Friday, January 13, 2006

The Second Broken Heart

Or I could just post from another computer....

Another day in the high thirties. Waking at eleven, scrambled eggs for breakfast, lying around reading books with Sarah. Today my niece gets back from visiting her mum, and we are making the most of the silence.

A few days ago I told the first in a diptych of stories of broken hearts. The first was the big man, the machinist in the fifty degree heat, and my blundering interactions with the cardiologist. He ended up staying with us, by the way, and left with a set of detailed instructions about what to do the next time he gets chest pain, and how much sooner to do it.

Now - the second broken heart.

And this is one of the more adult things I have ever posted here. Even anonymised as much as it is it's horrible on a number of levels. Don't read on if you are not the kind of person able to read horrible things, or if this is not what you want to read today.

Mr Calvary was a man in his late fifties, steel-grey hair, bulbous nose and bright blue eyes, who came in as a priority two with chest pain. As soon as I walked in to treat his chest pain I felt that something about him was oddly familiar. It was a relatively quiet night (like frutipicking or whaling, emergency medicine is a seasonal occupation, and summer is the silent season), and when he arrived he was the only conscious man in the high acuity cubicles.

I took the bloods and gave the appropriate medication while I asked him about his pain. He was presenting with resolved atypical chest pain, chest pain that had gone away by itself and was unlikely to be caused by his heart, but still required investigation so it was a less frenetic affair than that of Mr Grande a few hours later. Still, the nurse gave him an aspirin to drink and put oxygen tubes up his nose and an ECG and I took the first of his eight hour blood tests.

All done as quietly and respectfully as possible, because Mr Calvary was crying.

This is not an uncommon thing. Chest pain is terrifying, one of the three or four intrinsically terrifying symptoms (along with "I can't breathe", "I can't move", and "I can't stop bleeding"), and hospitals are terrifying places. And men who are terrified will sometimes cry before speaking. Not some uncontrolled sobbing, not even an alteration in vocal tone or facial expression, just bright eyes filling with tears that slowly trickle down their faces.

I tend to say little at these times. I say a very few things, which vary with the patient and the prognosis:

Much pain in the chest is not the heart
You did the right thing coming to hospital
Heart attacks are not like they were in the fifties, they are very treatable, survivable events, my own father had one two years ago and now he's up on the roof clearing out the gutters
We're sending you to the Royal, they're the experts at this kind of stuff, they can do whatever has to be done
Is there anyone you want us to call?

And then a brief time in silence. At times like this there is the danger of talking for your own comfort. Times like this the more you say the less people hear.

After a few moments he spoke.

"I gave up smoking a few years back. Did I say that?"

"You did. Excellent. Damn hard thing to do, isn't it?"

He nodded. Then spoke again. "I forgot to say, my dad, he had a bit of a funny heart-beat a while back. That can't have caused this, can it?"

I shook my head. "Doubt it. But it's good to know. We'll look into it."

He'd told me that, too. There was a pause while I busied myself taking blood. There was something he wanted to say, something that had to come out.

"I've been under a bit of stress," he said, finally. "My son, Jacob."

I waited.

"He came in here. I think you might have seen him. He did... he did a terrible thing." There was a pause. "But he wasn't himself when he did it."

I remembered him now. A few months ago. This man's face, as pale and lined as now, in the background of a small crowd. Standing with all the others outside the cubicle while I sat inside, speaking to his son. Mr Calvary, pale, shocked, standing with the six or eight men in the dark suits. Detective sergeants, detective inspectors.

And I remembered speaking to his son. A thick-set young man with an open, honest face, late twenties, early thirties, tightly curled black hair, wideset blue eyes. Talking to us, the psych nurse and me, speaking soft and low. Sounding open and honest and like he was trying to explain things to us and be as helpful as he could.

Dried blood on his hands.

I remember him telling us about what had happened - telling us how he had had a few drinks, nothing special, three or four beers, had gone for a drive. Didn't remember going over to where his ex-wife was living, the other end of the city. Certainly didn't remember anything after that.

And the next thing he remembered was standing on his father's doorstep, six o'clock in the morning, ringing the doorbell. Saying he'd done something... unspeakable.

I remember as we spoke I could hear more and more detectives turning up outside. Soft voices, low murmuring. Myself and the psych nurse running through the alternatives - dissociative fugue? unmedicated mania? schizoid delusional state?

And then, when we left the cubicle, at the edge of that group of people, his father -steel-grey hair, bulbous nose, uncomprehending look. Documenting everything a thousand times.

Going home. Not sleeping all that well.

And the next day the newspaper reports - was it two dead, the young woman and her father? Beaten to death, some kind of wrench or hammer? And the mother and the student lodger, critical condition in Mordor?

"I remember," I said. "I saw him." His father nodded.

And the newpaper article a few days later. Hanged himself in prison. I took a one and a half hour break that day when I heard, sat in the courtyard, stared at the ghost gums and the candlebarks.

"I thought you did," he said.

He looked at me. "I suppose you heard what happened?" He started to cry.

I nodded, put a hand on his shoulder.

"We've been under a fair amount of stress. On the heart."

I nodded.

"He wasn't himself," said Mr Calvary, and he started crying again. "He wasn't himself."

"I know," I said.

"He wouldn't have done it if he'd been himself. He was a good boy," said Mr Calvary. "A good boy."

"I think he was," I said.

"He couldn't stand to be without her, you know."

"I don't think he could."

The crying stopped. I stood there a little bit longer, kept my eye on the ECG.

Anyway, we talked a little more, and his chest pain settled down, and when I left that night he was asleep. And the blood tests came back negative - the lab resassured us that his heart was not damaged.

Of course it wasn't. It was only broken.

Anyway. That was only the fourth patient of mine who has suicided. The only one who has suicided within a few days of being seen by me. And this isn't about who was to blame - we all knew he was at very high risk, somehow he managed to get past the safeguards. More on that later.

And maybe not. I don't know that this is postable. I don't know that this man's pain - and by this man, I mean the father, not the son, the one who was left to carry the weight, not the one who broke beneath it - I don't know that I can tell people this. I don't know if there is anything that he would want me to say.

I don't know. There is a question here that I am dancing around. Using people's suffering as entertainment.

See, when I first started this, it was for a number of reasons. I was trying to get my head around soome stuff, I was trying to keep a record so I would not forget, there was the raw material for the book, the tv show, the whatever. Career stuff - should I stay or should I go now, that kind of stuff.

But I don't know. The whole posting thing - I've been a bit ambiguous about it recently. I feel there may be unpalatable truths about what I post that I am unwilling to face.

Some of this stuff is about me. When it's about me, that's okay - at the worst it's some kind of exhibitionism, some kind of borderline behaviour. Maybe you grow out of cutting and overdosing and stuff into writing. The writer as the narcissist with boundary issues and a need for constant approval - an axis two disorder, a personality problem.

But at the worst, that's self-indulgent. Its when it's this trafficking in other people's pain... that's different. And I know that it's pretty thoroughly anonymised, and most of the patients are a palimpsest of two or three or four people I've seen. Sadly, Mr Calvary was not the first father of a murderer I had seen, and he is a deliberately artificial construct - the face of one, the medical history of another, the sins of the son of a third.

I don't know. There is this implicit assumption in medicine that information is freely distributable as long as it is anonymised - if you turn up in the ED with an interesting tumour, you can bet that someone will be making a powerpoint presentation about it the next week, and if you're really lucky you'll be a paper in the Annals of something. People are meant to ask, but I know that often they don't: my morbidly obese man from a few months back was still lying in the Royal with a tube shoved down his throat when I did my registrar presentation on "A forty year old man with sepsis".

Is it an act of violence to take someone's story? Can someone own what is said about "them", no matter how obliquely, how altered or obscured? I try to make sure that I alter every detail of every 'patient' I talk about - if you read about a slim Asian woman in her forties with gallstones, it was probably a zaftig Caucasian woman in her twenties who actually had the gallstones, and the Asian woman had something pancreatic, and so on. The conversations, the people, the cases are real, but it's not always the same patient and the same pathology.

Anyhow. It still bothers me. But I don't know that I'm moral enough a person for it to stop me writing.

Thanks for listening,


Blogger Foilwoman said...

"Or I could just post from another computer...." You have how many advanced degrees and you just figured that one out? [Imagine visibly tolerant yet still exasperated eye-roll at the Pope and Innana, right here, right now.]

Wonderful post, and I'm going to quote you (with a link, giving you proper credit) in my blog for some thoughts on narcissism (it's all about me, really) and blogging I've been having. If you want me to delete just email me, or tell your social secretary (the Pope) to tell me, and I will.

1:18 AM  
Blogger Laura said...

I had pictures taken for medical science once before. I had shingles around both eyes and they thought that was worth documenting. I was in my 30s and though they didn't quite ask if I minded, I didn't mind. Maybe someone else would feel less alone in their own freak shingles attack. :) Possibly they used my name and such in some medical publication. I won't ever know.

I just tonight came to your blog from FoilWoman's blog. I liked the stories. I liked reading about people and felt sad for the man at the taps and Mr Calvary. It puts the world in perspective to know other people are suffering too. I'm sure it must help you to write it out, whether you post it or not. I wrote my way through a few tough times.

I like what you wrote about remembering them. People would like to be remembered, to be known. Maybe your blog isn't as self serving as you sometimes think it is. I like taking photos of abandoned houses cause it seems someone should remember them, care about them.

11:12 AM  
Anonymous Camilla said...

I know what you're getting at, BJ, and it's a fine line. But I also think Laura has a point, about being remembered. This is a sort of odd thing to admit, but I sent a prayer to the man you wrote about in this entry. I know he's a combination of people, but still. It's the same urge that makes me send a prayer after a passing ambulance. "I don't know you, but we're all in this together". That kind of thing.

I love reading your writing, but I wouldn't say it's "entertainment" in that glossy magazine, Hollywood kind of way. In some way I can't quite put into words, it's Humanising? to read the stories of your patients. And I don't think I've ever felt uncomfortable reading anything you've written - in my opinion, I don't feel you've crossed any inappropriate boundaries.

Having said all that, I can understand why you're questioning yourself. I hope (selfishly) that it doesn't stop you writing, because I love what you write and how you write about it. But I'll understand if you feel the need to change how you go about it.

"icjhjoth" - an HP Lovecraft character?

8:39 PM  
Blogger Benedict 16th said...

I can just see it, Headlines in The FoxMurdochDaily
"Pope Shot" by BronzeJohn
or something like that*

I think it's your story, what writing isn't stealing, borrowing, interpreting from others. The interest is the perspectives you add, not the simple gore...
If we (your readers) wanted gore we would go to or similar. I'd rather read about your characters than "Angelina and Kenny lovefest produces a Jollie Roger" or the latest Paris (and Paris) or Apple or Moonunit or MJ are up to...


* I still remember the biggest headline I ever saw was two words under the mast head "POPE SHOT", but that was 1979 and GeorgeRingo the II

12:00 AM  
Anonymous Anonymous said...

Please write!
this is my first visit to your blog, and let me tell you, you are a beautiful person. I'm *glad* that you've chosen to give yourself to humanity as a doctor.

This blog has the potential to reach a lot of people in a lot of ways. Please reach those people, if you have it in you; this in itself can help you get over any stress of dealing with this stuff.

5:30 PM  
Anonymous Anonymous said...

Hi BJ,

I strolled over from Foilwoman's a couple of times, but this is my first comment on your blog, I believe. Beitasitmay, I was touched by this post, and felt the need to reach out.

The way I see it, there's a few things that make us human: the ability to reflect on our actions, examine our own behaviour, and to modify our future actions. The point is that if you did not reflect and write about your encounters, your learning would not perhaps have the same depth that it does now. And we all do have different ways in which we learn. Some find it difficult to use reflection; others again reflect only when they express their experiences verbally; others learn by relection on someone else's described experiences and emotions. So, by describing your encounters so vividly we all learn more about life and the roads we have and have not taken. We learn about things we need to tell our kids not to do, but also about where the value lies in life. Too often we think that value can only be had through fun and excitement - stuff the "entertainment industry" serves up. Too bad we find it difficult to cut through that to the core: that value lies in how we treat and care for and respect one another. And that there's something we can learn even in second hand experiences. So, is your blogging about this experience, and any of the others you described, narcistic? Perhaps. But only if the reading of it is voyeuristic...

8:26 PM  
Blogger de-identitized man said...

I see that Blogger chose to post my comment above as "anonymous" - is it trying to tell me something?

8:37 PM  
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6:33 PM  

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