Mai Maddisson   2/02/2018 2:46:55 PM

The most poignant word in this entire piece is the word ‘dependent’: In the context of this piece of course the comforter reached for is codeine. The alluded to need being pain relief: why has no one done an anonymous survey, maybe handed out by the pharmacists to codeine buyers (who may of course be buying it for another who has become a hermit) what the pain they are relieving is.

We, yes WE, are all dependent. At the end of a gruelling day we go home to our loved ones and friends and debrief the day leaving ourselves ready for another day. If the loved ones are overseas for an extended time then we press the Skype button.

During the last year while alluding to mostly another demographic a piece of mine was published in a different context. Among its words, extracted from a piece I wrote in2002, were
“Home is a place where one feels free to share one’s deepest pain without a sense of guilt. It is a place where one’s dearest wish is to extend that privilege to those around one..........
Home is a place where one does not have to be understood. Those around one just understand. They can relate to the notion that it is not always possible to coherently depict the events, which occur when one is caught in the turbulence of fast moving waters. They can relate to the notion that some of these memories may return with patient trust. They can accept that some memories will be forever dissociated. They can accept that at times one is incoherent because one wishes to spare another of ugliness in their lives. They can accept that one’s sadness and pain is to be trusted even if it cannot be accounted for in accurate detail. They accept that one is doing its best with the resources which it feels free to share.”

Australia is a vast pluri-cultural metropolis where there are endless people who can never find home: A home which was fractured at times decades ago. It would take months upon months to even begin to understand how they lost their ‘home’ which may still be visibly present.

Which one of us has the resources to set aside even two evenings a week for even one of our ‘codeine dependant’ patients, for the rest of time? Which of us is willing to do that for gratis: we all do it ourselves when we go home to debrief and our loved ones do not hand us an account. It is a luxury we all take for granted, yet we are quite ready to take the much less desirable, but only available luxury away from the patients we maintain we care about.

And even if all of us were willing to make such a sacrifice, given musical doctors’ chairs with only 7-10 minutes spent on each patient has become the order of the day, would there be a sufficient GP force to aspire to such a generosity.

The patients this piece alluded to will need someone/thing to depend on which our resources cannot provide: they are not mentally ill. Each of us, if left to go home to emptiness after a gruelling day, for even three months would probably increase that glass of whisky/wine or whatever the poison to larger amounts. Let us be honest, we are all addicted to human warmth and the opportunity to debrief our day to day tumbles.

And given the circumstances the patients find themselves would they even care if their lives were cut shorter? They will eke out in hope with whatever ‘poison’ they can access, and probably more toxic than codeine. As clinicians we have made ourselves feel better, let us not gloat that we have done the same for our patients.

Patients become sociologically isolated, at times, sequestrated by many means which are beyond our conception, and indeed we would all feel helpless when faced with their plight.

No one likes being a beggar. It becomes much easier to survive should one by chance find a little hope.

And no I am NOT philosophising: I well remember my last three years at medical school having arrived here as a ’refugee’ kid with fudged documents. Mother became very ill late in my third year, died during my fourth year. Until the end of medical school I went home day after day, month after month, year after year to a much younger sister whom I had become responsible for. All I can recall were the looks of those around stating don’t cramp our fun style of life: Words were not even needed to express that desolation. My eyes said it all.

Was it not for a very astute second assistant, who noticed that my work was patchy, either very good or very bad, I am sure that I would not be writing this piece. He found a way for me to catch up and offer me enough hope to complete the course.

It is easy to share now as I indicated in a piece written in a “Children in War” and called “Freedom comes when there is little left to lose”. I have become accepted in the world I was born into: That of war kids. The lack of opportunity to long ago make youthful meaningful bonds is no longer an encumbrance. At my age I don’t need more.
Ten, even five years ago I would have felt like a beggar making that disclosure.

Let us all get off our high horses and try walking for a while!