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Sport 10: Autumn 1993

♣ Forbes Williams

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Forbes Williams

They say that at Lourdes the streets are littered with empty wheelchairs, discarded crutches, the dirty bandages of those whose sores have miraculously healed. There must be people—priests perhaps—who have the strange task of gathering up all this medical paraphernalia before the wheelchairs can become a traffic hazard or the bandages a haven for maggots. Or maybe on the other hand these priests have the responsibility of spreading the crutches and bandages about, so the legends of healing can flourish, the miracle industry remain profitable.

Can I let you into a secret?

... some of you may already know I trained in medicine, and actually worked as a doctor on and off for several years following. My first year out of med school I worked as a house surgeon, finishing with three months in Accident and Emergency.

Of all the runs I did that year A+E was easily my favourite. For a start it was straight-off shift work, with none of the extra call or hours which are the bane of most house surgeons' lives. I alternated week about with another guy: one week on nights, the next on days and so on for thirteen weeks. At first I feared doing nights might interfere with my lifestyle, but as it turned out this wasn't the case at all, and in general I have fonder memories of working nights than days. One thing: after eleven I was on my own, king of the castle, no one else to tell me what to do. Sometimes it got precariously busy but somehow I always seemed to manage. The more serious cases I could refer onto more senior staff on call for their particular speciality; getting them out of bed was always a special moment. Even better, it was usually quiet enough later on in the night that I could snatch a few zeds of my own. Money for jam.

One slight negative with nights was the constant back-of-the-mind dread that there'd be some terrible accident, a sixteen ear pile-up on the Northern Motorway, with casualties from here to September. But, almost miraculously, my luck pretty much always held in this respect and my page 6 nights were generally free of true catastrophe. This was a particular kind of luck that seemed to follow me throughout my brief medical career. When I had the cardiac tracer there would never be a heart attack. On orthopaedics or neurosurgery I'd go entire Friday nights without a single call. Over time it became a fantasy of mine that I'd one day be employed in an honorary capacity—all paid for by the grateful city—endlessly on call, twenty-four hours a day, seven days a week, just so nothing bad could ever happen ... even so, in spite of my almost perfect record I still always had the vague anxiety that my luck would come to a terrible end any day, with an earthquake or plane crash or rest home inferno . . . regularly I swotted up my triage, as if careful preparation for bad fortune is part of the key to good ...

A positive aspect of A+E was that most of the punters were well, not so often the case in a hospital. Lots of twisted ankles and minor cuts. I remember one girl who must have been in love with me because she kept coming back with trivial injuries whenever I was on duty. Her speciality was standing on pins, which can take an hour or so to locate once they're well enough into a foot ... in those days the Dunedin A+E was also the National Poisons Information Centre and you'd often be fielding calls for that, mainly doctors, though anyone could ring. I remember in particular one guy in a panic because he'd given his cat an aspirin and now he was scared it would die ... or the woman who rang just as her husband was about to drink a cup of Round Up to prove it wasn't dangerous.

Without a doubt the strangest case I saw in those three months was a woman who'd swallowed a toothbrush. She'd been eating pâté but afterwards became fearful it was off and would give her food poisoning, meaning she might miss an exam the following day. For some obscure reason she thought cleaning the back of her throat with a toothbrush might actually help but she'd pushed it too far and swallowed it. Naturally I was a little suspicious because the story was anything but normal and maybe it was all an elaborate ploy to avoid the exam—and how can you swallow a toothbrush? Even so, she insisted, and there it was on the X-ray, a Reach toothbrush at that.

But I'm avoiding the point of the story.

One day a young student came in seriously injured from a fall. It was the end of the academic year and her mother was in from the country to take her home for the Christmas break. Apparently they'd only just had an page 7 argument, and—perhaps to let things cool off a little—she'd stepped out onto the balcony from her bedroom to get some washing she'd hung out earlier. Somehow she'd slipped over the railing.

Because it was daytime there were several of us on, the others all senior to me, and so they took over her case while I went on with the cuts and ankles. After about twenty minutes, though, a nurse came and told me they wanted me to give them a hand.

Daytime is the worst time for emergencies in hospitals precisely because there are so many senior staff around. There's a general misconception that it's more dangerous to go into a hospital at night as there aren't so many staff and those on have less experience, but take my word that's exactly the way you want it. It's no secret that everyone in hospital gets better at Christmas when there are no doctors meddling around.

In the emergency room of A+E, I could see the whole show was a shambles. I mean with hindsight it's clear to me this wouldn't have mattered, the poor girl was doomed; even so, there was still a lot of confusion. Too many people working at cross purposes, an air of panic, a couple of anaesthetists arguing.

They wanted me to deal with the mother. She was demanding to be let in to see her daughter, but there was too much going on. It was just not appropriate—and it was my job to put her off.

I like to think I was good at dealing with people: I suppose this is a vanity of most of us. All the same there were times when I felt right out of my depth: telling people I'd only just met that a loved one had died; breaking the news of a fatal disease to an outpatient. At these times I'd become aware in particular of how young I looked. Sometimes I could see it in their eyes, this extra twist of horror. A mere boy—Dr Howser was it?—swanking in in a white coat to tell them their lover of thirty years had just been killed. How can you do that with class?

The girl's mother was in the relatives' small waiting room. She was very on edge, almost hostile. I vaguely remember someone else, a sister perhaps, or a brother. I began to explain that everything was just a bit hectic right now and she'd get to see her daughter soon enough but she interrupted before I could finish.

Don't be stupid, I'm her mother. What do you mean I can't see her? She's my daughter.

I know, I said. But they need a chance to stabilise ...

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   Now listen, she interrupted again, I want to know what's going on. How badly hurt is she? Should I call my husband?

I realised I didn't know myself exactly how bad the girl was. Look, I said, I'll go back and check. Give me a minute, okay?

But back in the emergency room no one seemed all that clear. There were basal skull fractures. An Indian anaesthetist was trying to intubate her but there was too much blood coming up from her lungs. They were talking about urgent surgery. In the back of my mind I think I began to realise her chances were probably nil.

Her mother wants to see her, I said to one doctor, but he ignored me. I stood for a minute and watched them all, then walked slowly back to the relatives' room, trying to work out what to say this time. I don't think I was really trying that hard. I was kind of kidding myself that this whole thing was just a terrible nightmare and that there was no need for me to deal with it anyway.

I explained to the woman that they were still too busy for anyone to be able to go in. They're talking about taking her to surgery, I told her.

Well I can see her before that, can't I?

Sure, I said. Of course. I'm sure that'll be fine. I wasn't sure at all.

Should I call my husband?

I looked at her, dumb. It was clearly possible the girl would die—though of course I couldn't be certain—and I realised her husband would take maybe a couple of hours to get up from home. Somewhere in my brain I had this vague idea that it was silly for him to drive all the way for nothing. I think maybe the woman had added to this confusion by pointing out at some point that her husband's job was their livelihood and he couldn't just swan off without very good cause. Somehow I'd let myself be sidetracked into this loyalty to their livelihood. Beyond this, I still hadn't put it to the woman that her daughter might well die. I think I thought that if I said yes, call your husband now, that it would have been an open admission of her daughter's certain death. And I didn't want to do that.

I don't know, I said. Maybe you should wait a bit first.

I remember another time, as a final year student, when I was acting house surgeon on neurosurgery, generally considered the worst run of all. I spent the whole first week yelling slowly into the ear of a young woman who'd had a stroke about a year earlier and was still unable to speak. All the while I was thinking I was doing a great job, taking the trouble to help keep her so page 9 informed. At the end of the week I went into her room to explain something and for the first time her parents were there. I began slowly yelling in my usual fashion when her father interrupted.

She's not deaf, he said.

I mean I went back later to apologise, to acknowledge how stupid and offensive I'd been, but I still feel sick to think of it, me leaning right into her face and yelling at her and her just taking it because it was impossible to do anything else.

So the girl's mother didn't call her husband, not till later after the girl had died up in surgery. And she never did get to see her again, either-they whisked her away before either of us realised-no, the last thing she ever did with her daughter was argue. I don't think I can bear all the blame for that, but I was still a cog in the machine. Maybe I should have said the hell with it and taken her in anyway-what could they ever have done about it? I really don't know.

People sometimes ask me why I gave up medicine, though as time passes I get asked this less and less. I've never been much good with an answer. There are so many reasons ... maybe this story goes close, I don't know. Hell, I'm no saint, not even a lousy priest. There's not a lot I believe in. I suspect all causes are lost to me in the end.