Superman #75

Hail,

I don't know.

There are a lot of problems with writing about some of this stuff, some of the stories, some of the difficult ones.

There is the problem that writing about something in some way 'claims' it, says "This happened to me, this is how I feel and I am the central figure in this", claiming the suffering of the patient for one's self.

There is the closely related problem that by writing you somehow claim some understanding, some insight, some special knowledge... when in fact, a lot of this stuff takes place beyond event horizons, is stuff you can't really understand at all. I can't know the what or why or how of anyone else's head, I'm barely aware of my own.

And thirdly there is the danger of dulling by repetition, of boring the reader or myself, of writing yet another story of loss and tragedy. Over the years skin thickens, senses blunt, nerve endings die off. What was something awe-inspiring and life-changing becomes wallpaper, background, business as usual.

I know there these problems exist, but still, something happened yesterday, something important, and I am going to write this, because this is important.

When I was in the ED, what seems like an age ago but was less than a year, working with Dr Longstocking and Dr Iskandar and Dr Maad, there was a path ahead of us. We were postulants, commonly called registrars, in a training programme, and that training programme consisted of the learning of certain skills, the understanding of certain pathologies, the obtaining of certain abilities ... and in the end, becoming a consultant.

And when we registrars spoke of a consultant, we all meant Peter Greene.

Dr Greene was at the time and still would be the best emergency doctor I have ever seen. He had been trained overseas, some place where there was a lot of trauma, he had seen more gunshot wounds and bodies extricated from cars and blunt trauma than we would ever see. He had intubated throats bubbling with blood and stabbed needles into baby's bones to get access for life-saving fluids and he had brought people back from "no heartbeat, no respirations, pupils fixed and dilated", so that three months later when they got out of ICU they were waiting in the waiting room with flowers and chocolates for him.

Seriously, the best there could be.

"If I get cut in half by a train" Dr Long-stocking once said, "each half will hop over to Florey and Peter will put me together again."

And I think a lot of us knew we'd never be that good, and maybe we didn't even want to be that good in that way, but you shoot further when you aim higher. There was a path and the obstacles were the exam and the anaesthetics term and the rest of the stuff and at the end was being like Peter Greene.

And he wasn't just clinically good, either. When Dr Iskandar and I were with the Ice Maiden, the woman in her twenties who came in and died twice under our hands, it was Dr Greene who I went to see two days afterwards, and Dr Greene who sent me out of the room feeling damn good, proud and confident and relieved. And it was Dr Greene who talked to us all after the methadone baby died and Dr Greene who went around to people after the guy using the fire extinguisher as a club tried to kill one of our security guards.

Anyway, what do I say now?

Monday my brother rang me up and told me Dr Greene was dead.

Died by his own hand, hanged himself, found by his wife Saturday morning. Forty five years old, the body still at the coroner's.

The best emergency doctor I knew.

There's a lot that I could say here that wouldn't work. There's the stuff about the effect it's had - all last night there were people sobbing on the phone, registrars and nurses ringing each other up, horror and numbness and fury and reminiscing all in four short hours. Stories how he made us laugh or saved our arse, times when we saw people who should have died being brought back from the brink by him.

There's the stuff about risk factors, the stuff about how nobody knew, nobody thought, nobody suspected. Nobody wants to believe.

Over and over you hear undercurrents of incredulity that anything, anything at all, could kill Dr Greene.

Because - and I'm not going to get this across, no matter how I write it - he wasn't like that. Death was not in him, you sortof got the idea death backed off when it saw him. He wasn't thekind of person who could suddenly be dead, he was alive, strong, laughing, tall and handsome and broad-shouldered and everything. Everyone's mentor, everyone's idol. Competent and confident and supremely respected.

I don't know. There were some things that, looking back, chill me now.

The fact that he chose what is in this country the most lethal commonly employed form of suicide. The fact that he was so good because he demanded perfection of himself, and to him part of that perfection was not burdening anybody with your own problems. The fact that because he was so admired and so good he ended up doing less and less time on the ED floor and more and more paper-shuffling, administration, something he hated.

The fact that in his last days he was essentially surrounded by doctors.

The fact that he always listened to us talking about our terrors, but he never spoke about his own.

The fact that before he died he flew overseas, got the recruiting done, made sure everything was set up for the department for the next year, made sure we'd be looked after. Got things right.

I don't know. Like with a lot of these things, I don't know that this should serve a purpose, be an exemplar. Men die earlier, people who don't talk are at risk, perfectionism can kill you... we already know all that stuff.

I just keep thinking about how every talk he gave was grinning, occasionally mordant (he opened a talk on the management of road trauma with a photograph of an ambulance that had rolled over and a caption underneath asking "who do you call now?"), a joke in every paragraph.

Whatever. Please do not mistake this as a cry for sympathy, it is more, even now, an expression of disbelief. Tonight I am going around the ED, see how things are. Quiet, from what I hear, stunned and sorrowful, angry and unbelieving.

As far as I and the rest of the registrars are concerned, this has given me some pause, made me think, made me weigh things up. He was the goal, like I said. I am meant to be going back at the end of January, and I know I am less strong in virtually every way than him. Having said that, I bend before I break, and I suspect he could not. Oaks snap in the wind when grass does not.

If anyone medical is reading this, the thing to take away from this is suicide is not something that only takes the weak and the cowardly. If you've been doing medicine or nursing for more than a year and you haven't seen the weak survive things that kill the strong and the good and the great, you haven't been looking.

Anyhow, I have to get back on the phone.

The title above, by the way, refers to the DC comics issue called "The Death Of Superman". Never read it.

Thanks for listening,
John