Writing as Healing

The mother of identical twin boys sent me this story by Ranjava Srivastava.

 

“Losing my twin baby boys for ever changed the way I treat my patients.

I will never know the kind of doctor I would have become without the searing experience of being a patient, but I like to think my loss wasn’t in vain.

‘My obstetrician’s tears stunned me but also provided immediate comfort. They normalised the mad grief that had begun to set inside me.’
Around this time 10 years ago, I was poised to start my first job as an oncologist when personal tragedy visited in a way that would forever change the way I would practice medicine.

I had returned from my Fulbright year at the University of Chicago, blessed with only the joys and none of the irritations of being pregnant with twins. Landing in Melbourne, I went for a routine ultrasound as a beaming, expectant parent. I came out a grieving patient. The twins were dying in utero, unsuspectedly and unobtrusively, from some rare condition that I had never heard of. Two days later, I was induced into labour to deliver the two little boys whom we would never see grow. Then I went home.

If all this sounds a little detached it is because 10 years later I still have no words to describe the total bewilderment, the depth of sorrow and the intensity of loss that I experienced during those days. Some days, I really thought my heart would break into pieces. Ten years later, the din of happy children fills our house. But what I have found myself frequently reflecting on is how the behaviour of my doctors in those days profoundly altered the way in which I would treat my patients.

An experienced obstetrician was performing my ultrasound that morning. Everything was going well and we chatted away about my new job until he frowned. Then he grimaced, pushed and prodded with the probe, and rushed out before I could utter a word. He then took me into his office and offered me his comfortable seat. Not too many pregnant women need a consultation at a routine ultrasound.

“I am afraid I have bad news,” he said before sketching a picture to describe the extent of the trouble. I thought for a fleeting moment that my medical brain would kick in and I would present him with sophisticated questions to test his assertion that the twins were gravely ill. But of course, I was like every other patient, simultaneously bursting with questions while rendered mute by shock.

I was well aware that doctors sometimes sidestepped the truth, usually with the intent of protecting the patient. I knew he could easily get away with not telling me any more until he had more information but I also knew that he knew. I read it in his face and I desperately wanted him to tell me.

I asked the only question that mattered.

“Will they die?” 

“Yes,” he said, simply holding my gaze until his tears started.

As I took in the framed photos of children around his office he probably wished he could hide them all away.

“I don’t know what to say,” he murmured, his eyes still wet. 

Until then, in 13 years of medical training, I had never seen a doctor cry. I had participated in every drama that life in bustling public hospitals offers but never once had I seen a doctor cry.

My obstetrician’s tears stunned me but also provided immediate comfort. They normalised the mad grief that had begun to set inside me. Yes, the doctor’s expression said, this is truly awful and I feel sad too.

“You are sure?”

“There is a faint chance that one lives but if you ask me, things look bad. You know I will do everything I can to confirm this,” he said.

The obstetrician had told the unflinching truth and in doing so almost surgically displaced uncertainty with the knowledge that I needed to prepare myself for what lay ahead. I had test after test that day, each specialist confirming the worst. I think I coped better because the first doctor had told the truth.

Two other notable things happened that week. Among the wishes that flowed, another doctor wrote me an atypical condolence note. His letter began with the various tragedies that had taken place that week, some on home soil and others involving complete strangers. “I ask myself why,” he wrote, “and of course there is no answer to why anyone must suffer.”

Until then, everyone had commiserated only at my loss – and I was enormously grateful – but here was someone gently reminding me that in life we are all visited by tragedy. All the support and love in the world won’t make you immune to misfortune, he was saying, but it will help ease the pain.

Finally, there was the grieving. I lost count of the pamphlets that were left at our door to attend support groups, counselling sessions and bereavement seminars but we were resolutely having none of it. My midwife called me out of the blue – it was a moving exchange that taught me how deeply nurses are affected too. But I didn’t need counselling, I needed time. I valued the offers but I knew that my catharsis lay in writing. I wrote myself out of suffocating grief, which eventually turned to deep sadness and then a hollow pain, which eventually receded enough to allow me to take up my job as a brand new oncologist. How I would interpret the needs of my patients was fundamentally altered now that I had been one myself.

Cancer patients are very particular about how much truth they want to know and when. I don’t decide for them but if they ask me I always tell the truth. A wife brings in her husband and his horrendous scans trigger a gasp of astonishment among even the non-oncologists.

“Doctor, will he die from this?” she asks me.

“I am afraid so,” I answer gently, “but I will do everything in my power to keep him well for as long as I can.” 

It is the only truthful promise I can make and although she is distressed she returns to thank me for giving her clarity. Sometimes honesty backfires, when the patient or family later say they wanted to talk but not really hear bad news. I find these encounters particularly upsetting but they are rare and I don’t let them sway me from telling the truth.

Oncology is emotionally charged and I have never been afraid of admitting this to the very people who imbue my work with emotion. I don’t cry easily in front of patients but I have had my share of tears and tissues in clinic and contrary to my fears, this has been an odd source of comfort to patients. In his Christmas card, a widower wrote that when my voice broke at the news that his wife had died he felt consoled that the world shared his heartbreak.

It can be tricky but I try to put my patients’ grief into perspective without being insensitive. It’s extraordinary how many of them really appreciate knowing that I, and others, have seen thousands of people who are frightened, sad, philosophical, resigned, angry, brave and puzzled, sometimes all together, just like them. It doesn’t diminish their own suffering but helps them peek into the library of human experiences that are catalogued by oncologists. It prompts many patients to say that they are lucky to feel as well as they do despite a life-threatening illness, which is a positive and helpful way of viewing the world.

I will never know what kind of a doctor I might have become without the searing experience of being a patient. The twins would have been 10 soon. As I usher the next patient into my room to deliver bad news, I like to think that my loss was not entirely in vain.” 

……… 

I read this story with alarm. It made me feel anxious because I have and love a pair of identical twin boys. I felt involved because, like the writer’s doctor, I am a doctor who cries; and like the writer, Dr Srivastava, I am a doctor who writes. Finally we two are products of the same medical school (Monash) – Dr Srivastava graduated at the top of her class, in the present century, I graduated at the opposite end of my class, in antiquity (1969).

A final point of commonality was her reassuring remark that ten years after her doctor wept her home is full of the noise of happy living children.

I found the piece helpful. Dr Srivastava identifies and untangles the strands of her experiences with surgical deftness. Her doctor weeps, her colleagues show support and care and empathy and she heals. As a trained observer, the writer dissects her experience of grief, lays out its anatomy and reflects upon its organs and parts.

Like the writer, I find relief and understanding in the act of writing. I suspect that a part of this relief results from word search. The writer is obliged to seek the precise word for the experience. In my case this forces me to test and taste a number of words. Perhaps a dozen words might work more or less passably, but the acts of searching, of choosing, of trialling, help me to clarify what my feelings were not quite like. I mean I discover what I mean. Perhaps this functions as a working through, a self-conversation, something between analysis of an experience and re-imagining it. In my case too, the pleasure of words is an aesthetic joy that comforts me.

Medicine is a pursuit conducted with the living in the shadow of death. It is a pursuit packed with anxious questions: what is wrong with me, will I die, what can be done, will it hurt, how much, how will I know the answers, when will I know? This crying doctor feels the patient’s fear and his own and has to know the border that divides the two. My fears are for the patient, of the patient, of failure, of failing a person of flesh and feeling. My fears include the terror that strikes me when I see my patient slipping away, the knowledge of my mortal inadequacy.

The writer who lost her twins precisely names the elements in her emotional experience. With remarkable poise she traces the costs and the benefits of the loss. So coherent are her reflections I could feel myself learning as I read. I learned about her life and her work, how the two are not the same but never severable. I learned more of how a doctor feels, who she is, who I am.

Once Upon A Writer

Once upon a time I was a writer… No, not once – thrice upon a time.

First time: in second or third class the teacher directed us to write a composition. We did as we were told. I enjoyed writing. My composition was chosen and read to the class. I was a writer and one year later, when the Melbourne ‘Age’ published a little piece, I was a published writer.

Second time: at medical school, achieving mediocrity in exams, I found relief editing and writing for a paper. I published what I wrote.

Third time: with a family now grown up and my own parents failing, I was a writer heavily charged with material. I wrote and my friends and family responded. Among the responders one friend in particular responded decisively. Often enough she responded derisively; and not just often enough but more often than enough.

I had good reason to pay attention to my critic friend. She had been an adult reader for many more years than I had been an adult writer. Further my critic was trained in criticism while I was untrained in writing.

Curiously my early vulgarity didn’t trouble her much. My sentimentality (an abiding tendency) excited little reproof. And even the structural shambles, the way narrative fell upon narrative by accident into a happy enough heap, provoked no rebuke.

The problem with my writing was the writer. Contrary to my critic’s command I did not write of Howard the way Howard should write of Howard. In truth this was not willful delinquency (another abiding tendency) but incomprehension. So stratospheric is my critic’s sophistication, her principles eluded me.

The pages of my first two books are Howard-haunted. Howard Bloody Goldenberg is to be found in the middle of every page or in its margin or inescapably behind every page, pages that can never be thick enough to disguise Howard. This drove my critic mad. It was not that Howard was full of himself (he is that) but that Howard was represented without precisely the ‘self-reflexivity’ (my critic’s term) that she demanded. ‘Howard’, she wagged her finger imperiously, ‘Howard, you are refusing to become the writer Howard should be. Your subject, your great subject, is Howard…’

This criticism, emphatic and oft-repeated, merely increased my self-consciousness. Eventually it would drive Howard from the page. Thus, in book number three (‘Carrots and Jaffas’) there exists a character who resembles Howard but is not Howard. Although that character is a male in his sixties, a compulsive storyteller, an outback doctor with a large nose and lavatorial obsessions, he is not Jewish, not Howard per se. In truth I no longer trusted Howard to create Howard. My critic had achieved something worthwhile; she had demolished a formerly impregnable exhibitionist. This was surely to the good, for Howard the person showed an objectionable and retrograde refusal to adopt my critic’s view of the world. (The critic started adult life as a social activist, becoming a member of a commune, a welfare worker, resolutely a conscious and conscientious proletarian. In time she learned the profound error of her ways and unlearned her early amused tolerance of Howard’s political softheadedness.)

Meanwhile Howard had become a blogger and my critic became my bloggee. I would write, my daughter would post and my critic would criticise. More and more my critic criticised Howard for not being my critic’s faithful disciple. At one stage, in outraged surprise, she accused me of being ‘green’.

Given this blog’s unrepentant diarising of Howard’s life, his thought, his memories and stories – in short this blog being Howard on the virtual page – my critic found the entire exercise personally provoking. Possibly intentionally so. Her criticisms of Howard were now unrelenting, and of course, public.

It is timely here to remind my reader that my critic is a friend, that she certainly wishes for nothing more than my improvement. She has in mind my ascension into a literary realm which exists clearly in her sight and quite outside my powers of vision. In her private love of Howard this friend is staunch. In public she is an attack dog. At first puzzled, later a little hurt, eventually wryly amused that such a thing might be, I accepted her blank rebuttal of my private objection to her tone. ‘Howard’, she wrote (publicly of course), ‘Once your writing emerges into the public sphere you cannot expect criticism to remain private.’ Fair enough. Perfectly logical, fully consistent with literary purity. And perfectly blind to the imperatives of friendship.

I came to accept a painful reality:

The moving finger writes,

And having writ, moves on;

Nor all thy piety nor wit

Can lure it back

Nor cancel half a word of it

(From the Rubaiyyat of Omar Khayyam)

Eventually the moderator of this blog published guidelines of the limits to decent blogly conduct; and the critic, declaring herself to be my ‘troll’ (to me a new concept), banished herself from these pages.

My critic helped me immensely. She forced me to examine every self-syllable I wrote. She required of me an intensification of my self-consciousness. To this day she shadows every line I write, shaping my writing to conceal my thought, as she peers through the ether for Howard malignancy, stimulating me to a meticulous attention to some standard I never grasped but for which I blindly reach. Of course the cost is a friend who, in the name of friendship, has shat upon friendship.

Blogging On

I wrote a post a few days ago expecting it to pass with a yawn. That it did not is a surprise. That it might matter is an astonishment. That I’ll persist is the fault of the addressees below:

Dear palmerglassbox,

I am gratified to bring a ray of sunshine twice a week, but I am concerned about the other five sunless days. Please ask your doc to measure your vitamin D levels.

Dear Lionel Lubitz,
I like the idea of opening you (plural) up. It is ages since I performed a laparotomy. Thank you for your unhyperbole and for the teasing notion that the blog can annoy you (again plural). Someone’s taking notice.

Dear Susanne at Bilingual Options,
Your response delights me because you delight in the stories that delight me most, those about family. As one very familiar with the grandrats (Susanne is the model for the speech therapist in Carrots and Jaffas, and my twin grandsons were her patients), you know well their suicidal energies. And as for wordpress, it conquers even the mightiest intellect. Only my daughter can be its blogmeistress, and that by virtue of her power of persistence (in her childhood, read ‘stubbornness’.)

Welcome kaisywmills, who like Janus, has two faces, one feminine, the second bearded.

Claire McAlpine, bloggist and book critic, says blog on. Same to you, Claire, and more so. Your blog and your reviews bring good books to our attention.

Thank you Sulfen for what I take to be encouragement. It is no chore to write, the contrary in fact; my fear is creating a chore for the reader.

And Kerryn, who wrote so thoughtfully: Kerryn, when you encourage me to tell stories, you give my inner minstrel voice to sing. And your suggestion for a story about the bloke in my wedding photo is irresistible. (Watch this space.) Further, if, dear Kerryn you were born on New Year’s Eve about 35 years ago, you might have been delivered by me; and in that case you have met that man, you knew that face: he is my forever friend, my former partner in the medical practice you attended in childhood.

And dear Louis De Vries – the publisher all writers dream of and none can deserve – we know where the readers are: they are all reading on tablets, which were invented to bankrupt you, to frustrate me and to allow people to read in the dunny.

Dear Miriam Abud,
How delightful to find you finding me in this way. Suddenly the invention of the computer is justified, the existence of the internet worthwhile. The thought of anyone settling down to half a dozen of my writings thrills and amazes me. That it is YOU fills me with smiles of pleasure. I’ll keep going. And I think the radio would bring out all that is boring and pompous and opinionated in me. But if it would sell books…

And you, Helen, in urging more poetry you open a mare’s nest, a can of sperms, and a mix of metaphors. My own verse is largely limited to medical referral letters where, because they are confidential and hence unpublishable, the verse does least harm. On the odd occasion I post the verse of true poets, women – generally young undergraduates – drool and swoon, a pleasant surprise for an old gent. I suspect poetry drives many men away.

Hello, misssophiablog, welcome to this blog. I am impressed that yours has a FAQ section. Golly. When I need fashion advice I’ll turn to you, Courtney.

Hello Spot, your remark, ‘in the outback you give us another window on the world’ is unexpected and brings the sudden thought that a casual smartarse blogger might actually be some sort of postman to another person waiting for a letter, any letter. Suddenly, all this might be serious. Or significant. Thank you and golly!

Hello dear Faye Colls,
No writer could ever earn your unwavering loyalty. You are a warm and kindly spirit. Fair dinkum.

Dear Dear Bruce,
In your steadfast attention to my musings you create a blog of your own, revealing a soldier of the law who defended the weak to his own cost. You show us your wounds of honour, your human vulnerability. In all your humility you lift us up.

Dear Hilary Custance Green,
As well as having the very most remarkable and unforgettable and rhymable name an author or a blogger could desire, you write most thoughtfully and I should say, faithfully. Everyone should read your new novel, which I will buy in the UK in January – despite Amazon’s best efforts to sabotage you – and which I’ll review in this blog. Please ensure Foyles stocks the book.
I have just received your remarkable (and generous) review of Carrots and Jaffas. You have expressed my purposes so adroitly and divined my approach so comprehensively, you’ve actually deepened my understanding of my own book. Thank you, quite humbly, HCG. (in my trade hcg is the acronym for human chorionic gonadotrophin, which is the substance in a woman’s urine that tells her she’s pregnant when she pees onto a stick. You have elevated HCG to a more refined level.)

Dear Nick Miller,
Like you I find myself thwarted by wordpress. I’m all the gratefuller for your close attention to the blog, as to all of my writing. Carrots and Jaffas would have been a much poorer book without your criticisms.

Gerard Oosterman, hello, and thank you for commenting. Your own blog is masterly and you seem to have conquered wordpress. Bravo! (note to readers – chase up gerard’s blog: it’s a ripper!)

Dear I L Wolf, dear Margot Mann (in fact, beloved MCM), dear Glitchy Mind, dear Claire Word by Word, dear the chattyrachel, dear M. Talmage Moorhead (a name to rival Hilary’s), dear mannyrutinel, dear amandalyle, dear fictionistasan (intriguing monniker), dear M. Funk l PHOTOGRAPHY, dear Greg Mercer, MSN, dear jackiewilson, dear bluchickenninja – you all liked a blogpost that ran the risk of becoming a fishing expedition for compliments. You forgave me and you wrote. Thank you all.

And dear DovTheRov, you make me larrf, Thank you for the encouragement. You write a mean weekly newsletter. How many rabbis can make a minyan smile?

In Hebrew we have an expression: “acharon, acharon chaviv” – last mentioned, most beloved. Thank you Rachel, thank you, thank you.

Yours, twice weekly, I’m afraid.

Blog On?

Like every wise man I operate in thrall to my womenfolk. One of those womenfolk helps me manage this blog. Readers might have observed the blog stuttering in its cantering gait recently. I have slipped from my regular Monday and Friday postings, to no-one’s great regret. Noting this delinquency the Blogmeistress has commanded me to address my readers with some questions. She says I need to ask you what you want me to write about. The conversation went like this:

BLOGMEISTRESS: Ask your readers what they want.

HG: Why?

BLOGMEISTRESS: Why what?

HG: Why bother them? They’re enjoying the rest.

B/MEISTRESS: You need to blog, so you’ll reach new readers…

HG: Why?

B/MEISTRESS: Why what?

HG: Why do I need readers – old or new – of my blog?

B/MEISTRESS: You need blog followers so they’ll become readers of your books: your writing is OK; it’s just your attitude to technology that stinks. You write passably but all three of your books have been worstsellers. You need to get known.

HG: Look, no-one, not a single person has written begging me for a new post. No-one misses them. A blog that appears on your screen twice a week is an imposition. I’m giving them a break.

B/MEISTRESS: Blog – or fail as a writer!

HG: When I blog I fail because I take time and energy away from serious writing.

BM: Blogging is serious. You’re an appalling snob. You’re going to fail.

So, dear reader, dear slumbering follower, here are the questions a wise man must ask:

What would you like me to write about?

The news – all miserable – that I whinge about already?

My moral quandaries, in which I flail and thrash in a mighty masturbation of the conscience?

Oddities, trivial observations, exercises in whimsy and gentle self-mockery? Or would you prefer brutal self-mockery?

Family stories? Isn’t your own family is just as lunatic as mine?

***

Here is the question I am forbidden to ask: Could you care less?

Sorry to disturb your hard-earned respite.

Coincidence

“My grandfather happened to be in Britain at the start of the First World War. He and his brothers farmed the family property in the Victorian high country. Somehow though, he was visiting England, a war was on, we were part of the Empire, so he joined up.
Meanwhile back in Australia, his brother volunteered. They wrote to each other with their news: it turned out both had been posted to the Middle East, but to different units in different locations.

“Grandfather and great-uncle tried to keep in touch, and when Grandfather was given leave on Christmas Day he wrote to Uncle Bob promising to meet him outside the General Post Office in King George Street in Jerusalem on that day. He’d meet Grandfather there at noon. It didn’t surprise him that he didn’t receive a reply – there was a war on. His brother’s silence didn’t make him change his plans.

“At noon on December 25 – I think it was 1916 – Grandfather took up his station outside the Post Office and waited for Bob. By 1.00pm Bob hadn’t appeared, but Grandfather wasn’t worried or surprised. There was a war on, they both had to cadge lifts from army transport vehicles. He waited. Grandpa was excited and nervous; he and Bob hadn’t seen each other since before the war.
Grandfather said he needed to go to the toilet but didn’t dare in case Bob came and found he wasn’t there and they’d miss each other. He told me he danced around for hours with his bladder filling and his hopes fading.

“By four o’clock it was getting cool, the day was coming to its end and Grandfather feared he’d wet himself. Bob never showed. Another soldier passing by told Grandfather there were public toilets around the corner and one block down.
Grandfather strode down the street, turned left and collided with another man in uniform. “Sorry mate”, he said, untangling himself. Through the gloom came the same words in the same voice. The two men peered at each other. It was Uncle Bob.
‘The funny thing was’ – Grandfather told me – ‘Bob never received my letter!’”

That story was told to me by a workmate in 1974. It has stayed with me these forty years. I know that post office, I know the cold and dark of evening in Jerusalem at Christmas.

Today I received a flattering (and I must say insightful) review of my novel “Carrots and Jaffas” from a lady I’ve never met who lives, reads, reviews and blogs in France. (Coincidentally, we found each other by chance.) Claire McAlpine is my reviewer’s name. Somehow Claire managed to compose her review through a period of family medical crisis. How the empty page draws the pen!
Towards the end of her piece Claire McAlpine remarks on the long arm of coincidence that reaches out towards the end of my novel. She is right. As I wrote the section in question I had in my mind the accidental finding of kin, of brothers, between my friend’s grandfather and her great uncle Bob. This closing stage of the book gives voice to a daydream that I fall into from time to time in my work as a locum doctor in outback Aboriginal communities. Medical work in those places is full of nightmare: so much loss, so much suffering , almost all of it preventable. In my reverie I dream of a utopian resolution of the actual. My writing always hopes for redemption. In the closing pages of “Carrots and Jaffas” I gave voice to that wishful state; I allowed the intelligence and the questing longing of my character ‘the Doc’ to be rewarded by coincidence.
And I know from first hand stories of Holocaust survivors who have been separated from kin, for decades beyond hoping, that fate is not always cruel, that brothers are sometimes found.

I Reblog her review and thank Claire for the time and effort she put into it during a difficult time.

Word by Word

Allia NurseAll quiet on the blogging and reading front recently as life’s dramas intervened and demanded my full attention. Our daughter had a diabetic crisis 2 weeks ago and has been in hospital, she is stable now and happy to be home and said I can use this new picture she created for her Facebook page.

Consequently I have been carrying Carrots and Jaffas around with me and rereading passages, though I finished it more than 2 weeks ago and finally today had time while our son was at hip hop to move my scribbles here. Apologies Howard for taking so long to share your wonderful book.

Carrots and Jaffas is a wonderful example of how the virtual world allows us to come across writing voices that we don’t always find in bookshops or through mainstream publishers, that don’t require one to have publishing connections or be in the know. Just to be open…

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Carrots and Jaffas Reading and Chat with Clare Bowditch

Once upon a time a redheaded warbler sang a song to a crowd of people gathered to hear her and readings from a book about two red-headed twins. The singer was Clare Bowditch, songwriter, mother of twins-plus-one, social activist, philosopher and entrepreneur.
The reader was Howard Goldenberg, author, GP and marathon runner.
In this 3 minute video Howard reads from Chapter 1 of his novel ‘Carrots and Jaffas’, a book about two identical twins whose intimate bond is ruptured when a kidnapping occurs.

Please let me know what you think. Should I publish an audio book?