My Private Knee

After three months of physiotherapy and rest and exercises and anti-inflammatory tablets had failed to fix my injured knee, an MRI explained why: the outer cartilage was torn and the inner was tatty. I saw a surgeon last Wednesday and on Friday he repaired what was reparable and removed what was not.
 
 
The next day I sat on my couch in small pain, enjoying a liberal dose of self-pity. I had time and excuse to sit and live slowly. I read the ‘paper. A fellow citizen wrote to the editor in praise of Medicare, our universal health scheme. Her small daughter fell acutely ill and she hurried to the public hospital, where the waiting area was crowded and the public address announced the arrival of a series of ambulances. The delays would be long. However the sick child was assessed in Triage as urgent, was seen and treated expeditiously and expertly. By morning she was well enough to go home and her mother took up the pen in praise and thanksgiving. ‘How lucky we are’, she wrote, ‘to have such an excellent public health system.’
 
 
A second letter to the editor told the opposite tale. The writer suffered a limb injury and attended a public hospital. His injury was disabling and unremittingly painful. It was rapidly recognised as in need of early surgery. That was two years ago. His case is classified in the category of Most Urgent (elective). Every three months since he has returned to the hospital for routine appointments, where the diagnosis and the urgency are confirmed. His letter ends with a lament: ‘How can we kid ourselves we have a health scheme where Most Urgent can languish for years?’
 

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The writer and I both suffered injuries. Both of us received expert advice that surgery was necessary. Mine was performed within days, while my fellow languishes for years. My injury was minor but it did not feel trivial. For three months it hurt too much to run. I turned to the bike and the knee felt worse. Soon I could not walk without pain. I watched the muscles of my thighs wither and I lamented. Those legs had been my pride. I contemplated a life without exercise and I knew I would not know myself.
 
 
How is it my leg improves by the day while a fellow citizen suffers a worse problem and waits interminably? I cannot doubt the sufferer subsists on medication which is neither curative nor safe. By now he is surely addicted to his opiates. Why the disparity? The answer is my private health insurance, which, by dint of thrift and belief, I afford. Not everyone is so fortunate.
 
 
Even an unbleeding-hearted economic rationalist would see the disparity as just that, an inequality. I believe there is a solution which is not a new idea, but a forgotten one. I recall a politician by name of Don Chipp who became Minister for Health in the Liberal Government in the days before Medicare was sanctified, beatified and became untouchable. Facing the disparity, Chipp proposed government would underwrite the private health insurance of the poor. All citizens would be insured, all would enjoy choice of surgeon and hospital, the private health sector would expand and prosper through efficiencies that Public Health can never match, investors would rejoice and the Liberals would be congratulated in the polls. Meanwhile Most Urgent Surgery (elective) would be performed within a humane frame of time.
 
 
That scheme, which bore some resemblance to Obama Care, never came to pass. Labor rejected the necessary Means Test as ideologically repugnant. Chipp moved out of his party and created a third force in politics, which soon became a chronic and disabling pain to Liberal governments. Decades later my fellow citizen, uninsured privately, suffers privately, where he could be cured.
 
 

The Surgeon

This is an everyday story. We all know stories like this one.

“My friend never smoked but she had a cough. Her doctor said, “ Better have a chest x-ray.” The chest x-ray showed a shadow on her lung. The GP sent her to a respiratory physician. That doctor spoke with my friend, listing the possible diagnoses and explaining the process that would define the cause of her cough. She asked some questions. She was pretty scared, but she doubted she could have cancer: she had never smoked.

“My friend was sent to a chest surgeon for a bronchoscopy. She saw the surgeon in the operating theatre just as the needle was inserted into her vein for the injection that sent her to sleep. After the procedure she felt sleepy. She came home with a memory, or perhaps it was an idea she daydreamed, that the surgeon said: ‘Visit my rooms next week for your results.’ It seemed the sort of thing someone would have said.

“My friend’s husband telephoned the surgeon’s rooms and made an appointment. He accompanied his wife – who was still coughing – to her appointment. The surgeon appeared right on time, at 10.00 am, precisely. (The husband is himself a precise man. He notices things like that.) The surgeon gave them the diagnosis. They left the surgeon’s rooms at 10.02 am. My friend believes the surgeon said: ‘The biopsy confirms you have lung cancer. You need an operation.’ My friend’s husband confirms the duration of the visit and his wife’s recollection of the surgeon’s words.

“The next time my friend and her surgeon met they were once again in the operating room. While a nurse gowned and gloved the surgeon he gave instructions to a second nurse about instruments and the overhead lights. The surgeon had no time for conversation with my friend before she was anaesthetised.

“The morning following the operation the surgeon visited my friend and told her she was well and the operation had been successful. Three days of coughing and three nights of agonising pain followed. Morphine and Endone did not relieve her pain. On the fourth day the surgeon visited a second time and said, ‘You can go home.’ In fact she could not; she could not walk unsupported and every breath was followed by a wince and a gasp she had to stifle. A nurse arranged for my friend to convalesce in aftercare. Ten days later, still with her original cough that now shook her chest wound violently, my friend went home. Six weeks after the operation she was still coughing. It was time to see the surgeon again.

“My friend’s husband attended – her chest hurt too much to drive. He sat in the waiting room and timed his wife’s visit to the surgeon. He told me later: ‘Mr. S. beat his previous record. She returned to the waiting room in 30 seconds.’

“That afternoon I delivered some food my wife had cooked for our friend. She told me, ‘The surgeon said the cancer’s gone.’

‘Good’, qouth I. ‘ Great! Will you need chemo?’

‘He didn’t say.’

‘Will you have radiation treatment?’

She shook her head: ‘He never said.’

‘What’s next?’

“I don’t know.’”

As I said, an everyday story in this age of miracles and wonder. An everyday surgical miracle worker, himself a wonder of brutish mutism. What we do not read of is any disciplinary action taken by the authorities against the surgeon for his brutism.

Why not ? – I wonder.