Karen Hitchcock - The Medicine: A Doctors Notes

ALSO BY KAREN HITCHCOCK

Little White Slips

Dear Life

Published by Black Inc.,

an imprint of Schwartz Books Pty Ltd

Level 1, 221 Drummond Street

Carlton VIC 3053, Australia

www.blackincbooks.com

Copyright Karen Hitchcock 2020

The essays in this collection were published in The Monthly between June 2012 and October 2018. Karen Hitchcock asserts her right to be known as the author of this work.

ALL RIGHTS RESERVED.

No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form by any means electronic, mechanical, photocopying, recording or otherwise without the prior consent of the publishers.

9781760641931 (paperback)

9781743821275 (ebook)

Cover design by Regine Abos

Text design and typesetting by Dennis Grauel

Front cover images: magnolias: Swisty 242 / Shutterstock; syringe: Laborant / Shutterstock; grainy background: Panadin12 / Shutterstock. Back cover images: flower: Sandra M / Shutterstock; human body map: Hein Nouwens / Shutterstock. Part title illustrations: Plawarn / Shutterstock.

For Ida and Yvonne, my lit daughters

And for Dr Michael Oldmeadow, rockstar

Introduction

When I was a full-time doctor in a busy city hospital, Id cycle to work every day wearing black pants, a silk shirt and jacket. The uniform didnt vary as there were no seasons inside, nothing circadian. The temperature and lighting sat at a cool white all year round. When Id walk through the smooth sliding doors into the refrigerated air, the world outside ceased to exist. The hospital was a closed, complete ecosystem: food, showers and beds, companionship and drama. I could have lived there. It would have been more time-efficient. For when I left to go home I took the place with me: sick patients, departmental politics, unfinished clinic letters, roster disputes, a never-ending list of tasks and questions and key performance indicators. Bed shortages, shrinking budgets, clinicians juggling patients needs with those of the institution. I squashed my family and friends into gaps. I mentioned to my boss in some after-hours meeting that my daughters were home alone. He laughed and sing-songed, Uber Eats again! No need to wonder why, in the entire time I worked there, I was the only female full-timer in what was one of the biggest departments in the hospital.

These columns and essays were written in the early hours of the morning, before the trams in the street beyond my window started rolling, before anyone was awake. This was the outside space from which I got the chance to think quietly about what it was we were doing in all that hospital-hectic, which could induce a kind of white noise on the brain.

The Japanese have a word shrinin-yoku that roughly translates to forest bathing. You go outside, walk through some trees and just breathe. Doctors in Japan prescribe it for mental health and wellbeing. Observational studies and randomised controlled trials have validated the idea: we wilt when our eyes are starved of green. First I quit the hospital and went freelance. Then last year I moved from the middle of the Melbourne CBD into a house in the bush in the mountains, with plenty of water, an orchard and a vegetable garden. Full-time forest bathing. When Id panic that Id totally fucked up my life, Id walk outside, grab my pick and shovel and plant some trees. By the end of autumn Id sunk hundreds of maples and almonds and oaks. Its a giant feat of optimism to plant a twig and trust it into maturity. It changes your sense of time. Helps you catch your breath. I read apocalyptic novels, watch dystopian television and think: Id better plant more perennial vegetables. Who knows how crazy shits going to get. I listen to music and stare out the window, or sit on the grass and watch the seasons strip bare then dress the gardens, listening to the symphony of birds and insects. I dream and I think for long stretches of time.

I now work in my own small inner-city clinic a few days a week, practising slow medicine, mainly prescribing medicinal cannabis to patients who suffer pain, anxiety, insomnia or are dying. I see my patients in a small cream-walled room in an ancient mansion on a hill. It is quiet. I do not have a boss. I go at my own pace, at the pace my patients need. There is never a cannabis emergency. I make school lunches, attend school concerts. When my daughters want to talk to me, I dont have to smother twenty competing demands on my attention. I turn towards them, sit down and listen. I cook. We eat together. Its their turn. I pull on my overalls and sink my hands into the soil, and the memory of myself in the hospital is of a hyperventilating girl playing dress-ups. But I have written proof that I was able to preserve small pockets of time to think.

When the Doctor Needs a Doctor

Early Friday morning, I got cancer. Bad cancer, the kind that can colonise your bones. Mine had spread to one bone in particular: a rib in the middle of my chest. To diagnose myself I took a history, questioned myself about the nature of the pain and did a physical examination. The pain woke me up, it was grinding and rated seven out of ten when I moved or breathed. There was point tenderness over my fourth rib just medial to the mid-clavicular line, and crepitus (a distinctive crackling feeling when shards of bone grind together). The invaded bone curved right over my hearts left ventricle. A terrible click vibrated through my chest whenever I took a breath. Given that I hadnt fallen from a ladder, I knew this was a pathological fracture: one caused by something bad happening inside your body, such as spreading cancer. I lay down on the lounge room floor, staring at the ceiling, wondering if it was a breast or lung primary, and how many months I had left. Then I called my workmate Harry.

Ive had a lot of diseases over the years Hashimotos thyroiditis, hepatitis, a ruptured spleen and multiple episodes of lymphoma with peak incidences around the time of my final med-school exams and then, six years later, the specialist exams. There are millions of diseases, and a body can generate a kaleidoscope of sensations: whos to know for certain if the pain in your gut is the result of too much hummus and not actually a huge tumour in your pancreas? Who can know for certain without having a long, hard look at your internals with a high-resolution scanner?

Theres talk in the media and around the wards about over-investigation. That is, looking for a disease that is highly unlikely to be present. Take lower back pain, for instance. Each year Australia spends about 220 million Medicare dollars on X-rays, CT and MRI scans for lower back pain. Most people experience back pain at some point in their life, which makes back pain normal. Though normal, pain makes us anxious: we want to know why we are feeling it, if it is a sign of something dangerous, something that may leave us permanently incapacitated. After all, every nerve that allows you to move and feel your body travels through the spine; what if one of the bones has moved and compressed a nerve? So you go to the doctor, who engages you in a strange dance: she raises your leg, asks you to bend it, presses and pulls, taps your knees and ankles, bounces a pin across your skin. All good, she says. Heat packs and paracetamol, and dont take to your bed, she says. Your heart thumps. You had pictured severed nerves, surgical interventions; your future in a wheelchair. And in the face of all this she asks you to trust her