August 2015

The Medicine

Society’s safety net

By Karen Hitchcock
When social services are cut, hospitals are left to fill the holes

All my writer friends say, “You’re so lucky to have a real job, which has a real effect, in the real world.” They say it with an existential sigh. “You actually help people.” I usually just nod, my counterarguments too huge to mount.

I’ve fallen back into my dream of running away, to a place like rural Maine in winter, where you sit inside by a wood fire and watch coyotes dive for mice in the snow. Where you’re living so deep in the woods there is nothing and no one and nowhere else. I want to be snowed in, for a very long time.

I had a friend at university who ran away to join the Carmelites. One minute she was a vegan painter and the next she was in a closed order: cloistered, silent, with all day to read. Though I’m not a believer, it sounded almost as good as the snow.

Then a few years ago I moved house and my new next-door neighbours were nuns. My nuns are not like my friend. They wear normal clothes. They work in women’s refuges and soup kitchens, and support refugees. They organise Centrelink and medical appointments, and comfort those dying alone. They leave early in the morning – I watch them through my study window – and work their guts out till it’s dark.

I met Sister Agnes when the real-estate agent first showed me through my house-to-be. When I told Agnes I was a doctor, she gripped my forearms, threw an unshackled laugh into the wind and said, “Thank God.” On auction day, people crowded the street, as if it were a festival. The sisters sat in their front room, holding hands, praying I’d win.

Their order used to inhabit my house too, and they moved between them through a door in the fence. But then, like endangered birds, they started to die out. The few who remain – Sisters Agnes, Maria and Christina – are all in their 80s. Maybe another doctor will take their place when they die.

One day I bumped into Sister Agnes in the street. She looked as if she might cry. I asked her if everything was OK, thinking of Maria’s joints, Christina’s heart. “They’ve defunded the House of Welcome,” Agnes said. St Mary’s House of Welcome is a meeting place for the homeless, lost and chaotic that’s been operating in the Melbourne suburb of Fitzroy since 1959. The House provides meals, showers, company and assistance for hundreds of people living in the margins, those excluded from or unable to access other services. There are no inclusion criteria, no forms to lodge or automated telephone services to negotiate. It is the House of Welcome. “Where will they all go?” Agnes said, her hands covering her mouth. I stood there thinking of snow and closed orders, knowing where they will go: to the hospital.

When you work in a public hospital it takes a great deal of denial, repression, alcohol or convoluted self-justification to remain dispassionate about bad public policy. The hospital is society’s safety net, and it hovers 2 centimetres from the ground. If you have no bed, no shoes to stop your feet from getting all cut up and infected, no food, no medicine, no one to help you get to the toilet, if you want to die and have fallen through the chasms between our community resources, it is the grand old public hospital that will take you in.

I recently looked after a young woman with pneumonia. She was covered in bruises and living in her car. At the last women’s refuge her wallet and most of her clothes were stolen. She was on the years-long urgent-category waitlist for public housing. In between hacking coughs, she said, “I might have to go home.”

I’ve visited one of the nuns’ secret houses for women who have been kicked out – or repeatedly kicked in the face – by their husbands. It’s a light and airy house, full of women and children cooking and singing in a communal kitchen. There’s a garden and an aviary, and it all sits safely behind a huge brick fence and funding that is not government dependent.

Medicare is unsustainable. Welfare is unsustainable. Education is unsustainable. We hear statements like this all the time. Community services are being slashed like it’s harvest time. Welfare organisations that have grown from the particular needs of specific communities are being closed down, tendered and bound into large private companies who will “deliver services” more efficiently. Apparently, these are the sacrifices “we” have to make for “our” children’s and grandchildren’s futures.

My dad’s favourite saying was “Bugger you, Jack. I’m all right.” He’d say it when someone cut him off on the road, or when my brother and I stole the last pack of biscuits. It’s a fair summation of our current government’s social policy. You can even imagine the Ironman, with his this-is-all-a-big-joke smile, chanting it three times in a row while Madam Speaker nods her pristine bun and bleeding lipstick, aping Thatcher.

Small government. Personal responsibility. Have a go. Down with the leaner. I’m beginning to think that the bedrock of the political conservative is his belief that everyone’s just like him. As if they think that guy on the street corner with a hat between his knees could, if he really wanted to, get up, comb the grease and the hallucinations out of his godforsaken hair, and run for parliament.

There’s something missing in this belief system. The kind of imagination necessary to generate empathy, perhaps. A knowledge of history. And step by step, our rich country moves towards precipitous inequity.

Hospitals and doctors are good at treating diseased organs, and yet we now spend a rocketing amount of our time trying and failing to patch up social catastrophes. Forty thousand dollars ripped off the street becomes millions in the hospital.

I leave my house to ride to work, where there is no time for daydreams. But when I get home I plan to ask Agnes if she ever dreams of the snow.

Karen Hitchcock

Karen Hitchcock is a doctor and writer. She is the author of a collection of short fiction, Little White Slips, and the Quarterly Essay Dear Life: On Caring for the Elderly.

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