The Best Australian Science Writing 2012 (30 page)

Ranjana Srivastava

‘My husband is depressed,' she says. ‘My cancer has gone on too long.' Small tears coalesce into larger drops; soon her face is a soggy landscape that no box of tissues can dry. Some years ago, when she was first diagnosed, her husband was her rock. He cooked, cleaned, asked the right questions and said the right things. But the hard years and the relentless, nagging nature of her illness have clearly exacted their toll. ‘I am sorry,' I say.

‘I didn't see it coming,' she mutters.

Neither did anyone else, I think. When her husband left his job, I felt relieved that she would have a full-time driver so she would miss fewer appointments. And on the odd occasion when I asked him how he was, I read his shrug to mean ‘Fine' … because that's how I wanted him to be. ‘I don't want any more treatment. I don't want to beat the cancer and lose my husband,' she tells me. I beg her to not make hasty decisions about her fragile health and pledge to get her husband the help he needs but she has made up her mind.

She gives me a hug. ‘Thank you for all you have done. Please don't feel bad about my decision.'

I do feel bad, thinking of all the things we could and should have done, because although there was one patient, there were
two people. But there will be another time for recriminations because the next patient is a young university student starting chemotherapy for breast cancer. She is petrified and I can't help feeling anxious for her. We talk about the unfairness of life, about the fact that her friends are partying while she is hooked up to an infusion, and will not only lose her hair but also a breast.

‘Will I be OK?' she whispers, her voice heavy with hope.

I swallow before answering. Her mother and sister have died of breast cancer. ‘This is treatable – we are all going to do our best to make sure you do well.' Her face relaxes.

Next appointment. A 90-year-old Englishman with an incidentally detected small lung cancer apologises for the intrusion on my time. He is here simply to tell me that he is going to defy his children's wishes and not see me again. ‘In fact, the only thing I ask you is to leave me alone. Are modern doctors able to do that?'

I gravely reassure him that no one will call him back to my clinic. ‘Then I will say good day to you,' he replies, almost tripping over his stick in the rush to leave. But the dairy farmer, at 79 years of age, has other ideas. ‘No one is going to stop me from getting to 80! Give me all you've got!' I shudder at the thought of chemotherapy touching his fragile body.

The next two patients, in solid remission, usher in a much-needed dose of relief. Once they had doubted their ability to survive their ordeal, but now they come with a newfound zest for life. Yet each admits to pangs of anxiety about recurrence, so we talk about the difficult adjustment to being a survivor.

The last patient of the day is a 52-year-old lady. After an initial reprieve, she has not been feeling too well. ‘I just want to see my first grandchild being born. Just tell me I will be alive for it,' she pleads.

And so the day goes, different human dramas played out in short intervals. The script changes with every patient and the
task of being an oncologist requires a continuous and real presence. You need to mix stillness with emotional agility, honesty with tact. Maintaining hope while telling the truth is a balancing act played out many times over.

* * * * *

It is only with the passing of time that I have realised just how unalterably my life changed the morning I discovered I was going to be a doctor. While many who miss out on a place to study medicine move seamlessly to other successful things, I would not have been one of them. In fact, I am positive that had I stumbled into engineering, my name would have been associated with a few too many upside-down bridges, dead-end thoroughfares and unintentionally explosive soaps. This makes my gratitude for being a doctor almost as strong as my sense of relief.

After my birth in Canberra, I spent my early years in India, England and the US, where I completed high school. I returned alone to Australia at the age of 17, with the type of certainty only ignorance can bring that I was going to study medicine because I had done well at high school. In Melbourne, I discovered that securing a place in medical school was a little bit more difficult than filling out a form that nominated it as your first choice, but I still wasn't unduly worried, for I believed that the same grades that had secured me admission to an ivy league American university would get me across the line here.

I was told to present to campus, but no one thought to tell me it was for an interview. I still remember what I wore – an old white shirt, tangerine shorts and a pair of scuffed canvas shoes. By the time I found my way around campus in the intense summer heat, sweat was pouring down my face. When I finally located the airconditioned comfort of the meeting room, my heart sank. There, with parents in tow, waited impeccably dressed young men and
women, eager to impress the same interviewers I was about to meet. Every single candidate wore a suit; everyone looked the part of a doctor.

Jet-lagged and homesick, I still hadn't figured out that this was the kind of interview that made and unmade dreams. The mix of questions would invite humorous disbelief in today's age of strictly structured and timed sessions, but the ones I remember include, ‘Do you think there will be a day when mankind will know everything?' and ‘Can it be possible that someone's point of view is unequivocally correct in the face of a definite wrong?' I cannot imagine my teen self discussing these philosophical questions with any sophistication.

My rejection letter arrived in the mail. I still have it; it still looks pristine. It says, ‘This year we had nearly a thousand non-Victorian school leavers like you competing for less than ten seats. We are sorry to inform you that you were not selected.' With that note in hand, I gloomily went to register for engineering, an ill-considered afterthought for me.

Yet the lady at the computer said, ‘Darling, you are in the wrong place. The medicine enrolment is over there.' Piqued by her insensitivity, I replied, ‘That's not funny, I didn't get in.' It was her turn to look surprised. ‘I am serious.'

Dazed, I approached the medical faculty. The secretary was sceptical and her response was as practical as it was ruthless. ‘This sounds odd. I wouldn't take it for granted if you don't have a letter of offer.'

I returned home, neither budding engineer nor budding doctor, in fact wondering whether I would be going to university at all. Hours later, the phone rang. It was swift and impersonal. ‘Congratulations,' an administrator said. And I was in. Somebody must have turned down their spot, probably to take up an offer elsewhere, leaving a vacancy for me.

I am the only doctor I know who has never received a formal
letter of offer to study medicine. In its place, I have my rejection letter carefully stored away. I look at it from time to time – to me, it epitomises just how close I came to forfeiting my dream. It is no exaggeration for me to say, then, that becoming a doctor transformed my life.

Once admitted, I relished nearly every aspect of my training. People often think that after obtaining a basic medical degree, the path to choosing a specialty must be lined with a serious analysis of one's strengths and failings. I'm afraid I was far less judicious. I fainted twice in surgery, much to the disgust of the surgeon, who had only just made the first cut.

Watching a woman give birth and almost letting the slippery bundle slide from my hands made me doubt my ability to handle such critical moments in life. In paediatrics, I winced at the sight of a sick child – I couldn't bear to draw blood from a crying baby. When a drug addict abused me for resuscitating him and bringing his expensive high to a premature end, I ditched the thought of emergency medicine. I enjoyed psychiatry and found it a natural fit for my interest in learning about people's lives. But then, while still in the throes of uncertainty, I found inspiration in the unlikeliest of places – in a small rural hospital – and returned to Melbourne knowing that I wanted to be an oncologist.

I have been an oncologist for only seven years but it feels like a lot longer. Perhaps it has something to do with the intensity of my work, as every joy, sorrow and anxiety seems magnified when viewed through the prism of cancer. But every day, my initial impression is confirmed: the satisfaction of oncology lies in its art as much as in its science. If you or someone close to you has been struck by cancer, you will know immediately that what you want from a cancer specialist is critical and current information but, equally, empathy and compassion. The most accurate information delivered coldly can dampen, even destroy hope. But the warmest, kindest doctor who cannot confidently guide a patient
through a maze of complex information can cause equal harm. Being an oncologist requires constant awareness and finessing of this fine balance.

For a few months every year, I also take on the responsibilities of a general physician. In this role, I see patients with non-cancer ailments, such as injuries from falls, heart attack, diarrhoea and pneumonia, who are admitted to the medical ward of a public hospital. I am able to tell many of these patients that their illness will definitely get better, with fluids, antibiotics, or other short-term measures. Since nothing is short-term in cancer management, I relish the contrast these interactions provide.

I am fortunate that my work at a public hospital keeps me close to medical students and junior doctors who are still forging a path in medicine. Even more gratifying than teaching is listening to these doctors. On a day when one is feeling jaded, there is nothing like their youthful idealism to reset the button. In the time spared from work and family, I like to write. A physician who witnessed the prolonged suffering of his wife once said that it was impossible not to write if you treated cancer. The intimacies of the doctor–patient relationship are profound, and it is difficult to truly close the mind's door to what has gone on during the day.

The art of medicine

The mind

A dream of goldfinches

Vanessa Mickan

Some days the beauty of the natural world comes on almost like an ache. It is there right in front of me, but too intense, too big to put into words, to capture in a photograph or even to comprehend. The spring weather carries with it the energy of winter still. The air is crisp and cold like a crunchy apple. I want to grab hold of it, freeze the atmosphere like this forever. The branches are bare except for a few buds; the harbour's water glows in the early-morning light. A Red-bellied Woodpecker trills. Titmice call, but I can't see them popping around way up high. Goldfinches whiz and zing and whir. It triggers a memory that tries to run away from me, but I catch it and hold its tail for just a second before it slips from my grasp: a dream I had last night, a dream of goldfinches. There were thousands of them, brilliant yellow and black, flying through a forest. There was someone else in the dream, someone I was talking to about these birds, but I can't remember now. All that remains is the image of the birds flying fast, urgently, silently, between the trunks of great tall trees.

Forests

Flights

Acknowledgments

‘Gateway to heaven' by Wilson da Silva: published in
COSMOS Magazine

‘Neutrinos and the speed of light … not so fast' by Jonathan Carroll: published in
The Conversation
<
theconversation.edu.au
>

‘Blank canvas' by Corey Butler: published in
COSMOS Magazine

‘Under the hood of the universe' by Margaret Wertheim: excerpted from
Physics on the Fringe: Smoke rings, circlons, and alternative theories of everything
by Margaret Wertheim (Walker 2011)

‘The ill-effects of quackery v scientific evidence' by Cassandra Wilkinson: published in
The Australian

‘A hero's legend and a stolen skull rustle up a DNA drama' by Christine Kenneally: published in
The New York Times
, 6 September 2011 © 2011
The New York Times
. All rights reserved. Used by permission and protected by the Copyright Laws of the United States. The printing, copying, redistribution, or retransmission of this Content without express written permission is prohibited. Article edited by James Gorman.