“Can you help me understand why that man died when you said he wasn’t as sick as your other patients?” The medical student deserves a neat explanation; instead, her innocent question brings my regrets crashing to the surface as I wonder how best to explain to her the practice of medicine that increasingly comes wrapped in layers of politics.
The patient was a refugee twice plagued, once by war and then cancer. In the years that I cared for him, he’d tell me that the bright spot in his life was his Medicare card, which provided access to government-funded healthcare at public hospitals like mine. Youthful and requiring no treatment for his quiescent disease, he enrolled in English lessons which were finally paying off so that if the interpreter was a little late, he felt comfortable enough to start. His first words were “no pain”, “feel good”, “sometimes worried” and “thank you”. He was convinced that simply seeing me kept his cancer at bay, but I’d take pains to give him the credit for his wellbeing.
Then the inevitable happened. Overnight, he became unwell and scans through his local doctor showed a dangerous complication requiring urgent intervention. She underlined the findings and rushed him to emergency, where he waited so long and so quietly that the alarm was only raised when he came close to a cardiac arrest. Panic ensued and he was saved but his health took a dramatic downturn. Later, he told me that he was just waiting in the same queue as everyone else. The staff were kind but couldn’t understand how sick he was until he collapsed.
In intensive care each day was a battle, but his strength of spirit and the patience of professionals got him out. Sapped of energy he struggled to walk on the ward. His determination shone, and he pushed himself more than anyone else. Yet, each passing day made me more fearful for his welfare.
An interpreter came on some mornings but other than that, his lack of English made communication difficult, if not impossible, for the remainder of the day. His wife devoted herself to his care but was no more capable of speaking up. His daughter dashed between school and bedside to be his advocate but could barely look the doctors in the eye let alone demand that we do better. On many days, the true extent of his symptoms such as pain, breathlessness and weakness simply went unnoticed. Even then, he was quick to express thanks and never, ever complained.
His terminal decline began on that most dreaded of days in a hospital, a Friday afternoon preceding a long weekend. His discomfort had made him lose the little English he knew but remembering that I spoke Hindi, he pointed to his chest said, “dard”, the common Urdu and Hindi term for pain. “I will help you,” I pledged, feeling a fraction of the confidence I projected.
The next few days were awful. On the day he died, I sat down with his wife and daughter. I told them that like them, I hoped he’d beat this setback like the last, but didn’t think it possible. The whole room choked when the palliative care nurse requested to know more about Muslim funeral rites, so we were fully prepared “in case”. To my unforgettable surprise, the patient’s hitherto quiet wife rose to the occasion with an eloquent discourse on celebrating the gift of life and accepting the inevitability of dying. She was the consoler; we, the consoled.
Afterwards, I saw my patient. Too tired to speak, he raised both hands in blessing like he always did but all I saw was the sweat that clung to his face as he made this final gesture of humanity. The next time the nurse checked on him, he had died. The last I heard before his daughter’s phone card expired was that there’d be a door-knock appeal to afford his funeral.
I have no doubt that he was genuinely grateful for my care, but I also know that he had no idea how much better it could have been had he not been a refugee, cursed not only by deficient English but also by a lack of cultural understanding, crippling poverty, illiteracy, and so many more things beyond the control of one professional or indeed, a hospital.
I care for many refugees and unfortunately, they die like other cancer patients. But what made this particular death poignant is that it happened at the same time as Australia’s home affairs minister, Peter Dutton, warned the country of the risks of transferring critically ill asylum seekers and refugees held in offshore detention to the mainland for necessary medical treatment. Specifically, he said: “I don’t want to see Australians who are in waiting lines at public hospitals kicked off those waiting lines because people from Nauru and Manus are now going to access those health services.” Soon, the airwaves were full of chatter about “queue jumpers”, the people Australians love to hate.
Home Affairs Minister @PeterDutton_MP on asylum seekers: “We’re seeing people at hospitals missing out on medical services because people are taking it from Nauru and Manus. Australians will be angry about that as well.” #auspol #7News pic.twitter.com/ICtWdHN7k8
— 7NEWS Brisbane (@7NewsBrisbane) February 28, 2019
The prime minister supported his minister by reopening the Christmas Island detention centre despite local health authorities stating that the medical facility could not support the needs of such patients.
The government was determined to put the queue jumpers back in their place but as my patient lay dying, I couldn’t help thinking that he had died in large part because he had stayed in the queue and not spoken up for himself. He had too much respect for the Australian healthcare system to swear at a nurse, punch a doctor, or trash the waiting room with spit and broken chairs. No one condones such behaviour but it’s what’s served up to frontline clinicians by “regular” patients every day of the year.
Close to an election, the conduct of our politicians might provoke fear, but hapless patients stuck on a waiting list across the public hospital system deserve to know the truth. Health experts quickly dismissed the government’s claims as baseless.
The real question is not whether a crowd of refugees will suddenly receive an elective hip replacement or a hernia repair at their cost but whether we as a society can find compassion and understanding for those who suffer in ways that are unrecognisable to us. And if so, whether we will simply “let them in” or actually enable them to find the dignity and agency we all value for ourselves.
My patient never learned the English words to say all of this but as his doctor, I’d like to think that his death was not in vain.
• Ranjana Srivastava is is an oncologist and Guardian Australia columnist
