Closing the gaps
Closing the gaps[*]
The older brother was scary. He stood comfortably in front of his people on the marae, flanked by his family, surrounded by pictures of his ancestors, thumping on the floor with his carved wooden stick. He was getting old now, and no longer actively involved with the gangs, but his heavily tattooed arms and face, and his aggressive manner, spoke of a rougher past that was unfamiliar to those of us from a more privileged background. Today he was pulling no punches. He stopped banging his stick and pointed it directly at me. “You people from the hospital,” he said. “I’m surprised you had the guts to show up here today.”
The area for me had always held a menacing kind of beauty. Around the shore, numerous gorgeous bays were interspersed with dangerous headlands. Inland, huge dark steep rocks brooded over wooded valleys. The mainly Māori settlements scattered on the valley floors usually consisted of a marae, a church, perhaps a school, and a few rudimentary houses. The people seemed content to be living there. It was their place. The few big new houses with views of the sea, and the lush green cleared pastures with big new milking sheds, seemed incongruous in this setting.
This was my workplace. I decided at an early stage to learn as much as I could about the predominant Māori culture. I had support and help from staff at the hospital and from various kaumatua and kuia. Others were less understanding of what I was trying to achieve. Reactions varied from welcome and encouragement, to suspicion or even hostility, and frequently, amusement at my sometimes-pathetic attempts to pronounce our national language.
I attended when appropriate, events at the various local marae. This was typically as part of a group paying our respects at a tangi when someone had died. These were low-budget affairs. The family usually purchased a simple wooden coffin from the local store, and catered themselves for the large number of visitors who came through. People arrived in groups. All needed to be welcomed. As a doctor, I was expected to speak in reply, including a few words in Māori.
The medicine was challenging. The people were poor. Often their nutrition was less than adequate. Many of them smoked. They tended to present late. They preferred to be treated at home or in our little hospital rather than be sent away from their land and their families to the big city. We were generalists in health care. We had a good team in the local community health service and good support from the specialists at the base hospital. We did what we could to help people manage a range of conditions.
Jimmy was a typical patient. He was a single man. He had been a forestry worker and a minor drug dealer. Any money he may have made had been squandered on alcohol and other drugs for his own use. He had poorly-fitting dentures, which it turned out had belonged to his late mother. He had poorly-controlled diabetes and continued to smoke. A couple of years ago he had had his right leg amputated above the knee. His stump had never really healed to the point where he could manage a prosthesis, and he got around as well as he could on elbow crutches.
The district nurses had been struggling to manage a nasty ulcer on his other leg. It became badly infected. We tried him on oral antibiotics at home. When these failed, he agreed to come in to the hospital to have intravenous treatment. It quickly became obvious that this too was going to be ineffective. Jimmy was becoming increasingly generally unwell. We phoned the specialists at the base hospital, who advised us that Jimmy would need to come down for amputation of his left leg.
The problem of course was that Jimmy refused to go. He knew, as we told him, that he was unlikely to survive without an operation, but he wasn’t prepared to even consider it. He didn’t want to spend his last days sitting in a wheelchair with no legs, and he certainly didn’t want to take the risk of dying in spite of surgery in an unfamiliar environment so far away from home. We had long discussions with him and his family, most of whom wanted him to go down and have his leg off to save his life, but in the end we all had to go along with Jimmy’s wishes.
We did what we could. We controlled his blood glucose. We tried different dressings and different antibiotics. Nothing worked. Jimmy became weaker and more confused. His leg got worse. His kidneys failed. After further discussion with him and his family, we stopped trying to treat his infection. By that time, most of his extended family had arrived and were staying in his room. He died peacefully one night, surrounded by his brothers and sisters, cousins, nephews and nieces.
Jimmy was well looked after from that point. His family organised themselves to take him to the marae. Several of the staff wept as they took him away. One of the local kaumatua blessed his room. We got on with treating the other people in our care.
The next day, we organised a group to go to the marae. It was not far away, along the coast and on an unsealed road up one of the valleys. Already a lot of people had gathered. Many of them we recognised from the hospital. A few stood outside smoking. A group of local children had organised an impromptu game of soccer in a nearby paddock. People were scurrying in and out of the back of the marae and to and from the kitchen. Three local kuia, dressed in black and holding green leaves, motioned for us to come over to the front gate.
We waited quietly for the karanga, the spine-tingling wailing chant from one of the local women, inviting us to come forward. We moved slowly through the gate and towards the wharenui, eyes down, anticipating the interaction we were about to have with Jimmy’s family. We paused briefly at the door of the whare to remove our shoes. It was dark inside. As our eyes adjusted, we recognised the familiar faces of Jimmy’s close family and neighbours. Jimmy was lying in his coffin between two of his sisters at the far end of the room.
Following the instructions of the hosts, we lined up along one side of the whare, and sat together on a low wooden bench. We had indicated that the hospital manager and I wished to speak. The kaumatua representing Jimmy’s marae talked briefly amongst themselves. After some time, Jimmy’s younger brother got to his feet, cleared his throat, and spoke graciously, mainly in Māori, but finishing in English, thanking the hospital staff for the care we had given Jimmy, for the efforts we had made to prolong his life, and for attending the tangi. The women stood and led the hosts in a waiata.
The older brother seemed impatient. He glanced sharply at his brother and the other family members while he waited. He jumped quickly to his feet as the women sat. He thundered through an impressive tauparapara introducing his speech, made a rudimentary mention in Māori of the people present, of the marae and the building, and of those who had died. Then he switched to English. His eyes moved meaningfully around the room, sensing our discomfort, while we waited to hear what he had to say.
“You people from the hospital,” he started. “I’m surprised you had the guts to show up here today," he went on. "You were supposed to be looking after our brother.” He paused and glared at our group. “We told you to send him to have his leg amputated and you didn’t do it.” He paused again. He looked around the room. There was no reaction. We wondered what was coming next. He started again. “Yesterday, I had to go down to the Four Square and buy a coffin for my brother. It was six feet long. If you had sent him to have his other leg off, like we told you, we could have got one that was only four foot six. It would have been a hundred dollars cheaper.” The stunned silence turned to chuckles. The day after Jimmy’s death, while he lay on the family marae, waiting to be buried, everybody burst into laughter, at our expense. The rest of the speech was much the same as the younger brother’s.
After another waiata, it was our turn to speak. I made my usual bumbling efforts. Our manager spoke. We both felt more relaxed after surviving our earlier exchange. There had been tears, anger, and laughter. We all felt stronger and closer to each other after sharing the experience. We lined up to hongi with the hosts, pay our last respects to Jimmy, and share a cup of tea before returning to our little world back at the hospital.
[*] Published as a highly commended entry in GP Pulse Magazine short story competition 2011.