Tag Archives: suicide

What Does it All Mean? – V The Final Act

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‘TRIGGER WARNING’

The following post may distress some readers. Before reading, please ensure you have any supports you might need.

This hurts the most. 

If only, if only…

It happens and it hurts and the hurt can’t be helped; it can’t be talked away; it can’t be redeemed.

And when you lose the next one in this way, it finds you again unprepared, defenceless, bewildered.  

When I count those lost to me by their own hand, I find the tally low: three, three in over fifty years. These three, and two more who tried and who fell, falling, astonished into my outstretched arms.

The wound is not to my pride. The wound goes deeper. Petty pride stings at slights, but this is not slight. This one trusted me, that one looked to me, they stood before me in their naked grief and I tried to clothe them in my regard: You matter. Your life has value. Your unique being has meaning. 

I have been talking, I discover, to those who are beyond hearing. My words vibrate and pass, and unclothed and alone, the three take their leave. 

The first died for beauty. Believing herself dysphorically to be disfigured, she could not see the beauty all others could see in the photos her despairing husband took and showed her. Beauty cannot keep her lustrous eyes. She takes her leave, she takes her life. Her husband cannot take my calls.

The second died for lovelessness. Born a late child into a family already too full of children, born whole into a constellation deformed by the severe deformity of an elder brother, this one was never deemed to have needs. He called out for notice: Mum, I’ll be good! Mum, I topped the class! Dad, I was best and fairest! Mum, Dad they made me School Captain! Mum… Dad…

They never noticed. All their time, all their energy they spent on the other one, the one who couldn’t run, who would never read. Mum and Dad had no love to waste. The unloved one made himself lovable. I never met a more winning man. I noticed him, I regarded him. He won me. But mine was not the love he lacked.

Being lovable, being good, being the one who’d always try the hardest, he tried all I suggested; he took the medication, and the next medication. He accepted the referral to a psychiatrist, he engaged with the therapist, he accepted admission to hospital. He convinced the specialist he was recovering. He left hospital and he kept his appointment with me. He spoke to me in warm appreciation. He took his leave and, leaving me in false assurance, he took his life.

Twenty years pass and still I shake my head in bewilderment. So vital his being, so warm his blood, so much greater than both, his pain.

Of the last I write least. Two years on it remains too raw. Another who died for beauty. Ugly only in her own eyes, ‘unworthy’ of the lavished love of her parents. Unable to bear the hope with which I’d inoculate her, she separated herself from me in her final months. She died by her own hand. She died alone.

My feelings are not of guilt. Not being family to any of the three, I feel none of the woundof kin, none of that stab of accusation or anger. I cared for all three. They took from their scant stores of trust and they invested in me. I tried my best. It was not enough. We all lost.

Helen from Danzig

By Posted in Childhood, Family, Life, Love Tagged , , , , , , 6 Comments

Helen is ninety-three now. When she left Danzig in 1938, she was twelve. Every one of Helen’s grandchildren has quizzed her about Danzig for their roots projects and none of them has got much out of her. No happy memories, not a single friendship, nothing pleasant, Helen speaks of the place bleakly. Now adults, some of the grandchildren urge their grandmother to travel with them to visit her childhood places in Danzig. Helen rejects the idea categorically. No, she says dully, there’ll be nothing there. Nothing to see. No point.

Helen didn’t reach her present great age in such radiant good health by negativity. She’s creative and lively, she’s joyful company, fully engaged in her life and in the lives of all her generations here. It’s as if life began for Helen only on leaving Danzig. Australia embraced Helen and she embraced Australia. Helen’s Danzig was, it seems, a place of no life.

Sometimes Helen went to school in Danzig. Sometimes she didn’t go. She’d stay home where she wouldn’t be teased and frightened and humiliated. She’d stay home to feel safe. We asked her once, Didn’t you have any gentile friends?

I thought I did, she said. There was one girl. She was kind to us.

You need to understand. Mum helped Dad in the shop, every day. They needed someone to look after us girls, me and Mary. They found a family in the country who wanted their girl to move to the city, where she’d have greater opportunities. So she came. She learned to cook the kosher way. Mum taught her to sew and embroider. She became a daughter alongside us.

She worked in our house, helping Mum. Sometimes she took us to her own house in the village. We ate fresh bread there, with lard. We never had bread like that at home. When she married, we had the ceremony in our house. Mary and I were her flower girls. Then her husband joined the Nazi Party. Our friend left us. You couldn’t work for Jews…

I never learned anything in Danzig. School there was terrible. It wasn’t a place to learn.

***

Last night Helen put down the book she’d been reading, Her face was ashen. I looked and I saw ninety-three years of pain. She spoke: That’s a terrible story.

I asked what it was she’d been reading. She showed me the book:

‘Idiots First’, short stories by Bernard Malamud. The book belongs to me. I know some of the stories. I asked Helen, What story were you reading?

‘The German Refugee’. That’s a terrible story.

She spoke slowly: the word ‘terrible’ never had so many syllables before.

I waited but Helen added nothing. Her beautiful face slumped, her features collapsed. I searched her face for tears. Nothing. She looked down at nothing.

I held her for a while. The old lady grasped my arm, hard, as one might who is holding on. I asked her, What’s the story about?

It’s the story of a man from Danzig. He escapes, but he takes his life. Helen shook her head slowly. After what he loses in Danzig, he can’t live.

After a time she spoke again. I had an uncle in Danzig. He was very prosperous. We called him Uncle David. He had a mistress in Danzig. She wasn’t Jewish. When the Nazis came, she told Uncle she was breaking it off. It wasn’t safe. She ended it.

Uncle David hanged himself.

Helen stopped speaking. She looked at me, a child of twelve, wonderstruck by the evil of the world, remembering her uncle, remembering all the lost uncles. Out of her depth once more,

in her sea of sorrow.

Not Pittsburgh

By Posted in Faith, Family, friendship, Life, Medical, Travel Tagged , , , , , , , 9 Comments

I call and invite myself to visit with my friends David and Nancy in Pittsburgh. Nancy is a paediatrician and David a paediatric psychiatrist. Their lives in work are an inspiration to me. I get onto David. He’s welcoming and hospitable as always. ‘We’ll love to have you. What are your dates, Howard?’

‘Last week in October.’

‘That’s unfortunate’, said David, ‘I’ll be attending the meeting of the Academy of Child and Adolescent Psychiatry at that time, in Seattle. You couldn’t come to Seattle, could you?’

I can come and I do. And so I don’t go to Pittsburgh.

In Seattle, a sizeable city where the rain falls, coffee shops and bookshops abound – as in Melbourne. The coffee is good, just about good enough to compensate for the weather. Like Melbourne, Seattle is a UNESCO World City of Literature. I feel at home in Seattle’s mists and drizzle, with Seattle’s coffee and bookshops, and in the city’s richness of cultural endowment.

I attend the conference and I soak up the latest research into adolescent mental health. I see how my friend David knows everyone, how they cherish and venerate him, how the younger researchers find him inspiring. Over thirty years’ leading child psychiatry in Pittsburgh David has contributed richly to his field. Adolescents without number he saves from death by despair. A few years back I see him at his work, one-on-one with kids whose lives are blighted from the start. I see and I marvel at the pioneering work that keeps these kids alive and helps them thrive.

It turns out the Academy are honouring David, choosing him to give the Plenary Address. On occasions like this Americans enjoy pomp and formality. The Plenary is a grand event. Every delegate attends. A great hall fills. David and his fellow Illuminati – numbering perhaps one hundred – occupy tiered rows of seats facing the audience. The audience of seven hundred delegates and their friends and spouses fills the remaining rows. Oratory bursts into flower, moving with the spirit from Grandee, to Honoree, to Celebrity, to Worthy Worker. As Yeats wrote, ‘…all’s accustomed, ceremonious’.

I sit in the front, opposite my friend, myself aglow in his glory. David sits, pregnant with the words that will distill his wisdom. But before he will speak, we must hear from a Traditional Leader of the Peoples native to this area. Her name, we read, is Connie McCloud. A short, stout woman rises to her feet before us. She is not young. I notice her heavily tinted spectacles. You don’t need sunnies in Seattle; perhaps her sight is impaired. The woman does not move until a younger man with brown skin offers an arm, which she accepts, and she descends ponderously to the lectern. The President of the Academy introduces the speaker: ‘ It is an honour for me to present Connie McCloud to offer us her Blessing and her Welcome. Miss Mc Cloud has led her people, the Puyallup, for over thirty years.’  Someone adjusts the microphone to her height. Connie McCloud stands and regards us, visitors to her lands. She thrusts a fleshy arm upwards and she gives voice.

The voice is at one moment strong, freighted with pride and feeling, the next moment faltering beneath that heavy freight. The woman tells us proudly of her country, of its sacred mountain, its waters, its nourishing salmon, its deer, its skies and clouds and forests. ‘We have always been here! Despite all attempts to bring that to an end, we have always been here!’ The voice rises and the woman declares, ‘And God damn it, we are still here!’

She flings her stout arm backward and upward: ‘Our sacred mountain, which you will be told is Mount Rainier, is Tacoma. A newcomer named it for a friend of his, a magistrate named Rainier. Mister Rainier never visited these lands. He never saw our mountain.’  I’m reminded of Alice Springs, named for Alice Todd, absentee wife of the telegraph surveyor. The true name of that place is Mpartwe.

The speaker speaks of her lineage. She names her father, names his, then traces both to the brother of Great Chief Seattle. (As far away as Australia we’ve know that name for the lines attributed to him upon the imminent surrender of his lands: ‘Every part of the earth is sacred to my people. Every shining pine needle, every sandy shore, every mist in the dark woods, every meadow, every humming insect. All are holy in the memory and experience of my people.’)

At length Connie Mc Cloud says, ‘Here is my blessing. Here is my prayer for your success here in our lands. Here is my prayer that your wise people, your leaders, will find a cure for this suicide that takes away our young people.’ Oratory comes to its end as Connie Mc Cloud bursts into song. None of us non-native persons has heard song such as this. An ageing woman’s voice rises and falls, consonants and vowels sewn together into a strange fabric of slow rhythms and novel patterns, make their way into our stilled being. A sense of something solemn, something authentic and ancient and potent, penetrates us. The song rolls along, a river of sound that flows, from age to age, with steady pace, to its last syllable. We know a serious peace. I look up. David is mopping his eyes even as I do the same.

https://www.theolympian.com/news/local/article203194544.html

When at length David does speak, it is of death – of the premature loss of our young at their own hands. David is not a morose person. His rubicund features glow with ready playfulness. The life and the play reside alongside the gravitas of the protector of young lives. David’s theme this evening is ‘Saving Holden Caulfield.’  The reference is to Salinger’s The Catcher in the Rye, in which Holden Caulfield imagines himself as the catcher of children who tumble helplessly over a sheer cliff at the edge of a ryefield. David and his colleagues are the catchers below the ryefields from which our true life teenagers leap.

David begins with a light-hearted remark that I don’t catch. He twinkles and his audience relaxes. Then it’s down to business: ‘After all these years we’re seeing not a fall in teenage suicide, but a rise. After all these decades of research and treatment we’re not winning. It’s not as if we don’t know what works: research has shown us what works; we’re simply not implementing it. After these many years in the field my mind turns to retirement, to enjoying the grandchildren. But there’s that graph’ – David points to the rising line of trend on his slide – ‘and I’d like to see it point downward before I leave the field.’

David flies back to Pittsburgh, to Nancy and his children and his grandchildren. His house stands 500 yards from The Tree of Life Congregation where a family gathers on Shabbat to name their eight-day old baby boy.  A man posts on Facebook, ALL JEWS HAVE TO DIE. The man enters the congregation and the following are named among those who die:

• Joyce Fienberg, 75, of Oakland;

• Richard Gottfried, 65, of Ross;

• Rose Mallinger, 97, of Squirrel Hill;

• Jerry Rabinowitz, 66, of Edgewood;

• brothers Cecil Rosenthal, 59, of Squirrel Hill, and David Rosenthal, 54, of Squirrel Hill;

• married couple Bernice Simon, 84, of Wilkinsburg; Sylvan Simon, 86, of Wilkinsburg;

• Daniel Stein, 71, of Squirrel Hill;

• Melvin Wax, 88, of Squirrel Hill;

• and Irving Younger, 69, of Mount Washington.

Conversations

By Posted in Faith, friendship, Life, Love, Medical, Opinion Tagged , , , , , , , 2 Comments

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!

By Posted in Family, Life, Love, Medical, Opinion, Poetry Tagged , , , , , , , , 5 Comments

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.

Death Visits

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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.

On the Main Road

By Posted in First Australians, Life, Medical Tagged , , , , , , 5 Comments

Friday afternoon, the eve of the sabbath. Riding home from my shift in the Emergency Department at Alice Springs Hospital I would have missed her if I’d been abiding by the law. Luckily I was riding along the footpath when I came upon her. She looked about fifty but I reckon her true age at mid-thirties. Her large face seemed inflated, her eyelids puffy, her lips swollen, her natural flabbiness accentuated by deforming scars and oedema. The face was bronze in colour. Her gaze was inward – even when I was abreast of her, when I addressed her, I was absent to her. 

In all our minutes together we were never more than ten metres distant from people passing in cars and on foot. But in our leaden ballet we would dance alone.
She was shorter than I and a good deal heavier. The weight differential would matter when I’d struggle to lift her. I was a metre from her when I first registered her human presence. A slender tree at my right shoulder obscured her from sight. Abrupt movement caught my eye, a straining, forceful jerking of her thick neck and thorax as if she sought to escape. In fact the opposite was the case. 
The woman’s hands worked to adjust a cord that looped once around the tree then twice around her neck. I saw the cord and stopped. With all in place she suddenly slumped. Don’t! Don’t do that! – these were all the words I found. I flung my bike aside and threw myself towards the woman. She grunted but did not speak. My arms about her did not arrest her fall. The cord tightened. I remembered the knife in my lunchbox. As I groped frantically in my backpack she thudded suddenly to earth at my feet.  
A white cord floated down after her. The cord was a lengthy bootlace, the sort you pull on to tighten your running shoes. That slender tie would never support ninety kilograms of self nihilation.
Lying on the earth her silent body did not move. Was she breathing? A wave of alcoholic air reaching my nostrils answered that question. Was she conscious? I spoke. No response. I shouted. No answer. I placed my right thumb into the small bony notch above her eye and pressed hard. This truly painful stimulus evoked no movement, not a flinch. On the Glasgow Coma scale I reckoned her score at eight of a possible fifteen.
As I crouched in all my clinical perplexity an Aboriginal woman appeared at my side. Gesturing in the direction from which I’d been riding she said, The hospital is just back that way. Did I smile as I thanked her? I don’t know.
My lady was alive, breathing, intoxicated, apparently unconscious. In the long seconds since slumping she had not moved. What harm had her spinal cord suffered in that violent moment when the bracing cord arrested her fall? I could not know. My phone: where was it? Fast fingers delved and delivered from my pocket. I rang triple zero. The voice asked, Police, Fire or… Ambulance! I shouted. Ninety seconds after giving location and clinical details the siren sounded behind me. The vehicle pulled up alongside my waving, jumping body. A tall woman blonde woman alighted. She would have been in her thirties – like our patient, and unlike her. I answered her questions. A friendly smile lit her face as she said, Big shock for you, I’d imagine. This time I did smile. After a shift in Alice’s Emergency Department I’d become inured to shocks. The paramedic crouched over our patient and I heard her say: Hello girlfriend! as I mounted and headed home for the peace of Shabbat.
   

“I was never very good at Math. I was never so bad at Math that I bought a lottery ticket.”

By Posted in Life, Opinion Tagged , , , , 2 Comments

The maxim printed above was authored by Paul Jarrett, my friend in Phoenix. This ancient Phoenician is longer in the tooth than a sabre-tooth tiger and keen as mustard in the brain department. He locates himself as somewhat to the right of Barry Goldwater, an American conservative to make today’s Tea Partiers blush pink in comparison.
 

The Jarrett advice rings painfully true, not just of lottery tickets, but of gambling generally. I have seen lives ruined by the winning of a lottery; lives lost to suicide by failure to win at the track, the casino, the local gambling shop. I have known a stockbroker, a man of conscience and long experience, his retirement ruined by the depressive illness that followed losses – not his own, his clients’ – who gambled on the Exchange. I have seen desperate ugg-booted women in curlers, seated joylessly playing poker machines at 6.00 am.

 

Here’s a farmer that hanged himself on expectation of plenty…*

 

Last week’s paper told of a poor Sydney resident, shackled to menial employment by his immigrant’s accent, learn with resentment of a neighbour’s lottery prize. The immigrant kidnapped the winner’s son for ransom. In chloroforming him he inadvertently killed him. In one act the kidnapper lost his ‘prize’ and a father lost his son. In the next act the kidnapper lost his freedom for life. 

  

Paul Jarrett and Bary Goldwater

 I am in short, that miserable, un-australian being, a wowser. Like Paul Jarrett I was never very good at Math…

 

 

*From the porter scene in Macbeth

 

 

When Must we Disobey the Law?

By Posted in Asylum Seekers, In Detention, Life, Opinion Tagged , , , , , , , , , , , , 10 Comments

I have written previously of my colleague and friend Dr Paul Jarrett of Phoenix, Arizona. Paul is old, smart, a tolerant arch-conservative, highly principled. He has no time for those who break his country’s laws. The term he uses for such people is ‘scofflaws’, a bright word, new to my lexicon, pregnant with possibility.

We have scofflaws abroad in Australia. A month or two ago I read – and wrote – of the suicide death of the Tamil refugee Leo. He took his life, apparently terrified of deportation. Around that time, at a school in Adelaide, two star pupils were arrested, separated and flown abruptly under guard to a detention centre in Darwin. The two had been granted temporary refuge in Australia. Their status was now under active – and in the circumstances – ominous review. Stunned, the astonished school population, from classmates to teaching body soon responding with a public petition to end the boys’ detention.

Meanwhile around a dozen fellow Tamil refugee students at the same school took fright and took flight. They disappeared from the school and from the place where the authorities required them to stay.

The students broke the law.

Four weeks later the scholars remained at large despite attempts to find them. The South Australian Police, challenged to explain this failure of policing, expressed a Pilate uninterest: “As there is no report of a breach of South Australian law this is a matter for federal authorities.” Those authorities are piously named Department of Customs and Citizenship. Officials of the Department warn citizens not to aid, abet or harbour the scofflaws on pain of penalties including gaol.

I am a citizen, one of the warned.

The idea of scoffing at the law worries Paul, a thoughtful person. I always ponder Paul’s thoughts, reflecting as they do his ninety five years of living with eyes and brain open. Australia, like the USA, is a nation of laws. The laws constrain me and protect me. Scoffing at the law carries serious implications for our community.

Scoffing at laws is not new. Ned Kelly did it. Any of us who chooses to park illegally or to speed is guilty of disrespect towards that indispensible strut that supports society, which is our communal assent to be governed.

From time to time governments find laws inconvenient; the Howard government chafed at being constrained by the treaty granting rights of persecuted people to seek refuge on Australian soil. The government created a new law that excised parts of our country from Australia. In this highly imaginative act, the laws of our country removed parts of our country from the laws of our country.

Our legislators scoffed at our laws.

After the Nuremburg laws scoffed at the laws of Germany, certain citizens became non-citizens, subject to arrest, persecution and eventual extermination. Many of those former citizens took fright, took flight and sought shelter in the homes of their neighbours. Numerous German citizens aided, abetted and harboured those non-citizens. My people honour the memory of those scofflaws, whom we term ‘righteous gentiles’.

The words of the German pastor Martin Niemoller echo and echo again in memory:

First they came for the Socialists and I did not speak out – because I was not a Trade Unionist.

Then they came for the Jews and I did not speak out – because I am not a Jew.

Then they came for me – and there was non-one left to speak for me.

Niemoller spent the last seven years of Nazi rule in concentration camps.

Grateful that Abbott-Brandis Australia 2014 is so different from Hitler Germany, I wonder still how I will respond when a Tamil scofflaw knocks at my door?