The downside of our job is that you’re flat out so you cut corners and the first corner to go is significant interaction with the patient. Which means that for us, most of us, it’s not work on people, it’s work on … on objects. I think people are transformed in the process of becoming doctors, and the transformation is that a lot of the humanity within you is destroyed or pushed away. And that has to happen. Well, it doesn’t have to happen, it happens because it helps you cope, because it’s very hard to watch people die and look after people who are dying all the time if you’re close to them, so you tend to push them away and lock them out. I think that’s what we all do. We have a shield.
People talk about burnout but I think that’s nonsense. I think that what happens instead is that sometimes we get dehumanised. In fact a lot of my day’s work is boring, the paperwork and so on, and that’s partly because I don’t know the people I’m operating on. I think it would be much better if I knew them and cared for them as people, not just as a day’s work.
But people are often referred very soon before their operation. They might come in the night before and you might see them around eight or nine o’clock in the evening. They’re scared, you’re buggered, and it’s not an ideal situation for a friendly chat. And they’re just the ones that are conscious. As soon as anyone arrives everything’s stripped off them and they’re stuck in a white gown and a sterile bed. They’ve got nothing around them that even makes them look human and if they’re compos, you know, you have to ask them all the questions related to the disease. You might ask them a few personal questions, like what do they do. But that’s the way the government wants it. It used to be people came in two days ahead but everything is cost-cutting now and that’s expensive. And then there’s all the emergency cases where they’ve suffered major trauma and they’re already unconscious on arrival.
As for afterwards, so often, you know, they don’t want to sit down and tell you about their life until they’re feeling a bit better. By the time they’re prepared to do that, and they want to tell you about what makes them who they are, it’s time to kick them out because you want their bed for someone else. And they want to go anyway. It’s pretty horrible living in hospitals.
And then there’s the pressure of keeping the job turning over. See if you’re not doing enough cases a week, you’re not going to remain good enough. And every case, even though it only takes, say, two to three hours to operate on, maybe four, there is a lot of follow-up before and afterwards. They take six or seven hours out of your day. Say, six; multiply that by six cases every week, there’s thirty-six hours, minimum. And then there’s the research you’re meant to be doing and all the paperwork, and everything, you know, goes back and forth – there isn’t a lot of time.
So you don’t end up operating on human beings. I mean, I think some of my colleagues would say that I’m misleading you, but I put it to you that they do not operate on human beings, they operate on objects. But in the end they, the patients, get up out of their beds and go home and their lives are better than when they came in. So in terms of the success of the actual surgery, the result for the patient is the same whether they get to know the surgeon or not. But the point here is the result for you, the surgeon. I mean, if you want to live a meaningful life, then you have to get meaning out of what you do, more meaning than I just did something harder than I did a week ago and hence I feel temporarily inflated by it – which is about all most of us get out of what we do.
How do we deal with that? Well, society rewards hard-working, wealthy, inferiority-complex-prone people. They are in fact held up as the people to emulate. Obviously in your job the adrenalin must be flowing a lot of the time and that keeps you going, in a fairly unthinking way. That helps a lot, yeah – when you’re operating, it’s certainly adrenalin-driven, there’s no doubt about that. I mean, it’s like flying planes, that sort of thing.
But look, don’t get me wrong, doing the cases and getting them right does provide some satisfaction, because they all … they all have the potential to turn around and kick you in the teeth. And they do, regularly, no doubt about that. So having a couple of cases that go well, or solving a couple of disasters, that’s good. I certainly don’t get blasé. If you’ve got nothing else to do, then it becomes a test against the clock; to say, well, you know, I’ve done this in two hours and next time I’ll do it in less. So that’s pretty important.
(Sound of pager) Hang on a minute. No, no, that’s okay. Ring me at home about nine.
Where was I? Not many people get into neurosurgery. It’s very hard to get into, because you have to achieve a certain level of technical excellence, otherwise you’re out, they just throw you out. There are thirty-year-olds who’ve trained and they’re unemployable because they’re not considered good enough. And it’s hard, hard to go back into other specialties. They won’t have you. Even in general practice they say: What do we want a neurosurgeon in general practice for? What do you know about diphtheria, what do you know about treating children? It’s a one-way street. You can blow your career. I mean you can set up a general practice in the country, I suppose. So a lot of people say, hey, do I want to be thirty-five before I’m finished – that’s if I do well – and only then start to earn a big income, or a sensible income, and have a reasonable life? I mean, most people want to have a family.
Death? I thought I’d covered that. Well, part of the solution comes from this shielding mechanism, which makes you inhuman, so that you don’t see it as death. You don’t see it for what it is. And if you get involved with the psychology of how a unit coheres – medical staff, nursing staff, physiotherapists, the whole team – it’s always us and them, so to speak. And the most horrible thing that can happen is for one of us to get sick; then the illness takes on a more interesting, a more worrying perspective. As long as it’s one of them, the patients, then it’s, well that’s not us, is it? As for me, I hardly ever get sick. I would have had one day’s sick leave in my life. You do get tired, and then … as I say, when you’re operating it’s okay because the adrenalin flows and you can operate. It’s in between you feel terrible. So the biggest impact is actually felt in the home life – where, you know, you’re away all day, and your family might or might not be interested in seeing you when you come home a zombie. Then there are the little things, like sometimes my wife complains about the smell of bone dust.
Bone dust? Yeah, well you have to drill through the skull to reach the brain and the dust that comes off the drilling has a distinctive smell. Doesn’t bother me, but it seems to upset her.
The other point, of course, is the fact that a lot of my work is very technical, and the only people you can talk to about it are your colleagues. So you may come home and say nothing to your wife and kids for hours, because you don’t really want to bring up the trouble of the day, and then a colleague rings and so then you might talk to them for a whole hour about the difficulties of the day and how they could have been avoided, and what they would think, and so forth, and that can cause great displeasure to those at home.
Is there a debriefing after each case? Oh no, certainly not. If there’s a disaster, there is, you know, we talk a bit about what happened there, sure. And, you know, if you’ve had a number of disasters then it starts. There’s a serious inquiry into what you’re doing, like if you had, say, out of the last ten, three or four stuff-ups then they’d want to know why something’s up. And that’s where your career is really only as good as your last few cases because if things start going wrong you’ll be out.
You just keep trying to get better, that’s all you can do. And if you don’t like the place you’re in, you look at working elsewhere in the longer term. I don’t even know if I’ll be doing this in ten years’ time. I may get out of it one day. I’ve got into the property market a lot now and one day I might go into it full-time. The property market’s just a game, like anything else, and you test yourself against it. Can you make money out of it? Can you do better than the market itself
? I suppose it could pall, yeah, but not if I made a lot of money. It would be fun to make a couple of million a year.
What would I do with it? Well, I’d just invest it, what else can you do with it? It may sound like going around in circles but it’s the same as becoming a surgeon; the fact is, the more money you’ve got the more important you are, I mean, it satisfies your drive to prove yourself. I was discussing this with my sister recently and she was shocked. She said to me, oh, but at least in the process of proving how good you are you’re keeping people alive. I told her: that’s just a side effect. (Laughs)
Most of the professional aura you get from medical staff is the outer view of the shield, and it’s obviously cold and sterile. One sees less of it in those who’ve had major illness and been operated on themselves, because that forces you, it breaks down the barrier between us and them. They’ve become patients, they’ve crossed over to the other side. When they come back there’s far more empathy between them and the patients, far more. You can see it in their daily immediate interaction with the people, you know, they treat them much more as people, even as friends, particularly if they’ve known them as patients for a little while.
Can you programme yourself to do this? To have empathy? Look, what we’re describing is protective behaviour that covers difficult situations, like superstition or magic or Christianity. If you grow up enough you can put that aside but for most of us who are still secretly afraid of death and have other problems, we use these simple tools, which are insidious, they’re crippling because they take away all the joy of the job. There’s very little pleasure operating on objects.
But listen, one day this will all seem as quaint as applying leeches. One day you might even be able to cosmeticise your brain. How? Well, you might want to get an edge on the person at work, have a more retentive memory. You’ll go along to a surgeon and ask for some cognitive enhancement instead of breast implants. (Laughs) Look, my job will probably just get more interesting, from the novelty point of view. Neuroscientists are like cryptographers trying to crack an alien code, and bits of the code keep coming in. It means you always have some new challenge to wake up to in the mornings, something new to prove. Maybe I’ll postpone that career in investment for a few years yet.
John Lennon’s Gardener
We set out on a warm but overcast Sunday morning. At the bottom of the hill the ocean looked flat and grey, and clouds sat low over the headland. The old gate at the end of the drive was stiff and Mick had to hoist it out of a rut in the sandy soil and swing it across to where a stand of ragged banksias dropped their cones onto the dry verge.
‘Time you fixed that gate up,’ he puffed as he climbed back into the car. ‘I’ll have a look at it for you before I leave.’
‘The place is neglected. I’m never here. I keep thinking I’ll get away for the weekend but it never happens.’
‘You could sell it.’ I gave him a look and he shook his head. ‘Sorry. Old memories, I guess.’
Yes, old memories.
It was on my way to the shack, as a young wife, that I’d first met Mick. He was hitchhiking along the coastal road and my husband, Bill, stopped and we gave him a lift.
‘Where you headed?’ Bill asked.
‘Hoffmanns Valley. You know it?’
‘Never heard of it.’
‘There’s a commune there, Yudhikara, or some funny name. Got a mate who’s building a house in it.’
‘I didn’t know there was a commune in this area,’ said Bill. ‘Bit cold for it. I thought communes sprang up north of Sydney where you can get your gear off all year round.’
Mick grinned. He was an easy presence and we struck up an instant rapport.
We dropped Mick outside the pub in Tandarra, a tacky little seaside town then, and thought no more of it until the following Friday when we ran into him in the main street.
‘How’s whatsitsname?’ asked Bill.
‘Yudhikara. Yeah, good, I’m thinking of maybe propping there for a while. Why don’t you come out and visit?’ He turned to me. ‘Chick out there reckons she knows you.’
‘Knows me?’
‘Yeah, chick called Miranda someone.’
I gaped at him. ‘Miranda Meacham?’
‘Dunno. They don’t use second names. Miranda someone who said she went to school with you.’
‘Miranda Meacham is living in a commune? You’re kidding.’
Mick shrugged.
Now my interest was really piqued. Miranda Meacham had been school captain at my high school and girl most likely to succeed. Last I heard she was working for a law firm in the city; now she was evidently some kind of hippie. ‘How do we get there?’ I asked.
Mick drew a rough map on the back of my shopping list.
‘I’ll ring first,’ I said.
‘No phones allowed. It’s a rule. Just front up. People come and go all the time.’
From that moment I felt an urge to visit the valley. As a child and later as an adolescent you measure yourself by certain people, those among you who seem more blessed: smarter, wittier, better looking, wealthier and, above all, more cool. Miranda Meacham had been one of my measuring rods; I envied her more than I could ever have confessed to anyone.
I don’t recall exactly when Bill and I made our first visit to the valley but I do remember that it was hot. We drove a long way into the area known as Bell’s Country, past the hills where the tin mines were worked out and the Chinese labourers had long since packed up their joss house and moved on; past the fertile dairy farms that supplied the famous butter and cheese; on and on over a rough unsealed road that ran through towering bush of giant mountain ash and peppermint gum. Before long we felt disoriented; we might have been anywhere. Then, suddenly, the road emerged out of a blur of state forest into a small valley. The densely wooded hills sloped down into a lush green clearing where rustic stone houses with roofs of slate tile stood in a cluster on either side of a narrow dirt road. The road was not much more than a track, though it ran right through the middle of the valley. Along the edge of the surrounding grasslands stood a scattering of wooden cottages, timbers faded to grey, their broken guttering and derelict verandas giving notice that they were uninhabited. Two Jersey cows grazed languidly and there was a fenced-off enclosure with four elegant goats and a goat house painted in limewash. Puffs of white cloud hung suspended from a blue sky and a soft, filtered sunlight bathed the stonework in mellow tones so that the entire valley seemed suffused with summer haze. I almost gasped at its beauty.
We parked the car outside one of the stone houses that Mick had marked on our map with an ‘X’. It was a two-storey cottage with a pitched roof and would have looked quaintly English were it not for a narrow front veranda. A man lay in a hammock strung between two poles of this veranda, a dusty bare foot dangling from one end of the striped canvas and a broad straw hat rising just above the rim of the other. He looked up as we slammed the car doors shut and we told him we were looking for Mick.
‘You’ve come to the right place,’ he said. We knocked on the open door and Mick appeared, along with a big golden labrador that leapt up onto Bill.
‘Down, Gandalf!’ Mick growled. ‘Bloody dog.’ He had a proprietorial air which surprised me; he’d only been there a few weeks. He ushered us into a big open living area where another man was seated at a rough pine table eating his lunch. There was a cob of homemade bread on the table, a ceramic dish of curd and the remains of a green salad.
‘This is Dave,’ said Mick, ‘and this is Ariel,’ gesturing to a woman attending to the wood-fired stove with a toddler on her hip. ‘And this is little Gracie.’ Mick patted the child’s head.
Dave stood up with a welcoming grin and shook Bill’s hand. He was tall and lanky with black shoulder-length hair and traces of a Welsh accent. I liked him instantly. He was obviously smart, not some dozey drop-out, and Mick had told us that he was something of a leader in the commune. Of course the members of the commune didn’t believe in leaders but D
ave had a natural authority. Later we discovered that he was the one who had found the valley and negotiated the sale, along with Miranda Meacham who had vetted the contract and handled the conveyancing.
Dave invited us to sit on bush chairs he had made himself and when we declined lunch Ariel brewed some tea made from mint grown in her garden. It was watery and weak.
We asked Dave about the commune, only to be rebuked gently. ‘We don’t call it a commune,’ he said, in his sonorous Welsh drawl. ‘It’s a settlement.’ There was an important difference, he explained; the word commune gave out the wrong message and encouraged spongers and dopeheads. So far there were eight families who had bought in to the valley, and three more were planning to move there and build over the autumn when it wasn’t so hot. Right now they were fixing up one of the derelict timber cottages as a guesthouse for itinerant workers who wanted to make a contribution. In October it would be their three-year anniversary and they were having a special celebration, a weekend festival. We were welcome to come.
Ariel had made no attempt to join us and seemed absorbed in her task beside the stove, cradling her daughter on her hip like a young earth mother. She had one of those enviable hourglass figures of fine-boned shoulders and full breasts, a slender waist and curvy hips that give shape to a long skirt. Her silky brown hair hung to her waist and when she passed beneath the skylight on her way to the sink the sun caught it so that it shone with silvery highlights. I wanted to talk to her, to draw her into the conversation, but she was one of those women who are still and contained, as if surrounded by an invisible ring of silence.
Reading Madame Bovary Page 18
