On the Main Road

Friday afternoon, the eve of the sabbath. Riding home from my shift in the Emergency Department at Alice Springs Hospital I would have missed her if I’d been abiding by the law. Luckily I was riding along the footpath when I came upon her. She looked about fifty but I reckon her true age at mid-thirties. Her large face seemed inflated, her eyelids puffy, her lips swollen, her natural flabbiness accentuated by deforming scars and oedema. The face was bronze in colour. Her gaze was inward – even when I was abreast of her, when I addressed her, I was absent to her. 

In all our minutes together we were never more than ten metres distant from people passing in cars and on foot. But in our leaden ballet we would dance alone.
She was shorter than I and a good deal heavier. The weight differential would matter when I’d struggle to lift her. I was a metre from her when I first registered her human presence. A slender tree at my right shoulder obscured her from sight. Abrupt movement caught my eye, a straining, forceful jerking of her thick neck and thorax as if she sought to escape. In fact the opposite was the case. 
The woman’s hands worked to adjust a cord that looped once around the tree then twice around her neck. I saw the cord and stopped. With all in place she suddenly slumped. Don’t! Don’t do that! – these were all the words I found. I flung my bike aside and threw myself towards the woman. She grunted but did not speak. My arms about her did not arrest her fall. The cord tightened. I remembered the knife in my lunchbox. As I groped frantically in my backpack she thudded suddenly to earth at my feet.  
A white cord floated down after her. The cord was a lengthy bootlace, the sort you pull on to tighten your running shoes. That slender tie would never support ninety kilograms of self nihilation.
Lying on the earth her silent body did not move. Was she breathing? A wave of alcoholic air reaching my nostrils answered that question. Was she conscious? I spoke. No response. I shouted. No answer. I placed my right thumb into the small bony notch above her eye and pressed hard. This truly painful stimulus evoked no movement, not a flinch. On the Glasgow Coma scale I reckoned her score at eight of a possible fifteen.
As I crouched in all my clinical perplexity an Aboriginal woman appeared at my side. Gesturing in the direction from which I’d been riding she said, The hospital is just back that way. Did I smile as I thanked her? I don’t know.
My lady was alive, breathing, intoxicated, apparently unconscious. In the long seconds since slumping she had not moved. What harm had her spinal cord suffered in that violent moment when the bracing cord arrested her fall? I could not know. My phone: where was it? Fast fingers delved and delivered from my pocket. I rang triple zero. The voice asked, Police, Fire or… Ambulance! I shouted. Ninety seconds after giving location and clinical details the siren sounded behind me. The vehicle pulled up alongside my waving, jumping body. A tall woman blonde woman alighted. She would have been in her thirties – like our patient, and unlike her. I answered her questions. A friendly smile lit her face as she said, Big shock for you, I’d imagine. This time I did smile. After a shift in Alice’s Emergency Department I’d become inured to shocks. The paramedic crouched over our patient and I heard her say: Hello girlfriend! as I mounted and headed home for the peace of Shabbat.
   

Concussed

The phone call comes at 3.30 on the last afternoon of term. An unfamiliar voice speaks: ‘I have your boy here. He came into the shop and collapsed.’
The woman’s voice is concerned, competent: ‘He wants to get back onto his bike and ride home but I won’t let him.’ The woman gives the address, a shop on busy Centre road, Bentleigh.
 
The mother of the child calls the boy’s father, cannot contact him, drives towards the place in Centre Road. The heavy Friday afternoon traffic races, stops, starts, unpredictably. The mother suppresses her urge to speed, shakes her head: ‘What if he’d collapsed in this traffic!’ Alone with her fear, she calls her father, doctor to the injured boy. She gives her father the bones of the story, adding: ‘He told the lady in the shop he was hit in the head earlier today. She says he’s talking but he’s not making sense. He couldn’t remember my number. Didn’t know the password to his phone. She rang the school and they put us in touch… I’ve nearly arrived. I’ll call again once I’m with him. ‘Bye.’
 
At 3.50 the doctor’s phone rings. His daughter’s voice, the boy’s, an unfamiliar woman’s voice, traffic sounds, snatches of conversation – ‘Dad, I’m with him now. He’s awake. He’s seeing double… Yes, thanks, in the back here. Sorry Dad, the lady who’s been looking after him is helping me get the bike into the car. He lost consciousness a couple of times. What does it mean that he’s seeing double? And he wants to vomit?’
 
Forty-eight hours earlier the doctor saw a boy in Resuscitation at the Royal Children’s Hospital. The boy had been hit by a car. He lay on a trolley, his body a gangle of bones, on his face a large bruise and the dopey smile of a child with no memory of the car that hit his head. The doctor-grandfather spends a lot of time with injured children in Emergency Departments. The doctor knows what double vision means, he knows what vomiting means. The grandfather in the doctor avoids the question, asking some of his own: ’Has he had a head injury?’
‘Yes Dad. A kid at school swung his locker door open and belted him in the head. He went to sick bay for an ice pack. After school he rode to the shops.’
The boy’s voice pipes, indistinctly, the phone set on speaker. ‘Saba, when I look at anything I see two of everything.’ The child slurs the words.
‘What part of your head did the locker hit, darling?’
‘What do you mean, Saba?’
‘Was it the front or the back or the side?’
‘Are you joking, Saba?’
‘No darling. What part of your head was it?’
‘Above my ear, a bit in front of it.’
 
Just in front of the ear, in the temporal region, runs a vulnerable artery which shelters behind skull bone thinner than elsewhere.
The doctor instructs his daughter to drive directly to Monash Medical Centre which is not far distant.
‘I don’t know the way, Dad.’ The father-grandfather-doctor is notorious for his lack of sense of direction. He directs the daughter, hoping. ‘I’ll call Emergency at Monash, darling, so they’ll expect you… Take a book with you. You’ll be there for hours.’
‘Dad, he’s just vomited. Now he’s falling asleep. Does that matter? Do I need to keep him wake?’
‘Try to keep him talking, darling.’
The grandfather speaks to the child: ‘Darling you’ll go into the hospital and they’ll look after you until you’re better. Then they’ll let you go home. You probably won’t be staying in the hospital.’
‘Saba, what will happen to me?’ The voice quavering:’ Will I be alright?’
‘Dad, where will I park?’
‘Drive straight to “Ambulances Only”. At the moment you are an ambulance.’
 
At 4.10 the doctor calls Monash, asks to be connected to the Consultant in Emergency. A young voice, informal: ‘Emergency, Preeti speaking.’
‘Hello Preeti, I’m sending you a child with concussion. I’m his GP. Are you the consultant?’
‘Yes.’
The doctor briefs the young voice. She listens, asks a couple of questions, says, ‘Thank you. We’ll be expecting him.’
‘Thank you, Preeti. I’m quite concerned… He’s my grandson.’
 
When the doctor’s phone rings the time is 4.40. It rings as he’s hurrying to the toilet to pee, the third time in twenty minutes. He stands still, commands his bladder to wait.
‘Dad, I dropped him and they took him straight in. Doctor Preeti was waiting. I’ve just come back, I had to move the car. My phone’s about to die.’
‘Darling, Shabbat is about to start. But I’ll answer the phone if you ring. Someone will lend you a phone. If you need me, call me, even though it’s Shabbat.’
‘’Bye, Daddy. I love you.’
 
The old man puts the finishing touches to his Shabbat table. His wife is away, visiting their Sydney daughter and Joel and Ruby.
He covers the loaves of challah, races to the bathroom, showers, dresses, recites the Afternoon Prayer, racing the setting sun. He finishes, checks the time, realises he’s just too late to light the Shabbat candles: he won’t make fire on the Sabbath. Ordinarily he won’t use the phone. During Shabbat he’ll allow the phone to ring, enjoying freedom from the i-tyrant, celebrating the sample of paradise that is the Sabbath. But tonight he’ll answer it.
 
Darkness falls. The old man recites his Evening Prayers, rich with poetry from the mystics of Safed and the Golden Period in Spain. The dying of the day, the passing of the workaday week, the beauty of the sung hymns, all these have always found him susceptible; since childhood the eve of Sabbath makes him prey to tender feeling.
 
He looks across at the table, set for two. He recites the She’ma Yisrael prayer, inserting, by old family custom, an improvised prayer. He prays: ‘ Heal the boy and all who love him.’
 
The old man sings the hymns, he welcomes the Ministering Angels, he praises his wife – “A woman of Valour, who can Find? Her Price is above Rubies” – then he sings the Kiddush dedication, drinks his grape juice, washes his hands and sits to break bread. Before him, chicken soup with noodles and kreplach, four salads, slow cooked lamb shanks, potatoes. He eats alone, wolfing the feast he prepared for two. His elder daughter won’t be finished at the hospital until very late.
 
The food is good. He’d made a great effort for this meal with his daughter. He eats and gives thanks. Afterwards he reads. He reads three newspapers then opens the political biography a friend gave him. Deprived of sleep as he always is by Friday, he doesn’t expect sleep will come quickly tonight.
 
At 8.00 the front door opens. His daughter enters and they embrace. The boy is well. He’s back home with his brothers and his father. Surprised by her early arrival, the doctor listens to his daughter: ‘Dad, they asked him questions, they checked his eyes and his pulse and his blood pressure again and again. They tested his balance. He improved and they let us go. They said once four hours had passed the danger was much less. They timed it from when he collapsed in the shop.’
 
While the mother speaks the father prepares a salad to replace the four he wolfed. The child-mother eats with relish. ‘I’m sorry I spoiled our meal, Dad.’
She toys with the lamb shanks that come cold to the table. ‘Dad, I can’t eat any more. It’s been a big day.’
Father and daughter look at each other. No words are spoken, none needed; each knows the content of the other’s mind. The father looks away, knowing without looking how his child’s lip trembles and her eyes fill.
 
A minute or two of quietness, then the daughter smiles: ‘By the time we were leaving ED his speech was perfectly clear. He was saying he wanted junk food. Then he said, “Let’s ring the kind lady in the shop and thank her.”’

Jeremiah Jan

She sits in the waiting room, reading. Any patient who enjoys a good read will enter my consulting room in a good mood. I do allow my patients time for a very good read.
The book she reads from is thick, with old-fashioned morocco covers and red-tipped pages. Looks like the Bible! She doesn’t look mortally ill. Perhaps she’s mortally afraid of the new young doctor.
‘Good morning, my name’s Howard.’
We shake hands. Her hand is fair, a youngish hand. The owner of the hand says, ‘Hello, I’m Jan.’
‘You’re reading the Bible? Which book?’
‘Jeremiah.’
Jeremiah the cheerless, prophet of doom, a man willing to be jailed for speaking truth to power. Serious reading. Might have been worse, could have been Job.
The serious reader sits down. She speaks: ‘Howard, I’ve come for a talk. I don’t need a diagnosis; if I want a diagnosis I’ll see Doctor Don. I don’t need a diagnosis, I need a talk.’
We have our talk.

Another visit by Jan, another long period in the reading room. Eventually I show her in. We are only about ten minutes into today’s talk when the phone interrupts us: ‘Howard, Doctor Don needs you in the Treatment Room. Now!’
‘Gotta go, Jan. Sorry.’
I go.

When I return, after about twenty five minutes, I resume: ‘So, Jan, you were about seven when…’
‘Howard, you can’t just do this.’
‘Do what, Jan?’
‘Take up our conversation without a break, as if nothing terrible or significant has just happened.’
‘Can’t I? Why not?’
‘You need time, some space. You need to come to terms with whatever it was that was so urgent. You are a person too, Howard.’

In my consulting room, situated at the furthest end of the building from the Treatment Room, Jan would not have seen the frantic mother, the pale plump doll that was the baby, the child inert, lifeless. She would not have felt the body still warm, not seen two adult males breathing desperate air into a new body that would not breathe again. She would not have seen the face of the mother passing through shock to grief to the start of lifelong self-accusation.
Did she perhaps hear sounds of stifled sobs?

Many chapters of Jeremiah and of Job have been read in the thirty-five years since that day. I remember the child, I have not forgotten the mother.
Nor have I forgotten Jan’s instruction.

Another Toby Emergency

A scream from the back of the boat, the scream of amazed pain. Now follow loud cries as Toby’s face rises above the transom. Tears stream down his face, uncharacteristically pale. At the point of his chin a gleaming carbuncle of deepest red rises to a meniscus, then overflows. Brilliant red drops appear on the white deck, tracking Toby’s path to adult rescue.

I apply my nearly clean handkerchief to the wound. Toby darling, press this hard against the cut. Very hard.
I’m sorry, Saba. I’m sorry.
No need to be sorry, Toby – just press.
I’m sorry. I’m very sorry…

My bottle-green hanky is turning red. A quick peek underneath shows a deep and gaping gash. The wound is irregular; it will need meticulous suturing to minimize the inevitable scarring.

Before we arrived in Metung I commanded the kids: NO RUNNING ON THE BOAT, NO JUMPING ON THE BOAT.
I’m sorry, Saba, I won’t do it again.

Pablo scoops his son into his arms and we run to the car. The patient, cocooned in his father, is stowed in the back. We drive into the little town to look for the doctor’s premises: the Village Store, a hardware and fishing tackle shop, the pub, a real estate office, a few coffee shops – these account for one half of the Central Business District; a u-turn brings us to the post office, a laundromat and a petite pharmacy. The pharmacist, a lady of my years, petite like her shop, is sympathetic. She advises, Yes, there is a doctor in town… every Tuesday morning.
Hmmm. Do you have surgical glue?
I don’t think so. I’ll look…
The search doesn’t take long. No glue. We settle for some stout Steri-strips, a gross of sterile gauze squares and a gallon of Savlon.
Across the road the door to Hardware and Fishhooks is locked. It’s only four PM, Friday. The sign reads, Open 9.00-5.00, M-Thurs. Fri 9.00-1.00.
The Village Store stocks food, suncream, the dailies, the Metung Meteor. Unless it’s a condom or a painkiller I seek, no pharmaceuticals. Do you have Super-glue? (Super-Glue is identical to Surgical glue; it’s packaged in crushable phials for single use, to discourage germs.) The helpful young cashier leads me to her hardware shelf. No Super-glue but we do have Araldite.
Araldite. I’ve never glued human tissues with this product. Will I try it on my grandson? I call the Emergency Physician in Alice Springs, where ED is full of my workmates. Yeah, Araldite will hold it, same as Super-glue. But it’s thermogenic. In an emergency, better than nothing, better than Steri-strips alone. Translated, ‘Thermogenic’ means the glue will heat the skin.

Back to the car. No doctor in Metung: we’ll have to go to Lakes Entrance. Toby lies quietly, eyes widening as I approach his wound. A wince, a gasp as I peel away my hanky of dark green and dark red, exposing a valley of flesh. Briefly bloodless, the wound fills quickly. Clean white gauze is applied. Toby darling, press again, hard. Here.
The child’s eyes follow me anxiously as he anticipates the uppance that surely will come: I’m sorry, Saba. I won’t do it again.

Driving back through town I wonder about the boatyard. They repair boats there, they must glue things. The Boatwright is helpful: Sure, Howard, we should have Super-glue somewhere.
The tube is not new. They have no other but needs must…

Pablo and I remove the patient and lie him on a picnic table, Pablo cradling the child’s head. Darling, we are going to put some glue on your cut to close it up. First I’ll wash the cut with this yellow stuff. It will be quite quick.
A splash, a yelp, a bit of quick mopping and a flow of fresh blood. It is quite quick – and quite hurty.

Now I’m going to squirt some glue onto your cut, Toby. It will be quite quick.
Pablo, pinch the skin edges closed… like this.
Pablo pinches – which hurts – as I peel away the gauze – which hurts. Toby’s eyes widen in fresh surprise, he releases a single gasp, half rises, then subsides. He takes deep breaths, slow breaths, as I squirt the glue – which hurts – and Toby breathes on. Through the following three minutes, Pablo pinches the skin edges – which hurts – and Toby, calm in his self-mastery, gazes trustingly into our close faces.
A few Steristrips bridge the narrow ridge of pink that was a cleft moments before. The wound is closed, and dry, more or less regular, messy in its scatterings of dried blood. It will heal and eventually scar.
Toby kisses his torturers and thanks us: You’re the best father, Papi. I love you, Sabi…I am sorry.

Postscript that might have been a Prescript: readers of this blog might recall an earlier, very lengthy post, titled ‘Toby’s Fingers in the Bath Hole’. A year after the Fingers in the Bathplug Story, we had the Batteries in the Ears story. Toby spent an afternoon in hospital for removal of hearing aid batteries trapped in his ear canals. Once in-situ, batteries create an enveloping oedema of the canal walls, a watery swelling of the flesh that neatly encloses the little discs. Toby is not deaf (not yet) and has no need of hearing aids or their batteries. But the batteries he found were just the right size, so…

Additional Postscript: Toby’s cousin Noah described the accident: Toby tried to get from the back of the boat onto the pier but his life vest caught on this wire and he fell when he jumped.
“When he jumped”: that must have been what Toby’s “sorries” were for. Not a forbidden jump at all, this was a jump from the boat, not on it.

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Toby’s Fingers Stuck in the Bath Hole

My wife Annette and I are having an early dinner when my phone rings. It is Rachel, our elder daughter: “No-one is hurt, everyone is OK, but I’ve called an ambulance: Toby’s fingers are stuck in the bath hole.”

I reckon I’m equal to this little challenge: ”Darling, just soap his fingers liberally then they’ll become slippery and he can just slip them out.”
“I’ve done that, Dad, and it didn’t work. I’m attending to Toby, but I need help with the other kids. Can you come over?”
“We’re on our way. We’ll be 15 minutes.”

In the car, Annette looks at her watch and calculates that Rachel’s brother, Raphael, will be driving home about now. He might get to Rachel’s before we do. She calls Raph and indeed he is only a minute away from Rachel’s house. He isn’t driving; he’s on his bike.

We drive into Rachel’s street which is blocked by two large fire trucks, a smaller fire car, two ambulances and a police car. There is no smoke and there are no signs of a motor accident.
We park at a distance and make our way on foot to Rachel’s house. Flung to one side on the grass is Raphael’s bicycle. Ahead of us the large torso and bum of a fire officer protrude from the bathroom window. The head and shoulders are out of view, presumably inside.
We make our way to the interior. A large man walks purposefully ahead of us, lugging a heavy timber box of plumber’s tools. From the narrow hallway an ambulance officer carries a plastic drink bottle into the bathroom. The bathroom itself is small. What with the toilet, the shower recess and the old-fashioned claw-foot bath, two is a crowd here. This evening the crowd is larger: the ambulance officer, a young lady, is leaning forward, passing the drink bottle to a male colleague who sits on the edge of the bath. The missing fireman’s face and shoulders are framed in the window, as he leans inward, observing and giving advice and instructions to another fire officer lying on the floor. This is another partial fireman, his face and arms invisible beneath the curve of the steel bathtub.
What he lacks in extremities and face he makes up for in length: this is a very tall fireman.
In the tub, drained of its bathwater, sits Rachel, her back to the door. On her lap is the skinny white body of Toby, aged five, a runt, a set of bones with a piping voice. One of his arms extends to the bath hole. His fingers are not seen.
The mother is reading a story to her child.

From the family room, children’s voices are calling: Toby’s twin, Miles, and their older brother, Jesse, have sighted us: “Saba! Savta! Toby is stuck. His fingers are stuck in the bath!
Look! Lollies! Raph is giving us a special treat.
The boys peel themselves from the arms of their uncle Raphael, who stands with his bare chest, wet with the sweat of his bike ride on this hot evening of 30 plus degrees.
Miles and Jesse pull at our clothing, dragging us to the bathroom, to see Toby and his missing fingers. They squeeze past the ambos, step onto the prostrate fireman and clamber into the bath. We follow them, secreting ourselves along the far wall and we greet Rachel. Raph stands behind us in the doorway.
Rachel smiles the smile that we’ve seen before, the smile that welcomes mere chaos that unseats tragedy.
Pasted over her fear, and threat and alarm, Rachel’s smile invites us to see and share the joke.
It is hot in the bathroom. Toby’s free hand wields a lollypop that disappears and reappears in and out of the recesses of his mouth. He cries out his greetings, his words emerging through a slop of saliva and lolly juice. He is having a pretty good time.

Rachel gives us a synopsis: “I called the ambulance and told them that Toby’s finger was stuck. These guys came and called the fire brigade. While I was on the phone, Toby’s free fingers were curled up and cramped, so he made them more comfortable by poking another couple into the plughole. Now there are three fingers that are stuck.
“The fire guys have all the right tools and equipment. They get fingers out of plug holes all the time. I didn’t know that bathplugs are a fireman’s specialty.”
The fire chief in the window frame elaborates: “Normally, a plughole is a ten-minute job. They’re all plastic nowadays. But this bath is a genuine antique, made of genuine steel. The plughole itself is probably made of toughened steel: it’s usually a disc about half an inch thick, with half a dozen circular holes, all of them just about the width of a toddler’s finger.
“The plan is to cut away the drain pipe. This will allow us to raise the bath from the floor, so that Steve can get right underneath and free Toby’s fingers from below. He’ll push up on Toby’s fingertips with his own finger.
If that fails, we’ll have to saw away the steel drain and free Toby from the tub, and then tackle the fingers.

“You and your family won’t be taking baths for a while, Rachel. This bath will be in pieces once we’ve finished here.”
I take a look at my watch. 7.45 pm. Toby has been in the bath for an hour and a half.
While we’ve been talking, the home phone has rung and rung out. My own mobile has rung unattended. Now Annette’s phone rings and it is Toby’s Aunty Naomi, calling from Sydney. She had called earlier, just when Rachel was racing between the stuck child and the other children and her urgent phone calls for help. Since that time, Naomi has learned sufficient to frighten, and nothing to comfort an aunt who has visions of fingers lost by strangulation or by nightmare surgery. Naomi has no children of her own yet and she loves her Melbourne nephews and niece with an intensity which increases with the distance.

Naomi asks to speak to Toby. “Toby, would you like me to sing Rainbow?”
Toby nods, his mouth occupied by his lollypop.
Rachel switches the phone to Speaker and says:
” Toby is busy with a lolly. He does want you to sing.”
Naomi’s voice floats into the bathroom.
“Somewhere, over the rainbow,
Way up high…”
The phrases float, spacious, into the bathroom, the words a familiar caress for the boys at their bedtime. Naomi’s singing voice is a sweet soprano, usually crystalline. Tonight the voice is thickened with an unfamiliar tremolo.
“ there’s a land that I heard of
Once, in a lullaby…”
Toby is transfixed. His brothers are still. Three lollypops are held, suspended, while Naomi sings.
All conversations stops. The lengthy plumber pulls his face out from under the steel belly of the tub. His face is wet with sweat. Bathroom lint clings to his chin and brow. He lifts his head and listens. The ambos and the fire chief stand, arrested. The voice rises, crests a high note and falls. The singing undoes us, soft family and hardy professionals alike.

A skinny woman appears. She is Laura, Rachel’s best friend. Alarmed by the emergency vehicles congregating outside, she races in: “What’s wrong? Is everyone alright? Can I bring food?”
She listens, looks, offers cuddles, kisses the air with her famous loud smacking sounds and leaves, disappointed not to be catering. Laura makes me laugh, always has.

The tall man pulls his head in again. The Chief hands us a hacksaw. We pass it to the tall man. We hear sounds of sawing, long metal screams.
Alarmed, Rachel wonders aloud about Toby’s fingers: are they safely out of the way of the singing blade? The Chief says: “Don’t worry. Steve knows just where to cut. He leaves a margin of pipe just shorter than his own index finger.”

At length the drainpipe is sawn through. Everyone gets out of the bath excepting for Toby and Rachel. Annette, Raphael and I make room so the bath can be lifted. Eight adult hands hoist the tub aloft. Toby squeals with delight as he levitates.
Steve’s voice comes from the floor: “Toby, can you wriggle your fingers?”
Rachel and the ambos relay the request. Toby says, explaining the obvious to the unintelligent, “I can’t. They are stuck.”
The voice from the floor warns Rachel that he is about to push Toby’s fingertips upwards from below. Steve pushes, Toby says “Ow! You are hurting me!”
Apologising, Steve has another try and Toby cries:”Stop it, you bumhead!”
Steve stops.
The Chief retires to the fire truck, returning with some new cutting equipment which he passes to Steve. Steve now sets about cutting free the metal disc with its six perforations and its three child fingers.
The Chief invites Jesse and Miles to come and inspect the fire truck. He shows them the hoses and the heavy brass fittings, then hoists them high into the cabin and places them onto the driver’s seat, beneath the steering wheel. In the massive truck they are very small.
The Chief points out the siren, the two-way radio, the switches that elevate the ladders and all the usual automotive controls. Two boys are in paradise. I remove them before they drive off in search of a fire.

Back in the bathroom, Toby is pacific once more. He sits in the tub in his mother’s arms watching a DVD. The ambos take turns holding the portable screen at the right distance for Toby’s comfort. The DVD is in a language foreign to the ambos and fire crew. It is “Bob Esponja”, Sponge Bob in Spanish.
Now his brothers clamour to watch too. Raphael and I take them outside and hoist them onto the window sill recently vacated by the fire chief.
All of this takes place well past the bedtime of such small boys as maintain a normal, detached relationship with their bathtubs.
The boys watch and translate for the ambulance man and lady, Ross and Joelle (‘call me Jodie’) respectively. It is a cultural treat for Ross and Joelle, who have only previously enjoyed Sponge Bob in English with respective nephews.

It is about 9.00PM when the plughole with its nubbin of pipe and its heavy perforate disc is freed from the tub. Sponge Bob has finished. Toby looks at his naked self and the empty tub. He says mildly: “I am ready to get out now.”
Rachel rises, her bum and thighs numb after three hours, cradling Toby and his massive steel bracelet as she does so.
Escorted by Joelle and Ross, they make their way to the kitchen. Here Annette has covered the kitchen table with towels and a pillow for Toby’s head.
Annette takes Miles and Jesse to their bedrooms. Their protests are audible from the kitchen.
Jesse appears in the kitchen. He says,”I can’t sleep. I’m too worried.”
Somehow Annette persuades him to come back to his room. She lies down alongside him and tries to help him relax.

Now the Chief produces a narrow strip of steel blade, about a foot long and an eighth of an inch wide. Its surface is roughened and irregular; it looks like steel with acne. The Chief explains: “Diamond saw. It’s the only thing that will cut through that steel.”

The Chief threads the stiff blade between Toby’s index finger and the inner edge of the steel annulus. The sharp edge of the blade is applied to the steel and moved up and down. It seeks a niche or crack to bite at hard, but the steel is obdurate and the blade bounces off it. The Chief tries again and again. He is relentless. Steel against steel, the Chief versus the disc.
An exquisite Argentine proverb of Toby’s father, Pablo, runs: con paciencia y con saliva, el elefante se cogio a la hormiga.*
Over the next long time, the Chief will need all the patience and saliva he can muster. He sneaks the blade between the hard steel and the soft boy. The blade makes glancing contact with the disc, leaving a fine scratch in the steel. Now the blade comes again, finds the line of scratching and attacks. The linear scratch deepens minutely. It is nothing like a fissure. Many more passes of blade, many minutes in which Rachel braces Toby’s hand against movement. Rachel searches the face of the Chief. Is he discouraged? He is not. He is the elephant seducing the ant. He presses on.
The room heats up, the disc heats up and Toby protests. Now Jodie produces a green gadget and shows Toby. It looks like a fat whistle. “You put this in your mouth, Toby, and you breathe in. Then your hand will feel good again.”
Toby takes the toy, breathes in and out, relaxes and smiles. He likes his inhaled narcotic.
More laborious sawing, more minutes pass, many single tedious minutes, dragging themselves into hours. The disc is hot, the Chief is resolute, the ambos take turns positioning Toby’s wrist and the Toby rescue industry hums on. Eventually – it is around 10.00pm – Toby becomes fractious. He addresses Jody, the wrist-bearer of the moment. “Put my hand down.”
Jody explains: ”We have to hold it up high to get your fingers out, Toby. It won’t take long.”
Toby is not placated: “Stop it, bumhead!”
Bumhead’s offsider, Ross, gives Toby another suck of narcotic and he subsides.

A further half an hour passes, half an hour of sawing, story reading, perspiring and concentrating. The cluster around Toby and his still buoyant mother falls eventually into speechless reverie. Each person in her own thoughts, each concentrating on three thin fingers that remain pink and on a small boy’s face, pale now with medication and fatigue.

There is a bloke at the front gate who wants to talk to any member of the family. I am greeted by a shortish man with a warm smile and a huge camera. He’s from one of the TV stations. He apologises for his intrusion, he hopes he is not causing distress, would any member of the family be prepared to describe what is happening? I answer, “No.” The man accepts this gracefully and walks away.
I retrieve a phone call. It is Pablo, Toby’s aphoristic father. “Howardo, what’s happening? Is Toby OK? Should I come home?”
Pablo is up country, the indispensable leader of his team’s annual residential seminar. He is out of town but painfully in touch. It tears him in two.
“No, Pablo, Toby is safe and cheerful, his mum is cheerful and the house is full of fire people, ambulance people, family, friends and kibitzers. There’s no physical space for a mere father. OK?”
Pablo is OK, just. I am to ring back later with more news.
Back inside, Toby stirs, complains: “My hand feels uncomterful.” Jody confers with Ross, then turns to Rachel: ”We can’t give Toby any more of the painkiller in case it depresses his breathing. Any further doses need to be given in the Children’s Hospital, with anaesthetic and operating facilities.”

Rachel flows into action. She kisses her other boys goodnight, tells them that Toby will go to the hospital to get his fingers out and he’ll come home soon. She grabs Toby’s teddy bear, a couple of books and another DVD.
Toby says a warm goodnight to all the emergency people, not excluding bumheads.
Rachel wraps Toby in a rug, marches from the house into the open ambulance, concealing her son from the TV camera, and in a moment they are away.

I follow in my car. I work odd night shifts in the Emergency Department of that hospital. I might be useful in some way; I know people there.
By the time I arrive in Triage, Rachel and Toby are nowhere to be seen. The nurse in Triage seems to expect me. “Go into the Minor Procedures Room, Howard. They’re all in there.”

Indeed they “all” are. There are Jodie and Ross and a new fire team. Steve and the Chief and our previous team only do outpatients, it seems. The new bunch comes from another fire station and they do the inpatient jobs. There is a firelady and a fireman, both selected, surely, for their tenderness towards children. The fireman is as tall as Toby is minute. He looks at me, I look at him, Rachel looks at him. He says, “Hello Doctor Goldenberg. We met at your clinic. I married your patient, Robyn. Do you remember?” Indeed I do remember. He is Nick. Rachel is looking at him hard and long because he is so good looking.

Nick has no hand for me to shake because his are occupied with an intriguing apparatus, whose principles he at length will explain. The principles are alarming.
Meanwhile I meet Lucy, who is operating a portable DVD player for Toby, who sits in his mother’s embrace on an operating table. Toby grips his pale blue teddy bear as he always does – with one of its arms in his mouth. Every night that bear develops a soggy upper limb. The bear keeps Toby company through his hospital stay and then disappears, forever lost. Bearnapped, we suppose.
There is a nurse who is helping a doctor administer intravenous pain killers to Toby. The doctor smiles and greets me. We know each other. A quarter of a century ago, when he was a boy, I used to be his family doctor. Then he became my medical student. Nowadays, when I work at the Royal Children’s, I operate under his direction. He is the paediatric consultant on duty tonight. His name is Dominic.

Nick explains his gadget. It is a miniature example of the famed ‘Jaws of Life’ that road emergency crews use to disimpact a crushed motor vehicle from its trapped occupant. Nick’s gadget is a menacing midget of frightening power. It looks like a pair of dark steel pincers emerging from a cylindrical contrivance connected by strong piping to a device that couches like sin on the floor of the O.R. That floor dweller is a pump that forces air under enormous pressure to the pincers, coercing them apart.
Nick introduces the fine pincers into one of the unoccupied annuluses of Toby’s steel ring. He allows the pressure to build and build. The steel of the annulus resists the steel of the jaws. All our jaws are clamped hard, as we watch in dread the application of irresistible force to an object not amenable to persuasion. I close my eyes briefly against a vision of a sudden sundering of the steel bracelet or else an explosion underfoot of the compressor. The latter would destroy the fourteen limbs standing nearby on the floor; the former could shatter my daughter and my grandson.
I adopt the business-as-usual expression that one always deploys when one’s gamble with a patient’s health hangs upon the coin that one has set spinning, spinning, as it falls to earth.
With a discrete metallic sigh the annulus cracks and gapes. Firelady Lucy hands Nick a diamond–blade saw, which he wields now with a free-swinging action well away from Toby’s flesh. As the saw makes its remorseless way through the steel disc, Dominic inserts a shield for Toby’s finger.
Millimetre by millimetre the blade divides the inviolate steel. Sixteen eyes follow the progress of the blade, a remorseless icebreaker freeing the trapped one. The saw falls still, a fraction short of the shield. Now Nick applies a wrench to the opposing shores of the bay where Toby’s finger is marooned. Another steel sigh and the disc surrenders. Toby’s finger is free. Watching Aladdin and his magic, he pays no heed to our drama.
Two more fingers to go. Pincers, saw, wrench – all are deployed in unhurried speed. Nick frees Toby’s digits, tears gather at the edges of my eyes as Rachel kisses those finger tips.

Dominic examines the fingers minutely. He is checking for tissue damage. There is the small skin indentation one sees when a ring has been a little tight. The skin is pink.
Dominic tells Toby to wriggle his fingers. Toby does so, his expression of scornful surprise registering wonder at the obtuseness of the adult world.
Dominic wants to be certain that there has been no damage to nerves and blood vessels. After x-rays he will keep Toby and Rachel here, in an annexe, until the morning, “just to be sure”.
The morning is not many hours away. I kiss my grandson and I hold my daughter’s face in my hands and squeeze her beloved flesh. Then I drive home.
On the way to the car, I phone Annette and share the news. And I forget all about phoning Pablo and Naomi.
***

In the bath a few weeks later 7 year old Jesse has an idea: “Why don’t you see if you can get your fingers into the bath hole, Toby?”.

 

* Pablo translates: With patience and with saliva, the elephant fucked the ant.

Melbourne Boy Rescued After Plug Hole Drama

Melbourne Boy Rescued After Plug Hole Drama

 

You Can’t Chop your Momma Up in Massachusetts…

In January 2002, I went to Boston to cut a deal. The deal, a covenant really (in Hebrew, a brith), originated between God and Abraham. Abraham was the first to cut the deal. My job in Boston was to renew it in the flesh of my eight-day old great-nephew. When it was all over bar the feasting, all present joined in the heartfelt prayer: Just as he has entered into the brith, so may he enter into the Torah, into the nuptial canopy and into good deeds.

Then we joined in heartfelt feasting.

In the next room the baby, newly named Elisha, slept quietly. Quietly too, he bled into his diaper*.

When we checked on him we found him – as in the vision of the prophet Ezekiel – languishing in his blood. I applied pressure. This works nine times in ten. Elisha bled on. I sutured a little bleeder and waited. The baby boy bled on.

His mother and father and I bundled him up and raced him down the January street to the pediatrician’s* office. Boston is cold in January but we didn’t notice. The paediatrician’s nurse applied a tight bandage, saying reassuringly: ”Pressure always stops this sort of oozing.” Really?

Elisha bled on quietly. He remained pink and warm and peaceful.

An ambulance raced us across town, bells and siren ringing, to the Boston Children’s Hospital. Bearing all the authority of my years and my professional status, expressing myself with composed urgency and gravity, I gave Elisha’s history to a triage nurse; then to a nurse practitioner; after her to a surgical nurse and then to a medical student. All took notes, all reassured us pressure would do the trick, the ooze was slight, it would settle, Elisha looked well. All disappeared without trace.

Finally I met an Accident and Emergency physician from Iran and a Urology Resident from Israel. Beaut fellows both, they understood and honoured the Covenant of Abraham. The Israelite confided the story of his own son’s recent Brith Millah. And he spoke to the truism which comforts all surgeons: Healthy blood will always coagulate.

Meanwhile the sleeping baby boy oozed on. It was midday now, three hours after the Brith. A test gave Elisha’s blood count at forty percent. He slept on. And trickled away.

My brother surgeons took Elisha to the OR where, with the aid of the operating microscope, they ligated some minute bleeders. They invited me into OR where they demonstrated with some pride, a pink rosebud of glans, surrounded by a coronet of catgut sutures. “Look, no ooze”, they said.

No ooze is good news.

It was now three pm and I had missed my flight to the West Coast.

I hung around for an hour longer. At the next diaper change we saw the slightest pink loss. The same at the next change. And the next.

All the clinicians pronounced Elisha well. Cured. I should fly home, confident his little problem was fixed.

Misgiving, guilty at my surgical failure, I flew to LA and rang my niece from the airport. “He looks good, Unc. Hardly any ooze at all.”

I flew home to Australia.

A day later, Elisha’s mum called: “Elisha has haemophilia*, Uncle. The bleeding wasn’t your fault, not anyone’s fault, a mutation.”

Within weeks it became clear Elisha’s haemophilia was graded severe. Every second day of his life, Elisha has an intravenous injection of Clotting Factor Eight. On this regime he’s a healthy fellow.

Last week the World Haemophilia** Congress was underway in Melbourne with Elisha’s mum in attendance. She brought Elisha with her, together with his non-haemophiliac younger brother. Although I haven’t checked the pink rosebud I last saw in OR, the Elisha I see looks brilliantly healthy. Next January his multi-continental kin will gather in Boston to celebrate as, in fulfilment of our prayer, Elisha enters into the Torah at his barmitzvah.

· *In America they spell it thus.

· ** In Oz we spell it this way.

The Price of Life in Doomadgee

Just before noon the phone called me from the river to the hospital. The hospital held me until long past midnight.

A man with his jawbone fractured, pushed right out of alignment, said: “There was a fight. I was watching it and a man came up from behind, on my right side, and king-hit me.”

I called a plane to take Sampson to Mt Isa.

Eight thousand dollars.

 

A man came in and showed me his hand, puffed up, a boxing glove of soggy blood under the skin. Beneath the blood, the head of the metacarpal bone had snapped. I said: “You’ll need an operation. We’ll fly you to Mt. Isa.”

Eight thousand dollars.

 

On the TV Rafael Nadal struggled into night with back muscles in spasm. A chubby baby, feverish and short of breath, took me from the tennis. Over the previous day or two I had seen this baby at peace. He filled all who saw him with delight. Such abundant flesh, so well at home in grandmother’s embrace.

This was their third night visit in 48 hours. Grandma brought him in this time as previously. She nursed the weeping Buddha and comforted him. The rule in Aboriginal health says, “Three strikes and you’re in.”

I said, “He’ll have to go in. To Mt. Isa. You can go with him.”

“Grandmother said:” I can’t. I’ve got my own six-month old at home. I’m breast-feeding him.”

“What about his mum?”

“She doesn’t have him. I do.”

The letter from Child Protection said the same. So Aunty went.

 

Very late at night came an urgent call. The voice said: “A man has come in with a high temperature. He’s very old.”

The thermometer said: “39.9 degrees.”

That sort of fever says “sepsis.” In this man’s case his septicaemia arose as a complication of pneumonia.

I asked the man about symptoms. He shook his head. He had no complaints.

“What about pain?”

He said, “I think my head hurts.” He said it as if he was far from the pain. The pain was a sensation like memory; he had to summon it to name it.

The man sat bent forward, breathing quietly, speaking softly, his bushy moustache a permanent smile.

At his side sat a young woman. Her gaze never moved from the breathing old man.

I asked, “Is he your grandfather?”

She said, “Yes.”

“Will his wife come…?”

The young woman said, “No, just me. Me and my brothers.”

“He’ll need to go to Mt. Isa. Your grandfather is seriously ill.”

A sad shake of her head, She said: “I can’t go. My baby… My brother will go, one of my brothers, Ambrose.”

“How old is your Ambrose?”
“Eighteen.” Seeing the doubt on my face she said: “Ambrose will look after him 
properly. Us three – my brothers and me – we live with him, we look after him. We do everything.”

 

The old man’s vital signs went from worse to frightening. The sphygmomanometer said: “60/40”.

The Emergency Consultant at the Flying Doctor Base in Mt. Isa said, “The plane is on its way. Give him Adrenaline.”

We gave him adrenaline. We gave him three different intravenous antibiotics and a fourth, by mouth. Hunched forward, moving only zephyrs in and out of his chest, the old man breathed and the breath did not speak to my stethoscopic ears.

I said, “Please lie back if you can.”

He lay back, air moved in and out, the silver bush on his upper lip filled and emptied, emptied and filled, semaphoring life. The blood pressure machine said, “80/50…90/65…110/70”.

The young woman gave way to a brother. The brother, after a time, gave way to another. This was the eighteen year old, tall, thin, lightly muscled. His bearing was solemn.

The sound of an aircraft flying low overhead changed the tempo.

Quickly, quickly, gently, many hands helped the old man slide from the couch to the ambos’ trolley that he would ride to the vehicle and on to the airfield.

We pushed him towards the ambulance parked outside the front door. Lining the wall, gathering in numbers, gathering over the fretting hours of the old man’s time with us, waiting, standing quietly, were three daughters – themselves matrons – and men of all ages, boys, small kids supported on young hips and attached to slender breasts. Only minutes earlier the waiting room had been empty. All had stood outside in the dark and the heat. The chill of a hospital ward did not invite them.

All eyes now followed the old man. Hands reached for him. The ambos halted, the file flowed forward, a wave of silent care. I saw one woman, a daughter, her eyes swimming, her lips trembling. I stepped forward and said: “Your father has been desperately ill, but he seems to be turning the corner. He’s holding his own now.”

She said: ”He didn’t want to come to the hospital. He was scared. He thought you might fly him out to Mt. Isa. When they flew Mum out, she…” The voice, soft, husky, now faltered:“…Mum never came back.” 

 

I looked at the gathering and asked: “All these people – all his descendants?”

She said, “Yes, all his kids and his kids’ kids and their kids.

And there’ll be just as much family waiting for him in the hospital in town.”

 

The ambos took the old man away. The family melted away.

 

The senior nurse breathed out and said: “If I come to my final hours and I am surrounded by that much love, I will know I have lived a successful life.”

 

***

 

While the nurses tidied the Emergency Rooms, I wrote up my clinical notes. A nurse approached, apologetically. She said, “Would you mind? We have a lady here with a cut head. It might need stitching. It was a belt buckle.”

In ED an old lady sat. Seated opposite her, too long of limb to sit without sprawling, were two large men in navy blue with large guns at their hips.

I looked to the lady. She wore a patterned dress in black and white whorls. The bodice was splattered with red. Her head was a savannah of silver-black curls. I had to search for the laceration which was small and shallow. Blood had clotted in a thin line between the margins of skin. Nature had stopped the previously brisk bleeding.

There was not much to do, nothing medical.

I asked, “What happened.”

The nurse said: “Fifty dollars.”

The nurse shook her head. Was she angry? Disbelieving? Or simply busy with the wound?

She resumed: “Her husband demanded fifty dollars and when she didn’t hand it over he hit her with his belt buckle. Isn’t that right?”

The old lady spoke for the first time. She said, “Sixty.”

Unhappily, guardedly, I turned to the police officers and asked: “How can I be of help to you gentlemen?”

The taller one had blue eyes. His firm face softened. He said: “You can’t. We’re just waiting here until you’ve all finished, then we’ll drive her home. Don’t want an old lady to walk home alone. And it won’t be her home. We’ll take her somewhere else, somewhere safe.”