Tag Archives: loss

What Does it All Mean? – V The Final Act

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‘TRIGGER WARNING’

The following post may distress some readers. Before reading, please ensure you have any supports you might need.

This hurts the most. 

If only, if only…

It happens and it hurts and the hurt can’t be helped; it can’t be talked away; it can’t be redeemed.

And when you lose the next one in this way, it finds you again unprepared, defenceless, bewildered.  

When I count those lost to me by their own hand, I find the tally low: three, three in over fifty years. These three, and two more who tried and who fell, falling, astonished into my outstretched arms.

The wound is not to my pride. The wound goes deeper. Petty pride stings at slights, but this is not slight. This one trusted me, that one looked to me, they stood before me in their naked grief and I tried to clothe them in my regard: You matter. Your life has value. Your unique being has meaning. 

I have been talking, I discover, to those who are beyond hearing. My words vibrate and pass, and unclothed and alone, the three take their leave. 

The first died for beauty. Believing herself dysphorically to be disfigured, she could not see the beauty all others could see in the photos her despairing husband took and showed her. Beauty cannot keep her lustrous eyes. She takes her leave, she takes her life. Her husband cannot take my calls.

The second died for lovelessness. Born a late child into a family already too full of children, born whole into a constellation deformed by the severe deformity of an elder brother, this one was never deemed to have needs. He called out for notice: Mum, I’ll be good! Mum, I topped the class! Dad, I was best and fairest! Mum, Dad they made me School Captain! Mum… Dad…

They never noticed. All their time, all their energy they spent on the other one, the one who couldn’t run, who would never read. Mum and Dad had no love to waste. The unloved one made himself lovable. I never met a more winning man. I noticed him, I regarded him. He won me. But mine was not the love he lacked.

Being lovable, being good, being the one who’d always try the hardest, he tried all I suggested; he took the medication, and the next medication. He accepted the referral to a psychiatrist, he engaged with the therapist, he accepted admission to hospital. He convinced the specialist he was recovering. He left hospital and he kept his appointment with me. He spoke to me in warm appreciation. He took his leave and, leaving me in false assurance, he took his life.

Twenty years pass and still I shake my head in bewilderment. So vital his being, so warm his blood, so much greater than both, his pain.

Of the last I write least. Two years on it remains too raw. Another who died for beauty. Ugly only in her own eyes, ‘unworthy’ of the lavished love of her parents. Unable to bear the hope with which I’d inoculate her, she separated herself from me in her final months. She died by her own hand. She died alone.

My feelings are not of guilt. Not being family to any of the three, I feel none of the woundof kin, none of that stab of accusation or anger. I cared for all three. They took from their scant stores of trust and they invested in me. I tried my best. It was not enough. We all lost.

What Does it all Mean? – IV

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Warm Skin and Broad Shoulders

For my first twenty years in general practice, I worked in partnership with a famous man who happened also to be a great man. I’d heard of him before we met. His name was Donald Cordner, famed as the sole doctor ever to win a Brownlow Medal in Australian football. I learned you win the Brownlow for being the fairest and best player. Those two adjectives epitomise the man.

Donald happened to be, in his time, the tallest player in the League. Together with that height he was broad in proportion. On my first morning with him, Donald performed a tonsillectomy on a child of eight. Disdaining a trolley, he hoisted the patient in his arms and carried her to the Operating Theatre before surgery, then carried her back to the ward afterward. Donald personified two valuable characteristics in a doctor – the personal touch and broad shoulders.

At about five feet and seven inches I could only look up to this very tall man. My initial awe gave way quickly to admiration, for I saw in Donald a quality I’d seen at close quarters through the previous twenty-six years as the son of another GP. That quality was the courage to feel the pain of another, to share it willingly, to shoulder it and to carry on with calm. 

I saw Dad and Donald as they brought life into the world and as, inevitably, they walked closely with others to their final exit. They did this kindly and bravely. Every birth builds us, every death diminishes us. John Donne was right:

Therefore send not to know

For whom the bell tolls,

It tolls for thee.

Seated in close consultation with a young mother one morning in the village of Diamond Creek, I was interrupted by the insistent ringing of the telephone: Would I come urgently to the Treatment Room?

For the next thirty minutes Donald and I worked frantically to revive a six-month old baby who hadn’t cried that morning. Her anxious mother found her child inert, unresponsive, not breathing. We tried all we knew but the baby would not breathe. All through this time the mother stood at our side, fully, dreadfully aware. Through it all, the baby felt warm to my touch. That warmth was to haunt me.

I returned to my patient and took up our earlier conversation: Jen, how did you feel when he spoke to you…

My patient cut across me: Howard, you’ve just been attending to something terrible in the other room. You can’t just walk back in here and carry on as if nothing has happened. You have to give yourself some time.

Jen (not her real name) was right. Nobody had ever suggested a doctor too might need care. 

Over the following twenty years the bereaved mother brought her surviving children to Donald and me. We shared our unbearable, unspoken knowledge.

Another young mother, Julie, became my patient around that time. Over the next decade I delivered her babies and looked after her children. I tried to help her when she became depressed following her final childbirth, and again when she came to me for help through her divorce. Julie was a dynamo whose many ailments frequently led to surgery, and few of her numerous operations went smoothly.

Julie saw in me capacities that I could not recognise. When she brought a problem to me she did so with inordinate trust in my powers. Howard would know. That trust must have generated the power she imagined. She demanded I become a better doctor, and her faith or some species of love brought that doctor into being. 

When I left Diamond Creek she followed me to the city, travelling an hour each way to see me for her many incurable conditions. When Julie moved to a  more distant country town the trip to see her trusted doctor took two hours each way. Her ailments were many and her visits not few. She’d seek my counsel in her wilful mother’s decline. She shared the joy of new grandchildren. Her bones began to crumble and she looked to me for guidance about the medication that should strengthen bone, but weren’t there cases where the jaw would abruptly crack?

When aged about sixty, Julie developed intractable abdominal pain. Specialists failed to find the cause and I struggled to relieve her pain. Through all of this Julie looked to me with that unwavering trust.

Belatedly we found the small malignancy that was the cause of Julie’s pain. Cure by surgery was not possible. Supported by her brave husband, Julie endured the full ordeal of chemotherapy. To the end Julie chased a cure: she would not give up her precious life. To the end she trusted her old doctor. I was humbled by her faith.

Julie died.

Over fifty-one years I’ve seen death undo so many. Not all deaths were tragic, some were a release. Inevitably, though, some die in cruel suffering. I remember Robbie (not his name), a tender soul, a deeply spiritual man who’d survived a harsh childhood, and who emerged with a love that overflowed. Robbie and I shared a love of literature. He’d hunt out books he knew I’d enjoy and gift them to me, inscribing every volume with a message full of feeling. To this day I’ll pick up an old postcard, a cherished book suffering neglect, and instantly, Robbie’s handwriting, the curved lettering, bring him back; his love visible in ink.

One day I rode with Robbie as he drove his teenage kids to school. He kissed his daughter as she left the car, then he kissed his blushing son. As I followed, rather than allow me to feel neglected, Robbie kissed me too.

Robbie worked in Student Services at a university, later as a chaplain in ICU at a major hospital. He would see forty percent of his patients die.

Robbie knew his own heart would eventually fail. Numerous surgeons had opened his heart and repaired or replaced valves, not all successfully. Robbie’s cardiologist assured him his passing would be smoothed: he would not suffer. This GP reinforced this advice. Robbie and his devoted wife trusted our words.

When his time came, Robbie exited life in a prolonged and desperate struggle for breath. He died at home with his wife at his side. Years later Robbie’s widow – herself my beloved friend – continues to suffer grief born of betrayal.

In the end that must come, all we doctors can offer our patients is our warm skin and our broad shoulders.

Dennis, Twelve Years On

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I remember you today, Den, with the candle burning and with the prayers of mourning.

I remember you in our boyhood home in Leeton, where a life of risk called you always, and you’d drag me and I’d follow, with terror and tremor and delight. I remember you taking me into Dad’s Surgery, that forbidden room, where the ever-present smell of anaesthetic ether warned a boy of the consequences that would follow. You found Dad’s blood pressure machine and you showed me how you could squeeze the rubber bulb and inflate the bladder. You kept showing me, squeezing, pumping, and the mercury climbed above 200, 250, 290, until the bladder burst, and liquid mercury ran everywhere.

 

 

When you were eight you decided we should pay a visit on Miss Paull, my teacher, Leeton’s aristocrat, in her residence at the Hydro Hotel. I followed you up the long hill. I followed you up the sweeping drive. Bold as brass, you announced to the man in the black suit, who opened the door, ‘We have come to visit Mis Paull’, and the man showed us in, and Miss Paull emerged, all white and willowy and English, and she said, ‘Good morning Dennis, good morning Howard, how utterly delightful that you should come. Please join me for morning tea.’ And the man in the black suit sat us down and spread white linen squares over our laps, and I was in heaven, nearly wetting myself in excitement. On the way out you heeded the call of your own bladder and you peed on the Hydro’s flowerbeds.

 

I sit and I remember you, my big brother, how you protected me when we were small. I remember, when I was fourteen, Dad summoning me to the forbidden room and sitting me down for a serious talk. The tremors again, but this time I wasn’t in trouble. Dad said, Dennis doesn’t have as easy a path in life as yours. 

I didn’t want to hear this because I knew it to be true.

Dad continued: I want you to help him. My heart sank.

 

I did try, Den, but I lacked your boldness. When I saw other children bullying you I died twice. Others, children and adults and old people, loved you and cherished you, for the beauty of your soul, for your generosity.

 

You loved music with the abundance and the zest of all your loving. I remember you in ICU, in the room of your dying, and you lying there in your coma. Annette, your sister in law, played a Mozart CD for you, and you lifted your arms and you started to conduct. I hope that beauty stayed with you as you slipped away, Dennis.

 

 

It’s the 18th day of the month of Ellul, Den. I remember you and I miss you.

 

Early Spring

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The date comes up on his screen, September five. Instantly he sees a round face, lightly freckled. Her wavy hair is light brown.

He’s known her two brothers for years and her two elder sisters, both of them young ladies in their late teens. But this is the first summer  he and she have noticed each other: she’s 11 years old and he’s fourteen. While the slow afternoons make everyone else drowsy, the two go for walks to nowhere in particular. They talk comfortably about their mums and dads  and their brothers and sisters. They both come from large families and there’s lots to tell. Last week it was his birthday. Hers is in spring. One afternoon they find themselves at the far end of the island. There in the long grass they sit. Something tells him to move closer. He kisses her. Soon after they walk back to their families on their neighbouring boats.

 

The next afternoon he looks for her, but she and her mum have gone shopping in town on the further shore.

He doesn’t find her the next day either.

On the third day her elder sister says she went back to Geelong with Dad to buy her schoolbooks. He confesses to the elder sister he’s missing her. Her response surprises him:  Sometimes a young girl can feel confused if she has feelings she’s never felt before. It can scare her.

 

Summer ends and they don’t meet again. Most years he thinks of her on September five.

 

He’s about sixty when he buys a book by John Marsden. Its title is ‘This I Believe’. In it he reads the credos of one hundred eminent Australians. One essay is written by a woman shortly before she dies, too young, of breast cancer. A companion essay is written by her eminent daughter. He doesn’t recognise the surnames of the two women. The essays move him. He notes the dates of birth and death of the  mother. She has been dead now for some years.

 

Every year, on September five, he thinks of her.

Magnified and Sanctified

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It’s been ten years, Den, and only now do I feel I can say goodbye to you.

You were sixty three, I was sixty one. You died on Friday night. Your son brought the news to us at our shabbat table.

We buried you on the Sunday. We laid you to rest at an odd corner of the Jewish burial ground, beneath a young gum tree. I looked at the tree at that time and I remembered Dad’s fear of falling gums. I thought, here you are again, going against Dad’s prudent judgement. And I smiled.

You lie now, beyond the judgement of humans. Many were the people who judged you, fewer were those who tried to walk a mile in your shoes. They were big shoes.  Like everything about you, very big. Magnified, sanctified… People who did understand loved you extravagantly, in proportion to your extravagant life.

And now I can let you go. From the time of our final conversation I dreamed of you. The dreams were dreams of helplessness. You could not help yourself, I needed to help, I tried to help, but in those dreams, I could not. You called me that last time. The phone woke me from a dreamless sleep. Your speech rustled and crackled, the sweetness of your voice ruined by seven days with the breathing tube. You had rallied, they’d removed the tube; now, with your breathing failing, they needed to replace it. Your voice crackled: ‘Doff, they want to put the tube back. What should I say?’

I heard your breathing, a rasping, gasping sound. ‘Do as they say Den.’

‘Is it my best chance?’

‘Den, it’s your only chance.’

They returned you to your coma and they replaced the tube. Three days later you breathed your last.

At the cemetery we said, magnified and sanctified be the holy name.

One evening during the week of shiva my son led the prayers in honour of his uncle. He loved you Den. We loved you.

For ten years I dreamed of you, restless dreams, frantic. I was unable to help. Then I started writing about you and the dreams stopped. Now I sleep without the dreams. Sleep in peace beneath your gum tree, Den.

Silent Singer

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The voice floated across my lonely motel room in Darwin. The sound of slow sweet lament suited my mood in that anonymous room in a lodging for transients. The voice sang of home, of home lost, of home dreamed and remembered. In that room, at that season – the three weeks of mourning for Jerusalem and the Temple – the voice sang to me of loss, my own and the singer’s.
 
 
After a period working on Elcho Island I had arrived in Darwin at day’s end, had wandered blindly about the Darwin Festival, blindly had selected this CD of Elcho singers. Later, in the light I read their names. I recognised ‘Yunipingu’: hadn’t he been Australian of the Year? But this would be a different Yunipingu.
 
 
Only a couple of years later that floating voice had percolated through the ears  of the entire nation, seeped into our being and changed us. Distinctive as didgeridoo, his voice was recognised everywhere. His solo album was the cultural event of the year. Realising how a voice had become the sound that we recognised ourselves by, I wrote. “Australia is becoming more Australian.”  
 
 
Born in 1971 the singer passed away last week. He died during the three weeks of mourning. I listen to ‘Warwu’ and I feel for my country, impoverished. The singer has passed from us. So much loss, so many, so young.
 
 
 
 
click on this link to hear him singing 'Warwu': https://www.youtube.com/watch?v=XhkMP89rRMk

Writing as Healing

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The mother of identical twin boys sent me this story by Ranjava Srivastava.

 

“Losing my twin baby boys for ever changed the way I treat my patients.

I will never know the kind of doctor I would have become without the searing experience of being a patient, but I like to think my loss wasn’t in vain.

‘My obstetrician’s tears stunned me but also provided immediate comfort. They normalised the mad grief that had begun to set inside me.’
Around this time 10 years ago, I was poised to start my first job as an oncologist when personal tragedy visited in a way that would forever change the way I would practice medicine.

I had returned from my Fulbright year at the University of Chicago, blessed with only the joys and none of the irritations of being pregnant with twins. Landing in Melbourne, I went for a routine ultrasound as a beaming, expectant parent. I came out a grieving patient. The twins were dying in utero, unsuspectedly and unobtrusively, from some rare condition that I had never heard of. Two days later, I was induced into labour to deliver the two little boys whom we would never see grow. Then I went home.

If all this sounds a little detached it is because 10 years later I still have no words to describe the total bewilderment, the depth of sorrow and the intensity of loss that I experienced during those days. Some days, I really thought my heart would break into pieces. Ten years later, the din of happy children fills our house. But what I have found myself frequently reflecting on is how the behaviour of my doctors in those days profoundly altered the way in which I would treat my patients.

An experienced obstetrician was performing my ultrasound that morning. Everything was going well and we chatted away about my new job until he frowned. Then he grimaced, pushed and prodded with the probe, and rushed out before I could utter a word. He then took me into his office and offered me his comfortable seat. Not too many pregnant women need a consultation at a routine ultrasound.

“I am afraid I have bad news,” he said before sketching a picture to describe the extent of the trouble. I thought for a fleeting moment that my medical brain would kick in and I would present him with sophisticated questions to test his assertion that the twins were gravely ill. But of course, I was like every other patient, simultaneously bursting with questions while rendered mute by shock.

I was well aware that doctors sometimes sidestepped the truth, usually with the intent of protecting the patient. I knew he could easily get away with not telling me any more until he had more information but I also knew that he knew. I read it in his face and I desperately wanted him to tell me.

I asked the only question that mattered.

“Will they die?” 

“Yes,” he said, simply holding my gaze until his tears started.

As I took in the framed photos of children around his office he probably wished he could hide them all away.

“I don’t know what to say,” he murmured, his eyes still wet. 

Until then, in 13 years of medical training, I had never seen a doctor cry. I had participated in every drama that life in bustling public hospitals offers but never once had I seen a doctor cry.

My obstetrician’s tears stunned me but also provided immediate comfort. They normalised the mad grief that had begun to set inside me. Yes, the doctor’s expression said, this is truly awful and I feel sad too.

“You are sure?”

“There is a faint chance that one lives but if you ask me, things look bad. You know I will do everything I can to confirm this,” he said.

The obstetrician had told the unflinching truth and in doing so almost surgically displaced uncertainty with the knowledge that I needed to prepare myself for what lay ahead. I had test after test that day, each specialist confirming the worst. I think I coped better because the first doctor had told the truth.

Two other notable things happened that week. Among the wishes that flowed, another doctor wrote me an atypical condolence note. His letter began with the various tragedies that had taken place that week, some on home soil and others involving complete strangers. “I ask myself why,” he wrote, “and of course there is no answer to why anyone must suffer.”

Until then, everyone had commiserated only at my loss – and I was enormously grateful – but here was someone gently reminding me that in life we are all visited by tragedy. All the support and love in the world won’t make you immune to misfortune, he was saying, but it will help ease the pain.

Finally, there was the grieving. I lost count of the pamphlets that were left at our door to attend support groups, counselling sessions and bereavement seminars but we were resolutely having none of it. My midwife called me out of the blue – it was a moving exchange that taught me how deeply nurses are affected too. But I didn’t need counselling, I needed time. I valued the offers but I knew that my catharsis lay in writing. I wrote myself out of suffocating grief, which eventually turned to deep sadness and then a hollow pain, which eventually receded enough to allow me to take up my job as a brand new oncologist. How I would interpret the needs of my patients was fundamentally altered now that I had been one myself.

Cancer patients are very particular about how much truth they want to know and when. I don’t decide for them but if they ask me I always tell the truth. A wife brings in her husband and his horrendous scans trigger a gasp of astonishment among even the non-oncologists.

“Doctor, will he die from this?” she asks me.

“I am afraid so,” I answer gently, “but I will do everything in my power to keep him well for as long as I can.” 

It is the only truthful promise I can make and although she is distressed she returns to thank me for giving her clarity. Sometimes honesty backfires, when the patient or family later say they wanted to talk but not really hear bad news. I find these encounters particularly upsetting but they are rare and I don’t let them sway me from telling the truth.

Oncology is emotionally charged and I have never been afraid of admitting this to the very people who imbue my work with emotion. I don’t cry easily in front of patients but I have had my share of tears and tissues in clinic and contrary to my fears, this has been an odd source of comfort to patients. In his Christmas card, a widower wrote that when my voice broke at the news that his wife had died he felt consoled that the world shared his heartbreak.

It can be tricky but I try to put my patients’ grief into perspective without being insensitive. It’s extraordinary how many of them really appreciate knowing that I, and others, have seen thousands of people who are frightened, sad, philosophical, resigned, angry, brave and puzzled, sometimes all together, just like them. It doesn’t diminish their own suffering but helps them peek into the library of human experiences that are catalogued by oncologists. It prompts many patients to say that they are lucky to feel as well as they do despite a life-threatening illness, which is a positive and helpful way of viewing the world.

I will never know what kind of a doctor I might have become without the searing experience of being a patient. The twins would have been 10 soon. As I usher the next patient into my room to deliver bad news, I like to think that my loss was not entirely in vain.” 

……… 

I read this story with alarm. It made me feel anxious because I have and love a pair of identical twin boys. I felt involved because, like the writer’s doctor, I am a doctor who cries; and like the writer, Dr Srivastava, I am a doctor who writes. Finally we two are products of the same medical school (Monash) – Dr Srivastava graduated at the top of her class, in the present century, I graduated at the opposite end of my class, in antiquity (1969).

A final point of commonality was her reassuring remark that ten years after her doctor wept her home is full of the noise of happy living children.

I found the piece helpful. Dr Srivastava identifies and untangles the strands of her experiences with surgical deftness. Her doctor weeps, her colleagues show support and care and empathy and she heals. As a trained observer, the writer dissects her experience of grief, lays out its anatomy and reflects upon its organs and parts.

Like the writer, I find relief and understanding in the act of writing. I suspect that a part of this relief results from word search. The writer is obliged to seek the precise word for the experience. In my case this forces me to test and taste a number of words. Perhaps a dozen words might work more or less passably, but the acts of searching, of choosing, of trialling, help me to clarify what my feelings were not quite like. I mean I discover what I mean. Perhaps this functions as a working through, a self-conversation, something between analysis of an experience and re-imagining it. In my case too, the pleasure of words is an aesthetic joy that comforts me.

Medicine is a pursuit conducted with the living in the shadow of death. It is a pursuit packed with anxious questions: what is wrong with me, will I die, what can be done, will it hurt, how much, how will I know the answers, when will I know? This crying doctor feels the patient’s fear and his own and has to know the border that divides the two. My fears are for the patient, of the patient, of failure, of failing a person of flesh and feeling. My fears include the terror that strikes me when I see my patient slipping away, the knowledge of my mortal inadequacy.

The writer who lost her twins precisely names the elements in her emotional experience. With remarkable poise she traces the costs and the benefits of the loss. So coherent are her reflections I could feel myself learning as I read. I learned about her life and her work, how the two are not the same but never severable. I learned more of how a doctor feels, who she is, who I am.

Melatonin and the Meaning of Five Lives

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Melatonin and the Meaning of Five Lives

– written in the high season of jetlag

Why would I wake after only four hours of sleep? Here I am, sleepless in Pittsburgh. It is 2.00am and for five days now I have slept too little. There is nothing to stop me sleeping: the house is quiet, snow falling outside hushes the world. Sleep is an ambition unrealised.

My mind has nothing useful to do other than to keep me from sleep. My mind visits my home in Diamond Creek. The date is December 7, 1974. I see it all in the dark from my bedroom upstairs in the house of friends in Pittsburgh.

Around 7.00 am

I am first to waken. I wash my hands and a noisy clanking in the pipes threatens the precious sleep of the children. Steam emerges when I turn on the hot tap. I turn it off. I pay no heed to the meaning of noises in the plumbing, to steam from the tap. These are practical concerns; I wash my hands of practical concerns. I remove my wedding ring to recite my morning prayers and go to my work, leaving the children unkissed, leaving the ring on the dresser, leaving Annette as she prepares for the day.

Around 8.15 am

The receptionist says: ‘Mrs. West is on the line. She says it’s an emergency.’ I take the call. Lynne says, ‘Howard. I think you’d better come home, straight away. There’s been an explosion at your house.’ I don’t come home straight away; Lynne West is an excitable person and I have a patient sitting before me. More patients wait in the waiting room. I see these patients and I drive to my house.

Around 8.10 am

The house exploded.

Around 9.15 am

I do not witness the explosion but Lynne is eager to regale me: ‘I heard a loud boom from your house and I looked over and a huge cloud of smoke came out of the roof. And the walls fell down.’

But before encountering Lynne and her tale of smoke and thunder I turn from the unmade road into our dirt driveway at 36 Deering Street. Lying flat on the ground to my left are the brick walls of my home. Before me the driveway leads to an empty carport. ‘Empty, ergo Annette is not at home, the children are not at home. Ergo I have lost nothing but bricks and mortar.’ And, as I will discover later, a wedding ring.

Until I married I disdained rings on men. Worse than effeminate, in my regard they were affected. A judgement made before I married. This ring was different: slender, of unostentatious white gold, engraved on the inner surface with words of love from Annette, words for my eyes only.

Around 10.05 am

I run Annette to ground at her sister’s house. She has dropped our firstborn at kindergarten early, as she always does. Earlier Annette sat in the armchair, breastfeeding the newborn while the older two watched Sesame Street on a couch in the same room. I ring Annette and tell her she is homeless. That we have been so since shortly after

8.05 am

Annette and the children left home for kindergarten. Punctual as always. Not only early, but early for early, as I was prone to point out irritably, in Annette’s overturning of my native tardiness.

11.00 am

Annette joins me at the wrecked house. We find two goldfish still alive, lying in the few milimetres of water on the surface of the kitchen table. That flimsy table is one of the few sticks of furniture that still stands. Paintings hang at angles from the walls, canvas gashed by flying debris. The dining table lies in heavy fractions, its geometry denuded. Ancestral bedroom furniture has collapsed. Of the wedding ring no trace.

My mind is fixed on the hot water service that exploded. Emplaced on the slope beneath the house, the hot water service – that ticking bomb – stood directly beneath the armchair where Annette sustained our baby with her milk; one metre removed from the suckling pair were the Sesame Street watchers, sitting in pleasant terror of Cookie Monster. Lynne West’s ‘smoke’ was the steam released by that bomb.

Annette is upset: unlike me she never held in her imagination the thought that arrested me for one second or perhaps two: that my loved ones are lost. Annette is a mother of children and she knows, as I will continue to refuse to know, that a family lacking a home is a frail thing, that we have lost our anchor upon this earth.

Our son, aged two and a half, knows something. Prior to December 7 he is a highly verbal person. From that time, for the next six months, Raphael will not speak.

I lie in the dark, useless to myself, tossing in all this unusable time. But unwelcome consciousness wastes nothing. It takes me back thirty-nine years in time. There were questions that Annette faced in those first few seconds, questions that my son asked in his mutism.

In the simplicity of 1976 I asked nothing. Now the darkness asks me:

What does it mean?

Why has this happened – this loss?

Why has this happened – this being spared from loss?

What, as our lives were spared, are our lives for?

What will you do with, how will you use this time?

A novel experience, this guilt, this sense of time debt, the debt unserviced, accruing, unpaid. The infant at the breast, her elder brother, their big sister, each of them has employed the time, each has grown and grown, grown and learned, grown and created a family. Throughout all Annette has been their home.

What have I not attended to?

I must listen to the pipes. When the pipes, the pipes are calling I must listen. I must not wash my hands of practical matters. The practical reality was shrapnel of exploding wine bottles stacked next to the suckling chair, next to the Sesame watchers. Those jagged fragments were flung with force from floor through the ceiling into the roof space. Grenades of glass shattered the room of milk and sesame and soft infant flesh.

I must learn from the steam. Steam, as Lynne might put it, is smoke – and where there’s smoke, there’s fire. The steam warned me: get your loved ones to safety, far from the fire.

Why live? Why us? These teasing whys tease. Abstruse abstractions, they distract from the concrete, the practical.

And Annette? Annette is where truth is writ plain and practical. The truth lies with Annette.

These musings are, as I suggested at the beginning, the children of the muse melatonin. I am in foreign territory here, lost, perhaps even found, somewhere between memory and regret.

As if to answer the questions of the dark, questions I never spoke aloud, my host passes me ‘The Descent’, a poem of William Carlos Williams:


No defeat is made up entirely of defeat –

Since the world it opens up is always a place

Formerly unsuspected.

A world lost, a world unsuspected

Beckons to new places

And no whiteness (lost) is so white as the memory

Of whiteness.

My Mother’s Amygdala

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MumI am pretty sure my mother had an amygdala; every one of us does. If my friend Joe, who seems to know his amygdalas, is correct, Mum’s must have been smaller than most. He tells me the amygdala is the seat of fear in the brain.
Joe is a barrister. I remind him I am a doctor. “It’s fifty years since I last had need of any knowledge of the amygdala. How come you know about it?”
Joe says: “In my business it helps to keep up to date with neuroscience. Such things as the organ of fear can be important in court”. Which all makes sense for a criminal lawyer; but Joe does compensation cases only.

For a while I consider my mother. Then I describe her to Joe. Joe smiles. The more I speak of my mother the wider Joe’s smile.
“Mum lost her father to cancer when she was twelve. Then three years and one day later her mother died – “Mummy had rheumatic fever in her childhood. After Daddy went, she died of a broken heart.”
From the age of fifteen Mum and with her younger sister Doreen were raised by her widowed grandmother, “Gar”, a tender and enlightened and emancipated lady who taught her granddaughters to feel inferior to no-one on this earth. Nor superior, for that matter.

Mum failed her Intermediate Certificate, Year Ten in today’s language. She concluded she was a dunce (making no allowance for the effect on learning of the abrupt loss of a pair of parents) and left school. She attended secretarial college, worked as a bookkeeper, saved her salary and at the age of twenty set sail alone for Europe. The year was 1939. Her correspondence through that blithe passage via the Dutch East Indies into Western Europe is punctuated by increasingly urgent letters from Gar to hurry home: “There is going to be a war.”
Mum prepared for the war by sleeping on deck – “in case we were torpedoed” – on the last night at sea. Her ship made port in Fremantle on the day war was declared.

My parents raised us children in the country town of Leeton. Once a year we visited the great city of Melbourne where there were trams. Mum took me on a tram ride along Hawthorn Road, past the cemetery. “Mummy and Daddy are in there”, she remarked affably, indicating a long red brick wall. Behind the wall I glimpsed stone statues and crosses. Mum’s remark made no sense to me. ‘Mummy’ was on the tram with me and ‘Daddy’ was back home in Leeton. Mum explained: “It’s a cemetery. People who have died are buried there. That’s where my parents are.” Mum’s voice, warm with affection and remembered pleasure, sounded as it always did when she spoke of her mother and father. I heard no note of sadness. At seven years old I could only imagine losing parents as the absolute of perdition, of aloneness. A thought like the abyss. Mum seemed to think dying was a natural part of living; it happened but death didn’t spoil life. Not for Mum.

Mum told me once of a tram ride she took one night from Fitzroy Street to the home of her uncle (and co-guardian) in Beaconsfield Parade. “I was visiting a friend in St Kilda. I stayed later than I intended and I almost missed the last tram. I just caught it. In the morning I read in the paper that a young woman was murdered overnight at that same tram stop. She was killed some time soon after the last tram – my tram – left… Ever since I was fifteen I’ve known that people die. Last night just wasn’t my time.”

When we children were teenagers, now living in Melbourne, Mum sailed to Britain or Europe. She always stayed in the cheapest hotel, choosing the cheapest room that had private bathroom facilities. Invariably her accommodation was in some seedy district. One time she discovered she was staying in a brothel.”I was safely locked in my bedroom, when I heard a sound from the door. I looked up and I saw the door handle turning. Then the door that I’d locked opened. I sat quietly. No-one came in. The door closed and I heard footsteps walking away. Next day a man I didn’t know asked me to sleep with him. He couldn’t speak English but he showed quite clearly what he wanted in sign language. I couldn’t speak his language – which might have been Kurdish. But I showed him in sign language the answer was no.”
“How did you ‘show’ him?”
“I took out my photos of you four children. I told him your names and your ages. Your faces must have changed his mind.” I picture Mum recounting with delight details of her brood, regaling a puzzled predator with biography, smiling and brimming with goodwill in her natural belief that blood was thicker than semen. I think Mum’s sunny innocence would dent anyone’s carnal ardour.

Another trip, this one around the time of the Cuban missile crisis: mum decided to travel to Yugoslavia. Friends tried to talk her out of it, reminding her of the Cold War. Mum said, “I know it’s an Iron Curtain country, but I don’t think it’s very iron.” People in Tito’s concentration camp in the mountains probably felt both the iron and the cold. Mum, blessed in her innocence, did not sense the chill.

One week before her 92nd birthday, Mum lay in her bed in Cabrini Hospital and breathed. Breathing was a labour as Mum’s heart was failing. Between small gulps of oxygen Mum chatted cheerfully with me and Miriam, a neighbour. Suddenly she coughed. And coughed again and again. Wordless now, Mum at up straight and took great desperate gasps, one after another. Quickly Miriam excused herself and left. I turned up the oxygen flow and called a nurse, who raced in and injected some diuretic into Mum’s drip. Minutes later Mum was gulping comfortably again. She pulled off her oxygen mask and grinned: “Miriam and the nurse both thought I was going to croak, didn’t they?” – huge crooked grin now, now laughing – “Well, I didn’t!”
After that Mum and I talked seriously: I asked her if she had any late – possibly last – wishes. Day and night in the hospital she had her two living sons and her daughter and a tribe of grandchildren with her. Mum never wished for more than that.

Even the smallest amygdala will not save you when your heart is shot. Mum lived a few more days before falling asleep and dying without fear.

Consider Phillip

By Posted in First Australians, Life, Medical Tagged , , , , , , , , , 2 Comments

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.