Conversations

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

B wrote: Hi Howard,

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

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

Will you refuse me?

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

Dear B,

I cannot know…

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

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

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

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

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

I was right…

You asked would I help you.

I know I would try.

I cannot predict what shape my help might take.

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

But love will govern.

B again:

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

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

Let’s talk.

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

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

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

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

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

Hello F,

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

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

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

And that drive collides here with itself…

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

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

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

F resumed by email:

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

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

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

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

Your friend, F

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

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

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

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

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

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

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

Let Me Die! Help Me!

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

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

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

Eventually dying happens.

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

                                                The weariness, the fever, and the fret 

                                                Here, where men sit and hear each other groan; 

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

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

                                                Where but to think is to be full of sorrow 

                                                And leaden-eyed despairs –

 

 

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

                                                           Darkling I listen; and, for many a time 

                                                           I have been half in love with easeful Death, 

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

                                                           To take into the air my quiet breath; 

                                                            Now more than ever seems it rich to die, 

                                                           To cease upon the midnight with no pain, 

                                                           While thou art pouring forth thy soul abroad 

                                                           In such an ecstasy! 

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

                                                           To thy high requiem become a sod. 

 

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

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

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

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

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

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

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

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

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

No guarantees.

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

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

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

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?’
 

****
 
 
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.
 
 

Traralgon Marathon Report

Given the event took place over a week ago this report is pretty tardy. The truth is I have nothing to report.
If you’d asked me for my report thirty-nine years ago, I’d have leaped into print. Likewise had you enquired in June 1990, I’d have been bursting with news. In 2000 I reported on my run with Fidel. Even though he rode much of the way in my car, Fidel was awarded a Finisher’s medal as First Dog across the line. And in 2007 there was news of a different order.

But in 2017 I have nothing to report.

The Traralgon Marathon is Australia’s senior event. This year marks its fiftieth running. As well as being our first marathon, Traralgon is Victoria’s Country Marathon Championship. All in all a pretty lustrous affair. Competing under his nomme des jambs of Pheidipides, Howard Goldenberg ran his maiden marathon at Traralgon thirty-nine years ago. That year 181 runners started and 141 finished. I still have the official printout of the results. At the foot of the second of two roneoed sheets of paper (this report antedated the internet), you’d read: In 141st place, Pheidipides Goldenberg; time: 4 hours, 31 minutes, 31 seconds.

Every time I run a marathon I write one. That simple passage through time and space, so simple, so elemental, you mightn’t credit it worthy of remark. But every running feels remarkable to the runner. In the marathon the runner encounters the sole self, discovering some things that are unwelcome and others that make the runner feel a little proud. In a marathon, as Zatopek remarked, we all die a little. The event is charged with significance for this runner because the essentially solitary passage through time and space always involves encounters with others. It is the comradeship, the fellow feeling, the respect that elevate our experience. In that sense the marathon is a metaphor for our lives.

A watcher of the Barcelona Olympic Marathon might have caught images of the leading bunch of five as they passed their drink stop with seven kilometres to go. They had, running in intense humidity and heat, slowly outpaced a score of household names from Kenya and Tanzania and Korea and Japan and Australia. These five were the bravest of the brave on that particular day. One of these five, one only, would become immortal. Four of the five grabbed their special drinks at the 35 KM mark. The fifth grabbed and missed. And ran on, turning back being out of the question. The four drank and ran and drank again. One of those four passed his unfinished drink to the fifth. I do not recall whether the drink-giver won the event – I fancy he did not – but in that moment he joined the Immortals. In such small moments we see the glory of the marathon.
All this reads a bit portentously. Most running – and all of mine – is more comedic or shambolic than deep. In the field of my third Traralgon I sighted at the Start the esteemed and beloved Cliff Young, Australia’s most famous potato farmer, a previous winner of the Westfield Sydney to Melbourne Ultramarathon. Cliffy used to go on his training runs wearing his hobnail work boots. If he needed a haircut he’d trot the thirty kilometres from his farm to Colac, then run back home again. That day in Traralgon I wondered if I’d manage to get close to him. Around the three KM mark my legs became over-excited and accelerated and I hauled him in. Running a couple of paces behind Cliff I admired the light lacework of his tracksuit material. I drew closer. The lacework was in fact the work of a legion of hungry moths. Through the mothholes I could see and admire the pale skin of those spindly old legs.
‘Old men forget: yet all shall be forgot/But he’ll remember with advantages/What feats he did that day.’ Thus Shakespeare. It was in Traralgon that I ran my best marathon time. In those better years I’d usually finish in three and a half hours – not flash but respectable. Around 1990, everything went well. By the twenty km mark the field was well strung out, each runner alone with his thoughts and his hopes and his faltering strength. Somehow on this day only my shoelace faltered. I heard a slap, slap, slap – one slap at every second stride. I looked down; my right shoelace had untied itself. I stopped, resting my foot on the lower timber of a little footbridge. I tied the lace and cursed myself for the loss rhythm. 

Where strength falters it is rhythm that lulls the unthinking legs with metre that beguiles like music or poetry. I straightened and placed one foot forward, then the second, now the first, now the second. And here, quickly, rhythm returned. I ran on and on. I passed a browsing cow. She looked up and gazed at me, ruminating. I passed a lonely church. I counted cars parked on the verge, calculating numbers of worshippers.


Approaching Traralgon on the return loop I saw the smoking chimneys of the power station blackening the winter blue with coal smoke. Crossing the river I was welcomed by a pelican gliding overhead in his landing approach. I blessed the bird of good augury. After that I think I thought of nothing. At forty kilometres I felt weary and I cursed the distance remaining. I slowed, realising I was about to ruin everything. I never recovered my pace. I cursed my feeble will.

A short time later that felt like a long time I crossed the Line. My time of three hours and fifteen minutes and thirteen seconds was to be my best ever.

Four weeks before this year’s Traralgon I ran a brisk 6.2 kilometres on unforgiving concrete. I thrashed along, full of surprised pleasure in my pace. Later, when I checked the elapsed time (35 minutes) I was reminded how, nowadays, mediocrity is beyond me. After the encounter with the concrete my right knee started to hurt. The after-pain of running always reminds me of the achievement that brought it about. Pain always passes but while it lasts I smile with small pride.

In 2007 my elder brother Dennis, always thirsty for my company, offered to come along with me to Traralgon. With him Dennis brought a hitch-hiker, his flatmate and devoted companion, Sahara the Hound. Sahara was a dog I never managed to like. In this I came closer than most. For Sahara was a raucous, snapping, yelping creature, anti-social, sociopathic in fact. Sahara yapped and snarled her way into the rear of the car, lay down on the seat, growled a bit and fell into silence, then into sleep. For the duration of the two-hour drive Dennis and I spoke as brothers do, of nothing and of everything. We arrived, I registered and showed Dennis the Finish Line. ‘I estimate I’ll get here in four to four-and–half hours,’ I told him. My estimate was incorrect; I crossed the line in 3 hours, 45 minutes, beating the only other sixty-plus-year old male by a handy margin. In disbelief I checked and rechecked my time.

As ever, Dennis swelled with pride at the achievement of his younger brother. Here I was, 2007 Traralgon and Victorian Country Marathon champion (male, sixty-plus). I duly added the achievement to my Resume.

During the drive home, Sahara slept again. Again Dennis and I chatted. Dennis told me of a question he’d been mulling: ‘ I’ve decided: I’m going to have the operation, Doff. I’ll lose weight and I’ll be able to exercise. I’ll have more energy because I won’t have sleep apnoea anymore. The doctor says I’ll be cured of my diabetes.’ I misgave but said nothing. ‘Doff, I know you’re super-cautious. I’m the opposite. I’ll have the operation and I’ll get my life back!’ I hoped he would. Dennis went on: he’d complete his MBA in a month or so, he’d graduate then he’d have the surgery. After recovering from the operation Dennis said he’d revive his business.

Two months later Dennis graduated at the head of his class, with High Distinction. In September he underwent bariatric surgery. Fourteen days later he died of complications. Every June the Traralgon Marathon comes around and I remember.

In 2017 my training was the best for years. I entered, paid, arranged to travel with a support team comprised of a friend and his 11-year-old son. We booked overnight accommodation in Traralgon and I saw my physio about the oddly persistent knee ache. My physio, a gifted and devoted torturer, rubbed and pressed and stretched me. She prescribed exercises, with which – to our mutual surprise – I complied. And my knee hurt more. I had an x-ray that showed a pristine joint and a panel of four physios gathered in conclave before the light-box to advise me. I rested the knee as they suggested. I took the dicey non-steroidal anti-inflammatory medication that threatened my remaining kidney function. My physio taped my knee. I rested further and lost fitness. Two days before race day I could not walk to the toilet without pain. We cancelled the accommodation. The good people at Traralgon Harriers gave me a rain check to 2018.   

In 2017 I have nothing to report.
 
 
 
Footnote (kneenote, really): my knee feels better every day.

One Grandchild, One Sickness

A contemporary told me of a rule she and her friends observe at the monthly meetings of their luncheon group: “Only one grandchild, only one medical diagnosis.”

 

 

The rule struck me as wise. My grandchildren proliferate, for which I give thanks and tell stories and show pictures. This is a picture of my latest, Sadie.

 

 

Last night I visited Sadie’s house. To my good fortune she happened to be crying. My son passed Sadie to me and I placed her against my left breast. My heart beat at its steady 46 beats per minute and over the next few minutes I patted Sadie’s back in gentle diminuendo. She stopped crying. She rooted and tried to suckle. My collar proved unnourishing. After a while Sadie gave up on fluid and slept. I held her there, on my breast, for some minutes: was it twenty? Was it only five? I never felt more deeply alive.

 

 

So much for the one grandchild. Now for the one medical condition. Like grandchildren these proliferate as we age. I have lots. Every condition generates a story of compelling interest to the sufferer, and to the sufferer alone. Today’s was a visit to the periodontist. Have you ever been treated by a periodontist? If not I congratulate you.

 

 

In reality the periodontist is a dentist. The difference is one of specialisation. This practitioner doesn’t implant, doesn’t fill cavities, doesn’t do root canals, doesn’t make bridges. Nor even, in the usual sense, do extractions. Instead the periodontist extracts scale, plaque and whatever you have saved for your retirement.

 

 

Because the periodontist is truly a dentist she has lying horizontally on a jet age bed that rises and bends and straightens in response to unseen signals from the practitioner. Behind your right ear the practitioner keeps a small table upon which lurk small pointed instruments of hardened steel. These she keeps out of your line of sight lest you seize one, and in a reflex of self defense, you plunge it deep into her eye.

 

 

In short, periodontic procedures are notoriously painful. I took my seat this morning on the dental bed. The bed lay down and so did I. I opened my mouth. A bright light shone upon my face. I closed my eyes. At this point I ceased speaking. The periodontist looked inside. She said some gloomy things: ‘Gingival recession… pockets… these front teeth are loose, might lose them…’ She fondled my gums for a good time: ’I’m applying local anaesthetic jelly’, she said. I tasted something distinctive and highly unpleasant. I recognised the taste, one I remembered from the day in the bath in 1951 when my older brother pissed in my mouth.

 

 

Perio, as I will call her for brevity, now poked a hissing instrument into my mouth. I salivated. As the instrument hissed it cooled itself with a constant spray of watery mist. Fluid accumulated somewhere near the hole through which I customarily breathe. Perio probed, the gadget hissed and misted, the fluid level rose and for a time I breathed under water. This went on for a longish time, a form of dental waterboarding during which Perio asked repeatedly, ‘Are you OK, Howard?’ Each time I lied: ‘Yes, fine.’

 

 

From behind my left ear the unseen dental nurse waved a wand that hissed and sucked. Frequently this sucking instrument missed its target and sucked at my lower lip, a strangely sensuous experience. My mouth being open and full of fluid prevented me from thanking my unseen sucking kisser.

 

 

The bed became erect: ‘Rinse’, said the Perio. I rinsed. The bed collapsed and I took the hint. My mouth fell open and so, briefly, did my eyes. I beheld before me at eye level a long thin syringe of glass and steel, moving towards my gums. I’ve seen that sort of syringe before in movies in which a figure such as Mengele carries out unspeakable acts. I closed my eyes. My trapezius muscles clenched. My gums swelled hugely, all sensation fled and the balance of my hour passed. I drowned repeatedly. I rinsed, I spat. The bed erected itself, Perio said, ‘That’s it.’

 

Happily, I paid for her next BMW. I was happy because nothing hurt. I’m sure she’s not a real periodontist.

 

A Run in the Desert

The Alice Springs Marathon takes place on the third Sunday in August. Forgetting how cold the nights are in the desert Melbourne people marvel: ‘Oh, how can you bear to run in that heat?’

The temperature at 0630 this morning is three degrees. I manage that terrible heat rather well. But by the time I finish the day is warm, gloriously warm. Is there a more lustrous town in winter than Alice? The skies are blue – I am searching for an adjective – a blue to banish the blues. In winter, no haze, just light. The Macdonell Ranges dominate every prospect. Rugged, richly red-brown, frequently blanketed heavily in green, the colours mutating with the changing light. From one side colossal heaps of burning honeycomb, from the far side purples mauving to pinks, greens to slake a thirsting soul.

You look up and up, the walls of colour so close, so steep above you; you feel like singing praises; you shake your head at these ridges that dominate a town. Such immensity, such liberality, so close!
We runners set off in the last of the dark. The rock still black and near-blacks that will kaleidoscope and explode as we run.
As ever, on marathon eve, I made plans, plotted strategy, devised tactics. I wrote of these to John, my illustrious runner-in-law in New York: ‘This time I’m not running for survival, not running passively, aiming merely to finish. I’ll attack the marathon. I’ll run for a time: after my worsening Personal Worsts of Boston (five hours and nine minutes) and Traralgon (5.14), I want to beat five hours.’ I laid out my plans: dividing the 42.2 kilometres into four quarters, I would run as follows: first 11 kms in 70 minutes; second 11 km in 70 minutes; the next 10 kms in 75 minutes; and the final ten in 80 minutes. I concluded my letter to John with the words, ‘Man tracht, Gott lacht’ – ‘Man plans, God laughs.’
As in all my forty-six previous marathons I gave God a good chuckle today. He might have smiled as early as 2.48 AM, when sleep died and, with an excitable bladder, I arose early for early, and my day began.

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***
My younger daughter Naomi invariably issues two instructions on the eve of my marathons: ‘Have a good run Dad, and don’t come back dead.’ This year she adds, ‘Know with every step how I love you.’ Her anxiety peeps out and shows itself as I age.

I knew I’d have to harden myself against pain and fatigue. I would remind myself, whenever the going got hard, ‘It’s meant to be hard. That’s why we do marathons.’
As usual the field was rich in tattered and scarred males, blokes weathered and tempered by marathons run all over the country; and young women, girls really, all looking too tender to be serious. Yet I knew from experience these girls from Alice, outwardly delicate, are inwardly wrought of gristle and gut; I knew of old how they’d whip me. And today the Army turned out. A contingent of soldiers entered the race.

***
Last year I was injured. In my absence from the race they changed the course. Too deaf to follow this morning’s briefing, I know I’ll be in trouble if I find myself leading. Prudently I avoid that pitfall. After the Race Director finishes whispering his instructions, he raises his pistol. Bang! I’m not too deaf to hear that and I set off near the tail of the bunch to attack the Alice Springs Marathon.
After only two hundred metres, my breaths come fast and hard. I recall my mantra: ‘It’s supposed to be hard. It’s a marathon.’ One after another, runners pass me, as they should. My place is at the tail of the field. But I keep up my attack. In the course of my first two ‘quarters’ it will not be my watch that guides me but my breathing. I resolve to run hard enough to remain always short of breath.

And so I do.
Have I mentioned the beauty of this place? After only six winding kilometres we have left behind the town of Alice and run through Emily’s Gap. Like Honeymoon Gap, the name sounds rude, but the rich deep chocolate rocks grab my spirit and I have no thought for anatomy, none even for respiration; it is glory that transports me.

australianphotography.com

australianphotography.com

Past the ten km mark, I search for the end of my first ‘quarter’. I say to myself – I conduct lots of self-conversations during a marathon – ‘That’s a quarter of the distance done.’ But I reckon I’ve spent much more than that fraction of my strength. I find no comfort in these calculations.
Around the 20 km mark a blur approaches at speed from the opposite direction. Is this a duststorm? A willy-willy? No it’s my midget colleague and new friend Roxi, motoring fast on the homeward leg. This kid can run. She completed the famed Comrades run in South Africa while pregnant. Now lactating, she carries her biology lightly.

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Two Recipes for a Long Life

Recipe One
(Yvonne Mayer Goldenberg, 8 June, 1917- 7 June, 2009)

  
Eat only foods rich in butter and cream. Avoid any food that requires chewing, especially vegetables. (My mother was frightened by a vegetable as a child and never came near one again.)

Relax. Do not rush. Shun punctuality.

A lady who possesses the skill of changing a flat tyre should conceal such knowledge. ‘Why deprive some gentleman of the opportunity to behave chivalrously?’
(Mum believed in chivalry. As a child when instructed by her teacher to use the word ‘frugal’ in a sentence, Mum understood ‘frugal’ to mean one who saves. She wrote: ‘A lady was walking by the sea. A strong wind lifted her up and flung her into the waves. She could not swim. She saw a man on a white horse: “Frugal me! Frugal me!”, she cried. So the man leapt into the waves and frugalled her. And they lived happily ever after.’)

Rejoice in your kin; they are life’s benison to you. You will not have them forever. (Mum’s parents died in her childhood. Left with her younger sister in the care of her beloved grandmother, Mum cherished all her descendants with promiscuous undiscrimination.)

Smile. Nothing is so serious that it should furrow your brow – unless it hurt your little ones.

Talk to strangers, visit their countries. Walk the earth without fear. People are good.

Forgive your children their naughtiness. Indulge your adolescent children in their self-absorbtion. They owe you nothing; they give you all.

What you cannot cure you must endure – with a smile. (Mum’s hip was shattered in her twenties. For forty years she walked in pain, with a marked limp. She did not think to complain. Pain did not interest her. Likewise the disabling strokes she suffered in her last decades. ‘A stroke is boring’, she said.)

Decorate your life. Eat every day from your best china; use the good cutlery. (Which day will be better than today? Who better than the family to enjoy these things?)

Raise your boys to help. (‘Why should I be your kitchen slave? There is no pride in being a parasite.’)

Sex is good, sexual pleasure very good. Never boast of your conquests. Use a condom. (These last two dicta were delivered to her sons before the age of nine.)

Feminism is a mistaken impulse. (It arises from the absurd notion held by some that a woman could possibly be inferior to a man in any particular.)

Never open someone else’s mail.

Read. Meet new words. Look up every one in the dictionary. Read everything – the classics, the junk mail, the cornflakes packet.

Don’t fear death. Speak of it freely. (‘Death is a part of life, darling.’)

Do not fear harm. Fate is kind. Clothe your young in love but do not over-wrap them. Harm probably won’t befall them. Entrust them to the care of the universe.

Do not fear at all.

Recipe Two
(Myer Goldenberg, 5 December, 1909 – 10 September, 2003)

  
Fear everything. (Dad witnessed his friend die of electrocution when the stays of his yacht struck power lines. He operated on trauma patients without number. These events made him warn his children of the injuries that result from inattention or lack of care. One warning would never suffice. No number of warnings could suffice.)

Do everything. But take care. Sail, drive, use power tools. Never wave a knife around. Safety first. Safety last.

Fear nothing and no-one. No task is beyond you, no skill too hard to master, no knowledge beyond your reach, no person to be feared.

Eat vegetables. Overboil them first.

Be firm with children. Demand they meet your own high standards. Don’t coddle them in their minor ills. But if real harm come near, cross the country to protect or repair them.

Don’t let your children off lightly. But protect them ferociously from attack by an outsider.

Cherish your kin. Honour your parents. Honour your ancestry.

Honour your work.

Work hard. Keep going. Do not weaken.

Do not run marathons.

Be worthy. (Dad idolised his parents, particularly his father. Through his long life Dad wished always ‘to be worthy’. He meant worthy of his own father. Even in his eighties Dad fretted he was not worthy. I ached when I heard him speak so.)

Forgive. Never hold a grudge. Speak your anger then reconcile.

Never forget or forgive one who hurts your young.

Keep your words clean. Do not say ‘bum’, never say ‘bloody’. Forget ‘dick’. When you belt your thumb with a hammer, allow yourself ‘YOU BITCH!’

Exercise. Where you could drive, choose to walk. Walk fast. Your children can run to keep pace.

People are good. Life is good, health a blessing. Protect it with injections.

Do not fret about germs. They build resistance.

Breast feed. (‘They’re not just there to fill jumpers’).

Cuddle your children. Kiss them – the boys too. And not just in private.

Pass on your faith. Drill your young in ancient ritual and practice.

Tell the children Bible stories. Read those stories with passion and conviction. Pass on your heritage with love and pride.

Be proud. You are as good as anyone else. And no better.

Be authentic. Do not fear being different. Respect yourself and others will respect you.

Love your children. Succour them in your old age as you did lifelong when the need was real.

Show tenderness. A man can be soft and still be strong.

Tell the truth. Demand the truth. Nothing is more sacred than your word. Nothing nourishes better than trust.

Don’t arrive on time. Arrive early.

Never open someone else’s mail.

Work hard. Save for a rainy day. (Dad worked very hard. He practised medicine to the age for ninety-two and a half. To the end of his life he saved for a rainy day, never feeling the heavy rain upon him, never knowing the time had come to take shelter.)

Sing. Sing loudly. Sing with your children. Sing table hymns with your children on Shabbat; sing loudly in synagogue; sing sea shanties, sing nonsense songs. Opera is grand but Gilbert and Sullivan are brighter, more fun.

The compass needle on your boat flickers; at the poles the compass fails. Know your own True North. Follow it.

Embrace the sea. Sail, fish, and sing. Travel by boat at night, navigating by stars, chart and compass. Do not fear the sea. Never take it for granted.

Be vigilant. Experience the rapture of your mastery of an alien element.

Do not fear. Relax. Never relax your vigilance.

See the beauty, smell the ozone, relish this given world.

Thrill to the cresting wave, the heeling sailboat.

Surrender to the windless calm. Experience tranquillity.
Feel the caress of the sun, the bracing breeze. Both are good.

Give thanks. Be thankful.

Love your kin. Nourish them, work for them protect them, nurture them. Demand resilience.

Be brave. Be true.

When all is said remember the love.