, is terrific training ground for Monday’s Boston Marathon. We’ll run up the Newton Hills between miles 18 and 21, hills famous for breaking hearts, but the Bristol Ups, like the long, high dunes of Herzliyah, have toughened mine.

This is my race preview. I have trained long and hard, six days a week, resting only on the Sabbath. Each run feels easier than the last. Gone is the sense of labour in a run of a mere hour’s duration. My legs feel wonderful, muscular and light. There is the little matter of the creaking discomfort in the left knee – my good knee – a new sensation. The knee hurts only when it bears weight. Best ignored.

With the exception of a 3.5 hour run in the Jerusalem Forest all my training runs have been solitary. This is not of my choosing: running with a friend is four times easier than running alone. This is true for all runs, over all distances. I know: I have done the maths. However all my friends have stopped running; they have heard the call and they have gone inside for dinner or for breakfast or to their homework or to dull duty. So I run alone.

In Bristol Alfred Lord Tennyson has kept me company. Some fluke or inadvertence has selected the poems of Tennyson on my i-phone. Useless here in the UK for telephony, my i-phone has become the perfect companion. Deaf and mute to the world outside my earbuds, my Apple sings the songs of my choosing, or in this case, the poems of my non-choosing.

He was keen on death, was Lord Alfred. From ‘Ulysses’, where he found romantic allure in Death, the Adventure; to the dying of King Arthur; to the demise of the Lady of Shallott; through lyric after lyric, the Laureate spoke to me, morning after morning, of death. Last Sunday he spoke to me at great length of the loss of his friend Arthur Hallam.
Endless his grieving, dark his spirits, Tennyson’s mood finds its echoes on these misty Downs.

That day found me running near the railing that kept me from stepping out into air and falling hundreds of feet in near-dark to the river, tirra lira, below. A blaze of red in the gloom, patches of white at shoulder height; what are these? A brief breather is permitted. The patches of white turn out to be cards, handwritten by members of a local junior cricket team and a junior football team, in memoriam to a teammate. The blaze of red is a football club scarf inscribed in black marking pen: Russell Simmons # 14.
Fresh posies of daffodil and another, paler flower, bloom from the railings.

No-one else in sight. No-one to ask or tell. No-one else to lament. My head bends, defeated. A sudden roar, a cry of raw sorrow bursts from my throat. My voice thickens, my eyes are wet.

Running is an easy thing, marathon training now trivial.

Shaking my head, shaking it to shed reality, I look up once more. There are more words to be read on that blood-red scarf: You’ll never walk alone.

Postscript: Afterwards I Googled Russell Simmons, deceased Bristol sportsman, and felt still sadder.

Copyright, Howard Goldenberg, 10 April, 2013

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Book Alert

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a long time ago i tutored a group of medical students at melbourne university

one of these was dominic wilkinson

dominic was an unusual student, interested in ethics, coffee, dumb animals and conversation

he was built like a greyhound*, played violin in an orchestra, created, directed and acted in commercial theatre, pedalled a bike everywhere, ran marathons, ate no food that had a mother and eschewed leather shoes

he read widely, had a quirky sense of humour and was far too bright to be a doctor.

straight away i recognized dominic as a fellow dilettant

i knew he would find no time to study for exams and that he would fail

and go on to some more creative field

i was nearly correct: dominic passed his exams, graduating at the head 9780199669431of his elite class

he trained in paediatrics (too easy), ethics (too simple), philosophy

( that gives makes my brain ache)

he won a rare and prized scholarship to oxford where he conquered,

returning to oz with more degrees than a thermometer

five minutes later he is a professor in adelaide and has written this book

i was right: i KNEW he’d turn his mind to something creative

if you have a a baby, plan to make one or ever were one, buy dominic’s book

or even if you just enjoy sex, because you never know…

howard goldenberg

*an expression of one of my patients: “like a greyhound – all dick and ribs”

Now for the official blurb:

In ancient Rome parents would consult the priestess Carmentis shortly after birth to obtain prophecies of the future of their newborn infant. Today, parents and doctors of critically ill children consult a different oracle. Neuroimaging provides a vision of the child’s future, particularly of the nature and severity of any disability. Based on the results of brain scans and other tests doctors and parents face heart-breaking decisions about whether or not to continue intensive treatment or to allow the child to die.

Paediatrician and ethicist Dominic Wilkinson looks at the profound and contentious ethical issues facing those who work in intensive care caring for critically ill children and infants. When should infants or children be allowed to die? How accurate are predictions of future quality of life? How much say should parents have in these decisions? How should they deal with uncertainty about the future? He combines philosophy, medicine and science to shed light on current and future dilemmas.”

Death or Disability? The Carmentis Machine and decision-making for critically ill children is published by Oxford University Press. It is now available via the OUP website on the link above, or via Amazon UK, France, Canada, US (released in March) or Book Depository (free postage)

 

After Uluru

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‘… There’s been a death.’

I am in my small house in Yulara, cooking for shabbat on a Friday in December 2006, when the phone ringImages. A male voice speaks: ‘It’s Sergeant Benjamin, Doctor, of the Mutitjulu Police … I’m sorry to trouble you … there’s been a death.’

A pause.

The voice resumes: ‘It was a hanging. We need someone to certify the death. The nurses here can’t do it; it has to be a doctor. I am sorry, Doctor.’

The voice is careful, it is feeling its way. I don’t know the officer. The voice I hear is sober – sobered almost to a halt by the news of a death.

I ask the officer to bring the body to the clinic. We arrange to meet in twenty minutes’ time.

It is early evening – 1830 hours in official language – when they pull up at the clinic. Even at that hour the heat is relentless. The sky is painted blue. There are two vehicles, a police car followed by an ambulance in its familiar livery of white slashed with red. A large oblong man steps out of a police car of such startling blueness that the sky pales behind it. The officer’s face is deeply creased.

We shake hands.

His offsider gets out and straightens. She dwarfs her sergeant. Apart from the odd post-adolescent pimple, her face is smooth. She walks over to the ambulance and commences a laughing conversation with the nurses who have driven the body.

After a time the nurses are free to attend to my questions. I address the older of the two, the one I know from the clinic: ‘When was she found?’

She turns to her associate. For a moment, both are silent, then she says, ‘I’m not really sure. The family called us an hour ago – when they felt ready to let us take the body, I guess. Someone found her before that and called the family. We don’t know when …’

We release the latches and the heavy door of the ambulance clunks open, revealing a large white bag resting on a collapsed stretcher. Warm air flows from the interior.

The nurses step backward. Fumbling, I try to pull the stretcher a distance from the vehicle’s dark interior. The nurses step forward and help, then again retreat. I pull on the zipper and the bag falls open, exposing the head and upper body of a human.

I pause. No sound, no movement.

There is a moment of reverent peacefulness. The skin of the person whom I stand and regard is brown, the same brown that glows from the earth and the many heads of rock in the early sunshine during my early morning run. That colour has penetrated me, claiming me like a mother.

I place the back of my gloved hand against the brown skin. It is still warm. Just as shocking, the face is very small.

I straighten and ask the nurses, ‘Do you have a date of birth?’

One shows me a file. She points upper left, where I read, ‘19 November, 1991’.

I look again at the small face. There are a couple of blotches of acne. The child has buckteeth. The body is short and slender, the body of a girl who has scarcely begun the journey to womanhood.

I have no doubt, I feel no hope, but I rest my fingers lightly over her carotid artery. It is still.

I check her eyes. Dull now, pupils wide, fixed and unresponsive to the light – those are pearls that were her eyes.

I apply my stethoscope to her chest. The silence of death is drowned in a distracting chorus of inanimate rustling and chafing sounds. These are the artefacts of my examination. I hear no heartbeat. No air moves in or out of the chest.

This is the body of a fifteen-year old girl whose life is extinct.

No motion has she now, no force; 

She neither hears nor sees; 

Rolled round in earth’s diurnal course, 

With rocks, and stones, and trees.

I have another question for the nurses: ‘What do you know of her health before today?’

‘Six months back she was sniffing, but not since then; there’s been no sniffable petrol in the community since then … There were some family problems. She had been seen by Mental Health …’

The answer is unsatisfactory. Any possible answer would be unsatisfactory. It all boils down to one thing: we do not know.

On an afterthought I lean forward again, peering past the fine cheekbones and the slender jaw, peering at the soft tissues beyond. There, on her throat I see what had to be seen, a bracelet patterned in her flesh, a curvilinear design that is unexpectedly graceful. It is the embossing in her skin of the fatal rope.

… Continue reading →