My Private Knee

After three months of physiotherapy and rest and exercises and anti-inflammatory tablets had failed to fix my injured knee, an MRI explained why: the outer cartilage was torn and the inner was tatty. I saw a surgeon last Wednesday and on Friday he repaired what was reparable and removed what was not.
 
 
The next day I sat on my couch in small pain, enjoying a liberal dose of self-pity. I had time and excuse to sit and live slowly. I read the ‘paper. A fellow citizen wrote to the editor in praise of Medicare, our universal health scheme. Her small daughter fell acutely ill and she hurried to the public hospital, where the waiting area was crowded and the public address announced the arrival of a series of ambulances. The delays would be long. However the sick child was assessed in Triage as urgent, was seen and treated expeditiously and expertly. By morning she was well enough to go home and her mother took up the pen in praise and thanksgiving. ‘How lucky we are’, she wrote, ‘to have such an excellent public health system.’
 
 
A second letter to the editor told the opposite tale. The writer suffered a limb injury and attended a public hospital. His injury was disabling and unremittingly painful. It was rapidly recognised as in need of early surgery. That was two years ago. His case is classified in the category of Most Urgent (elective). Every three months since he has returned to the hospital for routine appointments, where the diagnosis and the urgency are confirmed. His letter ends with a lament: ‘How can we kid ourselves we have a health scheme where Most Urgent can languish for years?’
 

****
 
 
The writer and I both suffered injuries. Both of us received expert advice that surgery was necessary. Mine was performed within days, while my fellow languishes for years. My injury was minor but it did not feel trivial. For three months it hurt too much to run. I turned to the bike and the knee felt worse. Soon I could not walk without pain. I watched the muscles of my thighs wither and I lamented. Those legs had been my pride. I contemplated a life without exercise and I knew I would not know myself.
 
 
How is it my leg improves by the day while a fellow citizen suffers a worse problem and waits interminably? I cannot doubt the sufferer subsists on medication which is neither curative nor safe. By now he is surely addicted to his opiates. Why the disparity? The answer is my private health insurance, which, by dint of thrift and belief, I afford. Not everyone is so fortunate.
 
 
Even an unbleeding-hearted economic rationalist would see the disparity as just that, an inequality. I believe there is a solution which is not a new idea, but a forgotten one. I recall a politician by name of Don Chipp who became Minister for Health in the Liberal Government in the days before Medicare was sanctified, beatified and became untouchable. Facing the disparity, Chipp proposed government would underwrite the private health insurance of the poor. All citizens would be insured, all would enjoy choice of surgeon and hospital, the private health sector would expand and prosper through efficiencies that Public Health can never match, investors would rejoice and the Liberals would be congratulated in the polls. Meanwhile Most Urgent Surgery (elective) would be performed within a humane frame of time.
 
 
That scheme, which bore some resemblance to Obama Care, never came to pass. Labor rejected the necessary Means Test as ideologically repugnant. Chipp moved out of his party and created a third force in politics, which soon became a chronic and disabling pain to Liberal governments. Decades later my fellow citizen, uninsured privately, suffers privately, where he could be cured.
 
 

Another Toby Emergency

A scream from the back of the boat, the scream of amazed pain. Now follow loud cries as Toby’s face rises above the transom. Tears stream down his face, uncharacteristically pale. At the point of his chin a gleaming carbuncle of deepest red rises to a meniscus, then overflows. Brilliant red drops appear on the white deck, tracking Toby’s path to adult rescue.

I apply my nearly clean handkerchief to the wound. Toby darling, press this hard against the cut. Very hard.
I’m sorry, Saba. I’m sorry.
No need to be sorry, Toby – just press.
I’m sorry. I’m very sorry…

My bottle-green hanky is turning red. A quick peek underneath shows a deep and gaping gash. The wound is irregular; it will need meticulous suturing to minimize the inevitable scarring.

Before we arrived in Metung I commanded the kids: NO RUNNING ON THE BOAT, NO JUMPING ON THE BOAT.
I’m sorry, Saba, I won’t do it again.

Pablo scoops his son into his arms and we run to the car. The patient, cocooned in his father, is stowed in the back. We drive into the little town to look for the doctor’s premises: the Village Store, a hardware and fishing tackle shop, the pub, a real estate office, a few coffee shops – these account for one half of the Central Business District; a u-turn brings us to the post office, a laundromat and a petite pharmacy. The pharmacist, a lady of my years, petite like her shop, is sympathetic. She advises, Yes, there is a doctor in town… every Tuesday morning.
Hmmm. Do you have surgical glue?
I don’t think so. I’ll look…
The search doesn’t take long. No glue. We settle for some stout Steri-strips, a gross of sterile gauze squares and a gallon of Savlon.
Across the road the door to Hardware and Fishhooks is locked. It’s only four PM, Friday. The sign reads, Open 9.00-5.00, M-Thurs. Fri 9.00-1.00.
The Village Store stocks food, suncream, the dailies, the Metung Meteor. Unless it’s a condom or a painkiller I seek, no pharmaceuticals. Do you have Super-glue? (Super-Glue is identical to Surgical glue; it’s packaged in crushable phials for single use, to discourage germs.) The helpful young cashier leads me to her hardware shelf. No Super-glue but we do have Araldite.
Araldite. I’ve never glued human tissues with this product. Will I try it on my grandson? I call the Emergency Physician in Alice Springs, where ED is full of my workmates. Yeah, Araldite will hold it, same as Super-glue. But it’s thermogenic. In an emergency, better than nothing, better than Steri-strips alone. Translated, ‘Thermogenic’ means the glue will heat the skin.

Back to the car. No doctor in Metung: we’ll have to go to Lakes Entrance. Toby lies quietly, eyes widening as I approach his wound. A wince, a gasp as I peel away my hanky of dark green and dark red, exposing a valley of flesh. Briefly bloodless, the wound fills quickly. Clean white gauze is applied. Toby darling, press again, hard. Here.
The child’s eyes follow me anxiously as he anticipates the uppance that surely will come: I’m sorry, Saba. I won’t do it again.

Driving back through town I wonder about the boatyard. They repair boats there, they must glue things. The Boatwright is helpful: Sure, Howard, we should have Super-glue somewhere.
The tube is not new. They have no other but needs must…

Pablo and I remove the patient and lie him on a picnic table, Pablo cradling the child’s head. Darling, we are going to put some glue on your cut to close it up. First I’ll wash the cut with this yellow stuff. It will be quite quick.
A splash, a yelp, a bit of quick mopping and a flow of fresh blood. It is quite quick – and quite hurty.

Now I’m going to squirt some glue onto your cut, Toby. It will be quite quick.
Pablo, pinch the skin edges closed… like this.
Pablo pinches – which hurts – as I peel away the gauze – which hurts. Toby’s eyes widen in fresh surprise, he releases a single gasp, half rises, then subsides. He takes deep breaths, slow breaths, as I squirt the glue – which hurts – and Toby breathes on. Through the following three minutes, Pablo pinches the skin edges – which hurts – and Toby, calm in his self-mastery, gazes trustingly into our close faces.
A few Steristrips bridge the narrow ridge of pink that was a cleft moments before. The wound is closed, and dry, more or less regular, messy in its scatterings of dried blood. It will heal and eventually scar.
Toby kisses his torturers and thanks us: You’re the best father, Papi. I love you, Sabi…I am sorry.

Postscript that might have been a Prescript: readers of this blog might recall an earlier, very lengthy post, titled ‘Toby’s Fingers in the Bath Hole’. A year after the Fingers in the Bathplug Story, we had the Batteries in the Ears story. Toby spent an afternoon in hospital for removal of hearing aid batteries trapped in his ear canals. Once in-situ, batteries create an enveloping oedema of the canal walls, a watery swelling of the flesh that neatly encloses the little discs. Toby is not deaf (not yet) and has no need of hearing aids or their batteries. But the batteries he found were just the right size, so…

Additional Postscript: Toby’s cousin Noah described the accident: Toby tried to get from the back of the boat onto the pier but his life vest caught on this wire and he fell when he jumped.
“When he jumped”: that must have been what Toby’s “sorries” were for. Not a forbidden jump at all, this was a jump from the boat, not on it.

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Phone Calls from my Dead Brother

My brother Dennis

My brother Dennis

This evening and tomorrow the family will mark the seventh anniversary of the dying of my firstborn brother Dennis. We’ll light candles and congregations will join us in remembering him.

Two weeks before he died Dennis underwent elective surgery. I wondered if the surgery was wise. Dennis, whose life’s creed was hope, assured me: ”Doff, this operation can eventually cure diabetes. It will transform my life.”
We spoke daily on the phone – he from his hospital bed, I from a hellhole town in the deep Kimberley. Day by day Dennis seemed to be doing well. But on day four he told me: ”I’m OK but my belly hurts”. A belly ache bad enough for stoical Dennis to mention was bad enough to alarm me.

Day five, no phone call. That day the pain was worse. Dennis collapsed, his circulation failing as his abdomen filled with blood and stomach acid leaking from his wounds.
At his bedside in Intensive Care the following day we counted the tubes entering and departing Dennis’ comatose form. One into his windpipe to make him breathe; a second into a great vessel to deliver information; a third to bypass his kidneys which had failed; a fourth to drain his bladder; a fifth and sixth into peripheral vessels to deliver fluids and the hero molecules that just might save him.
The greater the number of tubes in a patient’s body, they told us, the lower the chance he would leave ICU alive.
I sat at his bedside and I watched my brother. Behind the clicks and gusts of his life machines swelled the sounds of classical music. Annette, his loving sister-in-law, thought to play that music, those patterned sounds that ever soothed his troubled breast.
I sat there and watched as nurses, tender or tough, kept my brother alive. The tough ones, resentful of something – were we too many, was this medical brother too medical, that sister too exacting, that aged mother too accepting? – made me feel small, in need again of a big brother.

Dennis turned the corner: blood pressure held firm, sleeping kidneys awoke, fewer molecules were needed. The doctors conferred and announced: “We’ll let him wake up now and breathe on his own.”

Dennis breathed and slept on. We all breathed, went home and slept.
At four in the morning my phone rang. A crepitous, rustling sound, a broken voice in windy gusts: it was Dennis: “Doff, they want to njjhrnnujicxvclbkvn”
“Den, I can’t hear you. Say it again.”
Gales and crackles and Dennis’ voice in fragments: “Doff… inaudible… they…unintelligible…the tube back in.”
“Den, are you saying they advise you to go on the respirator again?”
More gasping, a desparate heaving of voice: “Yes!” More gasping. “Is it a good idea?”
“Den, it’s your best hope. Say yes.”
“Alright Doff.”

That was the final phone call. Dennis and I never spoke again. By the time I reached the hospital Dennis’ coma was renewed, the respirator breathing for him. Soon his circulation collapsed again, the doctors tried heart-lung bypass (“It’s only ever been shown to work in children. It’s your brother’s last hope..”) and on the eve of Shabbat Dennis died.

***

I can speak or write of Dennis dying with a composure that surprises me. Even my fatal advice does not trouble me. Perhaps it was not the dying of my big brother, but his living, that calls to me and troubles my dreams.

Toby’s Fingers Stuck in the Bath Hole

My wife Annette and I are having an early dinner when my phone rings. It is Rachel, our elder daughter: “No-one is hurt, everyone is OK, but I’ve called an ambulance: Toby’s fingers are stuck in the bath hole.”

I reckon I’m equal to this little challenge: ”Darling, just soap his fingers liberally then they’ll become slippery and he can just slip them out.”
“I’ve done that, Dad, and it didn’t work. I’m attending to Toby, but I need help with the other kids. Can you come over?”
“We’re on our way. We’ll be 15 minutes.”

In the car, Annette looks at her watch and calculates that Rachel’s brother, Raphael, will be driving home about now. He might get to Rachel’s before we do. She calls Raph and indeed he is only a minute away from Rachel’s house. He isn’t driving; he’s on his bike.

We drive into Rachel’s street which is blocked by two large fire trucks, a smaller fire car, two ambulances and a police car. There is no smoke and there are no signs of a motor accident.
We park at a distance and make our way on foot to Rachel’s house. Flung to one side on the grass is Raphael’s bicycle. Ahead of us the large torso and bum of a fire officer protrude from the bathroom window. The head and shoulders are out of view, presumably inside.
We make our way to the interior. A large man walks purposefully ahead of us, lugging a heavy timber box of plumber’s tools. From the narrow hallway an ambulance officer carries a plastic drink bottle into the bathroom. The bathroom itself is small. What with the toilet, the shower recess and the old-fashioned claw-foot bath, two is a crowd here. This evening the crowd is larger: the ambulance officer, a young lady, is leaning forward, passing the drink bottle to a male colleague who sits on the edge of the bath. The missing fireman’s face and shoulders are framed in the window, as he leans inward, observing and giving advice and instructions to another fire officer lying on the floor. This is another partial fireman, his face and arms invisible beneath the curve of the steel bathtub.
What he lacks in extremities and face he makes up for in length: this is a very tall fireman.
In the tub, drained of its bathwater, sits Rachel, her back to the door. On her lap is the skinny white body of Toby, aged five, a runt, a set of bones with a piping voice. One of his arms extends to the bath hole. His fingers are not seen.
The mother is reading a story to her child.

From the family room, children’s voices are calling: Toby’s twin, Miles, and their older brother, Jesse, have sighted us: “Saba! Savta! Toby is stuck. His fingers are stuck in the bath!
Look! Lollies! Raph is giving us a special treat.
The boys peel themselves from the arms of their uncle Raphael, who stands with his bare chest, wet with the sweat of his bike ride on this hot evening of 30 plus degrees.
Miles and Jesse pull at our clothing, dragging us to the bathroom, to see Toby and his missing fingers. They squeeze past the ambos, step onto the prostrate fireman and clamber into the bath. We follow them, secreting ourselves along the far wall and we greet Rachel. Raph stands behind us in the doorway.
Rachel smiles the smile that we’ve seen before, the smile that welcomes mere chaos that unseats tragedy.
Pasted over her fear, and threat and alarm, Rachel’s smile invites us to see and share the joke.
It is hot in the bathroom. Toby’s free hand wields a lollypop that disappears and reappears in and out of the recesses of his mouth. He cries out his greetings, his words emerging through a slop of saliva and lolly juice. He is having a pretty good time.

Rachel gives us a synopsis: “I called the ambulance and told them that Toby’s finger was stuck. These guys came and called the fire brigade. While I was on the phone, Toby’s free fingers were curled up and cramped, so he made them more comfortable by poking another couple into the plughole. Now there are three fingers that are stuck.
“The fire guys have all the right tools and equipment. They get fingers out of plug holes all the time. I didn’t know that bathplugs are a fireman’s specialty.”
The fire chief in the window frame elaborates: “Normally, a plughole is a ten-minute job. They’re all plastic nowadays. But this bath is a genuine antique, made of genuine steel. The plughole itself is probably made of toughened steel: it’s usually a disc about half an inch thick, with half a dozen circular holes, all of them just about the width of a toddler’s finger.
“The plan is to cut away the drain pipe. This will allow us to raise the bath from the floor, so that Steve can get right underneath and free Toby’s fingers from below. He’ll push up on Toby’s fingertips with his own finger.
If that fails, we’ll have to saw away the steel drain and free Toby from the tub, and then tackle the fingers.

“You and your family won’t be taking baths for a while, Rachel. This bath will be in pieces once we’ve finished here.”
I take a look at my watch. 7.45 pm. Toby has been in the bath for an hour and a half.
While we’ve been talking, the home phone has rung and rung out. My own mobile has rung unattended. Now Annette’s phone rings and it is Toby’s Aunty Naomi, calling from Sydney. She had called earlier, just when Rachel was racing between the stuck child and the other children and her urgent phone calls for help. Since that time, Naomi has learned sufficient to frighten, and nothing to comfort an aunt who has visions of fingers lost by strangulation or by nightmare surgery. Naomi has no children of her own yet and she loves her Melbourne nephews and niece with an intensity which increases with the distance.

Naomi asks to speak to Toby. “Toby, would you like me to sing Rainbow?”
Toby nods, his mouth occupied by his lollypop.
Rachel switches the phone to Speaker and says:
” Toby is busy with a lolly. He does want you to sing.”
Naomi’s voice floats into the bathroom.
“Somewhere, over the rainbow,
Way up high…”
The phrases float, spacious, into the bathroom, the words a familiar caress for the boys at their bedtime. Naomi’s singing voice is a sweet soprano, usually crystalline. Tonight the voice is thickened with an unfamiliar tremolo.
“ there’s a land that I heard of
Once, in a lullaby…”
Toby is transfixed. His brothers are still. Three lollypops are held, suspended, while Naomi sings.
All conversations stops. The lengthy plumber pulls his face out from under the steel belly of the tub. His face is wet with sweat. Bathroom lint clings to his chin and brow. He lifts his head and listens. The ambos and the fire chief stand, arrested. The voice rises, crests a high note and falls. The singing undoes us, soft family and hardy professionals alike.

A skinny woman appears. She is Laura, Rachel’s best friend. Alarmed by the emergency vehicles congregating outside, she races in: “What’s wrong? Is everyone alright? Can I bring food?”
She listens, looks, offers cuddles, kisses the air with her famous loud smacking sounds and leaves, disappointed not to be catering. Laura makes me laugh, always has.

The tall man pulls his head in again. The Chief hands us a hacksaw. We pass it to the tall man. We hear sounds of sawing, long metal screams.
Alarmed, Rachel wonders aloud about Toby’s fingers: are they safely out of the way of the singing blade? The Chief says: “Don’t worry. Steve knows just where to cut. He leaves a margin of pipe just shorter than his own index finger.”

At length the drainpipe is sawn through. Everyone gets out of the bath excepting for Toby and Rachel. Annette, Raphael and I make room so the bath can be lifted. Eight adult hands hoist the tub aloft. Toby squeals with delight as he levitates.
Steve’s voice comes from the floor: “Toby, can you wriggle your fingers?”
Rachel and the ambos relay the request. Toby says, explaining the obvious to the unintelligent, “I can’t. They are stuck.”
The voice from the floor warns Rachel that he is about to push Toby’s fingertips upwards from below. Steve pushes, Toby says “Ow! You are hurting me!”
Apologising, Steve has another try and Toby cries:”Stop it, you bumhead!”
Steve stops.
The Chief retires to the fire truck, returning with some new cutting equipment which he passes to Steve. Steve now sets about cutting free the metal disc with its six perforations and its three child fingers.
The Chief invites Jesse and Miles to come and inspect the fire truck. He shows them the hoses and the heavy brass fittings, then hoists them high into the cabin and places them onto the driver’s seat, beneath the steering wheel. In the massive truck they are very small.
The Chief points out the siren, the two-way radio, the switches that elevate the ladders and all the usual automotive controls. Two boys are in paradise. I remove them before they drive off in search of a fire.

Back in the bathroom, Toby is pacific once more. He sits in the tub in his mother’s arms watching a DVD. The ambos take turns holding the portable screen at the right distance for Toby’s comfort. The DVD is in a language foreign to the ambos and fire crew. It is “Bob Esponja”, Sponge Bob in Spanish.
Now his brothers clamour to watch too. Raphael and I take them outside and hoist them onto the window sill recently vacated by the fire chief.
All of this takes place well past the bedtime of such small boys as maintain a normal, detached relationship with their bathtubs.
The boys watch and translate for the ambulance man and lady, Ross and Joelle (‘call me Jodie’) respectively. It is a cultural treat for Ross and Joelle, who have only previously enjoyed Sponge Bob in English with respective nephews.

It is about 9.00PM when the plughole with its nubbin of pipe and its heavy perforate disc is freed from the tub. Sponge Bob has finished. Toby looks at his naked self and the empty tub. He says mildly: “I am ready to get out now.”
Rachel rises, her bum and thighs numb after three hours, cradling Toby and his massive steel bracelet as she does so.
Escorted by Joelle and Ross, they make their way to the kitchen. Here Annette has covered the kitchen table with towels and a pillow for Toby’s head.
Annette takes Miles and Jesse to their bedrooms. Their protests are audible from the kitchen.
Jesse appears in the kitchen. He says,”I can’t sleep. I’m too worried.”
Somehow Annette persuades him to come back to his room. She lies down alongside him and tries to help him relax.

Now the Chief produces a narrow strip of steel blade, about a foot long and an eighth of an inch wide. Its surface is roughened and irregular; it looks like steel with acne. The Chief explains: “Diamond saw. It’s the only thing that will cut through that steel.”

The Chief threads the stiff blade between Toby’s index finger and the inner edge of the steel annulus. The sharp edge of the blade is applied to the steel and moved up and down. It seeks a niche or crack to bite at hard, but the steel is obdurate and the blade bounces off it. The Chief tries again and again. He is relentless. Steel against steel, the Chief versus the disc.
An exquisite Argentine proverb of Toby’s father, Pablo, runs: con paciencia y con saliva, el elefante se cogio a la hormiga.*
Over the next long time, the Chief will need all the patience and saliva he can muster. He sneaks the blade between the hard steel and the soft boy. The blade makes glancing contact with the disc, leaving a fine scratch in the steel. Now the blade comes again, finds the line of scratching and attacks. The linear scratch deepens minutely. It is nothing like a fissure. Many more passes of blade, many minutes in which Rachel braces Toby’s hand against movement. Rachel searches the face of the Chief. Is he discouraged? He is not. He is the elephant seducing the ant. He presses on.
The room heats up, the disc heats up and Toby protests. Now Jodie produces a green gadget and shows Toby. It looks like a fat whistle. “You put this in your mouth, Toby, and you breathe in. Then your hand will feel good again.”
Toby takes the toy, breathes in and out, relaxes and smiles. He likes his inhaled narcotic.
More laborious sawing, more minutes pass, many single tedious minutes, dragging themselves into hours. The disc is hot, the Chief is resolute, the ambos take turns positioning Toby’s wrist and the Toby rescue industry hums on. Eventually – it is around 10.00pm – Toby becomes fractious. He addresses Jody, the wrist-bearer of the moment. “Put my hand down.”
Jody explains: ”We have to hold it up high to get your fingers out, Toby. It won’t take long.”
Toby is not placated: “Stop it, bumhead!”
Bumhead’s offsider, Ross, gives Toby another suck of narcotic and he subsides.

A further half an hour passes, half an hour of sawing, story reading, perspiring and concentrating. The cluster around Toby and his still buoyant mother falls eventually into speechless reverie. Each person in her own thoughts, each concentrating on three thin fingers that remain pink and on a small boy’s face, pale now with medication and fatigue.

There is a bloke at the front gate who wants to talk to any member of the family. I am greeted by a shortish man with a warm smile and a huge camera. He’s from one of the TV stations. He apologises for his intrusion, he hopes he is not causing distress, would any member of the family be prepared to describe what is happening? I answer, “No.” The man accepts this gracefully and walks away.
I retrieve a phone call. It is Pablo, Toby’s aphoristic father. “Howardo, what’s happening? Is Toby OK? Should I come home?”
Pablo is up country, the indispensable leader of his team’s annual residential seminar. He is out of town but painfully in touch. It tears him in two.
“No, Pablo, Toby is safe and cheerful, his mum is cheerful and the house is full of fire people, ambulance people, family, friends and kibitzers. There’s no physical space for a mere father. OK?”
Pablo is OK, just. I am to ring back later with more news.
Back inside, Toby stirs, complains: “My hand feels uncomterful.” Jody confers with Ross, then turns to Rachel: ”We can’t give Toby any more of the painkiller in case it depresses his breathing. Any further doses need to be given in the Children’s Hospital, with anaesthetic and operating facilities.”

Rachel flows into action. She kisses her other boys goodnight, tells them that Toby will go to the hospital to get his fingers out and he’ll come home soon. She grabs Toby’s teddy bear, a couple of books and another DVD.
Toby says a warm goodnight to all the emergency people, not excluding bumheads.
Rachel wraps Toby in a rug, marches from the house into the open ambulance, concealing her son from the TV camera, and in a moment they are away.

I follow in my car. I work odd night shifts in the Emergency Department of that hospital. I might be useful in some way; I know people there.
By the time I arrive in Triage, Rachel and Toby are nowhere to be seen. The nurse in Triage seems to expect me. “Go into the Minor Procedures Room, Howard. They’re all in there.”

Indeed they “all” are. There are Jodie and Ross and a new fire team. Steve and the Chief and our previous team only do outpatients, it seems. The new bunch comes from another fire station and they do the inpatient jobs. There is a firelady and a fireman, both selected, surely, for their tenderness towards children. The fireman is as tall as Toby is minute. He looks at me, I look at him, Rachel looks at him. He says, “Hello Doctor Goldenberg. We met at your clinic. I married your patient, Robyn. Do you remember?” Indeed I do remember. He is Nick. Rachel is looking at him hard and long because he is so good looking.

Nick has no hand for me to shake because his are occupied with an intriguing apparatus, whose principles he at length will explain. The principles are alarming.
Meanwhile I meet Lucy, who is operating a portable DVD player for Toby, who sits in his mother’s embrace on an operating table. Toby grips his pale blue teddy bear as he always does – with one of its arms in his mouth. Every night that bear develops a soggy upper limb. The bear keeps Toby company through his hospital stay and then disappears, forever lost. Bearnapped, we suppose.
There is a nurse who is helping a doctor administer intravenous pain killers to Toby. The doctor smiles and greets me. We know each other. A quarter of a century ago, when he was a boy, I used to be his family doctor. Then he became my medical student. Nowadays, when I work at the Royal Children’s, I operate under his direction. He is the paediatric consultant on duty tonight. His name is Dominic.

Nick explains his gadget. It is a miniature example of the famed ‘Jaws of Life’ that road emergency crews use to disimpact a crushed motor vehicle from its trapped occupant. Nick’s gadget is a menacing midget of frightening power. It looks like a pair of dark steel pincers emerging from a cylindrical contrivance connected by strong piping to a device that couches like sin on the floor of the O.R. That floor dweller is a pump that forces air under enormous pressure to the pincers, coercing them apart.
Nick introduces the fine pincers into one of the unoccupied annuluses of Toby’s steel ring. He allows the pressure to build and build. The steel of the annulus resists the steel of the jaws. All our jaws are clamped hard, as we watch in dread the application of irresistible force to an object not amenable to persuasion. I close my eyes briefly against a vision of a sudden sundering of the steel bracelet or else an explosion underfoot of the compressor. The latter would destroy the fourteen limbs standing nearby on the floor; the former could shatter my daughter and my grandson.
I adopt the business-as-usual expression that one always deploys when one’s gamble with a patient’s health hangs upon the coin that one has set spinning, spinning, as it falls to earth.
With a discrete metallic sigh the annulus cracks and gapes. Firelady Lucy hands Nick a diamond–blade saw, which he wields now with a free-swinging action well away from Toby’s flesh. As the saw makes its remorseless way through the steel disc, Dominic inserts a shield for Toby’s finger.
Millimetre by millimetre the blade divides the inviolate steel. Sixteen eyes follow the progress of the blade, a remorseless icebreaker freeing the trapped one. The saw falls still, a fraction short of the shield. Now Nick applies a wrench to the opposing shores of the bay where Toby’s finger is marooned. Another steel sigh and the disc surrenders. Toby’s finger is free. Watching Aladdin and his magic, he pays no heed to our drama.
Two more fingers to go. Pincers, saw, wrench – all are deployed in unhurried speed. Nick frees Toby’s digits, tears gather at the edges of my eyes as Rachel kisses those finger tips.

Dominic examines the fingers minutely. He is checking for tissue damage. There is the small skin indentation one sees when a ring has been a little tight. The skin is pink.
Dominic tells Toby to wriggle his fingers. Toby does so, his expression of scornful surprise registering wonder at the obtuseness of the adult world.
Dominic wants to be certain that there has been no damage to nerves and blood vessels. After x-rays he will keep Toby and Rachel here, in an annexe, until the morning, “just to be sure”.
The morning is not many hours away. I kiss my grandson and I hold my daughter’s face in my hands and squeeze her beloved flesh. Then I drive home.
On the way to the car, I phone Annette and share the news. And I forget all about phoning Pablo and Naomi.
***

In the bath a few weeks later 7 year old Jesse has an idea: “Why don’t you see if you can get your fingers into the bath hole, Toby?”.

 

* Pablo translates: With patience and with saliva, the elephant fucked the ant.

Melbourne Boy Rescued After Plug Hole Drama

Melbourne Boy Rescued After Plug Hole Drama

 

Ninety five years of wisdom

My friend Dr Paul Jarret keeps his brain (and the brains of his scores
of followers) alive with his daily email transmissions. I receive an
average of four a day. Paul was a surgeon, an aviator, a morbid
anatomist (that means he cut up dead bodies to discover their cause of
death). He has a wonderful memory and a wry and tender way with words.
His brain will celebrate its 95th birthday this sunday.

Happy birthday, Paul.

May you live – and write – to a hundred and twenty.

Earlier today I received this from Paul:

Remembering the sessions I spent as a Medical student in the Surgical
Amphitheater I wonder what the Professor thought we could see from that vantage point? Surely when he was a student he sat up near the ceiling and like us was barely able to identify the incision, much less the viscera. I suspect that today’s Medical Students are shown videos down to the finest detail.

One of my classmates in the Amphitheater recognized one of the nurses down below although capped gowned and masked, by a mole on the back of her neck with which he was familiar. He obviously was not contemplating the origin of the cystic artery after recognizing that mole.

I can only imagine what it is like to be a Medical Student with computers,
modern models and all of the teaching aids available today.

In spite of such advances in teaching doctors, we still get sick an average
of 12 times in our lifetime and get well 11 times.

Medicine will become a Science when patients quit recovering to the surprise of the Physician and stop dying unexpectedly and for no apparent reason.

Between you and me and the American Trial Bar, it ain’t ‘gonna happen!

PBJ

Star of the Sea

Yvonne and Doreen are among the very few Jewish girls at Firbank. Some unpleasantness occurs and Yvonne pretends it isn’t happening, but Doreen, the younger sister, is not so submissive. (At the age of four she had objected to the dentist hurting her. When he hurt her again Doreen bit his finger.)

When her classmates tease her for her Jewishness, Doreen fights back. After a few of these fights, their mother recalls how happy had been her own schooldays with the Presentation nuns in Perth. The family withdraws the girls from Firbank and sends them to the Presentation nuns at Star of the Sea.

Yvonne and Doreen arrive at Star to find they are the only Jewish girls. On the eve of the Depression their father falls ill and the whole school assembles to offer prayers for his recovery. He dies and the school prays for his soul.

Their father’s investments crash and the family is hard up. Compared to Firbank, the nuns are cheap, but Star reduces its fees so the girls can stay.

A new Jewish girl arrives. Her father has died, and she is to be a boarder. The nuns discover she has no prayer book. They are greatly concerned. They have lots of Catholic prayer books but they ask Yvonne and Doreen’s mother to find a Jewish prayer book for the new girl.

A couple of years after their father’s death, their mother’s heart fails. The school prays, she dies – of a broken heart, as the girls recall it – one day following the third anniversary of their father’s death. The whole school comes to a stop to pray for her soul and for the two orphan girls.

Neither of the girls is particularly studious, but Yvonne rewards the nuns with a perfect score in Catechism.

Years pass, the girls grow up, leave school and marry. Yvonne moves to a small town in the remote Riverina, where she raises a bunch of children without a family to support her. She misses her parents, her sister and grandmother. She bears and feeds these babies, deficient first in family, then in iron, later in red blood cells. Finally, she is confounded: fulfilled in motherhood, she is nevertheless tearful and faint. In crisis, Yvonne returns to the nuns and finds comfort. Will you pray for me, she asks.

Doreen too, turns to the nuns whenever she needs surgery. She too asks them to pray for her: You girls are the professionals, she says, I think you are better at it than I am.

As the years pass, Doreen has cancer surgery, bowel surgery, heart surgery, the list of operations grows longer, and always she goes back to the nuns. She speaks to her old school principal, now retired: Would you light a candle for me Sister?

I’d burn the whole bloody Church down for you if it would help you, Doreen.

Yvonne and Doreen go the nuns again and again. It only ends, after sixty years, when their old principal, the last of their nuns, dies at the age of 103.