A woman appeared in the doorway: middle-aged, little makeup, mousy hair turned up roughly into a bun. She wore a white shirt, dark jacket and pants. There was a radiance coming off her, her eyes were a vivid blue. Thomas was already up.
Hello there, Tom, she said, what a good boy you are. In one smooth action Dr Forster pulled a bag of lollies from her pocket and gave them to Thomas, who put them in his pocket and stepped back. Beth stood and smoothed down her dress (it fitted, but she still wasn’t sure she liked it). I’m Dr Forster, said Dr Forster. I’m Beth Own, said Beth. Dr Forster took the two envelopes, big and small, from her. TV off now, Tom, she said, and Thomas turned the TV off. Follow me, she said, to Beth. Off you go now, Tom, said Dr Forster; leave it there. Thomas put the big bag of clothes on the couch. Tell Mum I’m still waiting for that report on the young woman called Kantree—will you remember that? Kantree. Thomas nodded. Watch the cars, she said. They listened to him go. He’s a good kid, said Dr Forster; they’re good people. Come on, let’s take a look.
Beth followed Dr Forster out of the lounge room and down the hall. The consulting room was at the back, an open, sunny room with big windows looking out onto the fences and roofs of the neighbouring houses. But no sooner had she closed the door than Dr Forster walked to these windows and pulled the curtains closed. She flicked a switch, and on the wall beside the door the fluorescent tubes in a long, wide lightbox stuttered on. Dr Forster opened Beth’s big envelope and one by one she clipped the pictures to the light. To Beth the shapes were recognisable—here a brain, there a heart—but the details now obsessing Dr Forster escaped her. She walked up close, stood further back, clipped two together, then three. Beth heard her making little noises: Mm, hm-hm, ah-ah, mm. She finished, turned the lights off, put the pictures back and threw open the curtains. Beth blinked and held a hand to her eyes. Dr Forster still hadn’t spoken. Beth hadn’t moved more than two metres inside the door. Sit down, said the doctor, as if she’d only just noticed. She herself sat behind the desk under the window and swivelled her chair around.
Well, Beth, she said, it is my pleasure to see you today and take a look at your pictures. (She was now opening the second envelope, sliding her finger under the seal, glancing through Dr Kolm’s referral.) You have been referred to me today by Dr Kolm, she said, to whom you were in turn referred by Dr Twoomey. Your diagnosis is becoming clearer, no question. And you saw other health professionals before that? This took Beth by surprise. Yes, she said, two before Twoomey: a locum—I don’t know his name—then a Dr Yi in Box Hill. Dr Forster raised her eyebrows and let out a breathy whistle. Do you have the invoices? she asked. Beth dug around in her bag. And Twoomey’s? Beth found it. Dr Forster straightened all three out on her desk, then slipped them into a clear plastic folder with BETH OWN on a sticker on the front. She pushed the folder aside.
I see you are a little confused, said Dr Forster, smiling, but there’s no need. You are in good hands. I used to have rooms in Toorak and saw some of the richest and most important people around—until I saw the light. My patients had money to pay, they paid me a lot of money, and I paid my greedy landlord in turn. A perfect feedback loop! So why wasn’t I happy, Beth? (Is that a question?) Sure, continued Dr Forster, some of these patients were genuinely unwell but in the end that didn’t matter: whether it was a common cold or cancer, they were each, man, woman and child, completely unappreciative of my skills. They paid big money: why should they thank me? It was a commercial exchange, and one that in the end left me spiritually undernourished. As a student I gave my life to the Hippocratic Oath—I swear by Apollo the physician, and Asclepius, and Hygieia, and Panacea, and all the gods and goddesses—and yet, here I was, turning my back on its precepts. The rich came to me, I gave them consolation and charged their private-health insurance companies a small fortune for it. But did I ever pick a poor person up off the street? Into whatever houses I enter, I will go into them for the benefit of the sick. These words now burned like a flame. So one morning I woke up and changed. My husband, Colin—he’s an orthopaedic surgeon—was horrified, of course. We had a lovely house in one of the nicest streets, four prosperous adult children; we were a whisker away from a leisured retirement. But I threw it all in, Beth, to come over here, to work for the other side.
Dr Forster did the air quotes, then gestured around the room. Behind her, through the window, a few streets away, Beth could see a tradesman up a ladder, working on a roof. The day was sunny, and the light in the windows bright. There was the distant sound somewhere of a leaf blower and of a car speeding over the humps.
I came to realise, continued Dr Forster, that, while not especially doing harm, I was not exactly helping either. There’s this book I read as a student, designed to get us thinking, that imagines a country, an alternative country, where if you get sick you are not treated but instead tried by a jury—where, in other words, illness is a crime. Hilarious! And yet, Beth, this crazy idea, I realised, was also a little close to home. Not everyone who gets sick is put to trial, true, but many are. The question is: how good is your lawyer? Who will sift through the evidence and guide you through the labyrinth of tests, diagnoses and treatment pathways? There are, you should know, many more treatments these days than diseases requiring treatment and a lot of vested interests who’d like to keep it that way. A drug was recently touted as a cure for melanoma. And how much will it cost? Fifteen thousand dollars a month! Freedom of choice? The open market? Sell your kidney for the sake of an aberrant mole? How does a person of limited means and little education navigate their way through that?
With my help, continued Dr Forster, and the help of my like-minded colleagues. We were at first a small circle, but every day we grow bigger. I am not the only one to have seen the light. We are here to help untie the knot, Beth, of indisposition, examination, medicamentation, palliation, expiration. How could anyone, why should anyone, have to negotiate these myriad pathways alone?
She slid a brochure across the desk: Management of the Third Tier. On the front was a picture of a poor family standing in the driveway of a drab suburban home. She gave Beth a moment to take it in. You can keep that one, she said. It gives you an outline of our aims and methods; there are addresses and numbers at the back. Dr Forster sat back, satisfied, and let Beth digest the picture of the family in the drive.
There was a thump, a crash, then the sound of tinkling glass coming from the front of the house. Dr Forster looked up. Excuse me, she said, and she left the room. Beth looked out the windows; the worker was bent over, walking backwards down the roof. She glanced around. There was a bookshelf on one wall and on another a picture-poster of a country road bathed in twilight. On the desk was a small photo of four young adults, cheeks together, smiling for the camera. She thought she heard voices somewhere, talking low. Was it the TV down the hall? She opened the brochure and started flicking through. It was true that a lot of what Dr Forster said made sense; many people she’d met along the way—Geoff, for example, the receptionist at Twoomey’s, the Kolms—now, in light of what the doctor had just said, did seem to represent some sort of secret society or something.
Excuse me, said Dr Forster. She was carrying a brick; there was a note tied to it with string. She put it on her desk, then picked up the phone and dialled. Jason? Today, just now, she said. She hung up, sat down, and pulled the bow on the string. She read the note, threw it and the string into the wastepaper basket and added the brick to a pile of others on the floor beside her desk. But there are people, of course, she said, picking up from where she left off, who disagree with our program. Sadly, I must count Colin among them. But we go on. She stopped, refocused her thoughts. So, she said, let’s for the moment ignore the brick—Jason will be here shortly—and discuss instead your pathway going forward.
But it was hard to ignore the brick. While Dr Forster went on, Beth kept glancing at it. She was explaining how, for many like Beth, entry into the world of ill-health could at first be confronting and, when managed by the sanct
ioned system, trying too. But the cohort of Third Tier professionals, she said, was committed to a different kind of patient care. Information and autonomy, she said, the tools to make smart decisions and the freedom to make them. Each care plan will be as different, said Dr Forster, as the individuals for whom they are made. It takes time, naturally, in the early stages, to work through all the possibilities, to have the tests and get some speculative diagnoses made and then for us to put together the data in some kind of cohesive way. But when we find ourselves in the woods, Beth, with the straight way lost, we must needs take the hand of our guide. All right, she said, up you get, bring your bag. Dr Forster opened a door the same colour as the wall and gestured for Beth to go through. She did, and immediately caught the familiar smell of antiseptic.
In the centre of this otherwise empty room was a high examination table with a lamp on an extendable arm and, standing around it, five young men and women. They all smiled as she entered. There was no desk or chair or anything else and the only window—still with its original animal-motif curtains—looked directly out at the fence next door. These are our trainees, Dr Forster was saying, we are always leveraging new folk up. We have five with us today—bra and undies, please. Beth wasn’t paying attention and took a moment to realise what she’d said. She put down her bag, stripped, set her clothes in a little pile on the end of the table, mounted the four steps and sat dutifully facing the students.
So, said Dr Forster, I’m sure you’re familiar with the routine. As a matter of course I will be checking your vitals—but, while I do, and this is actually the main purpose of our session today, our trainees here will be ready to answer any questions you have. A key component of our care plan, Beth—it’s in the brochure—is that we always allow time for questions. Your questions, she said, and I’m sure you have a few. She smiled. The students smiled too. Every health professional, said Dr Forster, needs to learn that the innocent enquiries a patient makes will not only be of therapeutic value to them but for us, often, too, the true key to the door of diagnosis.
She was standing behind Beth now, talking to the trainees over her shoulder. She jiggled Beth a bit further back on the table and put a stethoscope to her ribs. All right, students, she said, please try to keep your answers spontaneous and warm. She asked Beth to cough. And you, she said, try not to over-think it. This is your time, Beth—for anything that has been troubling you, any questions you have not yet had the opportunity to ask. Deep breath. Good. Ready, all? The lamp above went on.
Beth relished the opportunity to ask the questions that had been troubling her but at the same time she wasn’t sure what value there could be in getting her answers from a bunch of students. Still, she thought, it is not as if I have gleaned any helpful answers from a higher authority yet either. She looked one by one at the faces and eventually chose the girl on the end. What would you have done, she asked, at the first sign of symptoms? Good question, said Dr Forster, from behind. The other students started taking notes. I would have undertaken a standard examination, said the girl, carefully, but unless there was any obviously serious pathology I would have suggested a period of non-intervention. Definitely no tests at this early stage. I’d let the patient get on with things and schedule a second examination in five to seven days. Let the patient? Let the patient? said Dr Forster, putting a tourniquet on Beth’s arm. Let you, let you, said the girl. She laughed, blushed—the other students laughed too. And serious pathology? Non-intervention? But I would have explained it, said the girl. Simple language, simple language, said Dr Forster: could you repeat the question, please? Beth did. This time when the girl answered she kept a steady eye on her. When she finished she tapped her foot, shuffled on the spot, and looked to her supervisor for approval. Very good, said Dr Forster.
Should I have waited another day before asking my husband to call the doctor? asked Beth. The young man to whom she’d directed this question said it was hard to tell but maybe yes, as his colleague had said, they could have waited. But, he said, sensitively, your worried husband was not to know this. Very good, said Dr Forster: next. (She’d meanwhile taken seven vials of blood and put them on a tray.) Beth asked a third student if she should have seen Dr Tallafield when the appointment was offered (it still bothered her) but the girl who answered unhesitatingly said no. Tallafield was the wrong pathway for you, she said, it would have only made things worse. It was comforting to know that, from behind, Dr Forster quietly agreed.
Beth asked a question each of the remaining students—and then, at Dr Forster’s urging, a few more at random. It did feel good. Why have I been so impatient with my husband? Is my lack of care for my daughters merely a symptom or a deeper personality fault? Does any of this have anything to do with my mother? Why has no-one found any lumps? Where exactly am I sick? Why am I sick? Should I be worried? Will I get better? Where was that last bus with Loren on it going? Good, said Dr Forster, when the last student had finished, then she addressed them as a group. Go talk among yourselves now, she said, and see what you think, but I’d like to suggest that given the questions what we might have here is a Phase Four. Yes? The students nodded and in a singsong voice said, Thank you, Mrs Own! Then they went back to Dr Forster’s room.
How does that feel? she asked. Good, said Beth, thank you. Dr Forster turned the lamp off and flicked on a penlight torch. Open wide, she said, and Beth watched the little white blobs of light float across her field of vision. Everything went quiet then, except for the sound of Dr Forster’s breathing. The window to the soul, she said, softly, and she made another note.
All right, said Dr Forster, and she flicked off the torch; I’ll join the students now and help them refine a pathway for you, with signposts and guiding lights, then prepare some letters and other things to get you on your way. You will need scripts too, she said, I’m not lying when I say your overall picture is a little worrying. Have you spoken to your loved ones? But first I’ll give you a letter for Fatima at CommPharm, then one for Dr Panchal. I could send you to Fiedler but I think straight to Panchal is best. She was putting all her things away into what Beth now saw was a large drawer at one end of the table. Pop down, said Dr Forster, take your time, you can go back out through there. She was pointing at another door on the far side of the room. I’ll be with you shortly, she said. Beth could hear the muffled voices of the students talking, then a car pulling up out the front, then two doors slamming, one after the other. She dressed and picked up her bag.
The new door led to an en-suite bathroom with a sliding door on the other side. The seat was up on the toilet; there was a rusty streak in the bowl. Someone had put strips of tape across the taps in the shower and at the basin the only bar of soap was shrivelled and cracked. Beth tried the sliding door—but instead of leading back to the hallway as she’d hoped it took her into another room with, again, a window framed by the original curtains looking out onto a fence. This room had stacks of boxes in it, each with the word CheaPrint on the side. She pulled back some flaps: they were full of brochures, like the one Dr Forster had shown her. On the far side of this room was a stack of old suitcases and beside that a hatstand with a jumble of jackets, bags and packs, presumably the students’. Next to the hatstand was another door—which, finally, when she opened it, took Beth back out into the hall.
In the lounge room a large pane of glass had gone missing from the front window and a young man in work clothes on a stepladder was using a pair of pliers to pull the remaining shards out of the frame. Another young man was sweeping up the mess. The man on the ladder smiled down at Beth through the hole. I’m Jason, he said, this is Trent: don’t worry, we won’t be long.
Beth sat on the couch. It was nice with the window open—the sickly rose air-freshener smell had gone—and, in a strange way, it was nice having Jason and Trent there too, looking over her, so to speak. Dr Forster’s words still hadn’t quite sunk in. What did she mean by worrying? Does that mean I should worry? All right, mate, she heard Jason say, let’s get her up, and s
he watched the two tradesmen carry the big pane of new glass from their ute on two enormous rubber cups. They were both about the same age and both wore more or less the same overalls. Both were tanned and blond: Jason with short hair, Trent with long. They manoeuvred the pane into place and pushed in some little fixers to hold it.
Dr Forster came back with a bundle of things: Beth’s garbage bag of clothes, her big envelope of pictures and some other, newer envelopes with bits of paper clipped to them. The two men went on working; Dr Forster sat on the couch. First, she said, here is a letter for Fatima at CommPharm and the three scripts to go with it: one, two, three. (They looked like standard doctor’s scripts, a scrawled signature on each.) Next, in here—she opened a second envelope—is a referral letter and report for Dr Panchal. The report is about the images Dr Kolm has taken. I’ve also put the brochure in here, in case you want to find out more. But before Panchal, you must see Fatima and get these scripts made up. That’s important. They are precautionary at this stage, and to some extent prophylactic—but in a certain sense palliative, too. All necessary, in their way—until, that is, I confer with my colleagues and we get closer to a full diagnosis. But I will keep Dr Panchal informed. The drugs may elicit some side effects but they should be minimal: Fatima will explain all this to you. CommPharm’s address, and a map of how to get there, is on the back of that envelope, there. You’ll find them in Gladstone Park. This one here is a certificate, supplementary to the one Dr Yi has already written. Now. Dr Forster stood up. I’ve still got a few charity suitcases: let me get one for you. She went out and came back with a pink suitcase on wheels. Some of the edging was frayed. Dr Forster put all the things from the garbage bag into it, then, out of another, smaller, white plastic bag, some more underwear and toiletries. She zipped the suitcase shut and slid the envelopes, scripts and brochure into the front pocket. Then she stood it up on its wheels.
Some Tests Page 9
