This story begins in a desert. I’ve often wondered what the definition of a desert is – being Australian our idea of desert is a little skew. To us, deserts are perhaps simply an abstraction of distance. The mind-bendingly vast, scrubby interior of the country. An empty landscape hostile to most of us delicate life forms. But this story opens its pages in another country altogether, in Las Vegas, a desert of its own kind.
Eager to exit the glittery wastelands, we had booked a hire car in early 2020 to get ourselves over to the famed State Route 1, so we could drive up the plunging California coastline. I feel sure we’d booked something up to the task – had it been topless? Wide-winged? Just a little too showy? However, when we eventually located the supermarket-grade rental car office, it seemed our dream car had been given away. All that was left was a mini-van. And not a glorious, kooky, Little Miss Sunshine thing, but an industrial white block with disturbingly small wheels and enough cup-holders to be concerned about the mechanical integrity of the chassis.
But to the desert with us! Us and our deeply unfashionable chariot! To get to California from Las Vegas, one must traverse Nevada. Now Nevada. That has some deserts. I had requested an overnight stay at Death Valley Junction, because, well, I can’t really recall now. It just felt like something I desperately wanted to see. Death Valley, though, is kind of the Disney of deserts. It has parking lots and sign posts and Instagram reminders. It’s still spectacular: sunk below sea-level with its miniature cathedrals of salt, lakes of bracken pink, the silver glint of the roads, the disappearing shimmer of the horizon, but it was the drive in the silence of the van, through the low-slung hills, the land scraped clean by aeons of sun and wind, the dry-throated plains that went on and on, with hardly a car passing by us, that gave us a real sense of desert. And of course, Nevada has some of the wildest, and the craziest. The children begged to side-track to Area 51, although I was keen to find Bravo 20, the illegal bombing playground for the US navy, made famous by the photographer Richard Misrach in his desert cantos, with images of craters filled with blood-red fluid and smithereened military vehicles. And of course, just over the state border is the Mojave desert with the dessicating bones of hundreds of abandoned, perishing aircraft, presumably now overflowing post-pandemic like Potter’s Field.
Here I am, though, wallowing around in set-up, without getting to the real story itself. Which was, as we blithely appreciated the immensity of time and space from the hermetic glory inside our mini-van, that we were, as is our wont, I’m afraid, blissfully ignoring the warning light on the dash which had blinked into existence not long after leaving the sadistic outskirts of Vegas. Low tyre pressure, which, of course, couldn’t be right because we’d JUST PICKED THE VEHICLE UP FROM THE HIRE PLACE.
Scene cut for brevity here, but there are not too many ways or places in the world less inviting to discover a flat tyre than coming back to your parked vehicle in the emptying lot at Badwater Basin when the sun has had enough for the day and is clocking out. All I could think about was that ‘one day this will be the beginning of a great story.’
But this is where I was wrong. Because somebody had already told this story, and so much better than me. Again, to resort to some time-saving Nabokovian techniques (garage, spare) we were able to limp our way to the Junction itself, wobbling down the road at a speed recommended on the side of the emergency tyre, not conducive to harmonious behaviour either inside the vehicle or out.
We reached our accommodation. Here I refer you to exhibit one. Armagosa Hotel and Opera House. No amount of description will do justice to crunching into the deserted carpark long after the turquoise of dusk had morphed into a chilling navy-black, to the welcome of only a few buzzing lights. One of our offspring refused to sleep the entire night, staying awake and vigilant for the obviously ghostry that was thumping up and down the uneven faded carpet of the corridors outside the doors with their faulty locks. The place was outlandish, improbable, intoxicating. There was a fully functioning Opera House tacked onto a crumbling ruin of a hotel in the middle, and I do not exaggerate here, of nowhere. But it was this story, the story of Armagosa, that trumped mine, well and truly.
Marta Becket danced for Broadway. She did not, however, want to be constrained. She wanted to dance the dances she believed she was born to. So she took her worldly belongings on the road with her husband, and they drove the wild breadth of the US, unsure how to find expression for her desire to produce her own ballet shows. Cue a flat tyre in Death Valley Junction, in 1967. While her husband was doing the manly thing at the wind-strewn local garage, Marta walked across the road to the ruins of the Armagosa hotel and hall, boarded up with the last of the paint flaking from the walls, and she looked inside and saw her destiny in a single beam of sunlight. She purchased the hall for a dollar and went on to make it her own stage. She performed every single night. If nobody turned up to watch by intermission, she would cut the performance short and return to painting the walls, which filled over the decades with a psychedelically coloured audience of royalty and other regal theatre lovers wearing their finest clothes, silently cheering her on. During one performance, a trio crept in to watch. They were from the New York Times. And the rest, as they say, is history, as obscure as it now is. Marta danced for over four decades, dying at the age of 93, with her last wish that she would swirl into a dust devil above Death Valley.
Below is a link to the Opera House, and Marta’s story.
As you can imagine, I was smitten. In love with the story, with the splendid coincidences, but mostly just because it is the grandest of all human tales: that of divine folly. It is one of the most admirable, endearing, and sometimes world-changing traits. Great, grand folly, despite the critics and detractors, comfortable in their armchairs. Marta, you absolute legend. May you pirouette through the dust over Death Valley Junction forever.
It is a repugnant thing to wallow in one’s own misfortune while the world is suffering its own howling, mortal injuries. As we live, and gasp, through the ancient Chinese curse, we’ve discovered that interesting times are not defined in a way we ever foresaw.
Yet, here I sit, wallowing. I am looking out my window at a sky of crystal clarity, its blueness a result of just the right scatter of light, unimpeded by any stray molecules of smoke. Somebody brings me breakfast on a tray. A kindly soul knocks on my door, simply to ask how I am. People fuss with my arm. I am touched.
But here I am scrolling endlessly through my phone. Social media, news feeds, endless dull dopamine hits, what if I miss something. Determined to show I’m in control I put down my phone with a flourish and immediately open my laptop. Dramatically bang on the little cross to close twitter. Reopen twitter.
My hands shake as I type this, but then again, they’ve been doing this for days.
I reel through twitter again. I funnel all the news into a compartment I am trying to keep walled off, like an encapsulated bacteria; a place for all the terrible stuff. And there is a lot. If I listed all the things producing a whirling rage inside me, this post would contain nothing but, and I wanted to, no needed to, write about something else altogether. The rage leaks beyond its membranes though, and I feel more impotent than normal, sitting in this room, by this window, typing these words.
The good news is I’m sitting. It’s the first time in a week I’ve been capable of it.
The bad news, or should I say odd news (as they say that every adversity is fuel for a writer), is that the bed is not all that comfortable, there is twenty-four hour noise in here, my little wooden bedside table does not include a Gideon Bible and a menu for spa packages, but instead has oxygen cylinders and suction and other resuscitation equipment. Funny I should mention bacteria before, because that’s what has me in here, for my first ever hospitalisation. And it’s a doozy alright.
I will start by saying I am almost definitely getting better. In The English Patient, Booker of the Booker of the Bookers, when Katharine asks Almásy whether they will be alright, he answers ‘absolutely,’ but she responds, ‘”yes” is a comfort, “absolutely” is not.’ I am at that tender point here, but I know I am well enough to feel the compulsive pull to write, so that probably downgrades things from ‘absolutely’ to the aforesaid ‘almost definitely.’ I should, of course, be working on my manuscript for ‘novel 2’, but my head is still not performing its executive tasks all that well – the oddest of all sensations for someone who relies Very Heavily on a brain that functions passably and correctly most of the time – but I’m afraid Typhoid does that. Delirium is common, something to do with the sepsis and cytokines and general raging unwellness, and I have experienced for the first time in my life the rather terrifying yet undeniably interesting phenomenon of febrile hallucinations. Disembodied heads. In conversation. About all sorts of things.
The medical details of Typhoid are tiresome, and tiring. Oh so wearying. And all the stuff in the textbook you can read about anywhere, but it is the things on the periphery that have me fascinated, and like all writers, who are, after all, just a bit slower than normal humans, I must write about them to make any sense of them.
There are big things, and there are little things. The biggest of all is perhaps the most universal, that of confronting your own mortality. It’s all a little raw to be exploring that in too much detail yet, so I’m going to let that digest for a bit (may as well, as nothing much else is). Having said that, suddenly feeling you may imminently die, even if not justified, is a very sound opportunity to tidy up your psychological and emotional drawers. And, weirdly enough, I find out I’m no different to anyone else on the planet. All I really care about is the fate and wellbeing and love of proximity of those that are deeply connected to me during this short wild ride of life, and quite frankly, I can’t talk about this without tearing up, so Let’s Move On.
So aside from setting a tentative foot in the valley, and withdrawing it just as quickly, what else is going on, within and without?
Firstly, Typhoid. I mean, really. I sense the incredulity every time somebody new hears the word. They look at me askance (and I suspect will do for evermore), as though I have somehow escaped from an Edwardian novel. I wish I was making it up. I really do. To be honest it is a label of humiliation. An embarrassment. I have no doubt there is speculation aplenty going on, but this will be one of my New Rules (actually, it’s an old on, which I’ve never bothered to keep). Do Not Mind A Jot What Other People Think And Say About You.
There are all the usual things I could write about, and please just take them as read: how incredible Australian healthcare can be, how diligently I’ve been looked after, how grateful I am to be cared for, but none of that makes for a very interesting post.
Instead, let me tell you about having two grams of ceftriaxone bd. I must not have a bacterium left alive in my body; perhaps just a few hardy souls, loyal to the resistance, white knuckled trying to hang on. I know we contain multitudes. Humans are nothing without bacteria; you may well know we have more bacterial cells than human. I wonder am I more human now? Will I lose weight from the great biomass extinction? Where have they all gone? Is this why I’ve felt a little cray-cray – were the last good ones guarding my blood-brain barrier like centurions?
I have been ‘troublesome’ to get a drip into. The only rash I have is one of circular white spots, stuck on to plug up the holes. I’d always boasted about having great veins, as if life was some kind of vessel contest. Turns out I am wrong. They look good, but are not very useful. Like an Instagram influencer, I guess. I make all sorts of excuses, ‘oh I must just have unusual valves,’ or some such tosh, and I reassure whoever has failed with slightly trembly hands that I would be the Empress of Hypocrisy if I were in anyway critical of missing a line or two. I grit my teeth and get another one.
I’ve had my first CT scan. All I need to say was it was ugly in there. The saying ‘beauty is but skin deep,’ is now so confusing to me I don’t know what to think.
I am experiencing every moment three times. The first in this reality; the happenings that must happen, the drugs, the blood pressures, the merry-go-round of meals which are only missing the merry. The second time is understanding as a doctor what we put our patients through; watching the way the imprecise nature of medicine and pathology leads to thousands of possible decisions, all of them with benefits and consequences. The third is as a writer. The noticings. The sensation of contrast dye filling your throat as it enters your vein. The inconceivable power of gratitude. The way bacteremia focuses behind your eyes, daring you to move them just a millimetre. How pain forces you to live in the moment, and you cannot recall a single second of how it felt to be pain-free. Lips and tongue so dry everything sticks together and makes your words come out sounding funny. Faking the great smile when people walk in the room because you don’t want them thinking you’re not deeply thankful for everything that they’ve done, and really you’re a bit of a wastrel – I mean Typhoid – Really! – how embarrassing – there are people with gold tier, well-deserved illnesses in here, not the illness of stupidity – dear God you’re a doctor, don’t you know better? The opioid anaesthesia of daytime TV which blares out from every room, in every cubicle, wherever one waits. I wonder how anyone can think with this stuff shrieking into their face. I haven’t turned mine on, although I have a lovely nurse who has come in and told me the story of every Christmas movie she has ever watched (which is the BEST way to experience a Christmas movie, I’ve discovered).
And boy, have I had time to think. There have been several Faustian bargains made. And a number of deeper level understandings about humanity. Hardly surprising, it’s all come down again to love, forgiveness, kindness, integrity. All the promises I am making to myself for when I am upright and allowed back out into civilised company. Keeping that rage at the horrific injustices of the world in that separate box, so I’m not consumed and I can examine it a little dispassionately, keeping it super-focused. We’re all in this crazy mess together, and although I may despise some of the decisions being made by those in power, and in my name, I will try to understand why, and forgive, before I take any action. Yada yada. Anyway. I’m going to get better. Absolutely. And strong. Very strong. I have a Christmas to attend, with those that I love.
God only knows if I’ll put this anywhere public. Why does a writer write anything? Yes, to make sense of things, but also to be read, so perhaps I will. Now I shall return to my automaton scrolling, watching endless GIFs of Sydney Harbour being swallowed by smoke like it’s being suctioned into the maw of some terrible Grey Whale. Read about our magnificent firefighters. Read about our ‘leader’ in full smirking denial mode for whatever reasons he has. Read about Leeds and Trump and Brexit and Medevac and make sure I stuff all that anger into that box, to keep it alive and kicking, but away from the rest of me, which will wallow a little more, and recover. Thank you for reading this, if you do, and excuse the moderately dysfunctional neuronal connections. You are wonderful. You.
I have been asked the question, several times, ‘why did you set a novel about medical error up in Wittenoom?’ It’s a fair question really.
I have to answer this a little blind. Most novels arise from some odd place; they spill forth from the subconscious organ, wherever that is. Brain? Behind the spleen? Who knows. As most neuroscientists admit, we do not understand the creative process in the slightest.
All I knew is that a mistake I had made in the infancy of my career had stayed; fashioned itself into something solid, grew a little bit each year, beyond all the other mistakes, and started courting words. It wanted to be written.
So we faced the blank page, me and my brain, not really having any idea how to do this novel-writing business, and began. And the moment I did, needing to send my fallen doctor, somebody who had made an unforgivable mistake and was slowly dissolving in the acid of her own contempt, somewhere, the image of the abandoned, ruined hospital of Wittenoom flared true and bright in my head.
I’d travelled to that far-flung ghost town, which stayed clawing on for life with talons of ego and madness, battling all attempts by the Government to shush it out of existence, when I was a soft, unscarred intern. I had found myself alone and lost in the crumbling wreck of the hospital, the walls falling down, but gauze still on the floor and journals stacked and waterlogged in the corner. It was the strangest place I had ever seen. Eerie beyond imagining. The bricks from the walls were toppling, perhaps releasing the ghosts trapped in there, one by one. Relics of equipment were untouched, covered in dust. Dingoes howled nearby. Asbestos fibres floated in on the desert breeze.
But, life needed to move on. I shifted back down to Perth, and folded away anything that was not needed to survive a lifetime trying to become an Emergency Physician. However, when the book began to wriggle out of me, here it was. This hospital. This image. This place. And with this came the research. Which is why Dustfall came to be about the story of a brutal chapter in Western Australia’s history, but even more so, the story of the contempt that some corporations and Governments have for human life. The victims, the dead, those who suffered at the hands of others, they deserved a voice. It was a tough book to write, but through the extraordinary help of others, it is now on paper. In stores. People occasionally read it, and for every soul that takes the time to do so, I will never be able to express the extent of my gratitude.
I’m also asked, once in a while, whether the process was cathartic. Well here’s the bad bit. Right now, I’m not entirely sure whether I have survived. At the moment I’m taking a few months away from the hospital. Away from Emergency Medicine. God, I hear you say, not another one.
I don’t particularly want to write about this blindsiding vulnerability – (oh how wonderful is it to appear invincible, in control, untouchable) – but, I am a writer, and the only way I can truly think is with these things; these words, sentences, thoughts, coming from my fingertips.
After all this time, to feel a tiny bit broken, feels the truest kind of failure. We hear a lot about failure – how it is the only way to learn, how it allows us to rise up and grow, like we are some kind of gaseous villain in a superhero movie. But I’m not sure it’s always like that. For some, it’s a pervasive, long term ‘not good enough.’
Medicine, we are beginning to learn, has been a powerful force amplifying that message. You are not good enough.
The compassion equation no longer adds up. While we know that we must reach deep, every single day, into our well of compassion to be half-decent clinicians, the same cannot always be said for those who stand over us, with their administrative roles and executive titles. An unexpected culture of mutual disrespect and suspicion about motives has somehow infested many of these relationships, and it is not clear how to find our way out.
We know the health dollar is limited. We know that agitating for individuals is sometimes at cross-purposes to the greater good when it comes to budgetary allocation. We know we must work to make our systems as efficient as possible. But to come away believing that one’s efforts are not good enough, is, over time, damaging.
I am no stranger to the not good enough mantra. I am, after all, female. I see the same wounds from the same words in others – people whose first language is not English, in the voices of our First Nations people whose lives intersect mine, those with illness/disability. Not good enough. For what, one could rightly ask? Who knows, but we have a society that, more and more, seems to enjoy empowering the voices of the strong – those who feel entitled to make others whisper such words to themselves. Have current global events contributed to this anti-mantra? Where oppression of any voice other than that of wealthy white people goes unfettered? I would like to say wealthy, white men, as it mostly is, although it seems to be the first two adjectives that appear the most in this picture.
I’m not good enough on social media. I’m a fool, at my age, to even care. But I do. I see all the things I should be doing, particularly in critical care, to be a decent clinician, and I know I can never be that person. Why am I not that person, I ask? I also watch the mob-think, the pile-ons, people tossed into the colosseum, and I sit back, aghast. What have we unleashed?
But then, as I look outwards for reasons why I’m sitting here, writing this, I wonder, is the enemy simply inside myself? Am I the cruel prison-guard of my own bruised worth?
There is, though, something rotten going on outside.
When I started writing Dustfall it was 2011. I thought I was writing something historical. That crushing individuals who are on the lower end of the power relationship see-saw was slowly becoming a thing of the past. The world was progressing. Tolerance, globalism, respect, although moving in fits and starts, was heading in the right direction. But I look at our planet now and wonder. I look as countries leak refugees, the result of war-loving men who wear their murderous decisions like epaulettes, the millions affected fleeing to countries which lock up wide-eyed children or push their boats away hoping they might silently drown. ‘Jobs’ trumps climate change, coin beats species loss, tourism beats Indigenous treaties. Women are not believed, lies from the top are.
What are we doing wrong? How do we fix it? Apart from trying to keep a tiny beacon alight, trying to show others the respect you believe is fundamental to our connectedness as humans, I’m not sure. Maybe this is my only advice. If you’re feeling not good enough, then chances are somebody else is too. And those personal connections, not advertised, not instagrammed, where you find yourself in the company of trust and respect, are kind of amazing. And if all else fails, write.
(as a post script, in the light of the inconceivable horrors going on in the US – just for one example, the slaughter of peace-loving Jewish people in their synagogue during a baby naming ceremony – I am re-reading Primo Levi’s If This is a Man. I needed some perspective on the world. What is a man, indeed? I highly recommend it.)
Plus – on the topic of ‘not good enough’, a recent post by the beautiful Shahina Braganza https://shahinabraganza.com/blog/wellness/was-i-enough/
Books find their way into your life by all sorts of means. Often they’re bought, or borrowed, or picked up from somewhere unremembered. The unforgettable ones then find their way into you. A novel read is more than just a story consumed, pages turned, characters met. Each time I read a good book it somehow steals off the page into my molecular makeup. I may not always remember their details, but it is as though with each memorable book I am laying down bricks, one by one, building a slow Taj Mahal of experience. It means this lamentable little body can be so much more than just me.
My little ‘books of 2018’ series celebrates these ones that have, indeed, become part of me. So to Louise Allan’s The Sisters’ Song. This book feels as much part of me as my own. Louise and I were in a writing trio while both of our manuscripts were emerging from the swamp. We worked on them at the same time, sending each other (along with our third member, GP and writer Dr Jacquie Garton Smith) snippets: long and short, wordy and clipped, drafts and outlines. We took wrong turns together and rescued one another from the mire.
I learnt a lot from seeing Louise struggle with her manuscript – as much as I learnt from my own rejections and failures and dispiriting tussles with this process which seemed overwhelming at times. In Louise’s book I was witness to the characters’ evolution, watching them come into their own and stake their claim in the world of literature. I was also party to the improvements and momentum, from a shortlisting in the TAG Hungerford award, to a contract with a large commercial publisher.
And thus The Sisters’ Song was born. It is a book both contemporary and historical. Its themes are universal – women’s lives thwarted by the expectations of both society and their own selves. Louise examines the relationships within families and within marriages, fraught all of them, with painstaking care. Early 20th century Tasmania is evoked with exquisite detail, and the lives of the characters are incredibly well, and beautifully sketched out. Louise’s book is officially a bestseller. Its gentle themes and questions have resonated with the reading public, and it has sold incredibly well. Louise is also a great supporter of other writers, both emerging and established, and she deserves her place in the canon of Australian literature.
It has been an honour and a saviour having Louise for a writing buddy. Our styles are distinctly different, but that does not mean we haven’t been able to offer one another what we both desperately needed to turn our manuscripts from nonsensical early drafts, into completed books.
Here is The Sisters’ Song.
The year will soon be thinking about folding away its linen, packing up and preparing to roll out its credits. It’s been a bit of a one really. Awful in many ways: cruel, fetid, tribal, amoral. But amongst all of this there has been, as always, beauty, hope, joy, amazement. And, of course, as the flapping banderoles of the latter, there are books.
I’m a terrible blogger; a hopeless archivist. I’ve read many, many books this year, and haven’t always shouted into the ether my thanks to those who’ve slaved over their creation. I know how hard it is to produce a book. I understand the fragility of releasing one. I appreciate what it means to have one’s book connect with a single other human.
So this tiny, likely unread, series, is to give name to the top 12 books that have regaled me with their words this year – those books that have given me delight and elation and rapture and that have, for many reasons, entered my heart. Books do that, you see. Become part of your being, your memory, your DNA, your circuitry, your life.
Each one of these books have given me something precious in their own way. They have slung shot me further along this business of existence, and made me happy that I’m part of it, this writerly, readerly life.
One a week, until 2018 properly shuts down, twelve books for which I am grateful.
THE EVERLASTING SUNDAY, Robert Lukins.
It was odd reading Robert’s book. We released our debut novels at pretty much the same time. What, I wondered, would happen if they were both really similar? University press, unknown writers, not overly fitting into any pigeonholes, what if they were cut from the same pattern? Reader, they were not.
The Everlasting Sunday is a trip and a half. It is unsettling and dizzying and downright extraordinary. Set somewhere Englishy, boarding house lonely and snowy, it is never quite real, but never unbelievable. It is the Lord of the Flies I always wanted to read. Robert’s writing is magic; every sentence crafted with intelligence and fierce control. I was immersed from the first page, and found it difficult to crawl out of a night. His language slows my heart down, his prose divine.
Somewhere in this is a bit of strange pride that I get to call Robert my contemporary. Perhaps it is more simply contemporaneous, but whatever it is, I feel a tiny kinship with the release of this book. I still see the falling flakes on the front cover, lit up from within, floating to the ground. I can feel the disconnection of the boys in Godwin Manor. I celebrate Robert’s masterful ability. It was the perfect novel to read when I was lost thinking about my own creeping out into the world.
Deeply excited to know what is coming next for Mr Robert Lukins. And if he doesn’t hurry up I shall need to go back and read this one again.
You may be wondering why the top copy of Penelope Lively’s Moon Tiger has slipped off her pile and is teetering on its back without dignity. Pushed perhaps; back-handed and left floundering like a flipped tortoise. I know why, but it took me some time to figure out. The carpet underneath these two innocent-looking stacks is a sensible shop-brown, as you can see, and covers the steps towards the back of an out of the way bookstore in a lane in the middle of a Perth suburb of unseemly prosperity. You can’t walk up these steps; they are covered in books. Books to be sold, books to picked up and paged through, books to be put back down again when their blurb is not sufficiently enticing or the protagonist has not called out loudly enough to the distractible browser. That is my book, next to Penelope Lively’s. THE Penelope Lively, Booker prize winner, Golden Booker pursuant, goddess of story and character and altogether blisteringly magnificent bookwright. My first reaction, upon seeing my book next to hers, was unclear, a little soupy. Was it a feeling of delight unsure how to embody itself – oh there I am, yes, that’s me, oh no, nothing really, no don’t worry, oh yes, ha ha that IS my book next to Penelope’s – or was it more a deadly slug of imposter’s guilt (I must move it before anybody notices and makes some sort of curare-like comment)? I would take a photo anyhow; record the moment, in case this dizzying proximity proved temporary. Why, though, I know you are asking, was the top of her pile tipped backwards, blood rushing to its head, whilst my pile, although not Euclidean in perfection, was at least orderly.
We must turn our clocks forward several hours to find out. Everybody must leave, the lights must be switched off, and the heavy lock on the door latched shut for the night before the mystery can be solved.
If you’re reading this, then you are the sort of person who understands that there is something otherworldly about bookshops. They’re non-Newtonian. Normal rules don’t apply. It’s at night time that the readers, the sellers, the wanderers, the eagle-eyed, those of us who drearily adhere to the constructs of the universe’s physical laws, when all of the people, anybody with mildly human form, obediently leave.
And that is when others arrive.
At night, Claudia, from the depths of Moon Tiger, stretches her long, sensuous limbs, and slinks out of her pages. She has not been to Australia before; Penelope sent her many places, but not here. She is faintly, and briefly, repulsed. The sneer of the sun has faded a patch of carpet nearby. The room seems safe and lazy; neither are qualities she admires. She sniffs. She is sure she can smell beer. It’s yeasty, whatever it is. She perches above her pile of books, and crosses those shapely pins. I shall wait, she thinks. Good things come to me. They always have. Tom, might be here, she thinks with a start. After all, if no laws apply, and I am here, why can’t he be. Her stomach contracts, her throat tightens. She puts a hand to that now world-famous red hair, hoping it survived the exit from the pages. And she waits.
Unhappily for Ms Hampton, who sits, twirling the back of an earring, looking serene on the outside while she is all anticipatory turmoil on the inside, it is not Tom that turns up, but Raymond. Dr Raymond Filigree has snuck out of Dustfall, and is looking around, confused. He is not confused because he is in a Perth bookshop, at night; not the size or the flesh or the universe he thought he ought to be inhabiting, but because he is always confused. You see, while both Raymond and Claudia could escape their books, they could not escape their characters. They seem to be the only two who’ve had the temerity to climb from their paragraphs this night, certainly up on the step area. Several other characters are milling around other shelves further away, but they are too small to climb down, their voices too slight to call out.
I would love to tell you that Raymond and Claudia got on famously; that Claudia inhabited her role of journalist and peppered Raymond with questions about Wittenoom, fascinated by the corporate and government cover-ups and their contempt for human life, and that Raymond would have melted at the sight of Claudia, completely forgetting about the odd, angular, widowy looking Miss Rosa hanging around in her cabbagey kitchen back in the book. I don’t pretend to understand why, but they detested each other immediately. I could sit here, on this page, pontificating why that might have been, but I will never know this part. It’s all second-hand reports, you see.
There’s conflicting acounts as to how Moon Tiger was toppled. It happened sometime near dawn. It seems as though Claudia, distraught that she wasn’t going to spend her precious time watching the sun rise from a slow-moving train in Egypt, drinking the last drops of gin from a crystal tumbler, gazing as the colours of the Nile morph from gold to pink to the shimmer of white daylight, while great herons and ibises fly by in streaks, not in the company of Tom’s powerfully evanescent beauty, threw what could only be described as a tantrum, leaving Raymond silent and apologetic in that English way of his, sorry that he hadn’t realised until too late her distress.
And then it is over. The bookseller unlocks the door, and comes into work for the day, She tidies up some of the piles of books, but not this one. Perhaps she knows too. She is a bookseller after all.
Doctors, the world over, are reeling. The global telegraph has been alight with conversations, most of them uncomprehending, shocked, dismayed, fearful. In several swift and definitive decisions, a UK paediatric trainee, Dr Hadiza Bawa-Garba was not only erased from the GMC register, but charged with manslaughter. This was in response to several medical errors – most of them oversights when the details are examined – which contributed to the death of a child in hospital. I have no intention of going through the case here, which has been expertly picked over by a good many sources. Suffice to say that Hadiza was slung to the lions, the consultant in charge leaving her naked, her hospital, her trust, the regulatory bodies entrusted with safety of both doctors and patients, all turning their backs to leave her to her professional demise. All for several decisions made when she was covering extra shifts, in a climate of heinous understaffing, and trying to manage a deluge of patients when she had just that day returned from maternity leave, unsupported and abandoned to her fate.
So much is baffling about this case and its horrific outcome. Nobody wants a child dead from misadventure. It is tragic beyond the reckoning. But for the regulatory bodies to kick back with the tendon strike and sacrifice an individual so? Is Hadiza supposed to be an example, like a spiked head at the entrance to the Thames? Unquestionably these decisions will serve to endanger patient safety in the future. Individual blame always does this, driving self-reflection and honesty underground.
Hospital systems are almost incomprehensibly complex. Patient safety is paramount, but the infinite interactions that occur within them will likely always outfox the desire to provide foolproof polices and structures. You can’t legislate for the illimitable.
The outcome of this case is extreme, but so many of the occurrences are commonplace. Without any desire to misappropriate a worthy movement, is this another instance of #MeToo?
We inside the beast are always going to make mistakes. Always. Most of them are small; oversights, errors of judgment, succumbing to biases, betrayal by the impossible circumstances in which we sometimes work. Most picked up by the lumbering checks and balances designed to avoid them.
No doctor ever wants to make mistakes. In fact, cheered on by cases like Hadiza’s, we, and the world we serve, see medical error as utterly unforgiveable, a deep personal failing. Doctors, for many reasons, are not very good at failing. I know what it feels like. I expect my experience is nothing special, but I know what it’s like to wake repeatedly in the early hours, my gut twisted and writhing re-asking myself why I thought a certain thing, or missed another. I know what it’s like to hide in the department toilets, trembling and wiping away unstoppable tears. I am on intimate terms with disgust. I know what it’s like to think, perhaps if I end it all… I know what it’s like to stopper in the shame and humiliation that comes with the perception of not being good enough. Mostly our punishment is a deafening, roaring monster within ourselves. And, if we are very, very lucky, we get a system that allows us to self-reflect, even better with some empathetic human support, and even better a respectful, inclusive way to analyse the system errors, which, almost always, are more contributory to any error than the part the individual played.
I’ve thought a great deal about the consequences of medical error. I wrote a novel about it. It’s the core of Dustfall. If perhaps a handful of people read the book, either medical, or not, and see into the heart of a doctor after failing a patient, then perhaps the six years of sentence struggling will be worth it.
I’m sitting in a narrow nook in the hospital library, all clandestine and covert. I come here far more often than I ought. Today I have this short, sighing reprieve, between teaching registrars in the morning and donning the top hat and whip to command the chaos of the circus until midnight smiles at me, telling me I can exhale and go home. So, like I frequently do, I have sidled into a mysterious corner among bookish shelves and musty journals and ghosts and flickering fluorescent lights. (I am not joking about the ghost. She will, however, have to be the subject of a latter post). Libraries are my oasis, my nirvana, my refuge, my asylum. They are the tents in my desert on a warm autumn evening with mint tea and breeze and the smell of cinnamon and honey.
I should, of course, be doing something sensible. I should be reading journal articles about ventriculo-peritoneal shunt complications, or doing my outstanding (and do please use this word in the pejorative, not the complimentary sense) online training modules, or reviewing some audit material or some-such. But, and this may surprise some of you, I am not.
My preference is to write a love letter. A missive of love, of admiration, of respect. I have just purchased, and am eating, chocolate (wholesome individual that I am) (and it’s the cheap purpley kind, too), which I have purchased from one of the seven wonders of the world (well, my list of them anyway). The volunteer ladies at the lolly shop.
Now I work in a place that’s full of good people. Very good people. Doctors and nurses and physios and orderlies and social workers, all doing the right thing, caring for humanity and all its faces, giving of themselves, supporting others, and, once in the bluest of blue moons, saving a life. But all of us have nothing on the volunteers.
These ladies, for they are all ladies, turn up every, single day. They are never paid. Their roles are legion. They meet and greet (they’ve managed to win the war against the machines installed to give directions at the swipe of a finger, for those who’ve been following this saga. Take that, Singularity), they trundle through the wards with a trolley full of Dan Brown novels and magazines about crocheting and celebrity scandals, they answer any questions from the lost and weary and damned that limp though the corridors, and best of all, they man the lolly shop. They are the most generous, Marcel-waved, wrinkly, powder-dusted, starchy pinafored, pieces of magnificence I’ve ever come across. Full of smiles and chatter and happiness whilst holding an abacus full of wizardly difficult addition in their heads. It is a beauty beyond compare. It is benevolence in human form, altruism covered in skin. Goodness and munificence and bounty. The rest of us are phoning up HR if our pay is 2 hours under and moaning about, well, pretty much everything, and these gorgeous elderly bunnies are helping the swearing homeless man who smells of last week’s urine choose his cadbury bar.
I am buoyed every time I interact with these marvels. There is one who holds a special place in my heart. She stops me each time we cross paths. She wants my help so that she can donate a kidney. She’s been rejected already, and thinks I, in my exalted position, might be able to help her sway the authorities (as though an impassioned speech might persuade those making such decisions that her presumably ailing nephrons promise to behave if she were chosen from the crowd, like a Tribute). I make half-hearted attempts to explain the difficulties, but then usually slope off, making promises I can’t keep. I love her. I truly do. She has told me there’s not much left in her life, and her god wants her to do this one last thing, to help someone else. It is my destiny, she says.
So many others have rich, worthy stories teeming under their creases and crinkles. And they have lives and families, overdue naps, movies to be seen, days left that may be so few they have numbers assigned to them, yet here they are, selling me snacks and sharing their light with this small world.
And, with this post, my time is up. My break is done, and my loins must be frantically girded, as I must brave the floor. I’ve done no work here, but I’ve given my words back to the ladies who’ve given so much to me. Thank you LOLs.
(PS the image is my view right now. OK, a bit of a stretch to the lyrical flapping tent in the cool desert wind, but still.)
I may have been a little overwrought. By lauding the kidneys over the lungs in the last post, it’s possible I’ve done the body-bellows a disservice. So I resolve to address this. Today we shall examine reasons why the lungs, if not winning first place in the organ stakes, at least get a solid participation certificate.
There’s the obvious reason we like lungs. The whole oxygenation thing. Goes without saying, that’s cool. Plus the reverse removal of carbon dioxide. Sure. Great. We get it.
And yep, they do that half-assed, kind of flashy job with acid-base equilibrium (not to harp on, but nothing on the kidneys). Compensation, buffering, yada yada.
But, if we’re going to applaud the air-bags, then we should appreciate their more eclectic functions. After all, who wants to be known as a work-horse when you can be avant-garde?
Following are several of the lung’s more glamorous responsibilities:
- Clot filter. When any muck, clot, or alien sort of material starts a-rambling through the vasculature, the immense pulmonary capillary network acts as a mostly impenetrable mesh, a fine sieve, a Gandalfian passage prevention kind of scenario. Which has raised the fairly recent question, in the light of our drunkenly lavish use of imaging, whether small pulmonary emboli are, in fact, a normal phenomenon. Lung lint, as they are amusingly alliteratively named. And, you may recall, lungs are a rich exuder of tPA and heparin like substances – helping melt away the coagulated clumps.
- Lung as pawn. First line of immunological defence. Unlike the pawn though, the lungs have a staggering arsenal of protective mechanisms: a mucous blanket, a muco-ciliary escalator escorting inhaled foreign bodies back out the way they came, ravenous macrophages swallowing everything even slightly alien in a liquid eighties pac-man style, and hundreds of other immunomodulatory functions.
- A dizzying array of metabolic functions – molecules passing through the lungs have a high chance of being modified, activated, broken down, gender-switched and so on. I suspect we have hardly a clue as to the depths of activity going on in the dead of the thorax when we are not watching.
- And, for the most surprising piece of new lung knowledge in 2017, some intrepid researchers from San Francisco discovered that the lungs produce up to 10 million platelets per hour, dwarfing the sluggish production line of the bone marrow. (Ed. note. One of the principle researchers was Mark Looney. I submit this without comment) (and who am I kidding. I am the editor. I was just trying to deflect such an infantile addition).
But let us move on from such dry physiological periphrastic discourse.
I have a story about lungs. It is not very pleasant. I have previously written about the German student exchange I endured when I was 16. My host family were not overly keen on having an exchange student, and they were quite fond of laughing at my expense. We were out to lunch one day just south of Nürnberg, and I was given a menu off which to order. My linguistic skills were lamentable. I recalled ordering an item like pinning a tail, blindfolded, to a donkey. It was lüngerl (or something similar). The family sniggered. I was wary. The dish came out, gravy brown and chewy, like a tyre stewed for 3 days in a steaming bog. I persevered. They laughed. Friends, lung is not a gourmet food.
Allegedly respiration was first described by an Arab physician, Ibn al-Nafis, in 1243. In the first half of the 16th century, the role of the lungs was thought to be to cool the heat and rage of the heart. In the next century, William Harvey, that most sensible of chaps, finally started to work out what the dickens was going on with them. The real Dickens speaks of our organ in Oliver Twist: “It opens the lungs, washes the countenance, exercises the eyes, and softens down the temper, said Mr. Bumble. So cry away.”
The lungs of vertebrates are evolutionary relations of the gas bladders of fish; in their most rudimentary form a simple outpouching of the oesophagus, allowing storage of a gulp of air in oxygen poor situations. Spiders have what is known as book lungs, and if I had to choose a type of lung, that is definitely what I would go for. Lungfish are ugly. There, I’ve said it.
A surprising number of songs have ‘lungs’ in the title. This includes Florence and the Machine’s Between Two Lungs and Megadeth’s Into the Lungs of Hell (if you were looking for a night lullaby for your children).
Now this is not a post about pathology and disease. We’d never get out of here if it were (and I can hear you straining to do so already). But as a last word, let us take a look at the lungs of some of the great writers. They were a pack of wheezing, dyspneic artists if ever there were, coughing their bloody expectorations delicately into their lace handkerchiefs. Proust died of asthma complicated by pneumonia, Keats, Katherine Mansfield, the Brontes, Chekhov and legions more succumbed to TB, Updike was carried off by lung cancer, and Evel Knievel’s life was (surprisingly, and really inappropriately placed here) terminated by idiopathic pulmonary fibrosis.
Thus, I end with an apology to the lungs, demonstrated this by this week’s award.
Thus begins a new series; blogposts to celebrate features of ourselves that are scandalously overlooked. Our internal organs. This will be a collection of pieces drawing attention to our hard-working innards, a compilation that will be barely educational, seldom beneficial, and not even remotely weekly. But I do so love the complex machinations of the bits that make up our bodies, and I thought I would like to write about them.
So first, the kidney. But why does this liver-coloured bean get first place? The gold medal? Let me count the ways.
The kidney is the modest and loyal guardian of the internal milieu. Unlike the flashy lungs, who, at the first hint of acid-base disturbance get all huffy puffy, the kidneys are slow, considered, and in the case of respiratory alkalosis, almost completely capable of returning the pH to normal, a feat the lungs can only dream of. Yes, the lungs may be quick to blow off CO2 in metabolic acidosis, but they bore easily, never quite finishing the job. The kidneys, on the other hand, quietly get on with their lumbering business of bicarbonate and proton shuffling, restoring neutrality without fanfare.
The derivation of the word kidney is joyfully obscure. It comes, possibly, from the root words for belly, womb, and teste. The proto-Germanic (and once again, bless that amusement park of a language) has kidney and testicle freely interchangeable. Allegedly it is also an obsolete, slang term for waiter.
Talking linguistically, when learning of the peripatetic ways of the internal workings of the kidneys and their tubules I first heard the term, and you may well be the same, countercurrent mechanism. What a joy! One could picture the molecules marching in and out of the newly sprouted urine, up and down the nephron, following the concentration gradient the way a retiree with a caravan chases the sun. Marvellous! Evolution is a crazy wonderful thing.
Humans can live perfectly well with a single kidney. Subsequently they have been the source of some fabulous urban myth stories about hand-written notes, telephones, and ice baths. On the sobering side, it means that organ trafficking is a dire global problem. Iran remains the only country where it is legal to sell one’s kidney – a legally traded kidney fetches several thousand dollars, but on the black market prices balloon to hundreds of thousands of dollars.
Your kidney can smell (allegedly). Or perhaps, more accurately, it sniffs at the urine as it gushes by. This marvellous fact was discovered by Jennifer Pluznick, a professor of physiology at Johns Hopkins.
Speaking of receptors, there are, almost definitely, hundreds, possibly thousands of different receptors on each nephron. And there are at least a million of these itty serpiginous pythonesque things per kidney. One can only read this, slack-jawed, and realise that we have barely begun to understand all the functions of this beany beauty. We are but toddlers in our knowledge.
The primary function of the kidney is, of course, to jealously guard the creation of the golden waters – to perfect the concentration of them, compared to plasma. The kidney is the gatekeeper, the demilitarised zone, the border patrol, policing the movement of all manner of molecules, in order to produce a perfectly balanced cocktail of liquid waste.
Allegedly it is edible, with steak, in a good pie, although I think that the human variety may not be the ideal ingredient.
For all its good and wonder though, it is a rather savage stonemason, and concretes small rocks into existence, made from various concentrations of calcium, oxalate, phosphate, uric acid, and cystine. It’s also been known to carve brick red stones out of xanthine, and struvite, which resembles glass crystals and can occasionally be found, disconcertingly, in canned seafood.
The above features are but a tiny fraction of the wonders of the kidney, its function and dysfunction, but it has given me great pleasure to award the kidney the title of top contender for organ of the week. I hope you’ll join me in a round of applause for this sensational viscus, however I’d be surprised if any of you have got this far. Please do add any nephrologically fascinating facts if you’d like.