The Vasectomy Doctor (20 page)

What I did through this deliberate act of civil disobedience was to bring about change to Mr Haughey's Irish solution to an Irish problem and make condoms available to those who wanted them without the need for seeing a doctor. I have no doubt but that these changes would have come along anyway sooner or later. But knowing the nature of these things and the Irish government's built-in resistance to grasping certain nettles it would have been later rather than sooner.

* * *

By this time I had a fairly good family practice built up and I had been brought into the medical card or GMS scheme. By and large I was single-handed which made the going a bit rough at times. Also I was on call for too many nights and weekends and was finding it very difficult to get away. The telephone answering machine I remember was a great invention for the hard-pressed single-handed rural GP. At least now you did not need to have someone sitting by the phone all day. The mobile or cellular phone, when it eventually arrived in 1984, was to revolutionise general practice. Now with a message on the answering machine giving out a mobile number, a doctor on call was relatively free to move about.

I still missed the hospital work and the better working and paying conditions of Canada. There were far too many demands for unnecessary house calls and it was very difficult to stop people coming to my hall door on a Sunday afternoon and enquiring if I was ‘on duty'. It may have been around this time too that I began to understand the concept of having a ‘vocation' for general practice. My tolerance for people making unreasonable demands outside of surgery hours was not without limits and I know that I was often impatient with people and their insistence that I respond to their every whim. These stresses too I have no doubt did very little to improve my floundering marriage.

Many of my colleagues did not share with me this tetchiness or intolerance of people's unreasonable demands or if they did they never showed it. At some level I envied them and their enormous practices which being nice all the time can bring. At another level though I wondered about their sanity and the quality of their family and personal lives. Doctors are first and foremost fallible human beings with feelings the same as anyone else. Not allowing oneself give vent to those feelings on the basis of being the possessor of a vocation could be positively bad for one's health.

To compensate for all of these things of course I had my vasectomy practice within the Irish Family Planning Association and within my own general practice in Clane. The nice thing about doing a vasectomy is that there is a beginning, middle and an end. A lot of the time in general practice this is not the case. An old woman is lonely and fearsome and depressed. She worries about dying and is short of breath. At night in bed her legs feel hot and she has noticed too that she is getting dizzy spells. Her eldest son is an alcoholic, her husband passed away four years ago with lung cancer. She has a pain in her left hand and she has been out of tablets for three days. The consultation has no beginning and certainly no end. Somewhere in there there may be a middle. But this is hard going when you have no vocation.

If someone comes into my surgery with a broken arm and a deep laceration to the forehead I am brilliant, I know exactly what to do and I will have them all fixed up in a minute. But if the same person should come in with a broken heart I am useless. Do not talk to me either about how awful your marriage is. I have a bad marriage myself and don't know what to do about it. I must have been the worst marriage counsellor in Ireland. If your marriage were in some difficulty before you discussed it with me, it would be much worse after your visit. My idea of marriage counselling was to blame whichever party was not present during the consultation.

I also had my writing. At first I wrote a weekly column for the
Irish Medical Times
and later moved over to writing for the
Irish Medical News
to which I still contribute regularly. Not only did this bring in an extra few shillings but also more importantly I think they allowed me to vent my feelings on a lot of topics as diverse as abortion, euthanasia, suicide and alternative medicine. Writing to
a deadline is a good discipline; it forces one to assemble one's thoughts
in a logical order and demands accuracy and accountability.

* * *

Up in Allenwood South a young man is squatted down behind his house trying to have a bowel movement. It is a small house but a neat one. He is surrounded by mushrooms of green milky froth. He is crying and occasionally lets a roar out of him. He is going to die and I can do nothing for him. I am a doctor, he is dying and I can do nothing for him. Young men trying to help him to vomit surround him. I can smell the Paraquat all around this place; its hideous green stain is mixed up with the milk that the squatting man has managed to vomit up.

How much of it did he take, I want to know. A young woman beside me says that she saw him drink a full cupful. One teaspoonful of Paraquat will kill you and everyone around the squatting man knows that and he knows it too and that is why he is roaring and crying and trying to have a bowel movement and vomit but it is too late. He is staring death straight in the face and death stares grimly back at him. He is already dying and he will be dead within a few days. The Paraquat has now gone into his bloodstream and is making its deadly way to his kidneys and to his liver and to his brain and every organ it touches will be completely destroyed and there will be nothing left. A vacuum. But most importantly of all the Paraquat is going to his lungs and this is where it will do its greatest damage in the shortest space of time. Tomorrow he will have gross pulmonary oedema and respiratory failure, the next day he will be on a respirator and the next day he will be dead because they will switch off the respirator as there is no point in going on.

Why did the squatting man drink a cupful of Paraquat? He drank
it because he had a row with his girlfriend and he wanted to show her. Show her what I never knew.

* * *

Running parallel with the condom debacle was the ‘pro-life amendment campaign'. Ever since the pope's visit to Ireland in 1979 a certain large section of the population had been whipping itself up into a renewed religious fervour and looking for a cause. The subject of abortion seemed like an obvious one. Abortion was already illegal in Ireland at the time but the pro-life amendment people wanted more. They wanted to make it doubly illegal by enshrining – to use their word – into the Irish constitution an amendment that would make any attempt at reversing the law prohibiting abortion unconstitutional. This they told us would copper-fasten – again their word – a prohibition on abortion in Ireland for all time. Thus they said Ireland would become like a shining beacon to the rest of the world as a unique place that respected and cherished all human life from the moment of conception. Others of us pointed out that:

• Abortion was unfortunately innate to the human species with examples
of the practice going back in history for as long as history will take us.

• That history, including recent Irish history, will show that where there is no access to legal abortion there will be illegal or so-called back-street abortion and baby abandonment.

• That since we were currently exporting our abortion requirements to
England at a rate of 5,000 per year any talk of us being a shining beacon
was a tad hypocritical.

• That there was no place on this earth that had a zero rate of abortion nor any example of any place in the world where abortion was successfully ‘stamped out'.

The first thing that those of us opposed to the pro-life amendment learned was that if you were against them then that automatically made you anti-life and pro-abortion. It was this kind of smearing that made the whole debate so terribly divisive, vicious and unpleasant. The issues and the way that the debate was constructed were destined to divide families and friends then and for a long time afterwards. Because of my position as chairman of the Irish Family Planning Association and the attention received by my opposition to the Condom Act I was invited to many meetings all around the country to speak on the anti-amendment side.

It was always a lost cause. People were going to vote yes ‘to save babies' lives', yes ‘to keep Ireland abortion free', yes ‘to life'. The fact that a yes vote did not necessarily mean any of these things was lost and in any case the priest from the altar had asked them to vote ‘yes' and wasn't that good enough for anyone? The pro-life people had God on their side and they were firmly dug into the high moral ground. They won by a very comfortable majority but eventually it was to be a hollow victory.

The eighth amendment to the constitution was passed and it read:

The state acknowledges the right to life of the unborn and, with due regard to the equal right to life of the mother, guarantees in its laws to respect, and, as far as practicable, by its laws to defend and vindicate that right
.

Nine years later the inevitable happened. A fourteen-year-old girl became pregnant as a result of rape. Mr Justice Costello granted a High Court injunction preventing her from travelling to the UK for an abortion. This caused a public outcry and the case was appealed to the Supreme Court. There, three days later and by the narrowest of majorities, the injunction was lifted. The judges took the view that in this case there was a substantive risk to the life of the mother since she had threatened suicide and therefore a termination would not be unlawful and she should be allowed to travel. This became known as the X case and it totally undermined the pro-lifers' Eighth Amendment. So much for enshrining, copper-fastening and beacons of light.

The situation now is that by Supreme Court precedent abortion in Ireland is not illegal where there is a substantial risk to the life of
the mother. But there is no matching legislation and the government
has repeatedly said that they have no plans to revisit this most contentious of subjects. The matter stands in abeyance and the numbers of Irish women travelling to the UK every year for abortions has fallen slightly in the last two years. That at least is good news.

* * *

I cannot say for sure if this woman is beautiful or not. I suspect that she is beautiful. Her eyes are beautiful, deep brown and almond-shaped. But the rest is hidden. I cannot make out her face because it is hidden behind her boshiya. She is tall and probably slim but I am not sure. Her body is in there somewhere within the voluminous folds of her thobe, which in turn is covered by her large black cloak called an abaya. Her clinical records tell me that fourteen different general practitioners have seen her over the last sixteen months. These notes also tell me that two years ago she lost a six-month-old baby and that more recently her husband has taken a second wife. She is on Valium, 10 mg three times a day. I can feel her pain.

I am in Saudi Arabia for two months because they will not let us build our hospital back home. The plans are drawn up; the money is in, the company incorporated. Kildare county council have granted permission but a local schoolteacher has appealed against the permission to An Bord Pleanála. This will hold us up for at least an
other year. It may even scuttle the whole project. The schoolteacher's
objections are ‘constitutional'. Because we foolishly mentioned female sterilisation in our articles of association this objector is now claiming that since the Irish constitution affords protection to the family and since being sterilised is somehow anti-family then the proposed hospital is ‘unconstitutional'. It matters not one bit that this objection is utterly spurious and fallacious. The quality of the objection is not the point. Any objection to An Bord Pleanála at that time had to go through due process and had the effect of delaying development for at least one year.

I had to get away or I was going to go mad. My marriage was going nowhere and the hospital was going nowhere. The pro-lifers had captured the high moral ground with their Eighth Amendment and it was time to get away for a while. Saudi Arabia was looking for general practitioners to work in their hospitals on short-term contracts of two months and this seemed like
an ideal opportunity to do
something completely different, to gather my thoughts and to regroup.

The hospital that I was assigned to was in a city called Khamis Mushait close to the Yemeni border and the Red Sea, in the south-west of the kingdom. The best thing that I can say about Khamis Mushait is that it is situated 3,000 feet above sea level and
therefore enjoys a Mediterranean-like climate most of the year round.
Thus at least we were spared the stultifying heat and humidity suffered by our colleagues in cities like Jeddah and Riyadh.

Our group of some ten general practitioners was housed in a
compound like a small old-fashioned housing estate. There was about
an equal mix of men and women, three of us were from Ireland. The minibus arrived every morning at eight o'clock to take us to work
in the GP section of the large King Fahad Military Hospital a couple
of miles away. This was an artificial ‘practice' grafted onto a hospital which reflected the fact that Saudi did not have many indigenous general practices on the ground. I did not think that this was a good idea at all at the time and indeed I suspect that by now the Saudi authorities will have spotted the limitations of this approach to the delivery of community health.

When Saudi suddenly became extremely oil rich they set about
building state of the art infrastructures like hospitals, medical schools
and clinics, from which to deliver a healthcare service for the people. Mistakes of course were made and one of them was to graft general practice onto hospitals to be staffed by overseas doctors and then to invite the people to go in and get some health advice. This was a disaster and I know because I worked at the coalface of this system for two months and can honestly say that I never saw one
bona fide
sick person in all my time there. Not one. Everyone coming in to see these overseas doctors had an agenda that had nothing to do with medicine. And what made it all worse was that doctor and pseudo-patient spoke different languages and came from cultures that were poles apart. This was a total mess and a charade.