Tag Archives: pain

The Price of Life in Doomadgee

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

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

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

I called a plane to take Sampson to Mt Isa.

Eight thousand dollars.

 

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

Eight thousand dollars.

 

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

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

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

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

“What about his mum?”

“She doesn’t have him. I do.”

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

 

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

The thermometer said: “39.9 degrees.”

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

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

“What about pain?”

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

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

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

I asked, “Is he your grandfather?”

She said, “Yes.”

“Will his wife come…?”

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

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

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

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

 

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

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

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

I said, “Please lie back if you can.”

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

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

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

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

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

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

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

 

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

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

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

 

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

 

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

 

***

 

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

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

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

There was not much to do, nothing medical.

I asked, “What happened.”

The nurse said: “Fifty dollars.”

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

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

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

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

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

Dying. Liberty. Law.

By Posted in Life, Medical, Opinion Tagged , , , , , , , , , , , 3 Comments

Philip Nitschke believes in liberty. In particular he believes in the right of a human being to die when he wishes to. He does not believe a government should trump that right.

I think, in principle – somewhat unexpectedly – I agree with Nitschke. Thus far.
I have seen my patients suffering intolerable pain that will not end. Governments, lawmakers, do not sit in the bedrooms of the dying. They cannot know how deeply disqualified they are here.
Nitschke has been a gadfly irritating the conscience of this country for decades now. I have felt an instinctive distance from him, quite unreasoned, candidly prejudicial. It was not until he declared (in response to questioning in a recent interview) that his philosophic touchstones are Camus, Marcuse and Nietsche, that my finger suddenly touched on the point of prejudice: Nitschke – Nietsche. The latter is a name to which no Jew can be insensitive. Like Wagner, like Eliot, a name carries echoes. I read Nietsche and I hear echoes of “Man and Superman”. Vibrating behind, the euthanasing of the ‘untermentsch’ in the Third Reich.
Nitschke thinks the euthanasing of people who are “tired of life”, as proposed in the Netherlands, is reasonable. The so-called  Groningen Protocol spells out criteria for infant euthanasia. The Belgian Senate approved by landslide proposals to extend euthanasia to children and to “people suffering dementia and other diseases of the brain.” The Royal Dutch Medical Association believes doctors can euthanase children because “a doctor’s primary duty of care is towards the patient.”
All this makes me shake my head. I know next to nothing of Nietsche, I have seen none of the context of the deliberations of my colleagues in the Royal Dutch Medical Association; I know nought of the Groningen Protocols (‘protocols’ – another word that echoes, echoes, echoes).
What do I know?
I know the problems of suffering are grievous.
I know that the ethical burdens are weighty.
I know just as severe pain cries out for relief, so societal dilemmas cry out for solution. People look to lawmakers to solve the problem by making a law. A law will be a relief, a slogan to comfort us.
I don’t believe that all problems can be solved by lawmakers.
I believe lawmakers have no right to legislate for one citizen to kill another.
I know there are some laws that some people will not carry out; and all too many others will.
I have no doubt that a society that authorises doctors to kill, kills trust in doctors.
Clearly what I know and what I think are insufficient. They are incoherent, not a policy, not a solution.
Human suffering cannot be outlawed.
Law is not the solution.
We are bound to pursue a solution.
But we might never find that solution.

The Man Who Had Cut Hands

By Posted in Childhood, Life, Medical Tagged , , , , , 3 Comments

A commotion from the waiting room. Raised voices, female voices, one shrieking, another, less frantic, also raised.

The frantic voice cries: Get him something for the pain. He’s in terrible pain. Get a doctor, he’s in pain.

Please don’t scream. Try to be calm. I’ll go and call the doctor… Here’s the doctor now.

The man who is in terrible pain lifts his hands,which are bleeding. Tall, in his mid-twenties, he has a scar that runs obliquely upward from his lower lip to the left hand corner of his upper lip. His eyes look yellowish. He bleeds from transverse lacerations on the backs of his hands. Both hands.

Odd.

 

In the treatment room the wounds are swiftly cleansed and anaesthetized. The man’s companion leans over the doctor’s shoulders squawking,  He’s in terrible pain. Give him something for the pain!

By this stage the doctor is busily suturing the numbed skin. The lacerations are jagged, roughly parallel, two on each hand.

Odd.

The young man’s companion is tall and thin, younger than he, agitated and relentlessly noisy.

The doctor looks up from his suturing, engages his patient’s gaze, asks confidentially, What happened?

Punched the windows. Both hands.

The doctor looks over his shoulder towards the injured man’s companion, still highly audible. He raises an eyebrow, asks: Was there a disagreement?

Bloody oath! It was her or the windows. I punched the windows.

The doctor thinks – wrong choice.

 

The young man’s skin is tough. It resists the doctor’s pressing needle. The doctor pushes harder, the skin abruptly gives way and the needle penetrates the doctor’s left index tip.

He pulls off his glove, washes the finger vigorously, asks over his shoulder – You’re not using any drugs are you?

Nah… hardly anything. Not now.

Are you injecting?

Nah. Not since I was inside.

The doctor scrubs harder.

The man adds: Look, you don’t need to worry. I haven’t got HIV. They test you before you leave.

The doctor looks unconvinced.

Look Doc, I’m clean. The only thing I’ve got is Hep C.

 

The doctor surveys the man’s hands: three lacerations down, one to go.

He asks the nurse for a syringe and a test tube, he draws blood from the wound, fills out a pathology slip, and sends the man’s blood for serological testing for a range of blood-borne infections.

In defiance of the law he does not seek consent from the patient. He scrubs again, re-gloves and resumes his suturing. He speaks: I’m testing your blood. I’ll give you the results when you come back to get the stitches out.

 

 

The wounds look tidy now, four curving rows of small black bows sit pretty as a flower bed against the thin red lines of closed lacerations.

 

The man and his lady friend leave without paying.

Only now does the doctor read the patient’s surname on the chart. He recognizes the name: he used to treat the man when he was a small child. His battling single mum did her best with the children. The sister turned out alright. Until today the doctor had lost track of the son.

 

The doctor sends off his own blood and learns that he has no antibodies against HIV, Hepatitis B, Hep C or syphilis. His patient does indeed have Hepatitis C. Now the doctor must wait three months to discover whether he has caught the incurable – and at this time, largely untreatable – liver virus.

 

The man who had cut hands never returns.

In the course of those months the doctor spends a lot of time in meditation.

The man who had cut hands was born in July 1972. Same month as my daughter.

He wonders about the birth of the young man.  Who delivered him? He asks his friend and celebrated senior partner, Dr. Donald Cordner: I met Rodney Blank the other day. I knew him as a kid. Did you deliver him?

Yes, I did… his sister too. What became of them?

The younger doctor fills him in. Then asks, You do believe in preventative medicine, don’t you Donald?

You know I do. What are you getting at, Howard?

Well I was just thinking – you could have saved lot of people a lot of trouble if you’d drowned him at birth.

Marathon Thoughts, 13.10.13

By Posted in Life, Running Tagged , , , , , , , , 4 Comments

Today I was to run the Melbourne Marathon, my 15th(?) Melbourne and my 43rd marathon altogether. Last year I injured a calf (leg, not poddy) and had to pull out at seven kilometres. I had never failed to finish before. It was a painful moral injury; the calf recovered but the moral wound did not. Today was to be my chance at redemption.

Forty three is a lot of marathons. Enough to learn quite a lot. I’ll list what I know for you. You never know when you might used them.

Running a marathon is hard. There are 42.195 kilometres to complete, equating to about forty two thousand steps. My car gets tired after 42.195 kilometres. The tough news is that every one of the 42,000 steps needs to be run.

Double knot your running shoes. Then they won’t come undone.

Apply Vaseline to toes, groins, armpits, scrota and nipples. Especially nipples. (Runner’s Nipple is one of the more dramatic running injuries. The nipples haemorrhage spectacularly. Why? Well, the nipple is an erectile little gadget. As you run, your skin heats up. Sweating follows, then evaporation of the sweat. Evaporation cools the skin, the nipple leaps to instant and enduring attention and the salty residue of the sweat on the nipple rubs against fabric. Forty two thousand wobbles of a breast result in a nasty dermatitis. Bleeding follows. Pain attends.)

Apply a curved line of Vaseline across your forehead, thus creating an eave, along which sweat can run to your temples. This spares your eyes hours of sweat sting.

Don’t run a marathon.

Having disregarded the last piece of advice, you’ll understand its compelling good sense. Corollary: if you run more than one marathon you are a person who persists non-sensible behaviour. Spouses and families will point this out to you.

Running a marathon damages your body. Within days or a week or two, your body will usually recover (The exception is the case where you die running the marathon, as happened to Pheidipides of old.) Do not imagine you are doing this for your health.

Running a marathon requires a lot of training. Racing a marathon – quite distinct from merely running to complete the event – requires a shit load (that is the technical expression) of training. Spouses (see above) do not generally like this. Sometimes you come back from a marathon to find the spouse has gone.

Running a marathon requires courage.

The marathon humbles everyone who attempts it.

The marathon runner discovers something about herhimself every time shehe runs it.

The marathon is an extreme test. Its extremity evokes extremes of feeling. Tears can flow.

The marathon runner who is forced to pull out due to injury within a few kms from the Finish is a tragic sight. In horse racing a steed that is injured can be shot on the track. A quick gunshot is an expedient that would be welcomed by both the injured party and those runners who witness that colossal grief.

(Death by gunshot is readily available in the USA.)

Plan to have a poo before you run. The runner has consumed megabites of carbs the previous day and all things come to pass. The alternative to evacuation prior to the run is to do so during. This wastes valued time. Unless, like the woman winner at Boston about twelve years ago, and like De Castella at Rotterdam three decades ago, you don’t stop when it starts and you go with the flow. In the case of the brave German girl, diarrhoea and untimely menstruation coincided. Unlike the runner herself, it was not pretty.

Although it must occur to about one in five females on a given race day I have no advice to offer regarding prudent management of marathon menstruation.

Trim your toenails a week before the event. Otherwise the nail might leave your toe somewhere between Start and Finish.

That is the totality of the wisdom I have to impart.

I did run today, I did finish – in brutal conditions – and I am requited. A little bit proud, self-amazed, a bit sore (I’ll be at my sorest the day after tomorrow), weary and happy. And very, very thankful.

Bullying in Fifth Grade

By Posted in Childhood, Life Tagged , , , , , , , , , , 1 Comment

Fifth grade is a long way behind us. The party is full of old faces. The boy I bullied back then walks towards me, his gait uneven, his face smiling. “Good to see you, Howard.”
Good to see me? Really?
“Hello Isaiah, great to see you. Hurt your leg?”
“Car accident, shortly after I got my Driver’s Licence. I was driving on the Hume. I hit a tree, hurt my head. I didn’t know I’d fractured my leg, not until three weeks later, when I came out of the coma.”
Three weeks in a coma! A shock.
“Will your leg heal?”
“They told me at the hospital I’d know after a year how good the leg would be. It’s been eighteen months…”
Isaiah leads me to a table where he takes the weight off his damaged leg.
“A single car accident. You’d know from medical school that a single car accident is usually a sub-suicide.”
“I didn’t know that.”
“Well it’s true. And I have no doubt that’s what mine was.”
I want to ask: what drove you to it? But the accidental pun will add hurt; and I am pretty sure I know the answer.

***

In grade five in our rural school, Isaiah is a philosopher and I am a social climber. Already taller than most of us by half a head, his hair a thicket of lustrous black, his manner professorial and his elocution like that of a news reader on the ABC, Isaiah is different. He wears glasses with wide black rims. He is an intellectual who is no good at sport; he’s neither rich nor fashionable nor popular. His voice is deeper than ours by a couple of octaves, a voice racing into puberty, but he is hopeless with girls.

It is fun to tease Isaiah for his mannerisms. We all do it from time to time and it raises a laugh. My social rise is based on performance, on raising a laugh. So I persecute Isaiah systematically. I organize a squadron of followers, to stalk Isaiah at recesses and at lunchtimes, and to chant my witticisms at his expense in a loud and public manner.

After one such lunchtime of bloodsport, Isaiah rises in his seat and addresses our teacher: Miss Redfern, allow me to introduce to you the Anti-Isaiah Army, organized and led by Howard Goldenberg.
Isaiah describes the marching and the stalking and the chanting, how the army surprises him in every nook and corner where he tries to hide. He lists the names of my volunteers and conscripts, he details the misery and humiliation, the desperation of his plight. Hearing this testimony the army deserts. Its generalissimo shrinks in shame, looks down, away from that tall figure, that crop of hair, that deep, true voice.

***

Isaiah’s speech marks the end of his persecution. He befriends me, confides in me. In his forgiving he heaps coals of fire upon my head. Neither he nor I speak again of the Army. School year follows year, Isaiah matriculates in unsung distinction and disappears. Three years on, he limps into my life at the party. He is glad to see me again. Really. He speaks and acts towards me as if his forgiving has been superseded by forgetting. As if his brain were injured.

***

The next time we meet we are in our sixties. Once again Isaiah is glad to see me, and I – glad in his gladness – feel relieved and warmed. And a strong need to be absolved. I tell him how sorry I am for my behaviour towards him in Fifth Grade. He searches my face for a joke. Or irony. Or mistaken identity.
Isaiah looks genuinely lost.
I explain, describing events that remain all too clear in my memory. Isaiah shakes his head, still crowned with its thicket: Howard I honestly don’t remember any of this. I do recall your friendship. I was grateful for it. Somewhere at some time over our lost decades someone has mentioned to me how Isaiah was one who suffered violence, real physical abuse, through his childhood years. Enough abuse, it seems, to obliterate the pain of small injuries perpetrated by Howard Goldenberg and his militia.

Copyright, Howard Goldenberg, 4 April, 2013