Striped Socks

In late 1969 the new doctor emerges half-baked from his progressive medical school. After graduation he spends three years in residence in major hospitals. He emerges from that great womb and enters family practice, feeling underdone still. But he blazes into his new work in a rural general with a few guiding verities. He will not create distance from his patients. He will not wear a white coat. He will wear bright socks, a signal to the young that he too is – was – is young. He will not hold himself aloof. He will not frighten children.

 

 

He starts his work and his feet are rainbows. When he treats children he sits next to them on the floor. Instinct rather than ideology guides the new doctor: he needs to be close; he wants to do away with barriers.

 

 

On his very first day, the ninth of April, 1972, the new doctor delivers a baby, a little girl. He becomes a long-term friend of the new mother. Every April ninth he remembers and often contacts the ‘baby’ – long after she grows, graduates, becomes a musicologist, a linguist, a creator of Aboriginal dictionaries.

 

 

He keeps changing his colourful socks but he does not change his ways. So long as his patients are, for the most part, young, the thin membrane that separates doctor from patient suffices for safety; the blurring of the professional and the human nurtures both the doctor and the doctored.

 

 

A young mother passes terrifying nights seated by her firstborn, watching him, willing his breathing as he gasps his inbreaths and wheezes his outbreaths. She brings the child to the new doctor. His concern comforts her. In time the boy’s asthma improves. The doctor meets and treats all three of that young woman’s children. He is drawn to the three, the thin boys gangling, the coal-eyed little girl, a faun. The children do not fear him. These too he befriends.

 

 

A few years pass and the young parents bring Grandfather to the doctor. The young family have taken the old man and Grandmother in to their home, thoroughly alarmed by the pneumonia he narrowly survived during the previous winter. Sixty years previously that man survived gassing in the trenches. His lungs are ruined, he might not get through another winter. Would the young doctor resume his care? He does, and further friendships grow.

 

 

Grandfather survives a dozen more winters in cheerful semi-invalidism, dying eventually in his late eighties. Grandmother, born in December 1899, lives to see three centuries and two millennia, living beyond all arithmetic probability, dying eventually, aged 104.

 

 

 

The father of the asthmatic boy likes to run. He’s a graduate in Architecture, a landscape artist who turns to teaching maths. He teaches at a school fifteen kilometres distant. Sometimes he runs those fifteen kms, up and down hills, across a couple of creeks to the school in the valley. The teacher shows his doctor friend the secrets and joys of running sandy country tracks. Up hills they run, sharing vistas of white, off-white, pale grey, deep grey, their breath white in the frosty mornings. Summer sees the two up and running before the heat strikes. Sweat-born raptures bind them in close friendship. The doctor showers and dresses for work in the en-suite bathroom of the aged matriarch. He tiptoes past the old lady lying asleep in her bedroom, greeting her after she has awakened. 

 

 

 

Years pass. Decades pass. All are older now. The Medical Board sends letter after letter to doctors, warning them to keep proper distance from patients. The Medical Board has never had the pleasure of being a country doctor. The doctor wears his garish socks still, unconsciously. He knows by now the byways of health, the pathways along which he and patients alike, stumble; ways that lead slowly or rapidly towards the universal destination. He knows his own vulnerability to the pain of others, the sorrows that seep through a thin membrane; and the power of hope to seep osmotically back. He knows too the cases where hopes of cure are cruel illusion. He seeks in these cases to be a guide, to keep company with his patient his friend. That a friend not pass, lost or alone, into finality.  

 

 

 

The running friend becomes unexpectedly breathless. Time passes and he cannot catch his breath. Tests show a shadow on a lung. Other tests reveal a tumour in the bowel. The years of torment begin. Surgery, chemotherapy, surgery again, scans and biopsies that show a third disorder, a serious chronic lung inflammation, nemesis now of three male generations. The teacher painter architect runner friend – what word can encapsulate a human person? – must take strong steroid medicines to stay alive, to breathe.

 

 

 

The breathing man works on a new painting. He paints a square-rigged ship negotiating a strait. He paints the ship then repaints it. His work reaches no finality. He shows the work to his doctor friend, who comes – as he used to in the running days – for breakfast. That’s a sound in New Zealand, a fiord really. It’s called ‘Doubtful Sound.’ Captain Cook came to the entrance, felt uncertain whether he’d get ‘The Endeavour’ out if he were to enter. He felt doubtful and he named the place for his doubt.

 

 

 

The painting shows a tall ship heeling before a strong wind. Its bow points bravely into the wind. The wind bears it towards the reef that guards the mouth of the sound. The rocks are a maw, open, baleful. The sails are close rigged. This is a ship under strain. Relieving that strain is a smaller boat whose heaving oarsmen pull the larger one towards safety. The doctor looks at the picture doubtfully. He was raised on boats. He’s negotiated dangerous narrows, but he had a motor to see him through.

 

 

 

That small boat, that’s a whaler. I used to row boats like that as a boy, on the Thames. In earlier times the master of a square rigger would launch the whaler to sound depths, but also, to help the mother vessel in places where the going was tight. When he felt doubt that he’d make it through.

 

 

 

The cortisone voice crackles, phrases punctuated by breathing pauses. The creator looks at his unfinishing work. Artful brushstrokes of blue, of greys, of white, create waves, wake, bow-wave. The ship holds its own. In all the stresses and forces it has not reached finality.

Budget 2014

As a family doctor I’ve been thinking about the co-payment to be made for bulk-billed visits to the GP. It has taken me weeks to come to some sort of appreciation of what is going on. A surprisingly long time, really given that I have average intelligence and a keen direct interest. Let me tell you what I have discovered – three things.

The first is no-one has a very clear idea of how the system will work. Will it work like the GST where the provider of the service acts as the government’s tax collector? Will the literally penniless who attend a GP be seen and treated, or must the GP send that person to a public hospital? Or will we be permitted (thanks Messrs Abbott and Hockey) to treat that person gratis? WHAT IS CLEAR HERE IS OBSCURITY. OBSCURITY FATHERS CONFUSION, WHOSE OFFSPRING IS ANXIETY. THE POOR WILL GET SICKER.

I work both in middle class clinics where we bill patients privately and in outback Aboriginal communities where bulkbilling is universal and absolutely and literally lifesaving. Privately billed patients will hardly blink. Aboriginal patients will revert to the traditional healer. If you aren’t appalled at this thought please consider the case of your own child, 500 kilometres from a hospital, feverish, endangered, and effectively unattended. Dickens wrote of this plight in the London of his day. Messrs Hockley, Abbott – go bush, sit down, listen and reconsider!

Finally, I gather the bulkbilled will enjoy a safety net. After ten co-payments, the system bulk-bills them again, free of charge. Ten times seven equals seventy, equals 1 and a smidgeon dollars a week, equals less the cost of one icy pole every five days. Where’s the gain? The gain is derisory: that means BUGGER ALL help to the bottom line. The gain comes at the cost of derision. Messrs A and H hold us in derision. Where’s the pain? The pain is in the deterrence. Don’t go the doctor if you are poor. It’s not government policy. Where’s your mateship? Your citizenship? Your sense of responsibility? The age of entitlement is over. Get real. Get rational. Harden the f-up.

I know how hard hard can get. That condition is called rigor mortis.

Loss

My friend Paul Jarrett is a retired surgeon.  He lives in Phoenix, Arizona. A wise and humane man, Paul is now in his mid-nineties. Every day he sends a volley of emails that entertain, edify and enlighten me. Visited by a spark of memory, he writes:

A Moment in Time

There was a girl in our class at Phoenix Jr. College whose last name I could not recall until Catherine  McComb reminded me. 

She was remarkable in many ways, lovely, tall, brunette, bright and friendly, but pleased to help any of us duller students with our physics, chemistry or biology studies.  She was a lady of beauty, charm and talent.

Over time she married, became a columnist for the local newspaper and wrote under her married name.

I lost track of her during the war, but after return when I was in practice, I ran into her at St. Luke’s while making rounds.  She recognized me, gave me a hug and a kiss, broke into tears and left, crying, without saying a word.  I do not usually have that effect on girls.

I have no idea what that was about.  I wish I did.  She died some time later and I finally concluded that she must have just received some bad news about her condition prior to seeing and recognizing me.  I do not know to this day what burden she bore however silently.

The memory of an experience like this remains over a lifetime and although names may be forgotten, emotional experiences are not.  Whatever was hurting her, she did not deserve and I was powerless to help.  The scene flashes in my memory once in a while.  I am pleased that Pete provided me with her last name, but disturbed when I recall that last recognition and meeting.  Had she spoken to me, probably all I could have done was help her cry, and she did not want that.

This sparked something. I wrote back.

Dear Paul,

Your story moved me. It disturbed a memory of my own of an event that took place about twenty years ago. It is something I think about infrequently, but when I do so, it affects me still.

It’s nearly lunchtime and I’m running thirty minutes behind time. I collect the last patient from the waiting room. To my delight it’s Lucy. I haven’t seen her for seven years or so.

Ten years ago Lucy and her young husband moved interstate to serve their church full time as youth chaplains. She bobbed up a few years later seeking my help:  I have a problem no-one in South Australia can diagnose. So I’ve come back to Melbourne to see you. Lucy’s problem turned out to be an ectopic e. And she prayed for babies.

The babies, a boy and a girl, arrived soon after. And now Lucy is here today.

In this country practice the doctor treats the whole family. I was the family doctor. I knew Lucy’s father parents, a broad man with deep dimples in his wide face. He’d smile readily and his loose features would collapse inwards in genial embrace of whatever passed. He was the first of my patients to undergo hip replacement surgery.  He died in hospital of an infection. I looked after her sorrowing mother and the four girls. I treated Lucy’s younger sister for the fatigue illness that followed Dad’s death. Lucy was the eldest. She married and moved to a parish on the farthest edge of the metropolitan area, but when she was troubled she’d drive across the city and come back to the doctor of her childhood.

Then she and her husband Christian moved interstate and created a family and I haven’t seen them since. And here she is…

Hello Lucy, how lovely to see you.

Hello Howard. It’s good to be here.

Something is missing from Lucy’s face. The wide smile that always raced across her fine features like a flash of brightening is a small pinched effort today. Something’s up.

What’s wrong, Lucy?

I have a lump in my breast.

Lucy is petite, still slim after the babies. The lump in her right breast is easy to find and hard. My anxious fingers check under her arms. There is an enlarged lymph node in her right armpit. The same side.

Can you feel it, Howard?

Yes, I can.

Lucy looks up from the couch at her old doctor. Her small face looks terribly young, her little body swims beneath the white sheet. She looks to the old doctor, that old look from the time when doctor would make everything alright. Doctor feels suddenly too young, or too old, or too something for this news.

My hesitation tells Lucy everything. Her face speaks. She knows. She understands. Her voice is steady, calm: what will we do, Howard?

I’ll let you get dressed, then we’ll talk.

The things we will do are much easier than the things we must think, the things we must say or must not say.

I arrange an immediate mammogram and an ultrasound. I request a fine needle biopsy of the lumps. And I secure an appointment for Lucy to see a breast surgeon within days.

These phone calls consume the minutes. Today Lucy and I have ninety minutes; by a mistaken stroke of a receptionist’s cursor my lunch hour has doubled. There is time to describe the nature of a mammogram, its discomforts, its austere indignities, its impersonal delays and interruptions. There is time to describe the relative painlessness of a fine needle biopsy. A result will take up to a week.

We sit quietly for a while, thinking our thoughts. More precisely, Lucy thinks and I guess what at she must think: What will I say to Michael? What will we tell the children? How will I tell Mum? And my sisters? They’ve had enough of loss?  I think that I know that none of Lucy’s thoughts will be for herself, for the support that she will need.

I notice Lucy glancing at her watch: Have I made you late for something, Lucy? Your children?

A shake of her head: No, the kids are with Mum.

Tears gather, tremble, fall.

My children…

How old are they now, Lucy?

Michael is six, Hetty is four.

A pause. Lucy mops her face, blows her nose, a long unselfconscious, snotty blow. Then more tears: They might not even remember their mother. At least I had Dad until I was twelve…

Lucy, I think it is cancer. If so, it is serious. But we don’t actually know. We don’t know anything at this stage. I promise I’ll tell you everything that I know as soon as I know it.

Lucy gets to her feet and tidies her face again for the world outside. She thanks me and turns to go. She stops before my door, turns back and reaches, draws me into a hug. I hug back. Hard.

I have finished my hug and let go. But Lucy holds on. Her body is shaking. She is crying again, she will not let go. My arms are gentle around her. After long minutes, Lucy has finished. She steps back, looks up and says: That hug, that’s what I crossed Melbourne for.

Paul, I never saw Lucy again. Her specialist kept me informed. The imaging showed a tumour, the biopsies confirmed cancer that had spread to the lymph node. Lucy underwent mastectomy followed by chemotherapy.  Eight years later Lucy died. Her boy, Michael, was fourteen, her little girl was twelve. Old enough to remember, old enough to grieve.

Some time after Lucy’s last visit a routine letter arrived from the Medical Registration Board. It warned all practitioners against any contact with a patient beyond that necessary for their clinical management. I thought about Lucy. Paul, that hug was as intimate as it was chaste. It was important.

I told my wife about it at the time. And last week when I received your letter I spoke about it with Annette again. As I did so tears gathered in my own eyes and my voice thickened. I felt the pain more keenly than before. And Annette understood and she comforted me. Continue reading