Letter from Tasmania

The pristine environment of Tasmania

Arriving in Runnymead* was like landing in a parallel universe. All seemed the same - but the eye can often deceive the mind when it chooses to.
The scenery was greatly pleasing to the optic apparatus with its wooded hills and wide, fast rivers. Walking into the medical centre with it’s easy sliding doors and spacious waiting room I was oblivious of the invisible threads that were about to bind me to this place.
Jo met me with a broad smile and politely showed me around the well equipped rooms and I began to think that this was going to be a very comfortable place to work. After all, Tasmania is a jewel of an island and home to some of the worlds most ancient and best protected old growth forests. Its wild ocean edges are home to some of the freshest and tastiest seafoods on the planet and the Tassy chefs certainly know how to turn that provenance into great dishes.
With my head full of such delicious images, I’d already forgotten about the intimidating compound that we’d driven past as we approached the centre. It was a foreboding scene. Razor-wire-topped, high-security fences encircled the monotonously grey buildings with their barred windows. Within the watch towers with their blind windows, ever vigilant guards were watching …. everyone. This maximum security prison was home to some seriously unpleasant people. It was also home to the building where the most criminally dangerous and mentally ill men were kept locked away.
It was the sort of place you really didn’t want to notice ‘less the image sank too deep into your memory and inoculated it with rank, dark thoughts.
The town that had sprung up around the prison was perhaps best described as shabby. It had once been a simple hamlet hidden in a valley next to the capitol of Tasmania. Then housing commission housing had brought in the first consignment of those wounded and lost souls who would stay on and set the living standard for Runnymead. With the arrival of the prisoners came their families in all their blended pain. Most had moved there in the vain hope of maintaining what for them could best be described as a normal family life. 

The bar for the living standard in Runnymead fell a notch or two lower.
I was oblivious to any of this as I settled myself behind my desk and created my own little nest in my allocated consulting room. It didn’t take too long before my illusion of comfort was severely disturbed.
The arrival of my fifth patient shook me out of my simple composure. He was a member of the Salvation army, an organisation for whom I have a great deal of respect. A few decades previously I’d been a volunteer medical officer for their Bridge program. In the Perth of that particular era the Sally Ann’s owned an old Hotel (now long gone and replaced by a faceless multi-story carpark)in the city where they’d set up their Bridge Program for the derelict alcoholics. These are the severely damaged souls that tend to inhabit most inner cities around the world. The Sally Anne’s would trawl the darkest spots and pick up the indigents that were unfit even to grace the Emergency Departments of the city’s hospitals. They’d pick them up in all their vomitus splendour and take them back to their “Hotel”. Here, the alcoholics who’d dried out, looked after the ones that had been carried in off the streets. The Detox Room was the euphemistic name  for the cellar of the pub and it was here where the 'patients' began their long journey of rehabilitation. But the cellar room where the four iron beds were painted a scene  that Charles Dickens would have been proud of! Water ran down every wall onto the flagstones and the smell of stale vomit and stale tobacco in the damp air oozed into your clothing and hair as soon as you entered the place. 
My job was to call past to see if everyone was still alive and if there were any serious medical condition that needed urgent attention. I was always taken by the gentle care that the old lags gave to those who’d just arrived. It was the only sign of beauty in that dank place. Mind you as soon as the men were well enough to leave the detox room, brooding hostility was never far away from the feral mind of a recovering alcoholic.
My fifth patient had just moved to Runnymead to help with the expanding Bridge program. It  crossed my mind that if a Bridge Program was needed in Runnymead then there must be a a large population of alcoholics and drug addicts in the area. This somber thought jarred uncomfortably with my image of pristine rivers and clean mountain air! 
Patient number seven confirmed this.
It was the black horror of his tee shirt - bearing the leering face of a skull - his scrawny stubbled face and the accompanying smell of stale tobacco mixed with old booze that set the tone for his consultation.
He spoke with the rapid fire patter of a man who was used to convincing others that he was genuine. His conversation - I think - was designed to shock. He’d been falsely implicated in a murder, he’d given crown evidence that had sent the perpetrator to prison. He’d been told there was a bounty on him, and he’d had a confrontation where a gun was held under his chin whilst he held a knife to the others throat. And worst of all for him, his mate had just been released from prison and was looking for him!
It was a shocking tale told by this unlikeable creature. A part of me wanted to believe him when he told how his heroin addiction had finished several years earlier and that he needed his “calmer” because he was frightened for his life.
His “calmer” turned out to be a request for a strong benzodiazepine - like valium on steroids - and his story was that his liaison police officer had advised him to get some to help “settle him” down otherwise he’d go crazy. (I was later advised by an officer at that particular station that officers would “never’ make any such suggestion … but …) 
Being a Doc, you really want to help, so I listened to him. I gave him some suggestions as to what he should do to improve his life and I gave him one prescription for his “calmer” with strict instructions that this was to be the only one I’d give him. I also told him to never wear that tee shirt agin because it frightened the life out of me!
He must have listened to me because when he returned the next day after his prescription had been rejected by the Pharmacy, at least his stubble had gone and he seemed more affable - and he wasn't wearing THAT tee shirt!. Sadly he didn’t take the news too well that he’d have to see a psychiatrist before any strong medications could be given. As he left the surgery he threatened dire implications for the person who was responsible for all this “shit”.
(The reason the prescription had been refused was that as he’d once been a registered addict - seven years previously as he’d reported - prescribing benzodiazepines can only be initiated by a psychiatrist.)
Looking back, if push came to shove then I think I could have managed him physically had it been necessary. 

But there was no way I could have handled Jared.

Jared is a 100kg white male with an uncompromising addiction to ice. His edginess is infectious in a closed office space, especially when you happen to know that he once drew a gun on his Bikey mates and told them to piss off … and they did. Perhaps he earned their respect during his educational term in prison. But whatever formed him, Jared is a bomb waiting to explode. The strange thing is that my colleague had been managing him extremely well with a certain medication but the Authorities deemed that Jared should only be getting that medication from a so called specialist! Try telling that to 100kg of explosive in a Docs consulting room. 
After he’d left I did ring the relevant authority and the very nice young lady was quite insistent that procedure should really be followed and seemed quite shaken that anyone might come to harm as a result of disobeying prescribing rules and regulations. 
I watched Jared through the waiting room window as he left the surgery. He got into the passenger seat of a newish four wheel drive car. There were two young women - teenagers - sitting in the back seat and loud music was pumping out of the car’s stereo. Jared may have been an explosion waiting to happen but there were other social disasters that may have been about to happen as well.
And you frequently see the consequences of what the Jareds of this world do to impressionable young girls in Runnymead.
Young single mums with babies. Lots of them smokers. Lots of them depressed too. In fact you see lots of overweight, depressed, single mums who smoke in places like Runnymead. Most of them have been abandoned  and they’re usually the daughters of old, abandoned, single mums who now look toothless and ancient at 43.
Most of them have forgotten long ago what it is to have some respect for who they are.  People have given up because they don’t think they’re worth it. Even more devastating is seeing it begin to appear in the little children's eyes around the age of eight or nine: and it’s heart-breaking. But when you see the environment in which they’ve grown up, how can you blame them?
But then there are jewels too. 
When a lean, spry patient comes in it makes me almost irrepressibly happy. 
Seeing the beatific smile on the face of an obese Mum who has nurtured her son through his ice-addiction will stay with me for the rest of my life. Such a story she told of hell on wheels, of his extreme paranoia, of his near fatal car accidents, the feral pushers and his dead addict mates. Of how her son was told he had 6 months to live if he continued using and he was only 21. Of how he dropped his weight from 95kg to 55kg when using and of how one man at an outreach clinic had mentored him through his recovery. If I could have got my arms around her I would have given her a hug. But I will never forget her.

*not the real name of the town. The names of the patients are fictitious.

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