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Volume 1, Issue 4
Winter 2005:

Win Some, Lose Some (Excerpt from Secrets from the Black Bag)

Susan Woldenberg Butler

Cell 2 Soul. 2005 Winter; 1(4):a23

RCGP (2005); ISBN: 0850843022; 224 pages

Dexter Veriform

'Unlike my friend Thucydides Hare, I always get personally involved with my patients,' said Dexter Veriform. 'He says he does, but he's too busy doing what's right. Perhaps I wouldn't have come to this, being locked away behind bars…' He snapped his hands back at the wrists, rejecting evidence of his incarceration. A muffled clank stressed the desperateness of his environment. 'Some of my old patients have stood by me. Others just stand there grinning, as Bob Dylan said. Don't look so surprised. I adore poetry, in whatever form it takes. My patients were full of it, positively overflowing, like "Daown by the barrrn to the caoos…" '

I always had a soft spot for that farmer. They called him Wiley Riley because he believed the blether of every travelling salesman. For a week he'd extol the graces of some new gadget or other, then nary another word. He had a special graveyard where he laid these apparati to rest. In the barrn. It was like that in rural New Zealand back then.

One morning in Caesar, the telephone went off at two minutes past six.

'What's the matter, Mr Riley?'

'Well, doctur, the caoo slipped the calf, so I lost a pedigree animal.' His accent was a mixture of Scots and goodness knows what.

'Yes, but what's the point of this call?'

I could hear him scratching his hair, long and curly as his sheep's. 'Well, doctur, the sheepdog got the pedigree spaniel into pup.'

At the end of a long story about the spaniel and the working dog, the farmer added, 'Would you come daoon and see the wife? I'm going down to the barrrrn to milk the caoos, and then there's the mare.'

By this time thirteen minutes had passed. 'Can you come to the point, Mr Riley?' I didn't try to hide my impatience. My patients see my every mood.

'Well, doctur, the wife's a bit crook.'

'In what way?'

'She's in bed, bleedin' a bit, and I'll be daoon at the barrrn so I won't be able to bring her up to see you. Just when you're coming daoon this way, would you call in?'

Now, to the farmer, coming daoon that way could have meant any time during the day. Some instinct ordered me to go at once. Your own instincts are vital in the country, because farmers can be casual. I did that six miles in six minutes. Mrs Riley lay in bed with a pool of blood, having a miscarriage, surrounded by three children under ten years of age. I fired her off to hospital. She needed a transfusion and a D and C.

We all had a narrow escape. Instinct told me to go immediately. If I'd taken my time, Mrs Riley would have been dead by the time he got back from the barrrrn. Like so many farmers, Wiley had his priorities: the cow slipping a calf, the pedigree dog in pup to a sheep dog, the old grey mare foaling and oh yes, the pregnant wife.

'Now, if this happens again, Mr Riley, get me immediately,' I said sternly. I remain immovable on the topic of showing emotion in front of patients despite many discussions with Thucydides Hare. Our own vicissitudes affect how we respond to patients, he says. If a doctor's second wife has just left him and his bank manager has called in his house and his business partner has left and he's feeling fairly bleak, then he might have a difficult time dealing with someone else's emotional crisis. Maybe that doctor should be aware of what's happening to him and not take on responsibility for that sort of case, I retort. Maybe he or she should say, 'I can't help you at the moment, but I can send you to my partner or arrange for you to see someone appropriate.'


In Caesar about a week later, that someone appropriate was the vet. I stopped by the farm to check on Mrs Riley. It was the day the bull fell sick. I hadn't noticed the farmer's prize bull when I'd left the car, my mind full of concern for the missus. I thought I'd parked on the other side of the fence from the bull. Must be upsetting for poor Mr Riley, I thought as I retraced my steps towards the car later, just look at how frantically he's waving his arms. Perhaps I misjudged him.

Then I stopped dead in my tracks.

Now, as the local doctor, I should have been able to drive off in a dignified manner, smiling and waving benevolently. Unfortunately, every ounce of Mr Riley's biggest bull eyed me from near the car. This prize Jersey was a twenty-five hundred pound pedigree animal. He stirred up the soil with one hoof, snorting through the huge copper ring in his nose. I must have been dreaming when I parked so close to the brute.

'Rrrrrr,' the bull growled in the lowest possible rumble. Now, the Jersey is a lovely cow, creamy-coloured with a black muzzle. There's nothing more beautiful. She'll come up to you to be petted. She's a gentle soul. I could weep over the Jersey cow. She is gorgeous. The Jersey bull is a different kettle of fish entirely. His androgens are exceedingly strong, and he shows it by what's between his hind legs.

A very worried doc wondered whether he'd make it to the car. I edged closer, always keeping sight of him. He spared me.

'I don't think your bull likes me, Mr Riley,' I said to the farmer, who had come running. 'He's so angry.'

'It's the car, doctur,' he replied. 'And he's crook. Vet's comin'.'

'Ah,' I said. 'I should have realised. Motor cars frighten him.'

'No doctur, your car scares the shit out of him.'

'Mr Riley!' I protested, loyal to my machine

'It reminds him of the vet's car. Same colour. The vet was here last week.' I remember hearing in the pub about that case of bull bloat.

As we stood talking, the bull took a turn for the worse. Now, in Caesar I overlapped with the Australian vet whom, fortunately, Riley expected shortly.

'Doctur please help us, he's me best bull,' Riley said.

'But Mr Riley, I don't have the proper equipment. The vet will be along any moment.'

'Wait here, doctur,' Riley replied, loping to the barn at top speed.

The bull and I stared at each other distrustfully. I had my hand on the handle of my wife's Mini, ready to hop inside at the slightest provocation. Riley returned before long brandishing a probang, a special long, flexible tube. In those days vets inserted this instrument down the throat to let the wind out.

'The vet left it here,' he explained.

I was trapped. 'I'll have a go but you'll have to help me,' I said, feeling a bit surly. Riley hadn't once inquired about his wife's health.

Riley managed to get the bull's mouth open. I inserted the tube. All went well, with the bull deflating nicely.

My mind began to wander, flooded by thoughts of my wife's cooking.

'Glunk.'

Not a good sign.

'Gulp.'

Even worse. Normally we hold our end of the probang quite tightly. For some unfortunate reason, the bull swallowed it.

'Quick!' I screamed.

Riley was already running toward the barn.

'Get me something to open his mouth!'

Riley's face creased into ecstasy. 'I have just the thing, in the barrrn …'

Oh no.

I sweated, I'll tell you that. I didn't know if Riley had insured that bull for its full value or how long it would take me to pay for it with a ruined career.

Riley ran back brandishing a clamp-like implement. 'It'll hold his mouth open. You reach in, is all.' I must have looked sceptical, because he added, 'The vet left this, too. We've been through this before.'

I should have known. I'm afraid I wasn't as easy on that bull's mouth as I'd have liked. It was my first time. I was nervous. Using that special tool, I prised and held open the bull's mouth. I didn't know what to do next, besides praying for the arrival of the vet.

'The vet puts his arm right down the gullet.'

I growled and closed my eyes for a moment.

The bull groaned.

I took a breath and slid my left arm down his throat. Damned if he was going to get my working arm. I trawled my medical texts mentally. Had there been a noted one-armed doctur?

My arm slid further into the bull. He didn't like that. Neither did I. Finally, I managed to pull out the probang. Riley returned it to the barn for the next emergency.

'Thank you very much, doctur,' Riley said, walking me to my car.

'Your poor wife needs some attention,' I said severely.

Just then the vet pulled up and jumped out of his Jeep, grinding his mangled cigarette butt in the dirt. His Great Dane and terrier trotted by his side. 'Great timing, huh mate?' he grinned.

I grunted and got into the car. 'Goodbye,' I said. I fiddled with car keys.

As I opened the window to give him a piece of my mind, the vet yelled, 'For Chrissakes, shut yer bloody window!'

I looked over, straight into the penis and balls of the Great Dane lifting his leg to pee. I cranked the window shut, praying it wouldn't jam. I'd started using my wife's Mini after meeting a farmer headed the wrong way on a one-way gravel road, driving a load of hay from his paddock. He took out the wing of my big car from the headlight to the front door. That Mini used to take me twice as long and make me twice as tired. I got the window up.

The Great Dane calmly finished his pee.

All ended well. I saw Mrs Riley and cured a case of bull bloat. I have to say, though, that the farmer's wife sticks in my mind a lot less than that Jersey bull's gullet and the Great Dane's genitals.

I snort when Harey suggests erecting barriers to protect myself. I roar when he mentions compassionate detachment and paw dangerously when he waves that red flag, saying that emotional involvement with patients might bias clinical judgment. Reason is not enough, I inform him. If I'd been the soul of detached equanimity, I'd have lost a patient. Instead, I listened to my intuition and saved Mrs Riley.


My intuition saved one patient, but the life of another slipped through my fingers, quite literally, as I held him in my arms. The worst possible thing is when a patient commits suicide. Poor Mr McLean.

One Sunday afternoon before Christmas, a call came to meet the ambulance at a nearby farm. Blast these Sundays and holidays! They make people crazy. Second shooting in two weeks. In the first, one young man had been told mistakenly — not by me, thank God — that he had a particularly nasty stomach cancer. He didn't want to be a burden to his wife so he jammed a shotgun under his jaw and pulled the trigger. The men use guns and they are mostly successful. The post-mortem showed no sign of cancer. How much should the family be told? The local medical community was still grappling with that one when I was called out to Mr McLean.

I'd never met the man despite my involvement with his lovely wife and daughters, so I can't blame myself for missing his signals. Mr McLean was one of those healthy farmers who kept away from the doctor. I knew the type and suspected the reasons for his action. Wool prices, his children's schooling and the drought had dragged him into a corner of his land he preferred to avoid: letting go all but one of his men, whose families had depended on his for generations, watching the land parch and his wife's face pinch.

I stuffed plasma, oxygen, the ruddy lot into the car and raced through the streets and into the surrounding farmland. Somewhere a siren wailed. I broke just about every traffic law, swerving around slow-moving tourists in every permutation of vehicle, self-propelled or otherwise. The town's population had swelled like a sponge, absorbing holidaymakers on a seaside sojourn.

Now, attitudes towards firearms are cavalier in rural New Zealand and Australia — as in most country areas, I suspect. A while back I stopped going hunting every year. I must be one of the few people round here who is anti-gun, simply because I know that if anything happens I'm for it. I'll be the one called out, like that Sunday morning that a farmer climbed through a fence and pulled his rifle after him by the muzzle. He survived a shot in the stomach but it meant resuscitating a chap in a panic, putting in a drip, getting the ambulance and going with him for the three-hour drive to hospital. My wife was not impressed, as she'd planned a family picnic.

Firearms and impulsive behaviour can be a lethal combination. There are all sorts of impulsive behaviours. Shopping is one, but it's not dangerous. Some husbands might argue that point. Arson's another, in certain circumstances. Certain suicidal gestures fall into this category, making a definite argument for gun control. We had a young chap once who tried to commit suicide with a shotgun, but it didn't go off, to his great relief. By some stroke of luck there was no bullet in the breach. He then swerved off in his car, got pulled up by the cops for dangerous, drunken driving, yelled and abused them and got carted off to casualty. He stayed in a hospital bed overnight and a prison cell next afternoon. He returned to work Monday after a bizarre weekend. Little did I know I'd end up in a prison cell myself.

These thoughts of guns and desperate men filled my mind as I turned off the main road toward the McLean place. I jumped out of the car and raced to the farmer's side. He'd chosen a tree behind the barn, not visible from the house but overlooking the fingers of headlands reaching into the sea. I knew that some people felt trapped by all this beauty. Another time I may have felt entranced. The ambulance arrived just after I did. I scowled and was left alone with Mr McLean. He'd put a twenty-two rifle between his eyes and pulled the trigger — and lived. Death was inevitable and we both knew it. The bullet lodged between the lobes of his brain but hadn't knocked him out.

I will always remember his eyes. By the time I got there he couldn't speak. He just looked at me, pleading with his eyes for me to save him. Clifford Beers said the delusion that drove him to a death-loving depression vanished as soon as he leapt out of a window.1 Mr McLean obviously felt the same, released by the commission of his horrific act.

There was nothing I could do.

'How can I help?' I cried.

Mr McLean just looked at me, speaking with those eyes.

I cradled him in my arms. 'I wish I could do something, Mr McLean,' I said, voice cracking. I wanted to intubate him because his respiration was going down, but something stopped me. I just sat there, holding him.

What would Harey have done? My good colleague talks about Louisa May Alcott2 volunteering as a nurse in a Civil War army hospital. Once the arrival of eighty ambulances awakened her in the grey hospital dawn. The sight of those hopelessly wounded men led her to admonish herself that she had come to work not to weep or wonder, so she corked up her feelings and returned to the path of duty, something she found very difficult. I could relate to that. One young soldier worried about a gunshot wound through the cheek and what on earth Miss Josephine Skinner would say. Louisa May controlled her risibles and assured him that Miss Josephine would admire his scar if she were a sensible girl. Harey's better at controlling his risibles.

Mr McLean's eyes stick in my mind. They shouldn't, but they do. Those eyes were pleading, 'Help me. I've done it, but I don't really want to go.'

I just sat there, holding him.

Now, Mr McLean seemed quite a decent chap. I regretted that this act formed the sole basis of our relationship. The dying process took about half an hour for the poor man. Thirty slow minutes in which I was powerless. Thirty short minutes out of a lifetime that will go with me to my grave. I laid him down gently. Would being uninvolved have made me better able to comfort Mr McLean? Would being distant from my patients make me a better doctor? All I know is that Mr McLean's eyes will haunt me forever. I couldn't save him and God knows I wanted to.


References:

1 Beers, Clifford Whittingham, 'A mind that found itself,' Medicine in Literature and Art, ed. Ann G Carmichael and Richard M Ratzan, Könemann, Köln, 1991, pp. 247-51.

2 Alcott, Louisa May, Hospital Sketches, Applewood, Bedford, nd, reprint, originally published: Boston: J Redpath, 1863.

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