Consider Phillip

Consider Phillip. He lies in his hospital bed, a person unknown. Deep in the stupefaction of alcohol he lies as one asleep. Possibly he is asleep.

I stand silently and watch Phillip and I consider him.

The police were alarmed when he vomited violently in their lockup. They called the ambulance that brought him to my one-doctor hospital. The nurses, veterans in the management of all forms of intoxication, called me, troubled by his scatterings of impulse, his wildly fluctuating state of mind and mindlessness.

 

I arrive to find a thin man of twenty-five lying on his side, inert. His body has curled into the position of a foetus in a textbook. Phillip’s narrow face, tapering downwards to a thin chin and a Ho Chi Minh beard, buries itself in a pillow. His eyes are closed.

I address him: “Phillip.”

No answer.

“Phillip. Phillip!”

Not a flicker.

“Phillip, I’m the doctor. I’ve come to help you…Phillip!”

 

Only minutes before my arrival the nurses found Phillip conscious and verbal. One moment he was weeping for the death earlier in the day of an aunty in his hometown on a nearby island; the next he was wolfing the sardine sandwiches the nurses prepared for him.

Now he is immobile, unhearing, a narrow form, a closed face, a straggle of black beard.

 

In these parts the death of “an aunty” can signify unbearable loss. And the access to alcohol can trigger irresistible impulse to harm.

I stand and consider Phillip.

Do I leave him lie – the chicken option? Or stir him up, revisit loss, possibly unleash the grog-drugged demons?

“Phillip, show me your tongue.”

Eyelids flicker, the eyes open. A mute question on a busy face: What – show my tongue?

“Phillip, I am the doctor. Please show me your tongue.”

Lips part, a pink lizard shows itself and retreats. Now it crawls from its dark cave and rests, clean, a healthy pink. But dry.

Phillip’s chart records a low blood pressure reading. Less than 100/60, it might betoken the relaxant action of alcohol on blood vessels. Equally such a reading might simply reflect his norm, his youthful good health. He’s a stranger here. We don’t know his normal BP. And it matters.

Abruptly Phillip sits up in bed. A pillow goes flying, bedclothes are flung aside. Phillip’s scrawny arm reaches behind his back, deep into his undies. He scratches furiously. He looks around. A wildness in his movements. He lies down and begins to whimper. He buries his head in the crook of an arm and weeps now, regular little bleating sounds, a child giving way to grief. Before I arrived, the nurses tell me, Phillip squatted on the floor, folded his head in to his torso, his body a concertina; at the same time he drew his arms against his chest and his fingers into the attitude of prayer – the nurses were taken by the strange gracefulness of his fingers – and he began to cry.

This second weeping exhausts itself. Quietness falls in the darkened room.

Without warning Phillip’s fingers race around his belly, scratching in a frenzy. Now they plunge to his undies and pull them down, exposing a circumcised member. Meanwhile my own hands yank bedclothes upwards to restore what? – dignity? – modesty? For the exhibition is so insistent, so obscure, so confusing, I feel alarmed and I am sure my alarm is for the women around me, anxiety occasioned by the actions of the thin man in the bed, actions quicker than thought, movements without reason or purpose. As the bedclothes jump and subside before me I am reminded of the inscrutable movements of the unborn. And indeed there is much that is infantine about Phillip, his way of looking at and into the attending nurse or at me, his helplessness, his mute, unknowing enquiry, his submission to tenderness.

 

I decide on an intravenous saline infusion to rehydrate Phillip, to wash out the grog and to lift his BP. And not incidentally, to provide immediate access to a vein in case of urgent need. I am thinking of sedation that might short-circuit a fatal impulse. On the other hand, sedation can further lower a low pressure and depress grogged breathing.

First I have to sell the deal. Phillip is (still) a voluntary patient of whom involuntary treatment would be assault.

“Phillip, we’re going to give your body a drink. We’re going to put a needle in your vein so we can make you feel better.”

The busy face, thinking what?

“We’ll put a needle in here.”
Phillip looks at the finger I have placed on his arm vein as at  something mystic.

Nurses bring the gear for a drip. The nurses who are due to go off duty do not go. Every able bodied person in the hospital gathers around Phillip. No-one has expressed it but all of us feel anything might happen.

The sharp trochar pricks Phillip’s cubital skin. Beneath my sentinel palm that rests gently on his shoulder I feel his muscles bunch. Now his hand flies up towards the face of the cannulating nurse. Her face tightens and darkens, her voice finds steel: Don’t. You. Think. Of It.

A moment that freezes. Ten eyes stare, Phillip subsides, we breathe out.

“Midazolam, 2.5 milligrams, now!” My command is a whispered shout. Moments later Phillip is sedated, leaving nurses and doctor unsedately measuring blood pressure and monitoring respirations.

 

Two hours later the nurse in command calls me, apologising needlessly: “Phillip is agitated again, should we repeat the sedation?”

“Should we? We have to!”

Incidentally the nurse’s midnight enquiries to the clinic on Phillip’s island confirm that his BP is always low. The pressure of a healthy child.

 

Sleep will not come. The eye in memory sees a teenager, crazed, sad, helpless, feeling everything, understanding nothing, terrified of the feelings that clamour and hammer in his head.

At length a question crystallizes and brings me back to Phillip’s bedside. We two are alone in his dark room. His eyes are open, his body at rest. Before I can pose my question Phillip has one of his own. He gazes at the inside of his elbow. He fingers the bandage that holds his cannula inside the vein. The white bandage is bright in the gloom. “What if I pull all this out?” His finger explores dangerously, his voice asks innocently. I beg Phillip not to touch the tubes, not to disturb the bandage. “We want to help you Phillip.”

Now for my question: “Phillip, what else have you had today – apart from the beer?” There has to be something else. I don’t see this behavior with grog alone. And more than that, Phillip stays beneath the roof a special house in this community. It is the house of an older white man. A white man with many younger black visitors and residents. A nurse at the hospital says: “We treat a great deal of sexually transmitted disease among the young residents of that house, and too many drug-taking people.”

 

Artlessly Phillip gives answer: “I smoked ganja today doctor. You know, dope.” He looks to me, that look he has, free and clear of adult care, of consequence. He looks to me, the grownup. Aunty has passed: it is for me to know, for me to be a parent.

 

 

 

Copyright, Howard Goldenberg, 27 February, 2014.

 

In the Poo and Out of it

Dennis and I are playing in the park in Wade Avenue. The trees are
bare and the air is cold. Mum has dressed me in a pair of overalls in
a heavy woollen fabric to keep me warm. The pants chafe my legs
pleasantly. The overalls have a chequered pattern in reds and greens.
We run across the park to its middle where the playground equipment
awaits. Our breath comes out in clouds.
We run to the see-saw, play for a while, then to the swings, then to
the roundabout. This is a heavy timber affair, a circular platform set
on some invisible centre so as to rotate with children aboard. There
are metal handrails that you hold on to while the roundabout goes in
circles that never end, so long as someone is pushing. When Dad pushes
you spin very fast and you need to hold the rail or you’ll fall off
onto the sand.
Today Dennis and I and Christopher Payne and his older sister are
riding the roundabout. There are no grownups so we have to push as we
ride. You hold the rail with both hands and you run in circles in the
deepening groove dug by pushers’ feet. My hot breath clouds are coming
faster, the roundabout is whirling, my head is spinning, the big kids
are too fast, the rail is almost yanking me off my feet as I leap
aboard at the last minute and taste the dizzy drug of motion.
Then, as we slow, it is off again and push, run and push, my breathing
a hard burning in my chest, racing, keeping up with the big ones, then
once aboard again, giddy, floating, trees and faces and shapes
blurring as they whiz around me.
The afternoon is darkening. Hot and happy to be accepted by the big
ones, I pay no mind.
Something is hot inside my overalls. Something is different: I can’t
feel the chafing. Instead there is a sensation that I half remember. I
understand what has happened but I don’t want to know it. I wait a
wordless moment, then get off and walk carefully away in the direction
of our home in Wade Avenue.
My walking is slow. Although I want to be away from here, away from
the other children, away from everyone, I do not hurry because I
cannot. I have to walk that slow, peculiar, wide-legged walk as my hot
legs send their messages of disgrace to my amazed mind.
The big children are calling out, calling my name, but I don’t turn
around. I hear Christopher’s voice and his sister’s. Loud questions.
Dennis says something in reply. Their voices say things that I cannot
make out as I keep walking. I hope, helplessly, that no-one follows. I
won’t be able to run away from them.
Here is Wade Avenue. The street lamps come on but they do not yet
penetrate the darkening. I am glad of the dark.

Mum comes to the door, the house bright behind her. I don’t know what
to do. I know what to say but I don’t want Mum or me or anyone to hear
the words. I stand and Mum is cuddling me gladly, now cuddling me
differently as she realizes, now helping me to the bathroom. Only when
we are inside that small room and the door is closed does she remove
her enveloping arms as she turns and runs a bath.

Somehow Mum has got me out of those loathsome overalls. They lie on
the floor, red and green and unbearable. After today I will never see
them again.
Mum lifts me into the bath, stands me with my back towards the tap as
she paddles warm water against my skin. Her hands are firm as she
applies soap and warm water to my bottom and my thighs. The hands go
everywhere they need to and I look out and not down. I look out,
across the narrow room, away from the overalls and succeed in seeing
nothing.
Now Mum is sitting me down in the bath and I allow myself to see. The
bathwater is clean, I am clean, the soap smells nice, Mum’s hands are
on me, soft and present.

Has Mum spoken? Nothing has been said about my disgrace, nothing about
the check pants. Nothing spoken, all is known and understood. I am in
clean pyjamas, redeemed.

***

Do my hands remember? Does my skin recall the touch, the knowing care,
the rescue?

***

Forty years later, following stroke after stroke of havoc inside the
vessels of Mum’s brain, she and I are once again in the bathroom.
Stronger hands help to lower and to raise a weaker body. Skin to skin,
they clean here, dry there, restore Mum to order and presentability.
From time to time over seventeen years this joy comes my way. It is a
job that calls for concentration but I never have to worry about
dignity. Mum has her dignity. It is inseparable from her.

Copyright howard goldenberg, 24 june 2009.