Modest Expectations Ate

Bob Hawke has died. A cricketer, he would have been proud of making 89. Unlike Whitlam, he had a very good first XI. Some were brilliant. He did not make the same mistakes as Whitlam. He was not divisive; as with all good captains, he gauged the strengths and weaknesses of the opposition, and that of his own side. He had at least one dictum – he exerted attitude change in his own party such that the old time union collective thinking in which he had grown up, was changed.

However, when you go against your normal working person constituency, no matter how beneficial that might be for the Australian community, paradoxically you increase the power and influence of those elements which remain emphatically opposed to your reforms and who, over time, would seek to distort or destroy those reforms.

In time others may pore over the Hawke legacy and I for one wonder what he would have done for Australia if he were of the current generation and waiting for Saturday.

A Surfeit of Coke

Talking of mortality, one option that has not been widely canvassed about the current US Presidency is that Trump may die suddenly in office. If it is true that he drinks 12 cans of Diet Coke a day, has a diet of fast food and is so obviously overweight suggests that he is a walking health disaster waiting to happen.

In his latest medical history his height is recorded as 6ft 3in, but on his medical record when was being drafted into the US Army the record says 6ft 2in. Has he grown an inch as an adult? Really? Look at his shoe heels. Already obese at his recorded 243 pounds, how does anyone know what his real weight actually is? That missing inch plunges him further into the Obese.

Of course we do not know about his health status any more than we know about his tax returns. He obfuscates from his sandpit. It is his whole strategy to create sandstorms.

However, the one thing that Trump cannot make a deal about is his physical health.   He can only hope that the drugs will deal with his atheroma, not to mention what appears to be a cancer-prone diet.

Judging by the media reports there is a chorus of learned doctors or psychologists who obviously believe he is mentally impaired despite the protestations. His bizarre behaviour is just a quirk of his personality – a legacy of his early childhood his apologists say.

Trump prefers Diet Coke, and his daily consumption of it is extreme. According to the pundits, the excess drinking is linked to mood swings and dementia. As we all know, because he tells us, he is a cohort where n=1. He may be thus unaffected and the mood swings may be due to other factors, but the world ought to know. It is reasonable to know the mental state of a person who has control of the nuclear button, and what has caused it.

Is he mad? It is a question that publically the world would not answer through its current beige array of politicians. There are those politicians who prefer the Trump flamboyance – a man of many mental colours. There is that state of Munich delusion that one can cuddle up to Trump, know this man’s mind, and get him to sign a promise to be a “good, predictable boy”. Some have tried to put a political straitjacket on him – to be his great friend and mentor – to their cost. That is his art of the Deal. It costs you, not him!

Well, his handlers could deprive him of Diet Coke and see what happened, and see if the twitter finger stops twitching and rationality prevails.

However he is well past satisfying Koch’s postulates. The Diet Coke could have replaced his blood and no longer would he be like any of us mortals …

He is the Child Trump caught up in The Rapture. The Rapture is quoted as a doctrine that at the return of Christ, all believers will be caught up, “raptured”, to meet the Lord in the air. The bodies of dead believers will be resurrected, and all believers, living and dead, will be glorified. To the believers, it is a passport to immortality. That is the Child Trump constituency, who may call him not King but at least Duke.

The problem as with Mr L Ron Hubbard, whose disappearance galvanised a whole generation of charlatans, if he dies now as a demonstrably unhealthy Old Trump, his followers may believe the Child Trump is not dead. He may become a cult for the Enraptured, setting up shrines with figurines of the dear little child with golden hair and red baseball cap along the highways of America waiting for him to come again.

However, that is probably better than that of him never accepting the American people’s verdict saying at the end of 2020 “You’re fired!”

Shoulder replacement – The Anatomy of Medical Advance

I have a worn-out body. A major road accident over 30 years ago did not help.

So I was attracted to an advertisement in a major metropolitan daily for complete shoulder replacement. The advertisement is cast in a way that suggests it is just the thing for a worn out shoulder. Out with the old; in with the new. Like repairing a car, but with a car you at least can get a written guarantee.

However, when one is embarking on a major operation, such as a shoulder replacement, it may go well. You, the patient, if it is a new procedure, may become the poster person for the operation, the one the hospital and surgeon wheels out when boasting how great you, the Result is. You are the Positive Result and are allowed to say a few words, the surgeon performs the benediction, interviewer sums up from the media handout – and the camera is turned off.

The problem is that what the advertisement lacks is setting out the complications, which are rapidly becoming the small type to protect the surgeon and which frankly most patients do not want to hear. There it is in small type at the bottom of the advertisement: “any surgical or invasive procedure carries risk. Before proceeding, you should seek a second opinion from an appropriately qualified health practitioner.”

However, if you get a complication with such a complex operation as a shoulder joint replacement, you are looking down a long corridor of pain and disability.

I consulted a shoulder surgeon some time ago, because that is how specialised orthopaedics is. This bloke was very frank. Shoulder surgery was difficult; unpredictable results; the surgeon he would recommend is “very good”. However, in the end it is how much knowledge I, the patient, have in making an informed decision. I weighed the evidence up, and said I had decided against an operation on either shoulder.

Outcome is one matter for making an informed decision, especially as increasingly surgery is leaving foreign material in your body. Some is fine; some is not and when a technique is new, how do you know the likely outcome? The answer is you, the patient, do not. Trust in the integrity and skills of the operator are paramount.

But not quite! What was absent from the advertisement was the cost.

Let’s list them.

There is the cost of the hospital stay – everything down to the nametag. The cost of the surgeon – the enquiry about whether there was an assistant and why – and then the anaesthetist. That person is often forgotten in determining the cost, because he or she is the person the patient sees fleetingly.

Then there is the cost of rehabilitation. Because there is a belief that the surgery has a magical effect similar to laying on of hands, the need for rehabilitation may be underestimated. Try to take a middle course and ask, even if it means flattering your particular surgeon that “it could not possibly happen with him or her at the ready”, get a price which includes a contingency item for the costs of complications.

The solution – make it mandatory for prices to be displayed, including the guaranteed consumer floor price – that is, the Medicare benefit. This makes the shortfall starkly obvious.

Then given the notorious asymmetry of information, it is suggestive that there may be a case of brokerage – where those with knowledge negotiate for the customer, without the emotional stress of having the condition. Needless to say, there is a business model to be developed where, through brokerage, the asymmetry in health information can be corrected – as long as the process is uncontaminated, as the mortgage brokerage system recently was shown to be.

It’s Time – The Bubble rhymes with Trouble

One has the feeling that Victorians are going to go after Morrison and his crew with cricket bats. Morrison is not the right fit for Victorian voters. The hillbilly persona does not wash well in Victoria especially as he so clearly identifies himself as a New South Welshman, and the fact that Frydenburg is the only Victorian of note left standing says a great deal about the state of the Liberal party. The problem is the myth of a liberal Victorian has been blown away with the rise of the populist far right in Victorian Liberal politics, since the Kennett accession in 1990s.

The situation uncannily resembles 1972 – a NSW Prime Minister and a Victorian Treasurer. However, the Leader of the Opposition was Whitlam in 1972 – New South Welshman, secured six seats in NSW, the greatest number. His “It’s time” introduced the charismatic presidential-style campaign. Despite everything, Whitlam did not win in a landslide. In fact, Labor lost four seats in Victoria, one in South Australia and two in West Australia. However, it picked up seats in Victoria (net two), Queensland and Tasmania.

Snedden was never in any danger of losing his seat of Bruce in 1972 and Frydenburg should be in the same position. But is he? The bellwether seat is Corangamite, long a Liberal stronghold but for some time marginal with the spread of Geelong to the west counterbalanced by the shift of affluent retirees to places like Torquay and Barwon heads. If Corangamite is lost, so is Australia to the Government.

And tellingly Shorten is a Victorian.

If the Labor party wins big in Victoria, and takes seats in New South Wales and South Australia, what happens in Queensland, Northern Territory and Tasmania becomes irrelevant in the numbers game, except in perpetuating the cleavage in Australian society. This cleavage is not more starkly demonstrated than by the Green and Labor advance in the northern coastal regions of NSW. However, go across the border into the Gold Coast and one is in solid Liberal Party territory.

One has to realise that love of a member in Queensland is inversely proportional to the despisal in the “Mexican” States. Listening to a highly intelligent North Queensland academic referring to the member for Dawson as “good ol’ George” is confronting for those of equal intelligence without the privilege of being baked in the tropical sun.

However, there are several differences in the political scene now and in 1972 and that is the rise of the Independents. The Independents are fashioning themselves into a party of the Centre, freed from the constraints of the Creationists, Falangists and Rural Socialists, that coalition within the Coalition. One of the important features of this election is to see how well the Independents perform – one observation is that they seem to do well when the incumbent member is so appalling that anyone somewhere decent becomes electable.

The bellwether here is Kerryn Phelps. She profited from the clumsy dumping of Malcolm Turnbull and the fact that she had a high profile. However, the problem with her high profile is that she has a great deal of baggage and given her time as President of the AMA and the nature of her support base at that time, it would be a surprise if she has maintained that support base. Considering that her opponent has had more time to assess her, is a former DFAT charmer, is as likely to be as smooth as Dr Phelps is spiky, then she has a challenge. If she holds the seat, then again one can guarantee the swing is on against the Government.

However, the lessons for the government are undoubtedly how this country goes about climate change, how it participates in the Coalition of nations in the South Pacific, how New Zealand and ourselves become outspoken on the matter – just as I would remind the reader that 20 years ago we were outspoken about getting nuclear testing by the French out of our backyard swimming pool.

So I can predict, but I am notoriously bad at it. However, irrespective of whether Morrison or Shorten is Prime Minister after this weekend, any future government worth its reputation should realise that Australia is the joint Guardian of the South Pacific and Southern Ocean and Antarctica – and that is only the start. Trade and jobs become irrelevant if the Earth becomes uninhabitable.

And that, Mr Morrison, is not a Canberra bubble!

The Curse of Pre-polling – The Loss of the Democracy Sausage

I have voted. It was very convenient. It was easy to park the car near the hall. No waiting time. I met both the Greens and Liberal candidates – both nice guys. However as it is a safe Labor seat, you are more likely to meet Elvis Presley than the Member.

Pre-polling is so popular, since most Australians view voting on the Day as one step from having to go to the dentist. Having to run the gauntlet of those trying to shove a piece of paper into your hand and then having to queue, in the end, everybody will have exerted their preference and have voted by Election Day. In several elections’ time, if this trend continues, Election Day may become the Day that nobody came. So there you are, with the picture of politicians with a heavy countenance as they have when they are voting for an increase of their entitlements, in bilateral solemnity agreeing to now decrease the pre-polling time in the future. After all, one has to protect the “democracy sausage”.

Mouse Whisper

Heard in the Louis Vuitton emporium in Pooncarie as one stockman said to the Vuittoneur as he was looking through the range of outback portmanteaux:

“Why is it that politicians are always having Visions? Who do they expect to see? And why – if you can have a Vision of the Future – is it not acceptable to have a Hallucination of the future? Makes as much sense.”

 

Modest Expectations Too

Ron Lord

Ron Lord died at the weekend. Ron was a journalist who grew up in the days of “concrete-foot-in-the door journalism”. This was the accepted muscular journalism of the Norton and Packer era in the late 50s. I met Ron when he was the resident journalist at the Australian Medical Association. He was never the high flyer that some of his fellow journalists who moved in the upper echelons of political influence were, but he was one of the first to recognise that there was a niche in health journalism beyond the learned medical journals.

He may not have been the first but publishing and editing Healthcover, a journal devoted to health policy in the 1990s was a bellwether for journalists who have trod the same pathway since. Ron was an edgy character, loyal to his employers but with a honed critical faculty, a person who knew his limits. He had a rare shorthand ability to rival that of a Hansard reporter, which enabled him to accurately and precisely record what people said rather than just printing the media handouts. Thus his was a refreshing approach to which I was privileged to assist.

His passing is a time for appreciating Ron’s contribution to health journalism and then moving on.

Can I jump puddles alone?

I wrote this first when I was severely disabled with pain, stiffness and weakness – the result of a presumed autoimmune disease. Mr McGuire’s recent ill chosen words reminded me that some able-bodied, articulate people can demonstrate insensitivity and in turn need to be reminded – although he seems to be awash with contrition.

Four years after first writing this reflection, although my health is much better, I am still dependent but with flashes of independence and thus hope.

When you go from independence to dependence in a relatively short period, it is bad enough.

But consider the case of this man, when the change was instantaneous – the result of trauma on a rugby field – and persistent. My condition pales by comparison

This young man was determined to walk at his graduation ceremony. His was a high profile accident and the media were there in spades.

The background to the television news report was that the young man had been severely disabled – the word paraplegic was not mentioned – only his determination to walk to receive his degree and, almost incidentally mentioned in the report, he had a wife. When the picture came on the screen he rose out of his wheelchair and with his wife supporting him as though he were a statue, he tottered a few steps across the stage. No, he had not walked – his carer had borne his weight and even though she was half his size, held onto him while he made the small distance across the stage. Then the news item was over – no attention to the wife’s efforts – no watching him struggle back to the wheelchair or more probably the wheelchair moved into position to avoid the need. He had said he would walk to receive his graduation certificate. It was the gritty devotion of his wife – his carer – that enabled him to do so. Good luck – his family could only wish that he would improve; but what struck me was the essential importance of the carer and how little reference was made to her in the news item.

Likewise, had it not been for me having my wife and others to care for me I would not have been able to continue to work at that stage and full time.

I hate being in a wheelchair. Not that I am in a wheelchair that much, but when I have to move more than 100 metres it becomes very difficult without one. What is wrong with the wheelchair? Nothing. I have been surprised by the comfort the modern wheelchair affords.

However, you become a different human being in a wheelchair. Until you make it clear that being in a wheelchair does not mean that your IQ is automatically halved, you tend to be ignored or treated as a child. I remember sitting in a wheelchair and being confronted by a small boy in a stroller. We were at a similar eye level and he with the ingenuousness of a child stared at me. To which I responded “ Son, see what awaits you.” His parents laughed but I wondered whether they continue to deny the five year old the use of his legs.

The other is that you exist in a forest of legs belonging to the able-bodied. You become acutely aware of that facility to walk, which you considered as an automatic right of homo sapiens. It is compelling to watch the easy facility of movement that you have lost. It brings home the sheer complexity of the evolutionary trail watching the striding young man or woman clasping the iPhone to the ear. There is plenty of time to observe when you are waiting in a wheelchair.

This waiting time is emphasised if you happen to be one of those people who has been both impatient and fidgety. In a wheelchair, impatience is not a wise strategy. Gesturing irritably – especially with a walking stick – is counterproductive!

Likewise, you cannot act on impulse – jump up and do something. Getting to your feet is a considered exercise. In other words, it is the carers who count in such an environment. Their understanding of the level of background support required is crucial.

This was brought home to me when I decided to walk along the Seattle waterfront from the ferry terminal to my hotel. At the time the Seattle waterfront was undergoing massive reconstruction and therefore hailing a cab was difficult and I misjudged both the distance and my capacity. “The little boy” had decided to get out of his stroller. For about 50 metres with two sticks it was bearable. However, as I moved forward the uneven asphalt became jolting potholes; walking down improvised inclines, minor to the able-bodied, become challenging ski runs. I struggled, and my carer kept watch for an hour, hovering and supporting, without saying how stupid I was. This was my “puddle” moment.

The occasional person, invariably a young woman, stopped to ask whether I needed help. For an hour I moved along, away from the dusty, sulphurous fumes and clanging steel of the waterfront, onto quiet civilised pavement. The hotel was in sight, and as you do when you walk with sticks, your eyes are mostly directed towards the terrain. What made this segment better was the line of copper beeches, which I could count as I passed each one. I remember when I ran those inaptly named “fun runs” and I was getting tired, it was the next telegraph pole in the street or on the highway, which was the marker of achievement.

My carer who had been ever present suddenly asked whether she could go and get the wheelchair from the hotel since the footpath was paved and the hotel was not more than two hundred metres away. She had picked the right moment. I agreed and she disappeared as I slogged on with the vain hope that I would get there before she could bring back the wheelchair. The definition of bliss is being propelled in a wheelchair up and through the hotel foyer to the bar for a cold ale.

Caring, as I have found out, and the interaction with the person in care is something you see, but unless you are in the situation, you will never feel the importance of that interaction.

However, caring is not the exclusive preserve of some professional group or a financial benefit enshrouded in impenetrable regulation. It is a basic tenet of our society.

It is up to those disabled but articulate, to continually advocate for a better deal, not only for the disabled, but also for the carers. Neither the carer nor the person being cared for live in parallel. However, the challenge remains of how best to translate that interaction between those who have the interpersonal skills intuitively and those who need to learn the skills to improve the interaction. The internet seems to be full of exhortation as to what is best for the disabled, but there does not seem to be much room for interactive comment.

Yet 272,000 carers are under 25 years. I have grandson who was then 14 and who, without prompting, brought me a chair when I needed to sit down. He knew without any words being exchanged what was wanted, because he was paying attention to his environment rather than a piece of technology.

As against this was a young girl of similar age, head down, concentrating on her texting who pushed past me into the lift. Suddenly there was a scream of anguish as the door closed on her inattentive self. It was fortunate that it was not a railway crossing – or a puddle, which turned into a fathom-deep pond.

The allusion in the title is to the Australian author, Alan Marshall, a useful text for us all. He did learn to negotiate that fathomless puddle. Has government with this recent budget done the same thing?

Mouse Whisper

Heard in the Louis Vuitton emporium in Tibooburra: What is better, a retail politician or a wholesale disaster?