Wednesday, January 25, 2006

J'adoube

And this will be another in the ongoing series of merlot-induced posts.

But for a good cause - my brother's clean bill of health came by today, and the compulsory red-wine-and-backyard-cricket protocol was applied. And I bowled Declan's friend Grego not once, hit the wickets not once but twice, and got him out once caught behind. And there was much rejoicing.

Anyhow -

Today I saw a man who should be dead.

He was in the methadone clinic, one of the methadone success stories - a tall, sun-tanned, vigorous man with bright blue eyes and clean white teeth and a loud voice. He was, he told me, in better shape now than he had been ever in his life.

"You can get so much stuff once you give up the smack" he said to me. "that boat I got, the thirty footer, me and a couple of mates went out fishing. Bought myself a new colour TV the other day - one of those ninety eight centimetre ones, plasma flatscreen."

"Excellent" I said. Our tv is forty three centimetres, and doesn't seem to be able to pick up the cricket after sundown.

"Watching all the American shows, all the cricket, all the games - you got Foxtel, Doc?"

"Not really" I admitted.

"Want to try and drop those last few milligrams, finish up with all this" he said, referring to his almost miniscule dose of methadone. "This winter me and the missus, we're all going to Thailand for a few weeks. How good is that?"

"Never been" I admitted, possibly a little more tersely than I intended. "Anyway: how long since you've used?"

"July thirty first, 1996. Around nine o'clock at night."

I looked at him. "What happened July 31?" I said.

And he told me. Had his last hit - two hundred dollars worth, back when two hundred dollars got you something worth injecting, not the crap they had nowadays. Big hit, drove home. Big old Holden Commodore. Hit a tree on Sauron Street.

"How fast?" I said.

"Not much. Sixty, eighty at the most. But I wasn't wearing a seatbelt. Pretty bad."

He pulled up his shirt to show a long, jagged scar, from the sternum down around along the ribs on the left hand side, all the way around to almost the middle of his back. Another line down the centre.

"Christ" I said.

"Did eight ribs. Both lungs popped" he said. "Pneumo - pneumo-somethings..."

"Pneumothoraces" I said. "Your lungs collapsed."

"That's the word" he grinned. "Both lungs. Lacerated my liver, crushed my spleen into chunks. Broke my breastbone. Even bruised my heart muscle, they said."

"God". I nodded, put pen to paper.

"And ruptured my aorta."

"Jesus Christ" I said. I had a mental image of the great artery from the heart tearing, blood jetting straight from the heart into the - depends where the tear was, into the sac around the heart, behind the lung, up against the windpipe.

A full tear was almost unsurvivable.

"Are you sure? Tore the aorta?" I said.

"That's what the surgeon said."

"You shouldn't be alive."

"That's what he said too."

I gazed at him, at the picture of health. "What happened?"

"I was out for nine days. I remember the drive, I remember hitting the tree, I remember sitting in the seat while the ambulance men cut me out. Couldn't breathe, felt like I couldn't breathe. Then I got in the ambulance, I remember thinking if I didn't get in the ambulance I'd die, and that's pretty much it. Woke up nine days later."

I nodded. "And the heroin?"

"That's the weird thing." he said. "They put me on the methadone in hospital I reckon, and I been on methadone ever since. But the smack? Never really had a taste for it since."

So that's the ultra-rapid detox from heroin. Not the most popular method.

He was not the first "should have been dead" person I've spoken to. There was one guy in Florey last year, who came in with 'abdominal pain'. I pulled up his shirt. There was an ugly red scar, a scarlet "S" that ran from just below his solar plexus to his groin, plus a few punctuation marks.

"What happened here?" I said.

"Bit of an accident at work," he said.

I nodded.

"Got between a forklift and a wall. Concrete wall. Had to take out ten feet of gut."

"Any problems with that?"

"Don't reckon. Actually, it's good. I can eat pretty much what I like. I don't get fat."

"Okay. What about here?" Another mark like a comma.

"Stabbed in 1988," he said.

A brief silence.

"And here?"

"Stabbed in 1992."

I looked up at him and decided that was probably as extensive a history as I was going to take about his injuries. On the way out of the cubicle I saw his nurse.

"Anything we need for that guy?" she said, indicating Mr Kent's** cubicle with a nod of her head.

"Forget about it," I said. "The bugger can't die."

And then a few years ago, the strangest story. I don't know about this one. I can tell it how I remember it, and it seems unlikely, but from what I remember it seemed unlikely at the time... although the man telling the story had nothing to gain but much to lose by his tale. Anyhow:

Mr Turac was a thick-set Turkish man, hirsute, balding, more softly spoken than his appearance would suggest. He lay with his white gown pulled up, a blanket over his lower regions, while I pressed on his belly.

"There?" I pressed up underneath his ribcage, and he flinched.

"A little" he admitted. "What is it?"

I pulled off my gloves. "Too early to say. Could be gallbladder, but could be liver. We'll have to wait until the bloods come back."

"What do you think?"

"The pain you're describing, the way it comes on... probably gallstones. But you said you had some kind of hepatitis last time you went to Ankara, so we're looking into that. The ultrasound and the bloods will tell us a bit more."

"Will I go home tonight?"

"Possibly. But if there's infection or the pain doesn't go away, you may need surgery."

"No!" He paled, one of the few times I have actually seen that - the colour dropping out of skin. "No surgery."

I paused, but he didn't seem to want to say any more. I spoke. "It's a
frightening idea, I know. But it's very..."

I was about to tell him how safe it was when he told me what had happened to him, thirty years ago, in Ankara.

He was young, barely out of his teens. Fit and strong, the son of a businessman, wanting to go in the military. He wanted to travel. Not a stoic man, a sensitive and cautious one. So, when a friend suggested a business trip to the Sudan, he seized the day.

"One thing" said the friend. "It is wild country. Full of disease and madmen with guns. You must be prepared."

"How so?" asked Mr Turac.

"The malaria. The yellow fever. You have to have injections. There are injections now for rabies - very painful, but you must have them. And you must have your appendix removed."

"Removed? Why?"

"Because we will be many miles from civilisation, on dirt roads, and the vehicles will be driven by bandits or drug addicts***. If your appendix becomes infected, we cannot get you to medical treatment quickly."

And his friend pulled up his shirt to show a clean, almost invisible scar. He had had the surgery himself.

So Mr Turac goes in to have his appendix out. He did have some sense of misgiving - it was, after all, a perfectly servicable organ. It had done him no harm, in fact it had served him well all its life. And as far as anyone could see, it was a perfectly healthy and functional piece of tissue. It could normally look forward to a long and healthy appendiceal life.

But not now. Now Mr Turac was lying on a hspital bed, not unlike this one, in a white gown, prepared (physically, at least) for surgery.

They put the mask over his face. He breathed deep and counted, one, two, three.... and that was it.

Until he woke. it was cold, and silent. The room was light, everything was light. He could see no objects. He looked around.

Was this the hereafter?

He turned his head from side to side. There was a sheet over his face. He reached up one stiff hand and pushed, pulled at the sheet. It slid away. With difficulty he sat up.

Mr Turac turned his head. Two men sat at a chessboard, playing chess. One looked up idly, saw him, screamed, leapt up, scattering pawns and kings, and fled, his fellow fast on his heels. Mr Turac lumbered to his feet.

His throat hurt. His belly hurt, in fact it hurt like fire. There was a scar splashed with iodine, near his hip. His belly had been shaved. He tried to call out but he could barely speak. He lumbered out of the room, clutching the gown behind his buttocks.

And there in the silent corridor he waited, until a nurse came along and asked him was he okay, was he alright, was he lost, and he pointed to the room from which he'd come, and it was, of course, the morgue.

I don't know what to make of this story. This is what I remember him telling me - or what I remember four years later.

Is it possible that, as he said, that something had gone wrong, that he was pronounced dead in surgery, and woke up in the morgue? Is it possible?

I don't know. Possible that he "died" (in the weaker, temporary, modern sense of the word) in surgery? Certainly. Seen it happen.

Possible that, having died, resuscitation attempts were commenced and ceased and he was pronounced dead - and yet still lived? Of course - I have been in the resus room when we (not yet me) have pronounced a death in a man or woman (never a child) whose heart was still beating.

But that he was pronounced dead, treated as dead, irretrieveably dead, not only while heart was still beating but while lungs still moved, while his brain still fucntioned? However slow the heart, however slight the rise and fall of his chest, whatever they saw when they shone the light in his eyes?

I don't know. Even on the eastern coast of Turkey, thirty years ago. I don't know.

But I do feel that Mr Turac believed it. His terror, his pallor, his refusal to contemplate surgery in any event. And he was not a man with a long history of mental illness. He was a man with an otherwise sane and balanced view of the world, a man in a position of responsibility.

Who knows? I don't.

But I suppose we now know they play chess in the hereafter.

Anyway, back to cricket and merlot amongst the living.

Thanks for listening,

John

*That, by the way, is what killed Princess Diana. Or so I am told.

**Sorry

*** Apparently there are no words in Turkish for "I hope you have a great time, send me a postcard"

6 Comments:

Blogger Foilwoman said...

Is there actually any medical reason to have one's appendix taken out prior to a trip like that? Other than having appendicitis, of course.

2:56 AM  
Anonymous Camilla said...

Dear gods.

That's all I can say really.

6:01 AM  
Blogger Tournee Du Chat Noir said...

Foil:

They certainly do it before you go to work in Antarctica. I suppose it would depend on how long the trip was expected to take... But my dad went on a few trips to remote and probably dangerous locations (we lived in Ethiopia for 18 months) and they never took his appendix out. The whole family did have to have all of those vaccinations though.

Camilla: Yee-harr about the mug! -I'm still seething because a rotten gormless teenager (Not AL but her friend who has a California accent despite never having left the country, as do most of the girls her age) smashed a beautiful mug my mother gave me 25 years ago...

10:28 AM  
Anonymous Camilla said...

Chat: What a bummer about your mug :( :( :( It's awful enough if you break your own precious things, but when someone else does it - argh!! What a little rotter. I hope she was suitably apologetic.

As for the Californian accent - WTF?? I don't know what's got into kids these days (ha ha people probably said that about us 20-something years ago!).

11:50 PM  
Blogger Champurrado said...

Doctor:

Congratulations on the brilliant bowling! And a good story as well.

12:20 AM  
Blogger g_pi said...

Wait, I can't find the first asterisk...

What killed Diana?

3:06 AM  

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