Death Visits

Death visited last week, snatching away a lady whom we’d expected would recover. She was 87 years of age, a little disorganised in her brain, not vigorous but not too ill. We admitted her to hospital in the morning for observation and nursing care. Her elder sister had dementia too. She visited in the afternoon, escorted by her carer, a slim Asian woman.
 
 
At 3.00pm our patient enjoyed her afternoon tea. At four she took a nap. While asleep she stopped breathing. Big sister called us. Her cardiogram showed a heart attack. Her end of life instructions read: NO CPR. NO RESUSCITATION. She died. I left the dead concealed behind curtains and approached the living. I leaned and spoke clearly: ‘Your sister has just died in her sleep.’ It was the carer who fell onto the shoulder of her client, crying. The elder sister comforted her: ‘Don’t be upset. You get used to that.’ The calm features of the Asian woman twisted in grief, her face suffused. What silent sorrow of her own had been roughly torn open?
 
 
 
Meanwhile death had been stalking another two of my patients for days. I could hear his tread closing on them, unhurried, inexorable. For the younger of the two, death – release from her cancer – could not come soon enough. She begged, 'Let me die. Help me to die.' We gave her all we had, our promises of kindness, the usual feeble half-answers. She lapsed into a dull quiet, defeated by our timorousness.
 
 
The elder patient was far from ready. She had lived through the Second War in Europe, had seen much. Late at night she grasped my hand, breathlessly contriving a voice that filtered feebly through her oxygen mask. She pulled me close: ‘What will happen to me?’
I looked at her aged face, searching her: ‘Are you afraid?’
‘Yes.’
‘What are you afraid of?’
’Dying.’ She looked hard into my face.
‘You don’t need to feel afraid. When the time comes you will fall sleep. You will not suffer. You will sleep and you will not wake up. We won’t let you suffer.’
The old lady brought my hand to her chest and gripped it hard, pulling me closer. We breathed together in the darkness. No voice. Her smile said her thanks.
 
 
I went to my quarters and fell fast into sleep.  My phone rang. When the screen read ‘Unknown Caller’, I knew it would be the hospital calling. Surmise told me death had arrived for one or other of my friends. No, not yet. A third patient, more peremptory, had summonsed death by swallowing two weeks’ medications. With one hundred and forty tablets inside her she dictated to the nurse the disposition of her possessions: ‘Give my good overcoat to this one. Give the money that’s coming to me to that one.’ 
 
 
Sleep was slow to return. I lay and calculated the effects of twenty-eight strong blood pressure tablets, and an overdose of aspirin. I must have slept, for the ringing of my phone disturbed me. ‘Unknown Caller’ again. No, no-one had died. A child had a red throat.
 
 
Over the following hours of darkness ‘Unknown Caller’ rang six times. Asthma, wet lungs, fever. No death. At dawn the call hauled me from deep sleep: ‘Come now! Cardiac arrest!’ A large inert body, a small nurse pushing down hard, again and again and again. A flickering trace on the cardiac monitor, a chain of us thumping an unwilling heart, injections of adrenaline, a failed electric shock. No pulse at the wrist. I called a pause, the hopeful triangles on the monitor fell into a flat line. No breaths, no heartbeat. The husband of the inert figure stood, watching, his hand on his mouth. We tried again.
 
 
After a time I called a second halt. I listened for a heartbeat. I listened and watched for breathing. I shone a torch into pupils and found them wide with death. I walked across the room to the husband and said, ‘Your wife has died.’ A massive man, erect, he crumpled into silent weeping. His heaving trunk was enveloped instantly in the embrace of a woman I had not sighted. I spoke into the bereaved man’s free ear, ‘She didn’t suffer. She was unconscious from the instant she fell.’ The embracer’s arm groping blindly, grabbed me, held me hard in the grieving ruck.
 
 
At length I extricated myself. The small nurse from Uganda wiped his eyes. Another nurse said hoarsely, ‘I was at school with the husband.’
After certifying the death and writing my notes I left the hospital. Outside, the chill of an Alice Springs morning felt welcome on my skin. I wandered to a park and attended to my dawn prayers, delayed by a death.

After Boston

There is nothing sensible about running a marathon. It is a difficult thing to do. There appears to be a physiological upper limit of tolerance to distance running. At some point around 35 kilometres most runners experience a steep falling away in efficiency. Sports physicians suggest humans were not made to complete a marathon distance, which is a little over 42 kilometres.  
 
People die running marathons. While most do not die, or even suffer serious or lasting harm from the marathon, even a single death is one too many, given that there is no need, no practical purpose, to completing the full distance.
 
Running marathons is not even an efficient means to attaining physical fitness; you can achieve equal fitness with brisk walking as with running, and the risk to life and joints is far lower when you walk.
 
Earlier in my own marathon running ‘career’ (a suggestive term: it isn’t a career in the sense of something I do for a living; something that runs off the rails is said to ‘career’) I had the opportunity to go for a training run with the great Rob De Castella in Boulder, Colorado. Earlier I had discussed with sports doctors my experience – common among marathoners – of slowing radically over the final 7 kms of the race. The physicians had suggested that human beings weren’t meant to run that distance: there was the physiological limit I referred to earlier. De Castella, himself a sports physiologist, was educated by the Jesuits at Xavier College in Melbourne. 
After our run, exquisitely taxing at that altitude, I put the same question to De Castella. It was the Jesuit rather than the physiologist who answered: “If human beings gave up just when something became difficult we wouldn’t achieve very much, would we?”
 
That is the answer. In that nutshell is the reason that Paris and London will see tens of thousands compete in their respective marathons next weekend. It is for that reason that we love to do what we hate. I have run and hated and loved forty three marathons, in places as diverse as Boston and Alice Springs. I hope to run more.
 
If the marathon runner defies physiology the marathon watcher defies sense. In all weathers she stands outdoors and watches an endless, anonymous train of athletic mediocrities, watches for hours on end, feeding these strangers everything from jelly snakes to orange segments to fried snags. At her side her small child claps everyone who lumbers past. Her teenage daughter holds a placard that reads: YOU ARE ALL KENYANS.
 
My mother knew nothing of sport. Her lack of knowledge stood her in good stead for the marathon, indeed for any sporting event she witnessed. At the time of the Melbourne Olympics Mum took us kids to the fencing. She knew only that the swords were not lethal weapons, that the fencers’ precious eyes were safe. Those facts were enough for Mum. She barracked for the victor, she urged on the vanquished. She loved them both equally and generously.
 
IN 1956 the Olympic marathon course led from Melbourne to Dandenong and back to the MCG. The route followed the Princes Highway, which passed the end of our street. Mum stood and cheered every contestant on the way out and waited for their return. By that stage the runners were jaded and strung out. The leaders too were well separated. As the runners passed our street an American was leading. Coming second or third and looking tragic (in a way I came to recognize in my adult life) was a New Zealander. “Good on you, Kiwi”, were Mum’s words from the empty kerbside, a distance of only a couple of feet from the runner. Mum’s sweet urgings encouraged the runner, who visibly accelerated. Later Mum would say, “I helped him to win.” In fact the Kiwi did not win – Mum was no stickler for small facts – but she put her finger on a larger truth: he was a winner: he finished. He did his best.
 
It is in Boston that the runner and the spectator most truly meet. There the amateur runner is embraced by the uncritical spectator. She too is an amateur. She hasn’t a clue who is favoured to win; she has twenty seven thousand favourites; she loves them all. A literal amateur. Extraordinary statistic: of a population of three million persons in the greater Boston area, one million spectators come out to watch the race. The spectator comes out and she remains there, cheering, clapping, waving placards, uselessly feeding, encouraging every last pathetic struggler, every finisher, every champion. These three, as she well understands, are one and the same.
 
She was there, this ignorant dame, when I sailed past her, full of hope, energy, crowd fever and coffee early in last year’s race. She was there as I struggled up Heartbreak Hill. She was there in Boylston street to see the winners – man, woman, wheelchair champions (both genders) – as they crossed the line. She was there when the first bomb went off. Was it the first bomb or the second that took her life? I do not know. 
 
I know this: she will be there again this year when the race is run again; there in her thousands at the start, in her tens of thousands in the middle, in her weaving, praying throngs through the weary late stages, there among the ecstatic crowds that squeeze joyously at the kerbside as crazed runners find speed for the final gallop along Boylston Street. She’ll be hoarse and weeping as the untalented race along those cobblestones in their ragtag glory, arms pumping, heads high, fists aloft as they cross the line.
 
And what of the runners? We are wiser now. Inevitably, sadder. Running – that senseless frolicking of supposed adults will never be the same.
A record field will contest Boston in 2014. Terror will enjoy its limited success – some attention for a cause, or as seems likely in this case, no clear cause; some increased security, some minor oppression of amenity and civic liberty – but the lovers of Boston will meet and embrace as they always do, at this, their festival.
Running, our ceremony of joy, now sanctified, will always be the same, that familiar pointless folly. 
 

The Last Refugee

Imagine this. A disaster at sea, a lifeboat adrift, full of survivors, now despairing, now in hope, as land takes form through the mists ahead. A form is seen in the water. The boat comes alongside, the form is human and alive. The human extends an arm in supplication. Weary survivors take the limb and heave. The lifeboat, already heavily laden, tilts, takes water. The heavers persist in their heaving and the boat takes more water. A murmur within the boat swells to a cry: “Let him go!”

But the human is already aboard. The boat rights itself, the shouting subsides to a murmuring. The boat drifts on.

Imagine this: a second story. Australia prospers, confidence surges and trust becomes the settled order of things. Somehow Australia’s peoples lose their fears of difference, neither Sharia nor Tjukurrpa nor Kosher is imposed by any person upon any other person, but all are respected and all thrive. The leaders of the government decide to lead opinion rather than to follow it. They declare, “We who have plenty can take in those who have nothing more their need and their stories. Let us welcome them, let them come in!”

And so it comes to pass. Australia booms, its empty lands are claimed, cultivated and nurtured under the guiding hand of the first inhabitants. Australia feeds its peoples, feeds Asia, and prospers greatly. The seekers for asylum fulfil the promise that every newcomer brings. Australia accepts scores of thousands, who succeed in the new land and become part of the community. The community now takes in hundreds of thousands as History smiles upon the land and even the climate shows clemency.

The seekers for refuge are numberless, the land is vast, its resources seem endless. Eventually the land is filled. The flow of seekers for refuge slows to a trickle. It stops. All now are saved, all are safe. But wait! A boat. Aboard the boat are two persons. They extend supplicating arms. The peoples of Australia, accustomed to rescue, habituated and drenched in its ethos, wish to help. But their land is full. There is no room for newcomers. Australians squeeze up together, they wish to rescue those people who extend those arms. They make room, a little room: just one, one alone can be squeezed in. But there are two humans in the boat.

Imagine this: a third story. A lifeboat full of survivors of shipwreck drifts in an uncertain sea. This boat is full. Its gunwhales barely clear the calm surface. Whenever the seas rise all bail mightily to save the boat that saves them, and the boat remains afloat. The boat drifts on.

A shape is seen ahead in the water. As the boat comes alongside, the shape moves, cries, flings human words of thanks, raises an arm in supplication. All aboard the craft can see, all understand: “This lifeboat is barely afloat. If we take in this human his weight will sink us; every one of us – every human person – is lost.”

So much for my little stories. Readers of this blog are well acquainted with my pain, my outrage, my shame. All that old stuff. My eruptions of moral rage have brought a brief pleasure, a relief not unlike the visceral satisfaction of purging. But these explosions achieve nothing, convince no-one who is not already convinced, influence no-one in government.

A couple of years ago I spoke at an awards ceremony for defenders of human rights. I told my lifeboat stories. I pointed out Australia’s lifeboat is not full. I was grand in my flight of brave words and noble ideals. I carried the audience, which, led by two Federal parliamentarians, rose as one to applaud. Afterwards each of the parliamentarians, one a frontbencher in the government, requested a copy of my speech which they’d put up on their websites. One confided: ”You have said what we would like to say but cannot.”

What to do? What more to do? What can we – we powerless people do – beyond voicing our outrage, our shame, our grief? Firstly, we must continue to raise that human voice, to give human words to the suffering of fellow humans. That voice, those words, these are the marks of our being human. These words, the irreducible minimum:

Written in Pencil in the Sealed Railway-Car

By: Dan Pagis

here in this carload
I am eve
with abel my son
if you see my other son
cain son of man
tell him I

But what more? As my little stories suggest, ultimately we persons of good will – and I mean that to refer to my fellow Australians at large – sooner or later must face a terrible choice. At the end of all our rescuing there will always be one more supplicant, one too many for our resources, for our lifeboat. We will face a choice. This is Sophie’s choice, whereby we will chose one to be saved and send another – a human other – to perdition.

But Australia’s lifeboat is not yet full. So, what more, what wiser, what more potent act can we non-governors do? The answer cannot be simple, but our powers of imagination, of thinking hard and speaking softly, have helped in the past. Thus Petro Georgiou of happier memory, with Jozef Szwarc, softened the adamantine policies of John Howard. The image of a dead child floating in the shallows of Lesvos softened the policies of Tony Abbott.

I know of one small group in a faith congregation that has approached leaders of other faiths in an attempt to think hard together and to speak softly together to those who govern. State governors have spoken for their people, saying, give us the children; let them not return to offshore detention. Dr David Isaacs blew a whistle on his return from offshore that mobilised doctors and nurses at Melbourne’s Royal Children’s Hospital and now at Lady Cilento in Brisbane. The RCH refuses to discharge child patients to places of detention. We must understand that for what it is: the RCH is not some Marxist commune, not a place of sedition. It is rather an emblem in the state of Victoria. It stands for the highest skill and care. When the RCH speaks it carries Victoria. None gainsays its voice or its acts.

So, what to do? Think hard, confer, suggest, bring ideas to government. One idea, hardly original, strikes me as promising: let Australia progressively divert funds, currently used for offshore detention, towards a respectable, respectful supra-national staging and assessment process in south Asia. There we would maintain accessible, supportive consular representation. No-one would need to board a leaky boat, no-one would need to jump a queue, no human person would come to Australia and be called by a SIEV number. Our brothers and sisters would arrive with their own names.

We might save money, we might not. Neither governments nor we the governed see these issues in money terms: governments never count the cost when augmenting our cruelties; and we bleeding hearts never count beans. No, these issues are strangely unmonetised. The people of Australia hanker quietly to regain some self-respect.

Respectful policies will save lives. We might save our souls.

Do you have a better idea? Work on it, tell your minister of religion, your minister of the crown, the playgroup mothers, the neighbours. Governments need to follow. It is up to us to lead. We won’t save everyone, but we can hardly do worse than we do at present.

At the Hospital for Sick Children

A too large five year old fills a cot whose sides are raised. His limbs move unpredictably and without purpose. He plays with a six-month old’s bright rattle.

His Mum is Ebony, solid and calm, about thirty. She tells me some of the story of Simon, her boy, naming a heritable syndrome of faulty collagen that causes joints and bones to break or dislocate.

 

But Simon’s bigger problem is the stroke that affected him in utero. Ebony felt turbulent convulsive movements in her belly when she was 20 weeks pregnant. Her tummy had swelled excessively, a sign of polyhydramnios, a hint of underlying abnormality in her unborn child. An urgent MRI showed cysts in both sides of the baby’s brain. After Simon was born he suffered seizures. It took two years before the doctors found the right medications to control Simon’s fits.

 

Ebony tells me all this levelly, undramatically, without reflecting on the strain and the burden she bears for this child she loves. Somehow too, she shows me she is not denying that strain; simply this is Simon’s story; she, Ebony, is not the story.

 

Scanning the clinical notes I gather Simon and Ebony live alone. “What about Simon’s Dad, is he part of Simon’s life?” – I wonder.

“Yes. One day a week… he left six months after Simon was born. He said it was too much for him…he’s a social worker.” A smile, not bitter, but of learned knowing.

 

“I started studying Art while Simon was in Respite. My work is showing in Perth at the Biennale. I sold a picture!”

Another smile, this one of delighted pride.

“The man who bought it was a senior man in the government. When he discovered my opposition to our mandatory detention of refugee children he told me he wouldn’t have bought it if he’d known that.”

 

At my request, Ebony pulls out her portable picture gallery, a series of images on her phone. I lack the vocabulary for the power and originality, the life, in these electrifying images.

“I paint on paper in oils.” I can see from her phone how the oils give a vividness to Ebony’s pictures.

She continues: “I said to that government man, ‘You can have your money back if you want to return the picture.’ But he hung on to it.’” Another Ebony grin.

“And Mr. Morrison, the minister in charge of that cruel policy, he wanted one of my images for his Christmas cards. I said, ‘Sure. You can have the image free of charge. Just change your policy first.’ He sacked the man who took that message to him.”

 

I read Ebony my blog piece – “How We Killed Leo”. Ebony gasps when I read of Leo gifting his organs: “I knew Leo. Down Geelong way, we all did. We all loved him. Such a good person. I never knew about his organ donations. And now we’ve lost him.”

 

Two minds in unexpected harmony.

 

We look down at Simon who continues his sporadic horizontal calisthenics. His belly is large, oddly misshapen. As if it were filled with tumours. I ask Ebony some doctor questions. She shakes her head to all my questions until I ask about the boy’s bowel habit. “He hasn’t pooed for a week. Geelong Hospital sent me to the city because they know him here. They’ll do an enema here and then we’ll drive home.”

I make some calculations: nine hours from her door and back. Nine hours of time and waiting and caring. I look at Ebony and she smiles: “It’s a relief. As long as Simon’s alright…”

Dying. Liberty. Law.

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.

Let Me Tell You a Story

It’s about the Melbourne Marathon.

I know, I know, there’s nothing more boring to a non-runner than the idea of someone putting one leg in front of another about 42,000 times. And, yes, I did try to your patience with a little marathon piece a few days ago. Yet this is a nice story…

Last Sunday I ran the Melbourne Marathon. The weather forecast was for a horrible day – wild winds, light rain, thunder, more wind, hail. Hail!

We lined up for the start at 0645 and the weather was overcast, still, mild. Perfect for running. The forecaster lied. An attractive young woman approached me: Hello Howard. Remember me? You used to come to my shop in the city.

I don’t really remember: Yes, of course I remember! But I’ve forgotten your name…

Jeanette. Beaming, dimples in full flight: You helped me have a baby.

What a thought.

Jeanette continues: One day at the shop you asked me if I wanted kids. If I did I should not waste time. Thirty five was better than forty, you said, and twenty five was better still. I was thirty five. I did want children, we were trying, not succeeding. You sent me to the right people. We have a child, one only. IVF failed when we wanted a second. He’s wonderful. He’s Lucca, he’s six now. I work closer to home, Closer to Lucca.

I do remember now. I remember Jeanette serving in her shop, that smile, those dimples flashing above her burgeoning tummy.

We wished each other luck for the marathon and lost each other among the thousands.

The promised rain started at 25 kilometres, the slightest fall, a runners boon, like the quality of mercy ‘that droppeth as the gentle rain from heaven upon the place beneath’Still no wind. Blessed weather.

By 35 kilometres the quality of mercy had been eclipsed. Heavy rain, rising winds attacked slowing legs, cooling bodies. Brutal conditions for the final, always testing phase of a marathon. If self pity is the sincerest of human emotions, then I was desperately sincere at the 35 km mark.

Running a little ahead of me in St Kilda Road a young couple, both tall, slim, both wearing black, caught my attention. The young man leaned down and across and kissed the woman slowly, a tender kiss, gentle rather than passionate.

I slowed and the two disappeared ahead of me.

One kilometre later I came upon the young blackshirts again. They were walking, the man’s arm around the woman’s shoulders. As I drew alongside I saw she was weeping. Are you hurt?

A shake of her head.

Can I help you? Is it medical?

The man answered: No… Thanks for offering. She’ll be okay.

I jogged on, pondering. The marathon injures your body and your spirit. Tired, deeply deeply tired, cold, unable now to run, perhaps this girl is simply sad.

My own spirit had suffered bruising as I saw my target of four hours disappear, then my fall-back aim of 4.20. Even 4.30 was beyond my moral strength as I allowed the pacemaker lady to glide ahead. One resolution – to finish. Another – not to chase, not to torment myself.

The wind redoubled its force, the rain soaked us, we lifted slow feet in their Nikes, their Asics, their New Balances, which were once lightweight running shoes, now receptacles of water. We moved forward towards a Finish that we could not see.

An hour later? An age unmeasured, the MCG at hand, the Finish somewhere inside and a small lady just ahead of me carried her little flag that identified her as the 4.30 hours pacemaker.

Wise resolutions forgotten, I raised my knees, I swung my arms, I lifted my head, I raced. Through a tunnel, onto the MCG, following the armies in their soaked flags, I raced. Huge breaths sped my new legs. Around a bend, leaning into the curve, chasing my wild legs, I raced. And crossed the line, gasped, managed not to vomit and looked at the digits on the clock that said: four hours, thirty minutes and 18 seconds.

It was a long and shivering walk of four kilometres to my car. Enjoying the sincerest self pity, I was disturbed by a young lady on my right, who exclaimed: Dr Goldenberg! Do you remember me?

The same lie: Yes, of course.

Remember I came to you when I couldn’t get pregnant? You sent me to Dr Raphael and – look in the pusher – there’s Chloe!

Chloe, her round face pink and warm inside her rain spattered shelter, slept peacefully. I thought of my newest granddaughter, Ruby. Same age, same round face.

Yes, I do remember.