On The Edge

When I was a medical student I went to the Highlands of Papua New Guinea for four months to work in Immanuel Lutheran Hospital, Wapenamanda, Enga Province.  One Friday night a group of us drove 25 miles up the road to the town of Hagen to see a film.  Hagen was pretty rough; bit of a Wild West town.  The theatre was packed.  I can’t remember what the film was, but I have a vague notion Barbra Streisand was in it.  What the burghers of Hagen made of her I can’t say.

Half way through the second reel there was a commotion, the film came to a halt, and the house lights came on.  The police had entered the theatre, in force, looking for a man on the run.  Suddenly the fugitive broke cover and made a dash for the exit, bottom left.  But the police had the exit covered.  He scrambled across the people in one of the front row stalls to the right hand aisle and sprinted up to the rear right exit where half a dozen officers overpowered him and pinned him to the floor.  It was clear that the audience as a whole found all this infinitely more entertaining than the film, and there was laughter and applause as the fugitive was led out.

I found it all reminiscent of the denouement of the Hitchcock version of The Thirty Nine Steps.  The entire scenario was intensely theatrical precisely because of the location.  I didn’t so much observe a fugitive being apprehended by the police, as a thespian playing the part of a fugitive, being apprehended by a troupe of thespians whose police uniforms were from wardrobe.

On another occasion we were driving to a remote location to carry out a paediatric clinic when our vehicle got diverted to an Aid Station and we started to receive injured patients from a pitched battle.  Most of the injuries were spear wounds.  I was given the task of moving from patient to patient, putting up as many intravenous drips as possible.  I had the same sense as I’d had at the movies, that I was not so much treating a group of warriors, as a repertory company depicting the activities of a battlefield dressing station.  The atmosphere was strangely euphoric; even people with serious injuries seemed quite happy.  I wondered if they were overacting.  It all seemed a bit hammy.  Yet their blood was not ersatz.

I have this notion that when we elect to behave at the dangerous edge of things, we first apply the greasepaint and put on a costume.  Psychiatrists call it “acting out”.  Most of the rage you see in hospital emergency departments is sham rage.  The trick of the emergency physician is to find a formula that will permit an aggressive person to step over the footlights, come out of role, “corpse”, and act like a human being.

But occasionally the rage is real.  You have to recognise that.  And it’s a mistake to imagine it’s only other people who can go berserk.  It’s in all of us.  A couple of years ago I had the most hellish toothache.  The dentist couldn’t pinpoint the problem and ended up giving me a course of metronidazole.  I won’t say it was a fob off, but I took it without much confidence.  A week later I had an entirely sleepless night spent pacing the floor, swallowing codeine and gargling with whisky.  Nothing touched it.  I went back to the dentist determined to get an extraction.  She could do a total clearance for all I cared, so long as I was rid of this “hell of all diseases”.  You sometimes hear of an elephant in a zoo with an undiagnosed tusk abscess who suddenly loses the plot and wrecks the joint in a frenzy.  I might have wrecked a dental surgery.   Maybe the dentist sensed it.  At any rate, the extraction worked, God bless her.

But don’t imagine there’s not something out there that will make you flip.

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