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.

On the Main Road

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.”

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?

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?

When Must we Disobey the Law?

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?

Two Flies on a Wall and Darky Harris

fliesWhen I was a boy I came across cultural truisms like, “Aussies will bet on anything; they’ll bet on two flies walking up a wall.” What I heard was something to celebrate, a playfulness in the Australian spirit. When I inherited from a great uncle a curious little plank with two identical circular depressions, someone had to explain this relic of “two-up”, a national pastime. It spoke to me of the irrepressible Aussies of  “Songs of a Sentimental Bloke”. As a more than commonly sentimental bloke myself, I was not disposed to judge or diagnose any malady.

In 1972 I met Darkie Harris. I was the new GP in an ethnically homogenous semi-rural community, an oddity in a skullcap. Somehow the community embraced and included me while excluding the pig-raising Maltese and my only co-religionists ‘the Jews on the hill’.
Darkie Harris differed from everyone and in ways solely his own. Unprepossessing, short, stocky, swarthy, with a face marked by scars and improved by large purpling lips and a vocal tone that ranged from a growl to a bark, he looked older than his fifty-four years and fiercer than anyone so old (I was then exactly half his age) had a right to look.
Darkie distinguished himself by a sort of verbal pugilism. By word and facial expression, and yes, by facial complexion, Darkie dared everyone he encountered to fight him.

What was it that Darkie wanted to fight against? One thing, one thing only. Racism: I don’t care if you’re a chinaman or an abo or a white man. If I cut you, you’re blood’s the same colour as mine.* Darkie was the only person in the town who saw this Jewcomer doctor as undifferent. In equal parts alarmed and charmed, I found I liked him. To most in town I seemed exotic, to some a too shiny exception (‘you’re not like the others’), to some an emblem of a nobility I never earned.

Darkie was retired by the time I met him. He’d take up his position on a bench outside the Chinese café and the fish and chip shop run by a pair of Maltese brothers. He’d sit and glower, softening into a winning chivalry towards women (a sweep of the hat, a flash of gaptoothed smile, “Good morning, Ladies”) and to engage toddlers in amiable conversation while uncertain mothers tried to hide their nervousness and drag their children away.
Darkie sat on his bench and kept vigil. He was waiting for the unguarded comment, any reference he could take exception to, any sneer at the immigrants he championed.
Young hoons and would-be thugs about town learned to shy away from Darkie. As he informed me on a number of occasions, I’d sooner have a fight than a feed. Darkie was referring to his younger self in the Depression days when he was a runner for an illegal bookie, a risky position in a volatile industry. But in 1972 his interlocutor would take Darkie at his word as he’d rise and stride, frothing, barking menacingly to confront the casual bigot.

Darkie never gambled. Those were not the risks he’d take. He described his working life as an honest buccaneer. He served his boss – some degree of criminal – honourably. He’d take the blows and deliver his own and he’d return home and hand his earnings to Joyce, his leathery wife, who subsisted in a cloud of tobacco. Before Joyce Darkie would humble himself, confess his escapades and worship.

The stories of Darkie and flies on a wall and two-up created the sketchy image I had of gambling in Australia. We must have had gambling addiction but I never knowingly met one. I knew dimly of the ancient rabbinic edict that disqualified a gambler as a witness in court proceedings because an addict could neither trust himself or be trusted by others.

In 1976 I went for an early morning run in Launceston, pausing to poke a curious nose into the local casino, a gruesome cellar where women in curlers and moccasins sat mechanically before fruit machines from six in the morning.
Shaken, I ran away.
For some years in the late nineties my younger daughter, a psychologist, worked as a therapist at Gambler’s Help. Her stories of human wreckage at our dinner table opened my eyes. In 2000 I met Alan, a shining youth who became my patient. He starred at hockey, graduated from his elite school, studied business, was recruited by a leading financial institution that trained him as a currency dealer. Two years ago Alan married his golden girl Helen, a primary teacher. They bought a house together in the regional city were she grew up. Neither Alan nor Helen yet realised the bank Alan worked for had trained him as one of their corps of gamblers.
A year ago doctors in the city’s ICU worked on Alan through a Saturday night and all the next day and night. At 27 years of age, Alan’s life seemed at its end, his blood pressure unrecordable, his breathing and heartbeat negligible. It must have been his hockey that saved Alan, his underlying fitness, that brought him back from where his overdose had taken him. After gambling away the contents of the joint bank account, Alan punted on the marital home and lost it. On a weekend when Helen was out of town for a friend’s hen’s night, Alan wrote a note and swallowed the tablets that were to end his self-loathing and his shame. Only Helen’s dog, locked out of the house all Friday night and Saturday, raised the ire of neighbours with her barking.

The marriage died and was buried in a divorce. In the settlement there was little to apportion: Helen took her dog, Alan his shame. His need, his comfort, his fateful hoping – I mean his urge to gamble – survives. It is a daily battle which Alan does not always win.

I turn on the TV to watch sport. Sport still has the power to inspire me, to express nobility, to create wonder, to delight, to unite and uplift. Before and after and between plays, the gambling industry shouts its messages of slim hope, seducing, reducing the game to mere exchange. It is not possible for a child to watch sport on TV without seeing gambling ads. I turn off and prowl my bitter old mind and think of Alan.

In these wrinkled years the past glows, the present moulders, the future threatens. We need someone to blame. That’s why we elect governments – there are some things you just can’t blame on your wife. In the matter of our gambling pandemic I blame governments. Governments bankrupt of funds fall hard for the revenue that streams from gambling. Soon the treasury is addicted to gambling. A few budgets later, we have a government bankrupt of judgement and ultimately of morality. In their lonely amorality, our representatives fall into bad company, the Gambling Lobby. Governments collude with the industry to prevent and foil the simplest attempts to ameliorate our national malaise.

Over two decades I have witnessed the card games in remote Aboriginal communities. Large numbers, women usually outnumbering men, sit on the ground beneath huge trees and gamble from first light to nightfall. Darkness falls and the players shift to the bitumen and sit on the roadway and play through the night.
In Arnhem Land once a nurse and I battled through a long day to save an underweight, undersized infant with life-threatening pneumonia, the child starved because his mother had no money for food. After the necessities – I mean cigarettes and Coca Cola – the young mother consumed the family income at the card games.

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