My next patient was a tourist who hadn’t had a bowel motion for a week. “We drink about 4 cups of tea a day,” he said defensively. “There’s wind and a bit of fluid coming out.” I gave him powders to make his stools softer, pills to stimulate his bowel, enemas to lubricate from the other end.
“Are you sure it’s constipation?” The poor man asked.
“This is the desert,” I smiled. “Drink your water. If it doesn’t work, come back. I’ll do a manual evacuation.”
My student colleagues and I were following the surgeon on his hospital round.
“Mrs Harris has had a colectomy,” the surgeon said, speaking across the bed of a woman in her sixties. Her hair was coiffed. Her body was a mess of adhesives, tubes and oozing wounds. “We’ve removed 3 metres of her colon and she’s got a nice, pink stoma on her abdomen now.” He lifted a piece of gauze. Mrs Harris had a brand new anus, seeping blood-stained fluid and faeces, on her soft, white belly.
The surgeon asked a nurse to read from the chart. “BP one fifty over ninety,” she read, “respiratory rate thirty, temp thirty-seven point six, urinary output two hundred mils in the past two hours.”
“She’s doing well then,” said the surgeon.
Mrs Harris looked frightened. I tried to send her kindness through my eyes. On rounds I’d sometimes make my way to head of the bed and put my hand on the patient’s shoulder, quietly introducing myself. This time the surgeon and another student were blocking the way to Mrs Harris’ head. The other students avoided her eyes, staring at the monitors or the surgeon’s face.
The surgeon addressed the nurse. “Keep fluids running, nil by mouth another twenty-four hours, four-hourly obs. Keep up the maxolon and panadol IV.”
“Everything good, then?” he asked Mrs Harris as he left the room, not waiting for her reply. Once, on a round, he dropped a file. Instead of picking it up, he kicked the file under a bed for one of the nurses or cleaners to pick up.
The surgeon liked his students to respond rapidly to his questions in exactly the words he expected.
He had a rough drawing of an intestine on the whiteboard. He’d point to each part. “Ascending,” one student snapped. “Transverse,” snapped the next. “And this part?”
“The rectum,” someone guessed.
“Sigmoid!” he yelled. I’d known that, but was intimidated.
“What is this called, when we make a connection like this?” He was looking at me.
I couldn’t find the word.
“An anastomosis. You’d better sharpen up,” he said to me.
Then to the class: “We have a different kind of knowledge, which is why nurses can never equal doctors.”
I started to cry. It felt like the fear and distress of all of the patients we’d seen was accumulated in my muscles. I was angry, but I started to cry and couldn’t stop. I left the tutorial, escaping to the Ladies where I stared furiously at myself through bewildering tears.
I asked to change tutorials and didn’t see that man again. He wrote me a patronising note saying: “Don’t despair. Medicine is a broad church. You too will find your niche.”
I failed another two exams in my final years of my medical degree. One was an Observed Structured Clinical Exam (we called it an ‘Osky’) run by the physicians at the Royal hospital. I thought I’d done well — my knowledge was good — but apparently I couldn’t get the routine right. Perhaps my dreadlocks had something to do with it.
There was a way a physician looked and acted that I never got right.
The other exam was called a Long Case. We were required to question and examine a man with a life-threatening chronic disease. We would be assessed on the examination and our presentation of our findings.
“You seemed quite relaxed,” said the assessor critically after I presented my findings. He failed me by one half mark.
I was allowed to re-sit the exam, travelling hours from the city to do so.
“Your patient is a 57 year old woman with terminal breast cancer,” said one of the examiners. I crept into her room. I had 15 minutes to examine her.
“We might be interrupted,” my patient for the exam said. I was crestfallen. This exam was all that stood between graduation and me. “My daughter is coming to visit. She’s recovering from a mastectomy because she’s had breast cancer.”
“If she comes, we’ll stop,” I said. My patient, visibly relaxing, told me about her working life in a sweatshop, sewing labels into shirts. I’d worked in the district she came from. I listened to my patient’s heart, assured her it was a good one and checked her vision. Then it was time to go.
“Oh no, I haven’t checked her hand-eye coordination or had her stand up for the Romberg’s test,” I thought as I left the room. I was miserable as wrote my assessment of the patient and came to see the examiners.
“Well, the first thing we want to tell you is that you’ve definitely passed,” one of them said. “We both wrote comments on how tense and serious you seem. You could relax a little.”
I went to see my patient after the exam to tell her that I’d passed.
“I didn’t like those doctors,” she said. “They asked, did she do this, did she do that? I said, of course she did. She did all of that,” she smiled. I hugged her frail shoulders and thanked her for getting me through.
In spite of setbacks, I was finding my power. The Indigenous doctors association we’d founded in northern New South Wales years before was flourishing.
At one of our conferences, I met a pair of important old men. Traditional Aboriginal healers, they spoke through an interpreter, describing an ability to fly about at night to visit sick people in spirit. They said they could see into bodies and pull sickness out in a stone. They worked with doctors in Central Australia.
I told them I saw shadows in people’s bodies where they were ill and wanted to learn more about it. Invited to visit them, I made several trips to Central Australia to learn from them in the next few years. They were people of integrity, with the calm physical confidence of hunters.
When I spoke at two conferences that year I’d thought about what I learned from them. “If Europeans could build a pressurised metal tube that carries us through the air, why wouldn’t Aboriginal people make similar advances in knowledge? Aboriginal people were talking and travelling and lying under bright stars. Is it impossible that they created a body of knowledge that encompassed astral travel as an aspect of healing?”
Years earlier, with GB and our little son, I visited Lake Mungo and its megafauna fossils. I still remembered the life-size fibreglass Diprotodon in the modest museum there and the carefully preserved remains of the first fire humans used for cooking fresh fish. Exhausted from working several jobs, I had wondered then about those early ancestors who had feasted on fish and megafauna. They had meat for days. They didn’t have to work as hard we did. What did they create, in that rich culture of well-fed people not driven indoors by hostile weather? What had the Indigenous people been exploring while the Europeans made their ships, factories and guns?
Another conference I attended for many years was that of a lesbian doctors organisation. Many of the lesbian doctors felt like outsiders; it was paradoxically easy to fit in.
One of the foundation members of the organisation, Carla, was a lawyer before she studied medicine and frank about her achievements. “It took me ten years to feel I was a safe doctor,” she said one morning at her rural emergency department. I died a little inside. Here I was in my last year of medical school, over 40 already. I was beginning to feel impatient.
Though I was encouraged to write an Honours thesis for my medical degree, I could see no opportunity to write it. Carla offered her house to stay in. It overlooked the beach my Thunghutti clan used to walk to in the harsh New England winters.
I saw from the house two rows of towering bunya pines coming to the centre of the crescent moon beach. Thunghutti people carried roasted bunya nuts with them, throwing some away — maybe rolling the giant cones — as they walked. They sowed shelter and food for their winter walks to the coast over the years.
Working day and night for two weeks, I wrote the core of my thesis. After months more work, including support from my supervisors, it was done and accepted. I was told that I was the first Indigenous student from my university to achieve an Honours degree in medicine
Where I would work for my first year in medicine was a gamble. Wherever you got a job, you went. If you had family, they were expected to get by without you or move with you. GB and I had separated by then. My sonboy was grown. He and I had been students together, getting by on little money. He’d seen me struggle at the university and enjoy my studies. Now that he was finished school and old enough to leave home, it looked like I might leave first.
This post is adapted from a part of a chapter by Janelle Trees in the newly released book by Dr Aleeta Fejo, Dr Christine Fejo-King and Jan Poona Shattering Stereotypes: Experiences of Australian & Canadian Indigenous General Practitioners