Grace Tame, Australian of the Year in 2021 and Brittany Higgins both had the courage to stand up and use their own experiences to bring the issue of consent to public attention despite vocal criticism, and coercive control is now a punishable offence following the horrific deaths of Hannah Clarke and her children at the hands of her abusive husband.
Legislation is important but shifting attitudes is essential. This requires a concerted and collective effort to change the conversations we have at home, at work and in our leisure time. Raising men who respect women and regard sexism in all its forms as abhorrent begins at home and needs to be taken up by schools and the wider community until it becomes the accepted norm. While sexist comments and behaviour form part of our collective consciousness, women will remain silent when they find themselves victims of sexual abuse.
Imagine a world where a young man who tells a sexist joke or makes salacious remarks about a young woman is forced to hang his head in shame after being pulled into line by his friends. That the fear of being outcast and ridiculed by his peers results in a shift in his language and behaviour.
Until that happens, I will continue to see women like Melinda and live in a society where victims carry shame and blame. I will collect evidence that will languish in a laboratory with perpetrators never held to account. And when women present after remaining silent, I will manage their inevitable mental health issues in a health system ill-equipped to deal with long term and complex trauma.
Running
A couple of weeks ago, a patient Beck, returned to see me some months after I suggested doing couch25K (couch to five kilometres) as part of her resolution to get fit again after leaving a long-term relationship. It is a straightforward running programme that takes a beginner and/or couch potato through those early weeks of running and provides doable schedules that are flexible. There is something special about being able to run five kilometres. It is not an insurmountable distance, yet far enough to provide a real sense of achievement. Although running any distance is commendable, running five kilometres non-stop does have that edge. You shift from being someone puffing along hoping to get fit, to participating in the pre run dialogue when you line up for events like parkrun where you compare training, distances and running schedules.
Like every human endeavour, you learn the language and etiquette and become part of the running tribe which nudges you to push yourself a bit more and try new routes, longer distances or to sign up for events. Terms like fartlek (mixing speed with a slower pace), PB (personal best), tempo runs (start slow and then push yourself a bit harder than comfortable), negative splits (running faster for the second half of your run) and bonking. No, it’s not what you think. It means hitting the wall or running out of fuel before the end of a longer run. But it is fun to throw into a conversation!
Knowing these terms is not important, but there is something about being part of a group that makes the activities we do more enjoyable. One of the most powerful motivators to exercise is being accountable. Some of us are internally driven and having an external goal like an event in ten weeks will be enough to drag us out of bed through the dark, cold months of winter, but for many of us, committing to meet up with a running buddy or group will provide the additional peer pressure needed to keep showing up.
One of the most inspiring initiatives in the world of running is parkrun a free community event that takes place every Saturday morning at 494 venues (at date of publication) around Australia. You can run, walk, or volunteer at this positive, inclusive event and there is no pressure to finish within a certain time limit. You get your own number when you sign up and may opt to see if you can improve your time or to just finish. And if you get enthusiastic and turn up week after week, you can clock up 50 or 100 or 200 runs and your efforts are rewarded with a tee shirt that announces your achievement to everyone.
And one of the best things about participating in a group event like parkrun is that you can take on all kinds of interesting challenges. A colleague is aiming to complete a parkrun from every letter of the alphabet A-Z with an exemption for the letter X. This involves travelling with enthusiastic friends to events all over Brisbane, the Sunshine and Gold Coast as well as scheduling a few trips interstate. These Alphabeteer runners celebrate each parkrun by enjoying a café breakfast where they debrief, using proper running jargon, of course. Another aim might be to complete one parkrun every month for a year, or perhaps one every week together with a good friend or your running group. One of my daughter’s friends plans to continue her weekly parkrun challenge while she studies in Europe later in the year. And yes, there are parkruns all over the world.
There are a group of park runners called parkrun adventurers who travel internationally to complete parkruns in interesting and exotic places. I know when we lived overseas, I signed up for several running events that took me to all sorts of beautiful spots in Ireland that I would otherwise not have visited. And once you line up with runners in another country, you do get to meet new and fascinating people as a bonus. In an upcoming newsletter I will introduce you to a couple of the inspiring runners I met at events in Ireland.
The beauty of park running is that the challenges are endless and absorbing. Your weekends begin by doing something positive for your wellbeing, you spend time with some like-minded friends and might even get to try a new café. It is great for your physical, mental, and emotional wellbeing and is completely free. And in the unfortunate weeks where you are nursing an injury, you can still participate by volunteering.
Beck is now training for a half marathon and is still meeting up with her running buddies who are equally enthusiastic about this new challenge. She has met someone she likes through her running group and is confident to start dating again. The interesting thing about challenging yourself physically is that you move out of your head full of worries and anxiety and into your body. This translates to greater confidence in other areas in your life. After all, if you managed to run 5k,10k, 21k or a marathon, it demonstrates that you can put your head down, push through and keep putting one foot in front of the other.
When life feels tough and there are challenges that feel insurmountable consider contacting a friend and doing a couch25k together. In 9 or perhaps 12 or 20 weeks, you will be able to complete 5k. And if you don’t run the whole way, don’t beat yourself up. You have persisted despite the obstacles that life inevitably throws up. Head to your nearest parkrun and sign up. The chances are there will be someone older, slower, fatter, or less fit than you. And just like you, they got up, got ready and lined up at the start line ready to give it a go. Afterwards, celebrate with your buddies at your favourite coffee shop. And don’t forget to debrief. It is the stories afterwards that are the highlight of an event. I did it. It was hard and I was slow, but I finished.
I guarantee it will make the rest of your day and the following week a much happier place to be.
Writing
Stories are the oldest and most powerful way of sharing. Think about the last time you sat around a table with friends, family, or colleagues and remember what you talked about. It is likely you shared anecdotes about what your family, your job, the funny story about how you missed your flight on a recent holiday, how challenging it is to be the carer for an elderly parent and so on. Our stories give our experiences meaning and put a human face on the grief, joy and challenges that we all face.
Early in the pandemic, Brisbane Scribe Jane Connolly and I collected stories about individuals’ experiences during the first lockdown and created an anthology, Stories from the Heart. In the introduction, we wrote, The stories in this anthology are stories from the heart of Australia, the stories of its people. They put a human face on an unprecedented pandemic and capture the uncertainty, anxiety, resilience, courage, and humour which hallmark responses to cataclysmic events.
It was fascinating that when we invited people from all walks of life to contribute, many people responded by saying, I can’t write before telling us a story about how the pandemic has impacted them personally. When they finished telling us about being unable to visit an elderly parent in a nursing home or delaying weddings or significant birthdays or simply enjoying being forced to slow down, we would tell them what a great story that was and how much we would like to include it. Some of those people would then transcribe their experience into words and just like that they made the transition to being a writer.
Stories are fundamental to how we connect with each other, learn from others’ experiences, and share things about ourselves. Consider this quote from Ursula K. Le Guin. ‘There have been great societies that did not use the wheel, but there have been no societies that did not tell stories.’
If you are keen to learn about the basic craft of translating the stories you tell into words on a page, I recommend that you check out The Writers’ Studio. Sign up for their four week Unlocking Creativity course and you will finish with the essential tools needed to transform your creativity into stories. I did this course some years ago now and it was my first step along the path to becoming a writer.
The thing that made me most anxious when I started was getting and giving feedback from the other students who had enrolled to do the course. This ended up not only being my favourite part of the course but the most helpful for my writing long term. I would come home after work and eagerly log on to see if anyone had given me feedback and then began to reshape my stories and watched them improve.
This course reminded me how much joy there is in words and telling stories. It is challenging, nurturing and each cohort of graduates are just like you, writers who long to unlock their dormant creativity.
Every time you have a conversation, you are telling stories. When you write one of these down, you become a storyteller. Writing is simply fixing our stories to a page and making them available to more people. So next time you hear that voice in your head telling you that you can’t write or are not a writer, think about a story you shared with someone recently.
Now write it down and, just like that, you have become a writer.
Book Reviews
L-Platers by Madonna King
Raising the next generation is one the greatest and most important challenges confronting any society. While the late teens have always been fraught, the pandemic has added additional difficulties that will likely reverberate for many years as the affected cohort take on the mantle of early adulthood.
Lockdowns, prolonged study in isolation and the cancellation and postponement of many of the important milestones occurring during the final years of high school and early university have added new layers of uncertainty and difficulty.
Award-winning journalist, author and media commentator Madonna King, has interviewed educators, health care professionals, parents and a thousand teenage girls to bring us fresh insights into the issues that affect women standing on the cusp of adulthood. She has distilled her research into this realistic and easy to read guide by tackling the common and often confronting issues that our daughters may face. The book explores a range of diverse issues including identity, eating disorders and self-image, gender dysphoria, consent and sexuality, anxiety, mental health, and the complex challenges of (un)social media. One of the central and important messages of the book is to really listen to our teens. ‘"When your teen wants to talk, stop cutting carrots. Stop looking at your phone. Give them your attention." (Rebecca Sparrow) Attention is the currency of our time.’
Madonna encourages us to take a step back, put aside our own fears, our own agendas as parents and to listen, to provide love and support while simultaneously finding the courage to let go as our teenagers transition to womanhood and independence.
This is a necessary book that encourages parents to understand the world from the point of view of their teenage daughters and to guide them but also allow them to make mistakes. ‘Seeing her have to navigate life and make mistakes and try to figure it out on her own – it’s so hard to watch,’ (Dr Justin Coulson) but essential if we are to raise a generation of confident and happy women.
Chai Time at Cinnamon Gardens
We are told not to judge a book by its cover but when I bought my copy of Shankari Chandran’s novel, it was because I fell in love with not only the gorgeous cover but the title. It has since won the 2023 Miles Franklin award and is such a powerful story about having agency in our mature years, the ugly consequences of racism and how every individual’s history and story shapes their life.
The main character, Maya, is the owner of Cinnamon Gardens, an oasis where residents have an opportunity to live the final chapter of their lives growing and eating the food they love and nurturing not only their memories but those of the generations who have lived there before them.
This peaceful community who dares to do things differently and live the way they choose are threatened by the malignant forces of racism with heartbreaking outcomes.
I learnt so much about Sri Lankan history and the rich cultural heritage of a country I knew so little about. The beauty of this book is that each character has a unique and powerful story. Their often devastating experiences as survivors of conflict, linger in your imagination long after you have finished reading.
This is a powerful and important book for modern Australia where multiculturalism is constantly under threat by the malevolent forces of racism.
A Piece of my Writing
This month, I will include an article about living dangerously to the bitter end. It was published in the March 2024 edition of MiNDFOOD.
There is lively discussion about how our kids are protected from risk to a much greater degree than earlier generations. The transition from teenager to young adulthood can be filled with anxiety about risk, a topic that is discussed at length in Madonna King’s timely book. It is time we had the similar discussions around aging and the type of support and care we would prefer for ourselves as become frail and our risks of misadventure increase.
There are circumstances like severe dementia, where transition to a nursing home is appropriate. For many others, living at home is an option, provided appropriate supports are put into place.
Would you prefer to be at home alone with the freedom to eat when and what you like, to get up when you like, or would you prefer to be with others and have your meals and showering arranged for you? As a community, we need to have conversations about how much risk we are happy to live with. Is it worth living at home despite the risk of falls and injury or dying alone? Many of us would say yes.
I invite you to live dangerously into old age and support others to do the same.
Living Dangerously into Old Age
One of my very special patients died last week. Maude was 98 years old and spent the final decade or so of her life in a nursing home. I spent some time reflecting on her final years with her daughter and we both realised that much of our grieving had occurred over the past ten years as Maude’s cognitive function became increasingly moth-eaten and her quality of life slipped away in increments.
In the past five years or so, I have accumulated several older patients who hover on that narrow line between independence and difficulty achieving those pesky activities of daily living without help. Most of this cohort were in early retirement and living full lives when I first started seeing them. Now an increasing number are slipping into that twilight age where organs start to wear down and the risk of falls, often with devastating consequences, is high. A few of them linger in the past as the present becomes ever more confusing to navigate.
In the same week as Maude slipped away, I had challenging conversations with Ted, the son of another patient who is also in her nineties and still living at home. Betsy is a delightful lady, another of my favourites. Up until the last year, she was still sharp with quietly spoken opinions and a gentle sense of humour that always made me smile. Aside from a hip replacement and high blood pressure, she has always experienced good health. I only saw her for routine health checks and her annual flu vaccination.
A year ago, I started to notice those tell-tale signs of frailty. Her walking became unsteady until she progressed to a frame. She looked less polished at her more frequent appointments. Our community nurses arranged extra support at home. Rails in the bathroom and someone to help with cleaning and shopping. Betsy is fortunate to have supportive family who live nearby and drop in regularly to check up on her.
Things slipped after a bout of pneumonia where I did a home visit one Friday evening and started antibiotics. She then started to get recurrent urinary tract infections and became delirious. Betsy’s granddaughter worried, and rightly so, about her safety at home alone. What if she fell? What if she had a stroke?
And this is what led to the conversation with her son Ted. We spoke after a prolonged hospital stay where the discharge report recommended supportive care in an aged care facility. Betsy begged her son to let her stay in her own home, and he was torn about what to do. It was a difficult decision. Betsy was experiencing a phenomenon known as sundowning. In the evenings, she would set the table for her husband and other long deceased members of her family and chat to them. She had started talking about these loved ones in the present tense during consultations and I arranged assessment with a geriatric psychiatrist.
Betsy also attempted to climb over the safety rails, placed to protect her from the stairs leading to the backyard. On one visit, her granddaughter caught her trying to heat her microwave meals in their packets on the stove. Betsy was becoming more unsafe, and my instincts were to protect her from herself, to minimise risk.
I thought back to Maude and her final years in a facility where, despite gaping staff shortages, her care was meticulous. I know when she first moved, she was miserable and complained endlessly about the food, the routines, not wanting to participate in the organised activities that staff arranged to allay boredom. She had once been a large size model, long before this was a thing. She loved clothes, going out for coffee or lunch and shared her opinions about everything. It is hard to be certain, but I suspect her cognitive function took a steep slide after her admission to the nursing home despite a supportive family who visited often and took her out on weekends.
I imagined what I would want if I reached the age where my thoughts became disarrayed, and I was unsafe in my own home. I knew, without a doubt, I would prefer to live with some risk at home, even if it shortened my life. I would prefer some agency over when I got up, ate my meals and what I did with my days.
Nursing homes received a lot of media attention during the pandemic, most of it not positive. There was criticism about the level of staffing, the poor renumeration, the high death rates. There were those poignant images of patients locked in their rooms for weeks at a time unable to see loved ones, while those providing their care were dressed in full personal protective equipment. For someone with dementia, it must have been terrifying and confusing. I continued to see my scatter of elderly frail patients at home through the worst of the lockdowns, clad in the full regalia that constitutes PPE. We had a laugh about it all and I know seeing someone, even dressed in a spacesuit, brightened their week.
This diversion brings me back to the difficult conversation I had with Betsy’s son, Ted. I asked him what he would prefer, not only for his mother, but for himself. We agreed to work together to keep her at home. We arranged an automatic alarm so that if she fell, she would not be lying alone in pain for hours. Our wonderful nurses and occupational therapists arranged more supports and help. I agreed to see her at home regularly and Ted continues to drop past each evening.
This decision is not without risk, but sometimes, mitigating all risk makes life intolerable. The joys in life are found in the small things. In choosing what we do, when and how we do it. I visited a facility where I argued with staff about allowing my patient to enjoy a glass of wine with dinner. We compromised. I had to write it on the drug chart. One glass of cabernet sauvignon nocte (evening) with dinner. I thought this was meant to be ‘home’ where residents could enjoy a glass or two if they felt like it. As an octogenarian, the long-term impacts on health must surely be less relevant than the short-term benefits of a little pleasure.
Maude had a sweet tooth that never left her, right up to that last week where she stopped eating. I recall one lunch visit where staff were so busy, I stayed to feed her. Maude’s lips stayed tightly closed when I offered small spoons of different coloured pureed pap, even though her dementia was so advanced she no longer knew who I was. When I offered the custard and sponge, she ate every last bit and I ended up getting her a second one. Even at that late stage, she asserted herself, determined to have two desserts rather than the pureed food that protocol demanded to reduce her choking risk.
We are living longer. I see an increasing number of patients in their late eighties and nineties with varying levels of frailty. Some of them are immobile with excellent cognitive function, others are robust physically but lost in the labyrinth of memories, incapable of recalling what they ate for breakfast. Their care needs appear insurmountable at times.
When Maude died, she was incontinent, unable to feed herself and no longer able to recognize her family. It was not an option for her to live in her own home. Betsy is hovering in that twilight where she has enough capacity to make her own decisions. They may not always be the best ones but having the freedom to make them is integral to her enjoyment of life.
Aged care is not unlike the transition from childhood to teenage hood and ultimate independent adulthood. There is that overwhelming desire to mitigate all risk. Perhaps some of the crisis in aged care could be alleviated if we allowed more of our frail elderly to stay at home with well-funded support packages that included regular visits by their doctor, allied health and support staff. There are excellent services that connect the lonely elderly without family to volunteers who assist with technologies enabling the use of social media and connection with the outside world.
Government funded high quality home care packages for the aged are essential and much cheaper than nursing home care. However, this is not a responsibility that can be solely outsourced and solved with clever policy. One thing we learnt from these pandemic days and the recent devastating floods is the integral role of community to our social wellbeing. Many of us move away from elderly relatives but find ourselves living next door to someone else’s frail loved one. It is a simple thing to drop by and say hello, to offer to get milk or medications, wheel bins out or mow the lawn. These small but significant gestures go a long way towards keeping someone in the familiar space of their own home.
We are living longer. The recent horror statistics emerging from institutionalised aged care in the recent pandemic suggest that quality of life in our twilight years may be compromised to keep us cocooned and safe. Perhaps we need to be bolder, braver and dare to live a little dangerously, with dignity, agency and a glass of wine when we feel like it. Right up to the bitter end.
