In Praise of a Very Small Town

Before I answered the calI I’d never heard of Trundle. When I googled it I might have giggled. A town of six hundred souls, Trundle boasts the second-widest main street in New South Wales, and its pub boasts the longest verandah in the state. I didn’t giggle. I held my mirth.

All morning I chased my tail in the big city, I caught my plane, I recited the Traveller’s Prayer and I breathed out.

It was dark when the plane dropped me at Dubbo. The bloke in the burger shop near the airport added up my bill for one bottle of iced coffee, one bottle of putative lemon. I pulled out a ten-dollar note.

Something was different: the man didn’t scan the bottles. He did his calculation in his head. Ten dollars fifty, he said. The man looked up and saw my money. Ten bucks, he said. I thanked him. You’ll know where to come next time, he said. I said I will. I meant it.

I took the shorter route to from Dubbo to Trundle. I didn’t realise the shorter route would take me by dirt roads for much of the distance. Over the two hours on those back roads I startled a few kangaroos but encountered no vehicle passing in either direction. The dark of Dubbo was darker out there in the quietness and the road signs were unlit. I took a wrong turning and got lost. I got unlost and entered Trundle. The wide main street was brightly lit. Nothing moved.

At the hospital I asked the nurse, can you direct me to my quarters? No, she said, I’ll take you. Follow me. She jumped into her car, I into mine and we drove through the dark to a house that wasn’t brick. We bought this to let to visitors, she said.  We’ve spent seven years renovating it. The nurse opened the front door and I stepped into the perfumed past. Motel deodorant swamped all olfaction. The nurse pulled a switch revealing animals that greeted me from every side. A steel sheep and a steel cow stood at either side of the front door. In the lobby a crocheted mouse in a lilac dress stood knee-high by a bedroom door. A second mouse in white stood guard at the second bedroom. A third mouse in soft pink waited by the third bedroom. Ladies’ hats hanged from hooks, trailing ribbons of many hues. A large painting of Trundle’s main thoroughfare (famed for its width) stood on the loungeroom floor. The streetscape peeped brilliantly from behind a swath of brown paper upon which someone had written, apologetically, Sorry, Not For Sale.

Flowers fashioned of bright fabrics overflowed from waterless vases in every room. In the kitchen, mugs of colourful ceramic spilled from every cupboard.

Relentless decoration everywhere. Art deco china cabinet, four kinds of chilli sauce and very white bread indeed.

Décor surrounded me, pressing in from every side. Furnishings that dated backwards in time from the year 1950 overflowed in every room. Here was the Australian rural past in glowing abundance.

Tucked behind a bedroom door, in the depths of a very large leather hatbox, sat a felt hat in sky blue. An emphatic navy ribbon decorated the hat. Above all stood a framed text, written in smart neo-gothic. Its title read, The Story Of a Hat. The story told how that hat was made by hand for a wedding at a period when no woman went to church unhatted or ungloved. It was a matter of respect. The story, unsigned, ended with the words, This hatbox belonged to my grandfather.

Two thoughts registered: This house was, not renovated but de-novated – a home to memory. You would not sneer at sincerity. And kitsch would not be the word; this was love.

In the main street shopfronts stood beneath brave signage. Two of every three shops were closed. A sign read, Trundle Talkies. Excited, I raced across the road to check the movie times. I was too late by thirty years. I read the signage above the garage. Pontiac, Plymouth – those makes that ferried my family across the state in the 1950’s – now extinct.

A card in one shop window read, closed until further notice, ill child. I saw five clothing shops. The stock seemed to be the same in all five. Three were closed, one with a notice advising, Yvonne comes Thursdays and Mondays, 11.00 to 3.00.

I went to the first of the open shops to buy undies. The child in charge was sorry, they had none. I might try the Op Shop two doors down. No undies there either, but I noted the stock in the Op Shop looked the same as in its competitors.

Two doors down was the office of the Annual Abba Festival. Thousands attend. They put on a special train from Sydney. Everyone dresses up as one Abba person or another. Great are the festivities.

I doctored in Trumble for three days. Most patients were farmers, heirs to farms worked by their families for generations. Many of these people were older than I. None complained when an emergency elsewhere in the hospital detained me. If I said, sorry to keep you waiting, they looked mystified, then assured me it didn’t matter.

I thought about this. These people worked the farm from sunup to sundown. There was always work to do. But they had time to spare for other people. They’d survived the long cycles of dearth and plenty. In the present dry – the worst in memory – people were feeding their stock by hand. They’d stopped planting crops, waiting for the rains. They knew time differently from my patients in the centre of the great city.

My principal in the practice spoke of an epidemic of depression, of farmers dying of sadness. Others would be forced from the land, to walk away from the family farm. It occurred to me to ask, where are the Aboriginal people? Not here. We’re not on a river. And there’s no community in Parkes either – no river there. But strong communities in Dubbo and Forbes. They’re on rivers.

My three days completed I rose at 2.45 am to drive to Dubbo to catch the earliest flight to the city. I drove down that wide, wide street, built for the bullock trains to do their long u-turn.

I hurried through the dark, eyes wide for suicidal kangaroos. I arrived at the airport and checked in. I checked my phone: I’d arrived on time. Chasing my tail again.

Running from Office

The following verse followed me from the city and found me where I am working in remoter parts:

I had written him a letter which I had, for want of better

Knowledge, sent to where I met him down the ‘bidgee, years ago,

He was doctoring when I knew him, so I sent the letter to him,

Just `on spec’, addressed as follows, `Goldie, Doctor of The Overflown’.

And an answer came directed in a writing not unexpected,

(And for sure the same was written with that horrible doctors’ scrawl)

‘Twas his running mate who wrote it, and verbatim I will quote it:

`Goldie’s gone to Queensland doctoring, and we don’t know where he are.’

In my wild erratic fancy visions come to me of Goldie

Gone a-doctoring `down the Cooper’ where the Western doctors go;

As his flock are slowly sitting, Goldie runs past them singing,

For the bush doctor’s life has pleasures that the townsfolk never know.

And the bush hath friends to meet him, and their kindly voices greet him

In the murmur of the breezes and the river on its bars,

And he sees the vision splendid of the sunlit plains extended,

And at night the wond’rous glory of the everlasting stars.

I am sitting in my dingy little office, where a not so stingy

Ray of sunlight struggles not so much between the buildings tall,

And the foetid air and gritty of the dusty, dirty city

Through the air con floating, spreads its foulness over all

And in place of lowing cattle, I can hear the fiendish rattle

Of the tramways and the ‘buses making hurry down the street,

And the language uninviting of the gutter children fighting,

Comes fitfully and faintly through the ceaseless tramp of feet.

And the hurrying people daunt me, and their pallid faces haunt me

As they shoulder one another in their rush and nervous haste,

With their eager eyes and greedy, and their stunted forms and weedy,

For townsfolk have no time to grow, they have no time to waste.

And I somehow rather fancy that I’d like to change with Goldie,

Like to take a turn at doctoring where the seasons come and go,

While he faced the round eternal of the drafting and advising —

But I doubt he’d suit the office, Goldie, ‘Doctor of The Overflown’.

Nicholas Miller, legal practitioner and versifier, has doctored Paterson’s ‘Clancy ‘

The Continuing Silence

Paul, beloved friend,

Are you there?

Can you hear me, can you hear or feel or know the love I send?

Three weeks, four, have passed without a letter from my friend.

My friend kept me informed: he told me of the tribe of cats who lived in his caritas, his agape, his lovingkindness.  He called each of them by name.

My friend wrote of the roadrunner (likewise given a name; he kept me apprised of the rattlesnakes that swarmed in his wilderness places, as well as of the evangelist rattlesnakes on tv, and of the rattlesnakes who called by phone to extort from him in the name of righteousness.

My friend wrote of his work in the rivers of venereal pus that flowed among his captive patients in WWII. He wrote of aviation, of the sober joys and disciplines of flight. He wrote of his instructor, one Pemberton, whose memory and example he cherished.

My friend taught this doctor, a long generation younger than he, much of the medicine that had escaped him in his undergraduate days, and that eluded him until the happy day that Paul strode into his life and became a preceptor.

My friend wrote of prayer, of his habitation in the house of prayer.

My friend wrote on his bended knees as he prayed for his fracturing nation.

My friend sent me funny stories, he sent me risque stories, he sent me the news from the frontiers of science, and he sent me the news of tabloid headline that were of little science.These he derided with fine despatch.

My friend wrote often of the good people he had known, people who have long passed but whose good name and memory he kept alive with his remarkable recall and his great respect.

My friend wrote of Beverley who was the light of his life and the fire of his loins. He revered her, he missed and he yearned for her perpetually. Of her he wrote, ‘Great was the joy in heaven when she entered that kingdom’.

My friend’s body was wearying, wearing out, but his mind remained scythe-sharp.

My friend, his integrity unbending, was weakened by the cheating and the chicanery of the mendicants who plagued him. I felt Paul’s righteous being was affronted and his spirit distressed by these cheats.

My friend had standards and he never wavered.

My friend loved the human frame, the creation whose anatomy and parts he new so well. He saw in that frame the work of his Creator.

My friend wrote only weeks ago to report evidence of brain function persisting AFTER death.  What did he think of that? What now, stricken mute by stroke, does Paul think?

How are the mighty fallen.

My friend wrote to me with love. He wrote and he told me he was ready.

I am not ready.

Who, of Paul’s eighty faithful readers, can be ready?

Paul, I know nought of those awaiting your arrival above, but here on earth, great will the weeping if you leave us.

Paul, can you hear me?

Do you know our love?

Paul?

Paul?

Howard

Writing into the Silence

Ten years ago an extremely distant relative by marriage, an aged veteran of WWII, commanded me to send a copy of my first book to his wartime senior officer, who became his enduring friend. The book in question (‘My Father’s Compass’, Hybrid, 2007) tells of my relationship with my father, a righteous and loving man who has been my lifelong inspiration. The relative said, ‘Paul will enjoy that book.’

So I obeyed. Paul read my book and enjoyed becoming acquainted with my father, a man like Paul, of unwavering principle.

A correspondence followed. Seven emails a day informed me of Paul’s take on the news. He disapproved of Obama, and of his successor as President; much of Islam (as portrayed in the popular press) offended him as did illegal immigrants. He disapproved of gun control measures (‘if you take weapons away from the good people, we’ll be defenceless against the bad people’). He had a close relationship with God and the Republican cause. He loved humanity broadly. He loved his family with a proud particularity, and he nurtured tenderly the numerous stray cats and partially tame birds who adopted him.

My email feed from Phoenix Arizona included Paul’s never-dull reports on the weather – its extremity and its beauty – on mushroom toxicology, on rattlesnake behaviour and on the conduct of those human snakes who conducted relentless scamming campaigns aimed to impoverish him. He loathed millionaire TV evangelists. He warned Israel’s enemies that ‘Jews will not go quietly to the showers again’. He warned the dictator of North Korea of the obliteration of his country if he started military adventures against the USA. Paul loved his country and he suffered the fiercest extremes of spiritual agony when faced with the horrifying (to him) electoral choice between Clinton and her opponent. While many found that choice troubling, it distressed Paul, so seriously did he take his duties as a citizen.

In due course I met Paul in the flesh, enjoying his company in the house of his daughter Ann. Ann drove us to the sequoia redwoods nearby her California home, where she took a photo of those ancient trees towering over her ancient father, who in turn towered over me.

On a later trip I visited Paul in his Phoenix home where we sat on the porch enjoying the desert sun and where Paul smoked his constitutional cigar. I promised myself I’d visit again in February 2019 when Paul would turn one hundred.

A couple of weekends ago the emails from Phoenix came abruptly to a halt. Then the following appeared on my screen:

Good day all!

 

This is John Jarrett, Paul’s youngest son.

 

On Sunday, November 7th while Paul was getting ready to attend church, he suffered a pretty severe TIA, transient ischemic attack, which has put him under the weather. He has been having some difficulties in his daily routine so we have all been with him 24/7 until he recuperates.

 

Thanks for your thoughts and prayers and I know he’ll be back on the computer as soon as he can. He loves emails, so keep them coming!

 

John

 

 

I wrote to John, with my hopes and prayers for his Dad’s health.

John wrote back:

He had showered and was preparing to drive to Church this past Sunday morning when he became impacted by dizziness and faintness… He’s also “put up” with a heart condition that brought bouts of angina at times and he has been having these TIA’s for several years ongoing…  He has a stricture where his aorta connects to the main part of his heart and was told he was not a candidate for a stint procedure… So, he soldiered on some more…

He had one “spell” (as my sister call’s it) about 3 weeks ago when she was visiting that took 3 or 4 days to show improvement after being 99% speechless for several hours.  About 1 year ago, he was unable to speak while doing business at the banking teller window…  He was getting Christmas gift envelopes for his children and grandchildren.  He tried to type emails Sunday evening but was unable to make is fingers hit the proper keys… The speech problem impacts his typing too it seems… He hears with difficulty (as has been his hearing deficiency for years now) but understands all that he is able to capture in terms of sounds.

He might recover from this most recent bout but each time, full or even partial recovery is becoming increasingly difficult. We are all praying that he improve to the extent he can enjoy his patio, cigars and cats again!  He is extremely weak in his legs/torso and has been impacted by some by minor paralysis in his right hand and arm too…

Fifteen days have passed since Paul’s son wrote. Fifteen days of email silence. In the silence I picture Paul suddenly, taken suddenly mute at the bank teller’s window, as he tries to buy gift envelopes for his children and grandchildren.

Conversations

After I started posting some thoughts arising from the current euthanasia debates, four women whom I hold in esteem wrote in strong response. Two wrote openly on the blog, two privately. I will refer to them respectively as B, M, G, H.

B wrote: Hi Howard,

I’ve just read your maybe not rousing speech but impassioned piece on euthanasia.

If I should be dying and I should be in unbearable pain, and if through that pain I was not able to continue to relate to my loved ones other than to be overwhelmed by my pain, you would be one of the doctors I would reach out to to put an end to my pain and possibly my life.

Will you refuse me?

I first met B in 1971 when she brought about my birth as a doctor. I have not treated her since. Instead we have become colleagues and friends. B’s note shifted my thoughts from the abstract to the concrete. Here was a cry coming from deep in an ancient moment in my formation. The person who wrote is concrete. Reeling somewhat, groping for self-knowledge, I responded speculatively:

Dear B,

I cannot know…

I suspect love would defeat principle or conviction or predisposition to life.

In other words I do not know myself in abstractions but in my instinct and my sentiments.

My ancient affection for you, my strong drive to help – which surfaced in your case in c. 1971 are as likely to govern me as any personal ‘rule’ or law.

I am sure if someone came and demanded I act in any given way my instinct would be to resist.

I anticipated readers would respond with passion and with pain to my piece.

I was right…

You asked would I help you.

I know I would try.

I cannot predict what shape my help might take.

This is a heavy matter. No light answers. And for me, no right answers.

But love will govern.

B again:

From feeling like I was falling into a chasm your response came as a hand that reached out to stop me hurtling to my death. Strange metaphor given I was talking about asking you to help me to die. I am much relieved that love will play a big part in your decision making process, over and above noble and fine principles.

But the debate hypothetically may be akin to Solomon’s choice.

Let’s talk.

My friend G is another colleague, a person raised in a strong religious framework from which she emerged to find and form her own way. I suspect her hard struggle for freedom has left her with a strong respect for my right to find and form a path of my own. G asked:

Would you be comfortable referring one of your patients who met the criteria to hasten their end to another GP who you knew would agree to assist in that wish?

And if that patient asked you to be present during the event would you?

How much do you think religion affects your current view? Or are you unable to separate your religious self from your professional self?

All F’s questions arrived as text message on my phone. Like death a phone message catches one on the hop. An answer will be less considered, perhaps truer for its spontaneity. I wrote a text back:

Hello F,

I’m pretty sure my religious self is absent from this.

It’s as if something deeper and defining is at play.

I imagine that ‘something’ is what brought me into Medicine.

And that drive collides here with itself…

But on the other hand, it was religion that framed my earliest thoughts.

It is on reviewing the texts that I regret not telling F at the outset: I can’t imagine doing anything I will find comfortable. The best I can hope for is to be comforting.

But if a patient wants me there at the end, yes, of course I’ll come. I’ll want to hold her hand as she passes over to ‘that quiet land.’

F resumed by email:

I find people’s responses to this topic rather fascinating (and at times irritating). So many reactions are full of judgement and criticism when it’s a topic that requires the opposite – compassion, objectivity and an acknowledgement of all of the grey. It would appear that a single (subjective) experience of dying makes some people self-appointed experts on the topic. I am of the thought that there is no ‘truth’ in any one person’s experience. And I wonder if those who react so emotionally to the idea of not having the ‘right’ to hasten their own demise have been more traumatised/suffered by the dying of another than the person who was actually dying?

What do I know? I do know that I would prefer not to die of bowel cancer. My experience working on GI wards is that that would be a shithouse (excuse the pun) way to go. I know that until I am dying of a known cause I won’t know if I want the option to hasten my demise or not. I know that having witnessed many people dying of a known cause (some in pain, some in discomfort, some in fear) that I’m still not convinced that assisted death is the answer. But I’m not convinced that palliative care is the answer either – theoretically it should be but I doubt it will ever be financially. I know that those who have reached the palliative stage of their illness should never be admitted to an acute care ward in a hospital – I’ve witnessed far too many cases of what I can only term the neglect of those in their final days/weeks in acute care wards. And the reluctance of acute care nursing and medical staff to adequately manage final stage symptoms. I want to believe in palliative care but I’ve been waiting too long for results.

I know that if you were my GP and I had a terminal diagnosis, I would feel like I had the best GP in the world. I would know that when you asked a question you would be genuinely interested in the answer. And I would believe that you would have a moment of quiet grief when I left this world. And that would be a comfort. As a nurse I never felt any sorrow for an anticipated death of a patient – the overwhelming emotion I felt was relief. Relief that there would be no more pain, no more nausea, no more confusion, no more discomfort from lying day after day in bed waiting to be turned brusquely. But I have a feeling that you experience a moment of sorrow for each death – correct me if I’m wrong.

If I were your patient and I asked you to help me die and you indicated that you couldn’t then I believe I would want your help to find a doctor who would be willing. I would appreciate that you would feel obligated to offer alternatives but if my mind was made up and it was legal then I would want you to support my decision. You might not support assisted dying on moral and ethical grounds but having come reached a fully informed decision I would want your compassion to make that referral to a colleague who you trusted and respected. And the promise that if I changed my mind you would do everything in your power to make my end days as comfortable as possible.

Your friend, F

These words come straight from the bedside. They come from one who has stood with me at the bedside. I cannot gainsay a word of them. Yes I do sorrow for every death. Yes I sorrow for every pregnancy loss. I grieve inwardly for a miscarriage. There is something universal here and something personal. The universal is the instinct that drives all of us to struggle for life. The personal is hard for me to define or even to describe. It comes into focus most sharply for me at the birth of a child. Those moments find their mirror image in a death. The one elates me, the other deflates.

H is a writer friend, a novelist and a family historian whose earlier profession was neurology. She writes humane novels filled with unsentimental empathy. H was another friend whom I disappointed. She wrote:

I’m sorry you feel you could not give this final relief. I am a convert to assisted dying (this is not euthanasia – which implies someone else’s decision that you should die). My feeling has always been that adults who are dying should have some choice about their death, and seeing three dear relatives all the way to death, I am now utterly convinced that such choice should be available. I understand that in states in America where such choice is available, of those who take up the option only a small proportion use the drugs supplied. But, those who receive the drugs and do not use them, are much calmer and happier, for knowing that they have control and can die should they feel they have had enough.

H here echoes an experience described to me elsewhere by B, arising from her work with men diagnosed in the 1980’s with HIV-AIDS. At that time the diagnosis was a death sentence. Some of the doomed acquired the means of ending their lives painlessly, with the intention of using it at a time of their later choosing. Of those men only one availed himself of the drugs. The others lived out their natural term. Knowing they were able to die enabled them to live on.

I close here with one message of straightforward approbation. It comes from M:

Very thoughtful. And probably helpful to those who didn’t like your last post. I have put the link up on my FB page.

M often comments favourably on my blog. When she doesn’t approve she’ll keep her disapproval away from the public eye. M is of course (as she signs herself) my loving sister.

Let Me Die! Help Me!

The right to die has found its voice. Past generations heard little of that claim, the cri de coueur of our day.

I imagine we never wanted to die so much as we do now. In previous times when life was short, brutish and mean we struggled to stay alive. But now Medicine has taken over. Deaths are prevented, delayed and deformed. Few families in advanced societies have been spared the grotesque spectacle of a loved one subjected to medically prolonged dying.

Because we enjoy better health we live longer lives. Because we reach old age we accumulate the mutations that overwhelm our defences. Cancer results. The cancer epidemic is the trophy won for us by medical advances. And so Medicine sets out to fight its ugly daughter. We cut out tumours, we poison them with chemotherapy, we shrink them with X-Rays, we outwit them with genetically engineered antibodies. Many are the gains, great are the costs.

Eventually dying happens.

Death frightened me when I was younger. Now I can see death as a sometimes friend. John Keats nursed his brother through the long death of tuberculosis. Then Keats himself became tubercular. He knew what lay in wait for him: cachexia then death. The terminus he contemplated was like late–stage cancer, the body self-starved, the mind too aware, the complexion ghastly pale, the skin empty, disfigured:

                                                The weariness, the fever, and the fret 

                                                Here, where men sit and hear each other groan; 

                                                Where palsy shakes a few, sad, last gray hairs, 

                                                Where youth grows pale, and spectre-thin, and dies; 

                                                Where but to think is to be full of sorrow 

                                                And leaden-eyed despairs –

 

 

Keats wrote dreams of an easy death (in his Ode to a Nightingale):

                                                           Darkling I listen; and, for many a time 

                                                           I have been half in love with easeful Death, 

                                                           Call’d him soft names in many a mused rhyme, 

                                                           To take into the air my quiet breath; 

                                                            Now more than ever seems it rich to die, 

                                                           To cease upon the midnight with no pain, 

                                                           While thou art pouring forth thy soul abroad 

                                                           In such an ecstasy! 

                                                           Still wouldst thou sing, and I have ears in vain— 

                                                           To thy high requiem become a sod. 

 

When recently I posted ON EUTHANASIA I anticipated readers might react strongly. I was right: most who responded – on–line and off-line – experienced my thoughts as a wound. I learned how a doctor is expected to relieve all suffering. A doctor is a trusted friend. Once the doctor denies his patient her right, she feels he has betrayed her. The wounded person’s gaze is not directed here to the doctor as a moral agent, not as a person entitled to moral autonomy, simply as one who could help, who now, abruptly, at this last critical and defining moment, acts selfishly.

I wrote that changing a law does not necessarily serve wisdom. The reality here is no conceivable law can resolve all of the problems of our competing needs and values. We need relief. We need a doctor who respects our autonomy. We need a doctor who will not sit in lofty judgement.  We need a doctor who will protect life and now we need one who will take life. And we need to know he’ll protect when he should and take when we seek it. The forgotten need is that of the doctor to reconcile those parts of his work. Putting it a different way, if the doctor, in trying be all those things, violates her own being, inevitably she disintegrates. She must give away her integrity. And then all lose.

I read the responses. I felt them, the tremor of the soul that prompted brave, naked, passionate disclosure of self.  My mind went back to deaths I have known, deaths I have conducted. I recalled the baby who aspirated meconium in the birth canal. The baby’s chest heaved as it worked to ventilate lungs clogged with a material of the texture of bitumen. We ventilated him, he did not improve, he did not die. He would not die. Morning after morning I entered NICU and there he was, his skin marbled, his chest rising and falling in obedience to our machine. His life felt like a reproach. We had turned on the machine. I learned then that the decision to bring in the technology is more onerous than to withhold, to wait.

I recalled the first person to ask for my mercy. That person was my mother, the one who had given me life. Mum would have been sixty, I thirty. ‘Darling’, she said, ‘I have high blood pressure, I have high cholesterol; one day I’ll have a stroke. When that happens, I want you to slip me a mickey.’

I understood Mum’s reference to ‘a mickey finn’ – a lethal draught.

‘Mum, NO!’ – was my instinctive response, which I quickly softened with promises to read favourite literature to her.

Twenty or more years later Mum duly suffered stroke after stroke, the final one devastating. My son and I carried her up the stairs one day and I asked her whether she recalled our conversation. She did, clearly. I asked Mum whether she regretted my failure to ‘slip her a mickey’. Mum’s blithe response did not surprise me. Whichever way she might have responded would not prove any argument, would be particular, not general, would not resolve the next sufferer’s dilemma.

I sat with the heat and the passion and the pain of this debate. Having little faith in lawmakers to solve the problems of human existence and oblivion, I searched for some useful fragment to proffer. I recalled those numerous patients who had made written Advance Care Directives. For the simple doctor these expressions of your wishes are a godsend. I read them and I am ruled by your refusals. Some decline ventilation, some explicitly forbid ICU, some decline antibiotics or feeding by tube. Many directives are less specific: ‘Do nothing more than keep me comfortable.’ ‘Let me die with dignity.’ These last call for my deepest self-search. They challenge me to imagine what  comprises and what violates your dignity. They draw my mind into the unknowable tomorrow. But these directives too are helpful. Your opaque request demands my vision of your humanity. It’s a big ask and it’s a fair one. My parents asked of their children that we allow them to die with dignity. We did our best and we saw Mum and Dad pass more or less peacefully from us with our honest best. It’s a big ask but I feel equal to it.

So that’s my first suggestion: COMPOSE YOUR THOUGHTS, EXPRESS YOUR WISHES, WRITE THEM DOWN, GIVE THEM TO YOUR DOCTORS (IN THE PLURAL), TO YOUR LOVED ONES, TO YOUR LAWYER.

No guarantees.

The second idea came to me as I wondered about by own expertise in the matter of ending life by intent. I must do it unerringly. You don’t want to wake up mute and paralysed after I have botched it. Your family doesn’t want to see you struggle or convulse or vomit then inhale, gag and gasp. I’d need training. Then it came to me: the legalized euthanaser must be trained, supervised and certified. You’d want him to know the relevant law, the protocols. The euthanaser might benefit from ethical training. I am sure the practitioner will need pastoral support and peer supervision. He’ll need to be able to recognise and resist the opportunist heir-designate who wants Aunt Nancy knocked off before her care costs consume too much of the inheritance. (I had to do this once.)

So here’s my second suggestion, this to the lawmakers: A PERSON MUST BE LICENSED TO END LIFE. THE LICENSE WILL ASSURE THE COMMUNITY AND PROFESSIONAL PEERS THAT THE PRACTITIONER IS TRAINED, COMPETENT, HONEST AND WILLING. That final adjective might save many patients from the painful disappointment of denial of help by a doctor not prepared to end a life. (That doctor might be me.) You might or might not be able to respect the difficulty of a doctor who feels torn between your need and his vanity/arrogance/integrity/different sense of defining mission, but you need not suffer a humiliating rebuff in your extremity of need.

As I wrote earlier, a change of law cannot resolve everything.

From Laurenzo Marques to Nyngan on Bogan

A man accosts me in the darkened lobby of the hospital in the small town where I’m working. ‘Shalom’, he says.
He gropes inside the front of his shirt and pulls out a silver magen david.
‘Shalom aleichem’, says I.
We swap names. For the purposes of this story, his name is Federico.
Federico looks not ancient, not brand new. He’s tall, compact, has an olive complexion and he bends forward as he speaks. His accent is not Australian-made. His English is arrhythmic.


‘What are you doing In Nyngan, Federico?’
‘I live here. Thirteen years now.’
‘Will you tell me your story?’
He does so.
 
 Before I repeat Federico’s story, allow me orient you to the remote, obscure town of Nyngan by referring you to my recent blog post (Nyngan on the Bogan).
 
Back to Federico: ‘I come from Mozambique. You know, was colony of Portugal. In 1976 Salazar dies. A bastard, Salazar. Like Franco, not a Jew-lover. Both of them, friends of Mussolini. Salazar dies, the blacks start to revolt and Portugal says, OK, we leave. They just run away, no negotiation, no transition. Then starts the war. A civil war. Massacres, the usual thing. First the Portuguese come to the coast in sixteenth century, they set up the port, Lorenzo Marques, a stopping place to their bits of empire in India. They go to India for the spices. They build their African colony by sending all their criminals, convicts. Like Australia. Like Australia, the same, those convicts become successful and they are comfortable. Portugal comes, butchers the blacks, in 1977 they go, then more massacres. Africa.
 
A nice place actually, Mozambique – for a Portuguese. But not now, not in ’77. In ’77, I know if I stay I will die. I leave my birthplace. My barmitzvah was there. In the synagogue, in Lorenzo Marques. Now I am in Portugal, a refugee, among all the refugees – from Mozambique, from Timor, from all places that Portugal runs away from. I cannot go back to Lorenzo Marques. Another Jewish refugee. History’s old story.
 
 
No-one can go to LM now. It does not exist: now the town is Maputo. And the big statue of that old colonist, Lorenzo Marques, they tear it down. Now in that square is a sculpture of a bird.   
 
 
My grand-grandfather comes from Portugal to Mozambique. Now my family, all gone, all scattered. Six brothers and sisters, some in London, some in South Africa, one sister in Norway. She was the last one of the six I have seen. She used to visit me here in Nyngan, every winter of Norway. Last time I visited her was before five years. That last time, in Norway. Family all scattered. The Jewish story. Always the same. You know.
 
 
You want to hear how I come to Australia? Things happen for a reason. There is a meaning. I study history, I research. There is a reason. I believe that. So in Portugal I am safe. My grand-grandfather was Portuguese so I have citizenship. But no future, a refugee. The Jewish story. Always the same. So I wander. I work in Vancouver, I leave, my visa has finished. I work in South Africa. Many Jewish there. I work In London, in Finchley Road. Again many Jewish. I work in Norway. In between visas I work on cruise ships. Eight years on cruise ships; you don’t need a visa. On cruise ships there are Jewish. Also Barbados, every one old, everyone rich. Some Jews there too. I work In Korea. That’s where the miracle happens that brings me to Australia.
 
 
One year before Korea in Vancouver I apply for Australia. A Mozambiquean friend in Australia advises me: be careful what you tell them when you apply in the Embassy. Don’t say the wrong thing. So the embassy woman, she asks me what I will do – she means work – in Australia. I say I have qualification. I tell her I am chef. I don’t know what answer is the right answer. I know from my friend they don’t tell you what they want and what they do not want, but if you say wrong, they close the door. I answer, I pay the application. It will take a few months, the application, she tells me. Another cruise. And another. A letter arrives from Ottawa. The letter is from Australian High Commission in Ottawa. I have immigration visa. But no money. To come to Australia I must pay. So I wander on cruises and I work and I save. And I know I will leave the ships one day and I will settle and all my friends on the ship, always they will be slaves. I pay for a flight from Korea to Australia. Maybe three hundred American dollars, I go to the airline office to pick up ticket, the day before my flight. But it is a public holiday in Korea. Office is closed. I have paid, I have visa, I have no ticket. My flight is tomorrow. Here happens the miracle. I put my face against the window. I see people inside, cleaning. I make with fingers – come here please – come to window, I must ask. They come, but no-one speak English. They find someone. I tell him I need my ticket, I point to the office where the woman sold me the ticket, they go in, bring the woman out. A miracle. A public holiday, in Korea, the office is closed but I have my ticket. Things happen for a reason, I believe it.
 
 
 
In Australia, in Sydney, I work in Bondi Junction. Again many Jewish. I am there some years. I marry there, my wife have lymphoma before we meet. Then she is cured and we marry. Have children. Since thirteen years I am in Nyngan. I come here, I come here for the peace. I work at the pub as chef. Then the manager closes the kitchen, leaves Nyngan, manages from the city. I have no job, but things happen for a reason. I believe that. I sit in this coffee shop and the manager of the biggest hotel comes in, says, Hello Federico. Come work for me.
 
 
Small town, you know, everyone knows everyone. Good people here. My wife gets a second cancer. We drive to Dubbo, we drive to Sydney, we drive, drive. Always long drives, costs hundreds of dollars petrol. And the people of Nyngan collect money for our travel. Good people in Nyngan. Nothing happens without a reason. But my son, he’s grown up, I tell him – get out of Nyngan, no future for you here, go see the world, go build your future. You know I believe.
 
 
Will you do me a favour, Howard? I want for my doorpost the Jewish sign, for the doorpost, you know. I google but I don’t just buy. Has to be real, you. Needs the writing inside, not just the box .