The Best Australian Essays 2014 (8 page)

‘Dad, that's crazy.'

‘You don't believe me?'

‘No. You're acting crazy.'

‘You want to know something else?'

‘No.'

‘See this picture.'

My father held up a
Time
magazine with a picture of a black-skinned man with glasses. ‘Do you know who this is?'

‘No.'

‘It's Arthur Ashe.'

‘Who?'

‘Arthur Ashe, he's a tennis player who died of AIDS a few years back.'

‘So?'

‘Do you see anything unusual about this photo?'

‘No.'

‘That's me. I'm Arthur Ashe. I can tell by the shape of the glasses.'

‘But he only died a few years ago, right? Come on, Dad, how is that possible? Who were you before?'

‘I'm me, baby, but it's partial, you know?'

Needing to be away from him, I fought tears. ‘Dad, you've lost the plot. You've totally lost the plot.'

‘Fuck, you sound just like your fucking mother! Both of you so fucking critical.'

I stole away to my room and waited for my mother to come home. She arrived at the same time as the furniture van, with the fancy new lounge suite. My father asked the delivery man to stay for dinner and regaled him with tales of his newly acquired astrological knowledge. After dinner he invited the man to stay the night and then, in a flurry of movement, headed out to a party at a friend's house. We watched him go, exhaling in a communal surge of relief. This friend was a psychiatrist and a colleague, and surely something would be done. We talked shyly to the furniture delivery man, and showed him to the spare room.

Late that night the mother of the fourteen-year-old patient rang. ‘Look, I'm worried about your husband. He came to my house, he just dropped by. He says he thinks your daughter has returned. He sounds crazy. I don't think it's right, I mean, he's her doctor. It's not safe. He says he wants to take her away somewhere. She's just a kid, you know?'

After my mother hung up the phone, she searched and searched until finally she found the cheque book and the house-sized cheque.

I escaped the silent fear of the house to spend the night with friends. In their bright company I drank and drank, aiming for that engulfing darkness, and found myself instead crouched in the garden, shivering and lost. My older sister Zoe, vibrant and fierce – delicate of soul and wild of heart – had disappeared from our lives, but every day the event of her death expanded, as the person she was gradually diminished. Her suicide – my father's breaking point – pulling us all to pieces. Drunk in the garden, I mourned the loss of her and the brokenness of my father.

My friends searched for me in the leafy night. Bending down, they gently pushed the hair from my face. They took me to bed, tucking the covers tightly around me and turning out the light. I lay in the darkness, my head pounding and my stomach raw, and eventually slipped off into that quiet black place.

In the morning a friend woke me gently to come to the phone. My mother had called and it was urgent. ‘Jess?'

‘Yeah, Mum, what's wrong?' My throat felt razored, my voice shrill.

‘Jess, it's your dad. He went missing. They lost him at the party.'

‘What?'

‘He disappeared and they couldn't find him.'

‘Where is he? What happened?' My head throbbed loudly in my ears, and I pushed my fingers hard against my forehead.

‘He's at the police station. The police picked him up.' Her voice reverberated on the other end of the line. I was afraid to speak, afraid to find out why. The silence stretched between us. ‘Jess?'

‘Yeah. What did he do?'

‘Are you okay?'

‘Yeah, I'm all right. Tell me.'

‘He broke into someone's house and put some music on. He turned it up really loud and the police came. He was naked and muddy, I mean, he'd smeared himself with something.'

‘Is he okay? I mean, is he hurt?'

‘I think he cut himself a bit with the glass. You know, from the window when he broke in. But it's not serious.'

‘Mum, what's going to happen?'

‘He's not going to be charged, I don't think. It was clear that he's not well. He's going to be picked up and taken to the Richmond Clinic.'

‘The Richmond Clinic? Where all his patients go?'

‘Yeah.'

The phone shook in my hand, and I felt my lips turning downwards in a flickering involuntary grimace. Fighting tears, I clenched my teeth together until they scraped loudly in my ears.

‘I have to go over and bring him some stuff, some books and pyjamas. I can't pick you up. Can you stay there today?' My mother sounded tired and tight. I could feel her anxiety through the white cold plastic of the phone. ‘Jess, I'll ring you when I get back, okay?'

When my father broke into the stranger's house he carved mandalas into his palms with the glass from a shattered mirror, he smeared himself with sewage and ate a packet of cigarettes. Grief had unravelled his control. He was wild and savage and lost. The sorrow that had engulfed our home since Zoe's death had finally spilled into his outside life in a torrent of mad despair. He was hospitalised but he soon came out, and then he was hospitalised again. He talked of axes and Aphrodite and splitting skulls, and his old doctor friends called from Sydney and whispered to my mother down the end of the line.

‘Do you have any guns there? Get rid of the axes. Get rid of anything weapon-like.'

And when the raving was over and the muted sadness returned, it was somehow our fault and he could not forgive us. He was bitter and angry and uncomprehending, and we could not forgive him. He began to talk of my mother as that woman, and when she left the house for any reason she would return to the roaring sound of a chainsaw as he cut down another of her beloved trees.

Watching my father's slide into madness was terrifying. What we had known as eccentricity suddenly became much more than that. How could we tell what was his illness and what was him? He had always been spontaneous and unpredictable: unafraid of the unknown, testing the boundaries. What were the bounds of normal? Who made those rules, and who enforced them? My family were constantly on watch, but what signs were we watching for?

Raging against the dying of the light, my father was in and out of the psychiatric ward from then on until his death a few years later. And no, the causes were not natural. He had reached his breaking point and tumbled into the abyss.

And now, still nestled in those green hills, nearly eighteen years later, I watch myself in the same way. Walking through life warily, the line between destruction and perfection so fine as to be perilous. What is my breaking point, and will my life take me there? If the line between sane and crazy is fine enough to step over, how can I know when I've taken that step? And who, apart from me, is patrolling the perimeters?

In light of what happened to my dad, that yellow Esprit shirt has taken on a whole new meaning. I keep it hidden deep in my closet, the material so soft and worn it almost comes away in my fingers. Somehow, despite everything, it has come to represent all that is wondrous about living so close to the edge. Being in the moment, being open to the world, being full of spirit and life. Being deeply and utterly yourself.

Meanjin

The Medicine

Karen Hitchcock

It's months before the world will hold its collective breath because a handful of congressmen don't want the United States to provide health insurance for the 47 million of its citizens who don't have it. I'm in the Deep South, having a beer with a senator's chief of staff, and he's trying to explain to me why Obamacare is such a bad thing. It's something to do with the deficit, with taxes and small business, and I'm not following, not even when he shows me a pretty pie chart on his laptop. I'm embarrassed at his effort and at my failure, and I keep wanting to say, ‘Stop, save your breath, you're trying to convince a nobody.'

I spend my days downtown in a university hospital known for its innovations, for practising ‘accountable care'. Instead of doctors and nurses and patients, they have teams and ‘feedbacks' and outcomes. It's the way of the future; they want to apply it back home, where we apparently have an unsustainable system. Enter the lobby and you could be in a five-star hotel: polished solid timber and deep leather armchairs, every surface designed to be easy on the eye.

The handover from the night staff to the day staff takes place in the tearoom on the medical ward. It looks the same as an Australian tearoom, except the mugs are all neatly stacked and there's no threatening notice above the sink about how your mother doesn't work here so you'd better wash your own mug. There are a lot of whiteboards for a tearoom, and they're covered in flow charts and motivational affirmations, written by the clinicians who've all morphed into managers. There's a cork notice-board with a T-shirt pinned up at the armpits. It's black with green text:
Help Trent Get New Lungs.
A flyer next to the T-shirt explains that Trent is nineteen, has cystic fibrosis and is trying to raise $50,000 to pay for his lung transplant.
Buy a T-shirt for ten bucks! Help me in my quest!

The night was a tough one, but the staff aren't allowed to use negative words, not even ‘busy'. Instead they smile like adverts and say the shift was ‘active' and ‘challenging'. Before the staff can get out of there, they have to formulate a team-building goal of the day for one of the whiteboards. They come up with
Execute the day with joy
and
Work together
, but settle on
Spread the cheer
.

We gather in the corridor ahead of the ward round. One of the doctors takes a call and announces, ‘She's on her way.' Who, I ask? ‘The social worker. We can't start without her.' Social workers in Australia never join our ward rounds. They have barely enough time as it is to organise all the respite and residential care, family meetings, emergency funding and home help.

The social worker arrives, and we crowd in the doorway of the first patient. He's recovering from a bout of pneumonia, and the doctor thinks he needs a few weeks in rehabilitation to get him strong enough to return home. The social worker steps forward with her clipboard: ‘Unfortunately, Mr D.'s insurance doesn't cover rehab.' The doctor turns back to the patient: ‘Unfortunately, your insurance doesn't cover rehab and so you'll have to go home directly. Be careful, take it slowly, see your family doctor in a week.' Mr D. nods. We move on.

The next patient is ready for discharge. The social worker asks the doctor to change drug X to drug Y as the insurance company won't pay for drug X. The doctor changes X to Y. The next patient, a pensioner, is informed that he needs two more days of in-patient antibiotics for his infected prostate. He pleads to go home: ‘Doctor, please, it's costing me $250 a day in co-payments. I can't afford this.' The doctor says he's sorry. The social worker says nothing.

After work, I drive around downtown. Dozens of young fit black men mill outside soup kitchens and in car parks, their portable bedding close by. I see a woman and baby wrapped in a quilt, lying under a scraggy tree beside a mess of men and clothes and boxes. I haven't eaten all day and suddenly feel faint. I order a shake at a deserted diner. It is unimaginably delicious: chocolate ice cream made just soft enough to move through a fat straw.

I join the gridlock back to the suburbs; the streets grow quieter, greener, wider. I attend a party in a beautiful house. We are mostly doctors, drinking wine, eating steak. Our children roam the streets, clutching cups of homemade lemonade. I get to talking with one doc. To whom is he accountable, actually? How does he negotiate the health insurance minefield? What happens if the patient can't pay? He looks over my shoulder. ‘Oh, we don't get involved with that side of things … The hospital interviews them. They work something out.'
Interviews
them? About what? ‘You know, helps them calculate their assets …' I stare at him. He looks annoyed and says, ‘Do
your
patients have to wait twelve months for their hip replacements, like they do in the UK?' I raise my glass: ‘God save the Queen.' He smiles a winning smile. ‘Well, Americans sure wouldn't put up with
that
!'

I couldn't wait to get back to our overcrowded hospitals that stink of hot chips, where bad things are called bad names and you can swear freely in the tearooms. Where you're a patient, not a customer, so the lack of a fatal car crash is the only thing standing between you and a new set of lungs. You may have to wait months in pain for your new hip and then share a room with three snorers, but you'll get the drugs the government lets me prescribe you, and if you can't walk post-op you'll have physical therapy someplace ugly, and if despite all that you can no longer leave your house, the social worker will hook you up with Meals on Wheels. Spread the cheer.

*

The first time I see Irena, we are two doctors down and have a full waiting room. I call her name, four times. Finally she stands up: ninety-four years old, 125 centimetres tall.

The clinic is for elderly patients with multiple chronic problems: failing heart, kidneys and lungs, dissolving bones and aching joints, bone marrow that's drying up. In the name of efficiency, these patients cannot ask to see the same doctor at each appointment; they have to make do with whoever picks them up from the pile. They are old and complex and getting expensive – we wouldn't want to spoil them. There is a desk between us, and I am supposed to type notes directly into the computer as they talk, as if I am a travel agent. Of course, most patients are deaf, so we spend the consultation shouting at each other. Apparently, a doctor who knows you and in whom you might trust is less important than that god Efficiency. I have the highest respect for rules I agree with, so I make an unofficial arrangement with the nurse coordinators and start to see regularly my own cohort of patients. Irena becomes one of mine.

Though deaf, Irena whispers. I look at her: cataract, arthritis, stains on her cardigan, false teeth that are too big for her gums so they move up and down independently of her lips when she speaks. I get inefficient: I leave the desk and sit next to her so I can hear. Her English is halting, slow as calligraphy. I ask her if next time she wants me to arrange a Russian interpreter. She looks at me and raises an eyebrow: ‘You don't like my English?' I ask her how she has been since she last came to the clinic. She says what she says every time thereafter: ‘I am ninety-four, doctor. I am old.' She always pauses here and raises a finger before her punchline: ‘But I am not dead yet.' Then she laughs.

I sit beside her to feel her pulse or listen to her lungs, and she tells me snippets that over months become grand narratives. In Stalin's Russia, her husband was taken to a labour camp for running his own business as a tailor. They wouldn't let him take his violin. For a year, this tiny woman travelled to the camp every week and demanded they give it to him. She wrote letters. To Stalin. They relented. Her husband played so beautifully he was granted an unofficial reward: though it was against the rules, Irena could stay in the camp for a week.

Once patients enter a nursing home, they are no longer eligible to attend this clinic. It's another world, and all the rules change. I know Irena is on her way there when I sit next to her doing something clinical and she whispers in her ancient staccato: ‘Doctor. This week. I dirtied myself. Two times.'

The black heart of a health system based solely on utilitarian economics is the unspoken truth that once a citizen ceases to be productive their care ceases to be cost-effective. If you are old and sick and reliant on the state, you are a dead woman. As a Russian Jew born in 1919, Irena had been a dead woman many times before – in 1941, for instance, until her father, whom she never saw again, intervened in her fate, saying, ‘You must be far away by morning.'

When Irena doesn't turn up to two appointments in a row, I realise she's been moved to a home. I am sad and increasingly troubled by questions about the camp that only she can answer. Did her husband have his own room? What was in it? Was there a window? Was the bed comfortable? What did they eat? Was she happy? I start to feel panicked when I think of her. What was it like in there?

I call the nursing home and ask them to ask Irena if I might visit. She says to come tomorrow. The next day, I step into one of the taxis lined up in front of the hospital and ask the driver to take me to the nursing home. The taxi driver looks from my face to my hospital ID and back to my face; then he drives me 300 metres around the corner.

Irena's room has a narrow bed, a wardrobe, a bar fridge and a single armchair. I sit on her walking frame and ask how she is. She is old, but not dead yet. We laugh at this. She tells me she fell and thought she was being taken to hospital but instead found herself in this room. Someone brings one cup of tea and a dark brown biscuit and smiles at me over Irena's head. Irena dips her finger into the plastic cup, says ‘cold' and pushes it away. When I stand up to leave, she opens her fridge. It is full of brown biscuits, piled into the door shelves and drawers. She insists that I take some and wraps a handful in a napkin. She puts the parcel in my hands: ‘Will you come again?'

I push out into the sun and stride back to the hospital. The young rule the world; we stomp around doling out mean rations to the old, the machinery of our secure, able bodies purring to us the myth that we will live forever. And one by one my patients retreat to these small rooms and then slip away. Soon they will all be gone. And then it will be your turn and mine to sit in cells and drink the weak tea they hand out at eleven and two, hoarding biscuits in our fridges. Not dead, yet.

*

Before I started studying medicine, my grandmother was diagnosed with idiopathic pulmonary fibrosis. I had no idea what that was. ‘Scarring of the lungs,' she said. When I announced my plan to become a doctor, she was ecstatic with pride. She'd tell anyone who listened. Like the person scanning our groceries at the supermarket. She'd look at him, then at me, then back at him, and I'd know it was coming. ‘This is my granddaughter.' He'd look up, his face all like,
And?
She'd lean in and say, ‘She's going to be a doctor.' I'd roll my eyes and go, ‘Nan, jeez …'

When I visited, the first thing she'd say to me as I walked in the door was ‘Stop. Stand over there. Now turn around.' I'd roll my eyes. ‘I just want to look at you,' she'd say. ‘Now come here, and bring that comb.' She'd been a hairdresser. My hair didn't often live up to her standards.

In second year I bought my first stethoscope. When Nan said, ‘Stand over there,' I said, ‘Wait!' I pulled it from my backpack, looped it around my neck and turned around. You should have seen her face.

By the time I was in third year, she was eighty-one and permanently attached to a tube that went from her nostrils to an oxygen concentrator. The tube was long enough for her to move all around the house. When we went out, she took a small oxygen cylinder on a trolley. She said, ‘My lungs are “diseased” – what a terrible word … listen to them if you wish.' I pressed my stethoscope against her soft, pink skin, and caught my breath. By then I knew what the sounds meant. During her afternoon naps, I'd get into bed next to her with my textbook and she'd quietly watch me from her side of the twenty or so pillows.

One time she said, ‘I have a really bad pain here on my right side.' ‘What's it like?' I asked. ‘When did it start? Does anything make it go away? Turn around.' I gently pressed the spot and she winced. ‘I think you've broken a rib.' We looked at each other with our eyes open wide. Her doctor sent her for an X-ray, held it up to the light and said, ‘You've broken a rib.' She beamed at him. ‘I know. My granddaughter already told me.'

Just before my fourth-year clinical exams, she fell in the bathroom one night and lay on the cold tiles until morning. At the hospital they said she'd had a heart attack and things looked bad. She was too weak to drink. She gripped my hand, hard as steel, and whispered, ‘I don't want to die yet.' The physician said, ‘We should perhaps consider palliation …' I begged him, ‘Please keep trying.'

In hospital she told me halting, dreamy stories about how her husband developed a brain tumour in the 1950s. They knew it was a brain tumour because he was fixing his car one day and his right arm rose straight above his head all by itself. They stood there by the car, both staring at his risen arm as if it were a stranger. After the operation, she cared for him at home. The doctor taught her how to inject morphine.

One evening Nan's IV drip blocked and a junior doctor came to find a site for a new one. I don't know what the drip was for – fluids, diuretics or antibiotics. He said to me authoritatively, ‘You realise this is futile, to torture her like this?' I tried to explain – that, for her, being in hospital and the pain of a thin needle was worth the chance for a little more life – but it came out as a stutter. I just stood there under his accusatory stare, gripped with deep shame. He told me to wait in the corridor. I heard him croon to my nan as she winced with each of his failed attempts: ‘I'm sorry, you poor thing. This is cruel. We know it's unfair.' There was silence for a moment. ‘Let's try the cubital fossa,' he said to the nurse.