Sunday, November 11, 2007
A Fate-full Flight
I am on a remote flight up the Gibb River Road, when the last patient comes into the clinic. She has been dealing with domestic violence at home for quite awhile, and requests that I fly her and her 4 preschool children back to Derby on the plane. The smallest is a nursing infant in her arms. She tells me her partner has often threatened to kill her. And this morning, he told her to get everyone out off the house. She has no relatives in the community or any place to live.The local area nurse is concerned, but doesn’t really know what to do. I listen to the young woman for awhile; give her the message “No one deserves to be treated this way”, talk to her about the safety of her kids, explore her perceptions that she has no options. I ask her to wait a bit, and phone the Aboriginal Corporation for Women’s’ Assistance service in Derby. No one answers the telephone. The emergency mobile number gives me the message that it is “no longer in service”. And there are no police services on the Gibb River Road. (Heck, there are no police in Derby after 5PM. If someone is being murdered down the street, you may call and get Broome Police dispatch, who will send someone around in the morning.) In desperation I call our Social Emotional Well-Being (SEWB) counselor at DAHS and talk to her. She thinks she can find the Women’s’ Assistance worker, so I wait a bit.
During all this, the partner comes back to the clinic and asks my patient and the kids if she would like him to fix lunch for them? They all troop off together. While I’m waiting for the SEWB call back, I eat my own PB&J. I’m worried. How would I feel if I fly off and something bad happens? Yet the single-engine plane is very light, and it’s really not appropriate to carry the infants without proper seating. (It’s a hot and very bumpy day up there.)
The SEWB worker calls back: “No joy”. I’m on my own. The patient comes back after lunch and seems less anxious. I review her options again. I talk to her about coming to the clinic to make a police report if she feels in imminent danger. She doesn’t want to do that now. I talk about having the traveling counselor see her when they come up the Gibb in a few weeks. She’s pretty sure she doesn’t want that either, but I prevail on her that I will put in the referral, and she can always decide she is ok later. She seems satisfied and leaves. I wonder, was this just a ploy for a flight to Derby? Is she just conflicted and unhappy and needing someone to talk to? Has my advice helped? Have I misjudged the situation in any way? The cultural divide never has seemed so wide.
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The season is changing. Besides the daily 40 C temperatures, we now have clouds, and afternoon flights require tight seatbelts to avoid hitting my head on the up and down drafts. We fly home at 8500 feet, just beneath the flat bottoms of fluffy cumuli. It has rained 2.5 cm up the Gibb, and I again look down into remote gorges with huge white waterfalls. The rainfall has stimulated the grass and things are green in the Gibb, although still sere and dry in Derby. One community puts a herd of horses out on the schoolyard to “cut the grass”.
It is Spring here, but that makes no difference to the ubiquitous dogs in the communities. They have puppies all year around. Here is one of our nurses, Mary Jane, a Sister of Mercy, with a new pup.Which brings me to the issue of sainthood. The Remote Area Nurses (RANs) in Australia are excellent candidates in my view. Whether they are religious or secular, they live and work in many remote Aboriginal communities. They are essentially on call 24/7 for any accidents, of which there are many. And they do the best they can, with help only from RFDS by phone or hours-away flights. They know the people in the community, and do their best to educate them to do the right things. But they need tremendous patience to see that advice ignored day after day, year after year. And they risk “payback” from families if there is misperception about any adverse outcome in the clinics. It is not a job for the fainthearted. They are heroes in my eyes.
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I was thinking about heroism on my flight home this week. Lately I’ve heard a lot of stories from people who have been faced with insufferable situations. A mom adopts a child who develops homicidal thoughts and actions towards her. My patient with children is stuck in a situation with domestic violence. A family is faced with institutionalizing their autistic kid. A patient is diagnosed with cancer. Usually these are problems involving birth, life, love and death.
Several of my correspondents have intimated that my motives for this year abroad have been similarly heroic and altruistic. This feels very false to me. As we turn into the last 4 weeks here, I have looked back to my first post on this blog, a year ago. We were in a metamorphosis at the time. A sea change. Not a choice.
What is the choice when facing an impossible unsolvable problem? There is no choice. One just gets stubborn and pushes on through as best one can.
Yet, from the outside, there is a tendency to ascribe noble aspirations, heroic qualities to the people involved in the story. Only in fairy tales do we find heroes who choose to face danger voluntarily. In fairy tales the hero wins, despite all odds. Contrast them to the great myths, where Fate controls the outcome, often to the hero’s detriment.
When I was 17, I talked to one of my first physician mentors about the Lord of the Rings books, which I had just read for the first time. He commented that their cult status (at that time) was due to the well-written human qualities of the Hobbits. So I am reminded of one passage in the books, where Sam breaks the 4th wall in the narrative, and speculates that later generations will “tell heroic stories about Frodo and his faithful gardener, Sam”. He notes that the storytellers won’t relate that he and Frodo were in a situation where they just did what they had to do.
Fate and destiny certainly rule here in the Kimberly. People here seem to live in the present more than Westerners. The future is uncertain, uncontrollable, inevitable. The little boys I see here in the clinic hold still for me to look in their ears, poke sticks down their throats, give them injections. As 3 and 4 year olds, they are already stoics.
I think we Westerners fool ourselves about controlling our lives. We can try to choose who to be with. Where to work. Try to find pleasure by finding satisfaction in our actions, whatever they are. But our choices are limited. In the end, things happen, and we must grow or die.
And as I fly over these ancient rocky landscapes, I reflect that they will never transform into rich farms, great cities, or green golf courses. Fate holds sway.
