This is Gail

by O'Brien, Gail

  Mark was fit and young and as the founder of the Marcs fashion label had been one of Australia’s most successful fashion entrepreneurs when he was diagnosed with kidney cancer several years previously. He credited this daily treatment as being partly responsible for his good health and appetite in the face of disastrous metastases. Dad enjoyed talking with Mark, who was a family man as well as a successful businessman, and they shared moments of peace in the big comfortable chairs. These were the main reasons he went. But Leo became more persistent in his efforts to persuade Chris to help him promote his business. Eventually, this intruded a little too much upon the quiet of these afternoons and Chris stopped going.

  A year later at the literary lunch for Chris’s autobiography, Never Say Die, two people stationed themselves at the door of the Sofitel Wentworth’s large dining room. The thin Chinese man smiled at me and bobbed his head as I took one of his small yellow flyers. ‘Yin Yang Harmonisation Therapy’, it trumpeted, listing everything it supposedly cured from asthma to sexual problems to cancer. I showed it to Dad, who asked Susan Wyndham, the Sydney Morning Herald’s literary editor and the master of ceremonies, to clarify to the room that he did not endorse it as a therapy.

  It was a pity that Dad didn’t feel comfortable going to Yin Yang because those moments essentially amounted to meditation for him. In general, he found it difficult to still his busy mind. Even at night, Mum would be kept awake by his toes wriggling in bed, a signal of the busyness behind his closed eyes. He was introduced to meditation by friends. Dr Tim Carr, who Chris knew from studying medicine, taught him Transcendental Meditation. A lean and quiet fellow with intense, deep-set eyes, Dr Carr would come to our home and try to teach the novice student. Chris was given his own secret mantra, and would work hard on meditating each day. But I would often find him sitting upright in an armchair with his head tilted back and mouth agape as he had fallen fast asleep within minutes. Another close friend recommended meditation sessions at a house in Crows Nest. But as Mum and Dad battled the peak-hour traffic to get there, managing the time and stress it took to attend another appointment, the meditation sessions seemed like a self-defeating exercise.

  The Sydney Morning Herald’s Good Weekend magazine ran a story about Dad and afterwards we were flooded with letters and phone calls, many of which, again, contained advice and solutions. One call came from a man called Bill Sampson, a Nowra resident with white hair and a jolly laugh, who was spruiking a nutritional supplement called Immunocal in what seemed like a distribution channel similar to Amway cleaning products. Immunocal claims to boost glutathione levels in the body and, again, uses the rhetoric of antioxidants and immune function to explain its effect. It arrived in sachets of powder that were to be mixed with liquid. Dad winced as he drank the horrible white globular stuff. But, driven by desperation, Mum insisted he take it and would prepare the drink diligently, along with a sweet chaser to make it more bearable.

  It’s hard for me to hide my cynicism about these kinds of products. I don’t know whether Immunocal works in some circumstances. Maybe it does. But I do know that any product that is expensive, foul-tasting and sold to dying people should have solid evidence that it works. Otherwise in my view, it is simply part of the big industry that markets to desperate families who have nothing to lose but money.

  There were, of course, other alternative therapists whom my mother and father respected and trusted. A former trainee of my father’s, Greg Lvoff, organised a magnificent evening at the harbour-front Aria restaurant as a kind of thank you and farewell from all my father’s interns, registrars and overseas fellows over the years. Greg arranged for a limousine to carry the whole family there, showing sensitivity to the practical issues of driving and parking. The room hushed as Chris entered the restaurant; their tutor and mentor, whom they affectionately called ‘Prof’, now had unstable footing and pockmarked skin. During the evening Valerie Malka, a former intern who had since become head of trauma surgery at Westmead Children’s Hospital, perched next to my parents and told them about her father, a homoeopath, naturopath and medical herbalist with expertise in cancers and chronic disease. She suggested they see him. Chris and Gail were immediately receptive, the suggestion coming as it did from a young surgeon with a serious medical background.

  George Pierre Malka had kind eyes and a soft voice with a French accent. He had personally built up a compilation of anecdotal evidence of success in treating brain tumours using homoeopathy. Chris, who hadn’t mentioned that he wasn’t feeling well and had an upset stomach that day, sat down and George inspected his eyes.

  ‘You’ve got a problem in your stomach,’ George said.

  ‘How did you know that?’ Gail asked incredulously.

  George showed Gail charts that delineated sections of the iris and how they related to corresponding organs. Although iridology derives patchy results in scientific studies, Gail’s personal experience of witnessing this accurate diagnosis was persuasive.

  George gave Chris an array of supplements (selenium, fish oil, echinacea, evening primrose oil, vitamin C and coenzyme Q10), a new diet (totally vegan, no alcohol, no sugar), a brown liquid made of herbal extracts and tiny homoeopathic tablets to be dissolved under the tongue. The ‘black medicine’, as it came to be called, was added to Chris’s morning and afternoon swallowing schedule and was the most ghastly tasting thing he had had to take yet. But of all the alternative remedies they had tried, Chris and Gail felt most comfortable with this one. They trusted George and while they knew that there were no guarantees, they placed some hope in his remedies.

  Problems arose when the conventional and complementary treatments clashed. Dr Wheeler was an open-minded oncologist who understood that patients will search for answers wherever they think they can be found. ‘We just don’t know what the effect will be of taking that along with these chemotherapy drugs,’ she warned. ‘It is possible that they could decrease the efficacy of the drugs we’re trying. We don’t know how these things interact.’ Meanwhile George Malka expressed his opinion that Chris should stop taking the chemotherapy so that his own treatment would have the opportunity to restore Chris’s immune system and general wellbeing.

  A routine MRI scan in December 2007 showed multiple white spots adjacent to the site of the original tumour. The biggest was eight millimetres across and at first this was interpreted as possible tumour regrowth. But doctors Wheeler and Teo believed they were actually changes in the tissue induced by the radiotherapy. Either way, Dr Wheeler suggested a pause from the chemo. Dad, always feeling somewhat nauseous and lethargic from it and with a depleted white blood cell count, welcomed the suggestion. George Malka was also pleased with the idea that Chris would continue on the supplements and homoeopathic alternatives without the interference of noxious medicines. Over the following months, the scans showed no progression of those white spots and in fact, they appeared to regress and to fade.

  But it would not be long before a scan would reveal the relentless tumour on the march again, bringing my father to the crossroads of conventional medicine and less conventional treatments.

  Some people have asked me why Chris — a doctor, a man of science — would try all of these unproven remedies. I believe the answer is that although he was a doctor, he was also a husband and a father. He tried them all for us.

  Shedding the Ego

  When Dad shaved his head, he bought a canvas hat with a narrow brim from a surf store. He often wore this or other hats to cover his bald head, and they had the effect of making him seem younger and smaller. He was wearing that hat one day as he and Mum walked from the RPA Medical Centre back to the car. Gail was holding his hand and leading him along, taking the small tentative steps that had become his new gait. She looked ahead, momentarily distracted, and didn’t notice that she had stepped down a sloped gutter between the sidewalk and the road. Chris was unprepared for the drop when he stepped onto it. His ankle rolled over his foot and his body pulled on the ankle’s tendon away from the joint. He
collapsed with a cry as Gail gasped. She crouched down to him as he held the ankle between his hands, wincing as he rocked back and forth and she hugged him.

  ‘I’m sorry, Christie, I’m sorry,’ she said as the tears welled. ‘I wasn’t looking and—’

  ‘It’s okay, Pinkie, it’s okay,’ he consoled her, but his face showed the pain. Of all the moments I have asked my mother to describe, this is the one that upsets her more than any other. Chris was like a vulnerable child whom she felt she had allowed to be hurt. He was helpless and she was supposed to be his protector. It broke her heart to see him sitting in the street with yet more pain inflicted on him, wearing his little hat.

  My mother was always gentle and tender in her care of my father. The long, angry gash in his scalp — the legacy of the three operations, radiotherapy and chemotherapy, which causes wound breakdown — was refusing to heal. He sat with his eyes closed as she dabbed cream onto the wound. She did up his buttons when his clumsy fingers couldn’t manage. She was forever patient when his rebellious left hand caused a spill or a break. One time, when his and my attention was diverted by the TV, his left hand turned itself over and upturned an open tub of yoghurt, pouring the contents onto the couch.

  My mother had originally struggled with this change in my father’s identity. The sight of him sitting barefoot and bald-headed in those big armchairs doing Yin Yang Harmonisation Therapy caused her to bury her head in her hands. He seemed at peace with his fate, sitting in calmness and quiet. She clearly still had a way to go. But as 2008 wore on, Gail chaperoned and observed her changed husband during some remarkable moments.

  He was invited to several overseas events by colleagues who wished to honour him and his contribution to the treatment of head and neck cancers. In May he received an award for excellence in surgery in Hong Kong, and in July Gail and Chris flew to San Francisco for the inaugural Chris O’Brien Lecture at the world head and neck conference. It was an enormous honour to have a lecture named after him, a mark of respect usually reserved for posthumous rewards. As my parents settled into their comfortable seats on the plane and clinked champagne glasses, it almost felt like old times again. But as the plane crossed the Pacific, Chris became more and more unwell. Isolated in his illness, he couldn’t articulate to Gail what was wrong. Pounding headaches had returned and he felt nauseous most of the time. Gail worried they were symptoms of the cerebral oedema collecting again. American Express had been the only company willing to insure Dad to travel to the USA; what if he never got home?

  In San Francisco they were upgraded to a suite, allowing Gail to sleep on the couch as Chris tossed and turned through the night. Somehow, he would pull on his suit as if it was armour and be sociable for the functions or lectures they had promised to attend. At a cocktail reception on San Francisco’s waterfront, Gail kept Chris in her peripheral vision as she chatted with one of the other doctor’s wives. It was a chilly evening but a lovely scene as the black-tie-clad fraternity drank wine by the city’s wharves. The two women, who had met regularly over the years, chatted as friends, but when the woman made her goodbyes, she said, ‘Well, it’s been nice knowing you,’ leaving Gail to contemplate the only meaning this comment could have.

  They stopped in Hawaii on the return journey and Gail wandered around Waikiki Beach on her own when Chris was too sick to come out. She came upon a small tipi tent with an Irish fortune teller inside. No, it’s silly, she thought and went to walk away. But the Irish female voice called out to her, and she thought, What’s the harm? and stepped into the kitsch little marquee. ‘There’s something that you don’t think you’re any good at. But you are,’ the woman said. She went on with more platitudes, but didn’t say what Gail wanted to hear — that he’s going to be fine.

  In September they travelled again, this time to England for Chris to deliver the prestigious Semon Lecture at the Royal Society of Medicine, London. He spoke on skin cancer of the head and neck and received a rapturous standing ovation. But while his peers paid him more respect than ever, his illness mandated perspective. ‘Makes you wonder if they need a little more excitement in their lives,’ he joked with Gail back in their hotel room.

  Back in Sydney, Gail drove Chris to an increasing number of speaking engagements, from community events to large soirees. Rather than seeing his illness as a reason to retreat from the world, it pushed him further into it. His illness brought him closer to people and gave him a bigger platform. ‘I feel like I’m the owner of a celebrity brain tumour,’ he used to jest. ‘I feel like saying to this thing, this is all your fault, why don’t you go and talk to these people, how come I’ve gotta do the talking?’

  Gail watched how people approached Chris — strangers who had watched him on RPA and were now following his story in the newspapers and on television. They would tell him about their own journeys and hug him like a brother. It was obvious that while my father had always been driven by an altruistic calling, his experiences were revealing a new level of compassion and empathy.

  He attended mass more regularly, giving generously to the collection plates. He could not walk through the city without stopping for each homeless man or woman who sat in our path, often giving a ten- or twenty-dollar note or offering to buy them lunch. On one occasion, I stood back as he crouched down to a man sitting with his dog in a busy shopping area. The two chatted for a minute, before Dad stood up and walked back to me, smiling. ‘He’s vegetarian.’ He eyed a Japanese restaurant behind us. ‘Wait here, I’ll get him some sushi.’

  He was asked to speak at his old high school, Parramatta Marist Brothers, where he told the boys that men of steel have compassion in their hearts. He urged the Australian Medical Students’ Association meeting in Melbourne to treat patients as though they were members of their own families. He confessed that his own diagnosis and treatment had changed him as a doctor, giving him a more holistic understanding of the patient experience.

  Gail had told her obstetrician years before that she wasn’t the woman she had been. ‘Better,’ he had responded. So it was with my mother and father now. They weren’t the woman and man they had been when my father’s illness began; they were better. By the year’s end, stopped at traffic lights, Gail turned to her husband. ‘You know, it’s been such a terrible year,’ she said. ‘But I wouldn’t have been without it.’

  After a few seconds of silence, he responded, ‘Neither would I.’

  My dear mother,

  You said to me recently, ‘It’s not really a life worth living if there’s no suffering.’ Do you really believe that?

  Love Juliette

  * * *

  My darling,

  You and I have both heard people use ridiculous platitudes like, ‘Haven’t you got over it?’

  Why is it brought into your life in the first place if all you do is ‘get over it’?

  You don’t get over things. You keep them with you and learn from them. You live by them. It doesn’t bury you but you live with it. What is the point in life if you don’t learn from it?

  Your father learned so much during this time. He grew more through his own illness than through twenty years of medicine.

  Love Mum

  The Tumour, a Gift

  Chris’s determination to establish Australia’s first comprehensive cancer centre quickened as his life shortened. The million dollars from the NSW Iemma government had produced a sustainable business case based on a not-for-profit model. Within days of his diagnosis Chris recognised the tumour as a weapon in his advocacy arsenal; his prominence as a cancer surgeon and the lethal nature of his disease combined to give him unequalled authority to speak on cancer care in Australia. He used the tumour as a means of placing the question of Australia’s model of cancer treatment on the national agenda, writing an opinion piece in the Sydney Morning Herald in which he laid out the case for a move away from the 150-year-old public teaching hospital model to comprehensive cancer centres. New South Wales, he wrote, should have ‘at least one world-class cancer c
entre where diagnosis, cutting-edge treatment, caring cancer support, high-quality research and a fertile academic environment are integrated to facilitate ground-breaking discoveries, the development of new and innovative therapies and the achievement of better treatment outcomes’.

  But Chris’s solicitations for support from the federal minister for health Tony Abbott were meeting a ‘comprehension gap’, in Chris’s words. ABC radio announcer Adam Spencer on several occasions interviewed Chris on his high-profile and popular program. Listening to the interviews today, it occurs to me that Dad spoke like a man with nothing to lose, saying that Abbott was in denial of the need for a research centre of excellence.

  ‘My suggestion to [Tony Abbott] was that the federal government’s got money sort of literally falling out of its pocket, and holy mackerel, for the cost of a submarine or an F-18 or whatever jet plane they’re gonna buy next, they could build two or three of these cancer centres. And if the federal government grasped the nettle and said, “Okay, we’ll agree that there should be a national network of world-class comprehensive cancer centres, and we’ll contribute infrastructure funding to those, and help them to become centres of research excellence where research is integrated with the clinical care”, then I think that’d be a big contribution. But Mr Abbott doesn’t get that.’

  In an interview the following week, Abbott responded, ‘I have tremendous respect for Chris O’Brien professionally, and obviously I very much appreciate the difficult personal situation he’s in, and there’s a sense in which Chris O’Brien has tremendous moral standing on this issue and I guess as a health minister I’m a bit overawed by that . . . But we have a professional body we have recently established called Cancer Australia to advise us, and I think it would be fair to say that so far Cancer Australia is not convinced that establishing a small number of so-called integrated cancer centres is necessarily the way to go.’