The Patient (22 page)

‘Hmmm, so you feel like dying?' she asked, using the reflective listening skills she had learnt in her three years at university.

Jonathan sighed and said, ‘If I felt like dying, I wouldn't subject myself to this slow poisoning the doctors are putting me through.' He wondered what she was writing laboriously in his notes – probably labelling his behaviours and feelings, as if by naming them she could somehow understand what he was going through. Not that she truly seemed to be listening to him. ‘I said I
feel like death
,' he continued. ‘Hollow, empty, buggered. Look, I'm feeling pretty tired now …'

‘So, you're tired.' Another attempt at reflective listening. ‘You'd prefer to see me another time?' She had gained
a distinction in her social-work course but had failed in empathy here. She and Jonathan had no connection whatsoever. Half-listening to their difficult and stilted inter action, Vera understood that the social worker was not doing any good for this man and showed her out.

Later, as Vera was beginning Jonathan's chemotherapy, his oncologist and a registrar came by and looked at his charts. ‘His neutrophils are pretty low. His alkaline phosphatase seems to be rising. Do you want us to repeat the CT abdomen?' The registrar was trying to impress the oncologist.

‘What's a neutrophil?' asked Jonathan.

The two doctors looked at each other, confused that the patient had spoken during their deliberations. It was the oncologist who broke the surprised silence.

‘Neutrophils are responsible for maintaining your immune status. Normally, the chemotherapy affects the bone marrow, and this in turn lowers your white-cell count. This means that you may be more susceptible to bacterial infections.' He was really proud of his ability to simplify complex medical concepts for patients under his care. Jonathan had understood not a word. He just looked up with a confused passivity that the doctors interpreted as comprehension. Silence meant consent.

Jonathan sat at home each day and waited for either a medical appointment or his dose of chemotherapy. In the afternoons, he loved to wait in the kitchen for his girls to come home from school. It was as if he was catching up on his years of neglect and the childhoods he had deprived himself of seeing. Their exuberance, their energy and the vehemence of their articulate chatter about their school
day gave him an appreciation of the grace they had brought into his life, an appreciation he had never previously felt. How is it that he had allowed himself to miss the past 12 years of these wonderful lives? Now, it was as though he needed their sheer life force to drive him onwards. Each afternoon, he would regale them with stories about his youth, his own childhood. When Tracy came home, the girls would often be sitting around their father deep in conversation. His immortality, he knew now, could only be achieved through the remembrances and reminiscences of these children.

Jonathan and his father had developed the most unlikely of all friendships. Being under the same roof had not pushed them further apart, as Jonathan had at first feared, but had gradually, inch by inch, made them more tolerant of each other's beliefs. They still disagreed but were growing to accept that for the good of their relationship – and Mr Brewster's relationship with his granddaughters – they would need to respect each other as men and agree to disagree. Jonathan would put up with his father's occasional monologues about religion and the afterlife; in turn, his father had become less adamant that Jonathan's only hope was the same religion he clung to. They would sit together on the back porch – Jonathan smoking, his father sipping tea.

Before his cancer, Jonathan mostly ignored his father, along with all of the other people who seemed irrelevant to his life: the ones who couldn't help him in his career, provide good contacts and networking opportunities or boost his and Tracy's social standing. His father had always been a source of embarrassment, a reminder of the
mediocre life that Jonathan had always striven to leave behind, a middle-class office worker who had slogged hard at a dull nine-to-five job with nothing to look forward to but a modest superannuation fund at retirement and church on Sunday. Yet, here he was sharing his precious time with this man. They had rediscovered a bond that allowed the two of them, father and son, to sit in a comfortable silence sharing the togetherness of affection and mutual respect.

Since the dawn of time, there have been these moments between men – the sharing of thoughts and feelings without words. Whether on the edges of the rift valley in Kenya, or in the shadow of the great rock of Uluru in Central Australia, or in the glow of a fire after a day's successful hunting, men have shared each other's company through silent bonds and quiet contemplation. Jonathan had not experienced this in his corporate life, where noise, din and empty words were the norm. Standing around a bar with a drink in hand was only an opportunity to meet someone of influence, entertain with a patter of party stories and jostle for alpha-male status. He had never felt the true manliness that he felt now, when there was no struggle for superiority, no one to try to impress.

Sometimes, silence gave way to a discussion about the big issues, but they tried to stay amicable and not get into a fight, even though Mr Brewster was still a devoutly religious man and Jonathan was not. In fact, he had become even less so as his sickness had worn on.

‘If ten-year-old Kate behaved like God behaves in the Bible – wreaking revenge and giving way to anger all the time – I would punish her,' mused Jonathan one day.

‘God has his reasons, son. They're just not always
apparent to us – after all, we're only human,' replied his father.

‘But it doesn't make sense. Just when I get my head above water, establish myself, get the job I've wanted my whole life, God decides to put me through all this?'

‘Jonathan, I'd give anything to turn back the clock so you didn't get sick. But perhaps the flaw in your argument is that if God is merciful then there should be no suffering. What if suffering is the only tool that God has to bring about salvation, understanding? What if without suffering, humans don't learn?'

‘I don't know, Dad. You saw what Mum went through. And I certainly haven't found any truth or beauty in the suffering that I see in the hospital. I haven't found the profound answers to life.'

Occasionally during his treatment, Jonathan needed to be hospitalised for complications. A patient's kidneys sometimes have trouble handling chemotherapy. Jonathan's kidneys were coping fine, but because of his lowered immunity he developed severe infections and needed intravenous antibiotics.

Around Jonathan were a number of patients with whom he was becoming familiar over time. Weekly blood tests, physical examinations, chemotherapy sessions and occasional stints in hospital were shared by a band of people brought together by their synchronous clash with the evils of cancer. The tumours that threatened their lives had formed them into a battalion of the living – a battalion facing the darkness that awaited them if the wonders of modern
chemotherapy failed. As time went by, Jonathan saw some triumph over death, such as the 26-year-old father of three whose testicular cancer was cured by the intravenous poison that coursed through his veins, and the mother of six whose breast cancer retreated on a weekly basis as each dose of medication was given. For each of these triumphs, there were also the failures. The kidney-cancer victim whose slow demise was agonising to watch, or the 90-year-old prostate-cancer patient whose wife had insisted he receive an aggressive regime of treatment with bad side effects, while his empty eyes cried out for relief from the torture. ‘Help me, someone, help me,' they seemed to say.

One day after chemotherapy, sitting at the entrance to the hospital, smoking and waiting for Tracy to pick him up, Jonathan was jolted from his gloomy reverie by an older, turbaned Indian man who started talking to him. ‘I'm so sorry to be disturbing you, but I could not help noticing that your shoes are on the wrong feet.' The Indian was moving his head in a characteristic side-to-side motion.

‘Sorry, were you talking to me?' Jonathan had been deep in thought about the pain in his spine, which seemed to have increased rather than decreased with chemotherapy.

‘Yes. Your shoes are on the wrong feet. Would you like me to help you with them?' The man kneeled before Jonathan and started to remove his shoes. Jonathan pulled back momentarily and then just let the man change his shoes from one foot to the other. Indeed, he had got them the wrong way round. It was amazing that he had not felt it. Jonathan thanked him and asked if he was a patient in the hospital.

‘No. My name is Mr Sharma, and I come in each day
and see the Indian patients in the hospital. I ask them if they need anything. Some of them do not speak English, so I help them with translation or just keep them company. Some ask me to tell their fortune, and I do that. Voluntary, of course. I do not ask for money. I have nothing else in my life now, so it gives me something to do each day. And you? You look like you have been through a lot.'

‘Cancer. I've had I don't know how many operations, radiotherapy, chemo …' Jonathan trailed off, exhausted.

‘This life has brought much suffering. All the less to be endured in the next,' Mr Sharma said and smiled comfortingly.

‘What do you mean?' Jonathan's curiosity was aroused.

‘The suffering of this life will mean that when you are reincarnated next, there will be less to learn, less to suffer. It is all for a reason. Nothing happens without your permission and your ability to bear it. We only suffer what we're able to bear. If we bear that suffering well, then we create good karma, and that karma lives on beyond this material world.' Mr Sharma was looking at Jonathan intensely now.

‘So, you believe in reincarnation?'

‘Yes, I do. Have you ever considered it, Mr …?'

‘Brewster, Jonathan Brewster.' Just then, his deliberations on whether Mr Sharma had a point were interrupted as an ambulance pulled up to the reception bay and the driver got out.

‘I'll see if we can find a doctor to come and certify death. The body stinks. Just leave him in the back,' he said over his shoulder to his fellow paramedic as he walked through the doors to Emergency. Soon, he emerged with a junior doctor in tow.

‘We were called to the place by his next-door neighbours,' said the paramedic. ‘They could see the smoke coming out of the garage. They went to investigate and found him in the front seat of the car. He'd been there a while, apparently. He was dead as a dodo when we arrived, doc.' From his blasé tone, it was clear that the driver had seen it all before.

The back doors of the ambulance swung open, and the smell of car fumes hit Jonathan and Mr Sharma standing metres away. They watched as the paramedic unzipped the black bag and the doctor placed his stethoscope on the man's chest.

‘Yep, he's dead all right. I'll fill out the paperwork for you inside. Give me five.' The doctor disappeared into the Emergency ward, and the paramedic went after him to wait for the right forms to allow them to deposit the body at the morgue.

‘May God rest his soul. I hope that he has learnt something in this life and will be more contented in the next,' said Mr Sharma.

Jonathan was deathly silent. In the not-too-distant future, it could be him being certified dead. He shuddered at the thought of his children growing up without a father or Tracy remarrying. He turned back to talk more with Mr Sharma, but he was gone.

‘You're making great progress. Your CT scan shows that there's been no progression of your cancer in the last six weeks. There's a spot on your lung here. I think it's probably nothing, but we will get another X-ray in about three weeks. Meanwhile, you can go home, and we'll see you in the clinic in about a month.' And, with that, Jonathan was discharged momentarily from the agonies of chemotherapy. The oncologist appeared very happy with his handiwork, and the treatment had apparently gone well.

‘Isn't that great, darling? That is fabulous,' Tracy said on their way back to the car park. She was excited to get good news at last. ‘I think this calls for a celebration. Let's go to dinner. Your dad will be happy to babysit.'

‘That's a great idea, Trace.' Jonathan was trying so hard to sound convincing. ‘Where did you have in mind? Your choice. You've put up with enough. You deserve some fun.'

Tracy thought for a moment and said, ‘How about that great Vietnamese restaurant where we went for our anniversary?'

Early in the evening, they were getting ready to go out. Jonathan quietly crept away when Tracy was in the shower and vomited in the downstairs toilet. He washed his face with cold water to try to put some brightness into his complexion. At the restaurant, he excused himself to go the toilet three times to vomit. The last time, he was too drained to stand, so he knelt down in front of the white enamel toilet with its seat up. There were pubic hairs on the rim, and someone had urinated around the edge. Jonathan rested his head on one hand, his elbows on the rim, waiting for the next wave of nausea. When he had finished vomiting, he got up, washed and returned to the table.

‘Are you OK? You seemed to be gone a long time.' Tracy was still trying to have a good time, but she was getting worried.

‘I'm fine, babes. It's good to get out and about again, isn't it?' he said, trying to change the topic.

‘Jonathan, you look pale – were you throwing up?'

‘No, no, Tracy. I was talking to the waiter. He was telling me about the aquariums they have for the seafood.' Jonathan was attempting, with great bravery, to let his wife have just one night that wasn't haunted by his disease. Tracy was not convinced. She signalled the waiter and asked for the bill.

Jonathan was back to the toilet, vomiting twice more before, finally, the bill came and they could drive home. By the time he lay down in bed, Jonathan was beyond exhausted. He fell into a deep sleep, during which his late mother took hold of his hand and drew him towards her on a journey. He could feel her hand as she led him towards her path. He woke with a start, sweating profusely. He
needed to vomit again. This time, as he convulsed over the toilet bowl, he felt Tracy's hand on his shoulder. When he had finished, she wiped his face with a cool washcloth and took his temperature.

‘We need to get you back to the hospital again. This is not good. You have a fever.' Tracy was right, and Jonathan wasn't going to argue.

Both knew the drill as they again walked into Emergency in the early hours of the morning: the waiting, the forms, the triage nurses, the exhausted doctors. They settled down for the long wait.

About three rows away was a young boy vomiting into a bowl that his mother was holding. He had the typical chemotherapy baldness that Jonathan now recognised with ease. A couple of seats away from them was an old man coughing uncontrollably and beside him an older woman holding a blood-soaked handkerchief over a cut on her head that had obviously bled considerably over the course of the night. Blood had spotted the whole of the front of her nightgown.

Jonathan's head was hurting bitterly now. Perhaps it was dehydration or perhaps something more sinister. Between the debilitating nausea, the pounding in his head and the constant ache in his back, Jonathan was feeling beaten. He was sweaty and overcome with a dizziness that made it a struggle to remain upright.

‘I reckon they should send them back to Pakistan. I cannot stand that bastard.' It was the night nurse talking with the receptionist. She was speaking in hushed tones, but Jonathan and Tracy were sitting nearby and could hear her words.

‘What's he done now?' the receptionist asked.

‘You know how yesterday he sent that 18-year-old girl home and told her she should not be on the pill and that she should maintain her honour by refraining from sex until she was married?'

‘Oh, yeah. That was crazy.'

‘Well, we just had a hooker in with gonorrhoea, and he gave her a religious lecture about how she'll never find a husband because she didn't preserve her virginity.'

For over a decade, universities had been telling the government about an impending shortage of doctors, with no response. This was compounded by the fact that graduates were increasingly choosing lifestyle over income. Many were content to work in medicine on a part-time basis so they could maintain hobbies, sports, family and other interests, rather than work gruelling hours.

Those who are motivated by money are often lured overseas by large tax-free incomes in countries such as Thailand, the United Arab Emirates and Saudi Arabia. Western-trained doctors are walking the corridors of hospitals in Bangkok, Singapore and Dubai; medical tourism ensures they are kept busy and paid well. For local patients, the gap between what the insurance companies were willing to pay for medical treatment and what the doctors charged was increasing. So, more and more patients were realising that instead of making a large gap payment to get a knee replacement done locally, a patient might choose to pay less and fly to Bangkok, have his surgery at one of the excellent newly built hospitals and have a holiday. The results are comparable to anything in the West. Plastic surgery, breast implants and penile prostheses, to counteract impotence,
are all done overseas for a fraction of the cost of having them done locally. The cost savings are partly because companies sell medical products for lower rates to some countries. Take India, where the parts necessary for a hip replacement cost a fraction of the price they do in the UK, the US or Australia.

Now the staffing crunch had hit the hospitals, and there was a drive to recruit doctors from developing countries. Pakistan, Nigeria and India were prime targets for recruiting. The doctors quite often knew little about the culture, the norms and the accepted social values in Australia.

‘He truly is incompetent,' spat the nurse. She was one of a growing group of health professionals who resented the influx of foreign-trained doctors into the health system.

Jonathan was looking at the nurse, whose tongue and lip piercings were glinting in the overwhelmingly bright fluoro lights of the waiting room. She noticed him staring and hushed her voice to a whisper. His attention was then caught by a high-pitched voice shouting outside.

‘Fuck off. Just fuck off, you bastard. Let me go. Take your hands off me.' A young dishevelled girl ran in through the entrance. Her blouse had been torn, and her bra was showing. She was carrying one of her high-heeled shoes and was limping on the other one. Her make-up had smudged to one side so it looked as though it had been not quite matched up with her face in a photographic retouch.

‘Come on, love. I was only joking. You know I love you. Come on. You don't need to do this.' A heavily tattooed, inebriated man was holding onto her hand and trying to pull her back out the door.

‘Just watch me, you fuckwit,' she screamed. The old
man and lady winced and frowned all at once, giving them the appearance of carved pumpkins at Halloween.

‘Excuse me, is this where I report a rape?' she shouted.

‘I did not rape her. She's just joking. Ignore her.'

‘Just fill out this form and the triage nurse will attend to you shortly.' The receptionist made no exceptions. The man gave the girl a shove and stormed out of Emergency. Jonathan wondered whether the Pakistani doctor the nurses were talking about would be assigned to see her.

‘Mr Jonathan Brewster?' Jonathan looked up, and standing there holding his file was a doctor who fitted the description. ‘Hello, Mr Brewster. Please come in, and we will see how we can help you.' Jonathan followed the doctor with Tracy in tow.

He was compassionate, competent and pleasant. Jonathan felt an instant ease with this man, who deftly inserted a cannula into a vein in his arm to rehydrate him and administered anti-nausea medication. The doctor even stayed past the end of his shift into the morning to ensure that the Oncology team would see Jonathan without delay. It was difficult to reconcile the ferocious description the nurse had given of his cultural insensitivity and the reality of this apparently decent man who alleviated Jonathan's suffering, if only for a night. At dawn, he disappeared for a few minutes. Jonathan guessed he had gone to say his morning prayers.

Once Jonathan had been stabilised, Tracy left to attend to the girls, and once again he was alone in the hospital, a number fending for itself. It was late in the afternoon before there was a bed available on the Oncology ward, in a four-bedded room. Jonathan unpacked his overnight
bag. He was now well practised in making sure he brought it with him to hospital. It contained a picture of his daughters and his wife. ‘I am a human being with a family,' the picture seemed to cry out. The bag's other contents were toiletries, his favourite pillow, spare pyjamas and a robe. He always brought a book to read. This time is was
The Prophet
by Kahlil Gibran. He opened it up and started reading.

‘Jonathan, I'm so sorry to see you in again. What is the matter?' It was the familiar Indian voice of Mr Sharma.

‘I was vomiting a lot. They admitted me this morning. And you, are you visiting someone?'

‘Mr Gupta there has leukaemia. I have been tending to his needs.' Jonathan looked up to see a wizened man in the corner bed who had grey, almost waist-length hair. His veins seemed to bulge over his wasted hands. He was sitting up with his eyes half-closed, looking much more like a corpse than a living human.

‘Oh, you are reading
The Prophet
. It is indeed a book of great wisdom. The man who wrote that is more Hindu than most Hindus, more Christian than most Christians and more Muslim than most Muslims. His wisdom is timeless. His words are universal truth.'

Jonathan put the book down and stared at Mr Sharma. Universal truth: was there such a thing? Here around the wards lay agony and triumph, defeat and courage, honour and cowardice, charity and conceit. All of the manifestations of humanity could be found in this one corner of the hospital. Perhaps he didn't need to read the wisdom of Gibran or any of the other philosophers throughout history. Perhaps he simply had to open his eyes to the colours of
humanity around him. Above them all were the stars and the infinite universe – silent, uninterfering, divine, permissive. What did the multitude of stars and planets in the universe amount to before life had graced them; and what would they amount to after all life was gone? Nothingness. Meaningless nothingness.

The man in the corner would soon die. His body would start to decay immediately. Before long, it would be cremated and become ashes – ashes scattered into the universe. His carbon molecules might end up in a plant – say, grass – and be eaten by a cow. This could then be eaten by a little boy who would grow into a man. Cyclical recycling. This made more sense to Jonathan than reincarnation, his father's idea of God or the notion of universal truth.

The leukaemia patient called out to Mr Sharma, and he left Jonathan to his reading.

Jonathan found it hard to focus on the words because of the man opposite him, who looked about 60. He had a laptop in front of him and a phone to his ear and was shouting instructions to his secretary, checking emails and typing one-handed responses. A takeover deal wasn't going well, and he was concerned about his potential losses. The intravenous antibiotics he was receiving had run out, and he was cursing that the nurse had not replaced the bag.

Jonathan went to sleep late that night, and when he awoke the man was no longer there and had been replaced by an elderly woman. She just lay there, seemingly incapable of moving or doing anything. She didn't speak, even when greeted. Breakfast was delivered to her and soon after was taken away by the catering staff. The same thing happened at lunch-and dinnertime that day, and breakfast-
time the next. ‘Is she eating much?' a doctor doing his ward rounds asked a nurse.

‘No, not much at all. She has no appetite. The food just goes back to the kitchen the way it came,' she reported back.

‘Well, if she doesn't eat in the next couple of days we will have to put in a central line and feed her artificially.'

That night, soon after the lights were dimmed to allow the patients to sleep, a large clot formed on the main artery in the old woman's neck that supplied blood to her brain. The clot steadily increased in size and was buffeted by the constantly pulsing blood from her heart. As the clot grew further, the buffeting split a large part of it off from the arterial wall, and the fragment travelled upwards into unfamiliar territory. It stopped briefly at the entry to the base of the skull and then continued swiftly upwards into the brain. The clot was stopped suddenly, jammed in the artery as it narrowed slightly. As a result, no blood could flow to the old woman's brain. In the dark, the old woman's eyes opened, and she had dreams of her childhood in Ireland, the warmth of her father's hand, her wedding day, her children on swings in the park. As the light extinguished from her thoughts, she breathed out slowly and deeply, and her heart stopped beating. Minutes later, she convulsed a bit, but in the darkness no one noticed.

When the nurses did their 6 am observations, they found her hardened cold body and did not know what to do. There was much running backwards and forwards. Should they press the cardiac-arrest button? There was no documentation in her notes that she should not be resuscitated. The policy specifically stated that they should press
the button if the patient was not documented. They did not have the authority to declare that a patient was dead. The nursing-unit manager came and said, ‘Press the button. She is not documented. Start resuscitation.'