All posts tagged health

  • The Weekend Australian Magazine story: ‘Dying Wish: In-home palliative care nursing’, February 2017

    A feature story for The Weekend Australian Magazine, published in the February 11 2017 issue. Excerpt below.

    Dying Wish

    Few terminally ill Australians get to spend their final days at home. When it happens, it can be the greatest gift of love.

    The Weekend Australian Magazine story: 'Dying Wish: In-home Palliative Care Nursing' by Andrew McMillen, February 2017. Photo by Justine Walpole

    It begins with the lighting of a candle, the bright tone of a ­ringing bell, and a card plucked from a deck of Buddhist prayer cards then read aloud: “Now may every living thing, young or old, weak or strong, ­living near or far, known or unknown, living or departed, or yet unborn – may every living thing be full of bliss.”

    On this Monday morning in a northern suburb of Brisbane, six clinical nurses and support staff are gathered around a table inside a building known as Karuna House. Its walls are painted pale blue, its ceilings are high, and pinned to a corkboard are dozens of booklets gathered from funerals and memorial services. These are some of the organisation’s recently deceased clients, for the nature of Karuna’s work is to offer support to ­people who are terminally ill, providing in-home palliative care services to about 50 families at a time. ­Written in red on a whiteboard is the number four – the tally of clients who died the previous week in mid-November; the same as the week before.

    In a corner of the room beside an open ­window sits Camille Doyle, 40, who listens intently while making handwritten notes on a printed page that shows her clients’ names, addresses and current assessment: “stable”, “unstable”, “deteriorating”, or “terminal”. This fourth stage is followed by bereavement, which involves caring for those left behind. Today Camille will visit four homes; by now, she knows these people ­intimately and the routes to their houses so well that she doesn’t need a map.

    On a bushy block in Samford Valley, 25km north-west of Brisbane CBD, sits a large timber house owned by a married couple of 49 years. When Camille knocks on the door at 11.30am, she is greeted by Sandra Huelsmann, a 73-year-old grandmother who wears pearl earrings and a ­silver heart necklace. “Hello, Millie,” says Sandra, smiling. They hug, and Sandra welcomes the nurse into a home she has visited regularly for the past six months, an unusually long relationship for Karuna. The longer duration reflects the complex nature of this particular palliative situation.

    On an adjustable bed in a room towards the front of the house is Tony Huelsmann, a retired dancer, choreographer and dance instructor whose skills were once in high demand at schools throughout Melbourne and Brisbane. Sandra was one of his dance students. He was 30 when they met, seven years older than her, and it was love at first sight.

    Born in Germany, Tony has spent much of his life in Australia. Now 80, he is dying from complications associated with several internal and ­external cancers, including a rash of angry red squamous cell carcinomas that have colonised the skin of his swollen upper thighs. These painful sores require daily dressings, performed by a personal care worker, while Karuna’s rotating ­roster of nurses help with symptom management, bed-baths, toileting and bedding changes, as well as emotional support for both husband and wife.

    Since May, Tony’s world-spanning life has been confined more or less to these four walls while Sandra cares for his every need. At night, she snatches sleep where possible. It is their wish for Tony to die at home and they are both determined to see this wish fulfilled.

    To read the full story, visit The Australian. Above photo credit: Justine Walpole.

  • The Saturday Paper story: ‘Schlock Therapy: The Clown Doctors of Lady Cilento’, February 2017

    A feature story for The Saturday Paper, published in the February 11 2017 issue. Excerpt below.

    Schlock Therapy

    In hospitals throughout Australia a dedicated troupe of clown doctors dispenses therapeutic comic relief.

    In a quiet and unassuming corner of Lady Cilento Children’s Hospital in South Brisbane, a transformation is taking place. Inside a nondescript room are two women who seek to make people laugh so that they might forget their surroundings, if only for a few moments.

    Standing before a mirror in a small room, Jenny Wynter applies eyeliner to complement the bright red circles painted onto her cheeks, before picking up a watermelon-adorned ukulele to tweak its tuning. Louise Brehmer secures a series of rainbow-coloured hair ties into her pigtailed locks, dons a purple bucket hat, and fills the pockets of her white lab coat with an array of props. The final touch? Bright red noses, naturally, for a clown can feel only naked without one.

    Affixed to the lockers that occupy the back wall are photographs of six clown doctors, who work in pairs to prowl the bright-green building while spreading mirth. For a few hours at a time, these women dress up to stand out. They seek to become the lowest-status person in every room they enter; they aim for nothing more than to become the butt of their own jokes. When the red noses are on, they’re professional goofs. They act as outrageously as possible to make everyone around them feel better about themselves. “There’s not many jobs where walking down a corridor elicits a smile,” says Brehmer of their eye-catching costumes. “We’re here for the entire hospital, to bring an element of lightness to a serious place.”

    Brehmer has been doing this work for 16 years, and considers it a valuable addition to her career as a freelance actor. “I’m still learning,” she says. “Some days, I have no idea what to do in a situation.” Wynter is a comparative newbie: her background is in stand-up comedy, and she has been a qualified clown doctor since June 2016, having completed her “clownternship” after making 50 appearances in the role. “It’s so much about reading the room, and being willing to change at any point,” she says. “You’ve got to show up with an open heart.”

    On leaving the change room, they switch from friendly colleagues to partners in comedic crime. In the hallway outside, near an immunisation centre, they embrace and address each other by their stage names for the first time today. “Hello, Wobble!” says Wynter, who is now known as Doctor Angelina Jolly.

    As soon as they round the corner, they join the general population of the public hospital’s bustling second floor, and the improvised routine begins in earnest. Within the first five minutes of finding an audience, Doctor Jolly blows bubbles and distributes squares of toilet paper to some bemused boys, Doctor Wobble uses her stethoscope to check the heart rate of a visitor’s stuffed panda, and the pair of them launch into an enthusiastic rendition of “Twinkle, Twinkle, Little Star”, accompanied by Doctor Jolly’s ukulele. “A lot of the day is just spent cracking each other up,” says Wobble, while they ride an elevator up to the sixth floor.

    To read the full story, visit The Saturday Paper. Above photo credit: Jodie Richter.

  • Good Weekend story: ‘Shock Tactics: Preventing trauma in Australian teenagers’, November 2016

    A feature story for Good Weekend, published in the November 19 issue. Excerpt below.

    Shock Tactics

    As Schoolies Week kicks off around the country, emergency specialists are using hard-core methods – graphic dashcam videos, horrific injury images, emergency-room simulations – to deter adolescents from risk-taking behaviour.

    Good Weekend story: 'Shock Tactics: Preventing trauma in Australian teenagers' by Brisbane freelance journalist Andrew McMillen, November 2016

    It looks like a classroom, but today there’ll be no maths, English or history. It is a Wednesday towards the end of 2016’s final term, and no ordinary school day. Today’s curriculum will be taken largely from life experience, and the lessons will revolve around confronting simulations of what these students’ lives might be like if they don’t think before they act.

    This group of about 30 year 10 students from St Peters Lutheran College, in the inner-west Brisbane suburb of Indooroopilly, has travelled across the city to the Royal Brisbane and Women’s Hospital (RBWH), at Herston in the inner-north. All aged 15 or thereabouts, the boys wear short-sleeved white shirts with maroon ties, grey shorts and black shoes, while the girls wear long white dresses with vertical maroon stripes. Just like in any average high-school classroom, the front row of seats is empty – other than two teachers overseeing the group – and the back row is mostly occupied by boys, who provide a constant stream of whispered wisecracks to one another.

    Today, the hospital is hosting what’s known as the PARTY Program. The acronym stands for Prevent Alcohol and Risk-Related Trauma in Youth. It’s a concept licensed from an initiative that began 30 years ago at Sunnybrook Hospital in Toronto, Canada, and now operates out of 15 sites across Australia, including every state and territory besides the Northern Territory. PARTY began at the RBWH in 2010, and since then, 51 schools and more than 3000 students have participated in a day-long, intensive itinerary of hands-on activities and talks designed to open these bright young eyes to some of the difficult situations and decisions they’ll be exposed to as they edge from adolescence into young adulthood.

    “Some of the things that you see, hear, feel and smell today may give you some feelings you haven’t had before,” says statewide program coordinator Jodie Ross. “It’s quite normal that you might feel a bit off at points. If you feel a bit ill, or feel that you might faint, please let us know, and don’t run away to the toilet. We have had a young boy who fainted in there, and it was really hard to get him out.” At this, she is met with a few chuckles. “Today, we want you to learn from other peoples’ poor choices, because we want to see you come back here as doctors, nurses or allied health people – but definitely not as patients.”‘

    Ross has worked here as a nurse since 1996, and still puts in the occasional shift with the trauma team when needed, but coordinating this program at hospitals and schools across Queensland is her full-time job. Laidback in nature, the 41-year-old mother of two marries a warm presence with a wry sense of humour, yet some of what she has seen inside this building across two decades has informed her own parenting. “I have a 13-year-old boy and an 11-year-old girl, and they already know they’re never allowed to ride a motorbike, or even think about getting on one,” she says with a laugh. “I think I’ve scared them off, which is great.”

    The morning’s first guest speaker is Danielle Brown, a paramedic who has been with the Queensland Ambulance Service for more than a decade. She wears dark green cover-alls, pink lipstick and bright red fingernails. “I’m here to tell you about consequences,” she says, as the screen behind her flicks onto an image of a car wrapped around a pole, surrounded by emergency services workers. “If you ever do find yourself in a situation with us, please just know that we’re not here to make things worse for you, or get you in trouble. We’re here to look after you.”

    When she asks whether any of the students have visited the emergency department, a few of the boys raise their hands; all sporting injuries, as it turns out. Brown talks about alcohol and drug use, and about assault injuries. “Aggression isn’t cool,” she tells the group before she leaves. “For those guys out there trying to impress girls, can I just tell you – we’re really after the gentlemen, the funny guys. There’s no point in trying to impress someone by being ‘tough’.”

    Ross moves onto discussing sexually transmitted infections, and the kids crack up at how she frames the lifelong consequences that can come from a few minutes of fun, such as having to tell every sexual partner from that point on, “I’ve got a bit of herpes – hope you don’t mind!”

    Although none of these students have their learners’ licences yet, she dwells on the topic of road safety for some time – which makes sense, since the Queensland Department of Transport and Main Roads is the program’s primary funding source: in August, it provided an additional $1.54 million to keep the statewide initiative topped up for another three years. During this part of the presentation, the screen shows dashcam footage from cars where teenage drivers were distracted by their phones. These videos are horrifying to watch: the drivers’ eyes remain in their laps, even as the car veers outside the painted lines and towards needless trauma.

    To read the full story, visit Good Weekend‘s website, where you can also see a short film by photographer Paul Harris that was recorded on the day we attended the P.A.R.T.Y. program. For more about the program, visit its website.

  • The Weekend Australian Magazine story: ‘Saving Face: Brenton Cadd’, October 2016

    A feature story for The Weekend Australian Magazine, published in the October 22-23 issue. Excerpt below.

    Saving Face

    Need a new nose, eye or ear? Meet the ‘spare parts’ man changing lives

    The Weekend Australian Magazine story: 'Saving Face: Brenton Cadd' by Andrew McMillen, October 2016. Photo by Julian Kingma

    In January 1970, a young man joined the facial prosthetics department at the Royal Melbourne Hospital. As an apprentice ­dental technician, Brenton Cadd, 17, began learning on the job how to fix people with ­disfigurement so that they might be freed of shame or embarrassment. His mentor in the four-man department was Cliff Wellington, a ­signwriter by trade who’d served in the army as a dental technician. He had a painter’s eye for detail, and in 1945 he’d transitioned into the nascent field of facial prosthetics. Returned servicemen missing ears, eyes and noses were in dire need of some form of camouflage to help them blend into a crowd. Through a peculiar mix of technical ability and artistry, Wellington was an Australian pioneer who passed onto his young charge his aptitude for working on small, intimate canvases.

    Today, a framed photo of a smiling Wellington sits prominently on a shelf near the door that leads into a workshop managed by Brenton Cadd. For 46 years he has devoted his life to a single workplace and this single task. Through the use of silicon, empathy, paint, patience, titanium, plaster and good humour, he is a leader in a highly ­specialised field that employs only a handful of people across the country. He is a quiet achiever whose work takes time, and whose time at the Royal Melbourne Hospital is much nearer its end than its beginning. What will happen after he sees his last patient is unclear, for what he does for them is nothing less than life-changing.

    You could pass Cadd in a crowd without a ­second glance. If you are a long-time fan of the Hawthorn Football Club, you are likely to have done just that at a home game. He does not invest too much time in his appearance and wears polo shirts with a breast pocket in which he keeps a small notebook he calls “the brain” . It helps him remember his many pressing tasks. He is bearded, with kindly blue eyes that have looked upon thousands of patients who, whether they are able to articulate it or not, are relying on him to co-create a new identity for lives riven by the trauma of looking different from everyone else.

    Here he is, on a Wednesday afternoon in mid-August, looking squarely at a patient whose left eye was removed due to cancer. Geelong retiree Pamela Flatt, 68, sits on a high-backed ­dentist’s chair while her husband and daughter perch nearby. Flatt’s left eye socket is now covered by a skin graft and her disguise is a pair of thick-framed spectacles, with the left eye coloured solid white. In the near future she will no longer have a use for these glasses as a transformation led by Cadd is slowly taking place. Around the edge of her eye socket, screwed into bone, are three abutments made of pure titanium. Soon, a silicon-based ­prosthesis will be clipped into place with magnets.

    Flatt is a grandmother of six and a great-grandmother of three. Since her nine-hour operation to remove the cancer over a year ago, she has hardly locked herself away from the public eye: in fact, she has just returned from a trip to Thailand with a girlfriend, where she rode on an elephant. “Why not?” she reasons. “Life’s too short.”

    Despite her positive outlook, the metal implants have drawn attention. “Kids are looking at me like I’m an alien or something: ‘That lady’s got funny things in her head!’ ” she says. “They weren’t bothered until I had those things put in.” Nerve damage means that she can’t feel the ­titanium plate behind her skin, nor Cadd’s hands as he uses a small torque screwdriver to tighten the abutments. He then covers her eye socket with two layers of a rubber-like material for making a cast and lets it set on her face for a couple of minutes. Just like having a wax job, she quips.

    While she sits still and silent, Flatt’s daughter steps in to take a snapshot for posterity. “Someone usually takes a photo,” Cadd says, smiling. With care, he removes the cast, which will later be used for a custom-made mould that fits the exact contours of her eye socket. He excuses himself to retrieve from next door a beautifully hand-crafted eye prosthesis for a younger woman, complete with thick lashes, a realistic brown eye and dark eyeliner. It’s a work of art. “That’s what we’re aiming for,” Cadd says. “But we’re still about five visits off something like that.”

    The appointment concludes after an hour, but before Flatt heads back to Geelong she turns to Cadd and jokes: “I can’t be a one-eyed Cats ­supporter then, can I?”

    To read the full story, visit The Australian. Above photo credit: Julian Kingma.

  • Backchannel story: ‘Wikipedia Is Not Therapy!’, August 2016

    A feature story for Backchannel. Excerpt below.

    Wikipedia Is Not Therapy!

    How the online encyclopedia manages mental illness and suicide threats in its volunteer community.

    'Wikipedia Is Not Therapy!' by Andrew McMillen for Backchannel, August 2016. Illustration by Laurent Hrybyk

    One recent Tuesday night in the suburbs of Sydney, Elliott* was sitting in front of his home computer, editing Wikipedia and debating with a fellow volunteer who was continually undoing his hard work. He was devoting his weeknight hours to developing an article about Salim Mehajer, a former deputy mayor of a Sydney city council who had attracted national headlines for a variety of indiscretions, including shutting down a public street without authorization in order to film his own wedding. But as Elliott typed, his eyes intent on the screen, his mental state was deteriorating.

    Elliott, 37, knew the inner workings of the online encyclopedia better than just about anyone. Since his first edit in 2004, he had invented the popular ‘citation needed’ tag, used by editors to indicate when a statement requires more evidence. He had started the administrator’s noticeboard,where the site’s volunteer leadership could discuss inflammatory incidents. And he wrote ‘exploding whale,’ a quirky article that remains emblematic of the sparkling brilliance for which the crowdsourced encyclopedia is widely beloved. For the latter creation, which summarized how the Oregon Highway Division attached half a ton of dynamite to a beached sperm whale carcass in 1970, he was awarded Wikipedia’s first ‘oddball barnstar,’ and so another user pinned a bright green badge to his userpage to acknowledge his enterprising work.

    But on this particular night, his virtual achievements were far from his mind. With his wife and two young children occupied in another room, Elliott was locked in what’s known as an edit war, while using a different account than the one that had earned him his earlier plaudits. Elliott was convinced that his detailed account of Salim Mehajer’s traffic violations, including an occasion in 2012 when he ran over two women in his car, belonged on the site. His interlocutor, another Australian editor of prominent standing within the community, remained unconvinced. “I don’t like the guy either, but Wikipedia’s policies on undue weight, original research and biographies of living people don’t not apply because you don’t like someone,” the second editor wrote, mistaking Elliott’s industrious research for bias against Mehajer. On several occasions, this second editor had reverted these lengthy additions, before using one particular adjective to describe Elliott’s work: obsessive.

    Their bickering had been brewing for several days. The pair went back and forth in the article’s ‘talk’ page, which is linked in the top left corner of every entry on the site. Elliott argued passionately for his cause, and at one point logged out of his account to back up his own argument anonymously; these contributions were tagged with his IP address. Two days earlier, he had responded anonymously to another editor, writing, “I fart in your general direction, which is a hell of a lot more pleasant than editing Wikipedia, I can tell you!” After reviewing the conflict, a site administrator decided to ban Elliott on that Tuesday night. “Given the seriousness of this conduct, I’ve set the block duration to indefinite,” noted the admin.

    Elliott’s mind was on fire. Already short-fused from several months of unemployment and recent health and financial woes, he felt overwhelmed with stress. As he sat fuming in front of the screen, his wife approached and asked him to help put their children to bed. The request startled him, and he reacted with a flash of fury. Elliott immediately regretted his anger. Stunned and embarrassed, he grabbed his phone and keys, hopped into a white Hyundai, and sped off.

    After driving for a while, he parked outside a local school and switched off the engine. He pulled out his iPhone and started typing a lengthy email. Titled “The End” and sent to a public Wikipedia mailing list watched by thousands of people around the world, late on the evening of Tuesday, May 17, Elliott’s email begins, “I’ve just been blocked forever. I’ve been bullied, and I’m having suicidal thoughts.”

    More than 2,000 words later, after recounting the events surrounding his ban in the exhaustive manner of a man well-versed in defending his position to nitpicking online strangers, he wrote, “I know I’m not well. I have fought this feeling for a decade.” Elliott ended with this: “I sit here in my car and contemplate suicide. My despair is total. There is not a kind one amongst you.You have taken my right of appeal, my ability to protest and my dignity. You have let others mock me, and I have failed to contribute to Wikipedia’s great mission—one I feel so keenly. I failed. I’m not sure what I’m going to do next. I will drive, I don’t know where. I pray my family forgives me.”

    To read the full story, visit Backchannel. Above illustration by Laurent Hrybyk.

  • Matters Of Substance story: ‘The Snowball and the Avalanche: Medical Cannabis in Australia’, July 2016

    A feature story for the May 2016 issue of Matters Of Substance, the quarterly magazine published by the New Zealand Drug Foundation. Excerpt below.

    The Snowball and the Avalanche: Medical Cannabis in Australia

    Stories of personal suffering, where debilitating symptoms are eventually eased by medical cannabis, are appearing ever more frequently in the news. Andrew McMillen argues it is these sorts of stories that have engendered compassion in Australia, eroding the stigma around medical cannabis use and paving the way for science and more evidence- based legislation.

    Matters Of Substance story: 'The Snowball and the Avalanche: Medical Cannabis in Australia' by Andrew McMillen, July 2016

    The story of medical cannabis in Australia is much the same as in other countries around the world that have tiptoed this path before us. Here across the ditch, as in New Zealand, the United States and many other advanced economies, it is a situation where two strange bedfellows have been pitted against one another: stigma and science. For many years, because of their preconceived attitudes, staunch opponents of illicit drug use have remained wilfully blind to the benefits of medical cannabis experienced by sick people. Here, as elsewhere, this is not a campaign for the impatient. Change is slow, often painfully so, as it relies on a willingness for opponents to reconsider their positions in light of compelling evidence.

    In the last few years, though, the situation has appeared to change rather quickly and dramatically. The appropriate image is that of a single snowball rolling down a hill, gradually gaining mass and momentum until it forms an unstoppable avalanche. To this end, a raft of touching personal stories have been told in the national media. As a result, many state and federal politicians have sensed a shift in public sympathy towards sick people who are attempting to access medical cannabis without further complicating their lives by crossing paths with the criminal justice system.

    Support for plant-based medicine has gone mainstream, as evidenced by a July 2014 ReachTel poll that found that almost two-thirds of Australians believe cannabis should be made legal for medical purposes. It is telling that compassion is the driving emotion here, rather than fear – long-time advocates might well wish they had cottoned on to this tactic earlier.

    These personal stories don’t come more dramatic and heart-wrenching than Dan Haslam’s. In fact, his journey to accepting and using medical cannabis has become emblematic of changing attitudes to the drug across Australia. Dan was the snowball, and his descent down the hill began when he was diagnosed with terminal bowel cancer in February 2010 while living in the regional New South Wales (NSW) city of Tamworth. There, the then 20-year-old eventually discovered that the only treatment that soothed his nausea and stimulated his appetite while undergoing chemotherapy was cannabis. His parents wished there was another way. The fact that his father was head of the Tamworth Police Drug Squad made this desperate decision even more ethically and legally tortured than usual.

    To read the full story, visit Matters Of Substance.

    Further reading: my book Talking Smack: Honest Conversations About Drugs, published by University of Queensland Press in 2014.

  • Qweekend story: ‘School Of Hard Knocks: Lady Cilento Children’s Hospital School’, April 2016

    A feature story for Qweekend magazine, published in the April 9-10 issue. The full story appears below.

    School Of Hard Knocks

    Sick children need schooling too. At Lady Cilento Children’s Hospital School, learning proves positively infectious.

    Qweekend story: 'School Of Hard Knocks: Lady Cilento Children's Hospital School' by Andrew McMillen, April 2016

    ++

    In a light-filled corner room of a high-rise building overlooking inner-city Brisbane, a visiting local artist leads a class of six rowdy students. Aged between five and seven years old, they are tasked with creating artworks that illustrate their lives. A handful of the best drawings from this schoolwide project will be sent to China, where a school has a reciprocal arrangement. But it’s unlikely the Chinese students will be able to relate to the experience of these children – they are enrolled in a school very few families in Queensland choose to attend. This is the state’s only dedicated hospital school.

    Sam Cranstoun presents a cheerful front to the kids’ steady stream of questions and comments. The 28-year-old artist asks the four boys and two girls to use crayons to draw what they like to do. Camping, swimming, board games and PlayStation 4 rank highly, before one boy offers another option with a quizzical look. “School?” he asks, unsure of himself. He is testing the waters: is it cool to admit, at age seven, that you like school? “I’m sure your teacher will love hearing that!” says Sam, flashing a smile to the adults across the room. Gemma Rose-Holt, six, draws a swimming pool at the bottom of an enormous piece of paper, then a sun shining high in the sky. In the last couple of years, she has seen her father’s health rapidly decline for reasons she can’t quite fathom.

    Sam continues with the exercise by asking them to consider their place in the world. “Is China bigger than Gladstone?” asks one boy. They talk about their families and school. “Do you guys think about home?” asks the artist. “Yes!” they reply as one, before throwing their talents into happy drawings of the back yards and bedrooms they have left behind.

    “There’s an amazing view out the window,” says Sam, pointing behind the students. “Do you guys ever look out there?” At this, the six kids scamper to the windows, pressing their faces against the glass and pointing out the landmarks they can see from the eighth floor of the Lady Cilento Children’s Hospital in South Brisbane, which the Prep to Year 2 pupils are visiting for their art class. They can see Mount Coot-tha, the murky river, the Story Bridge in the distance. “I can see the cat-boat!” announces one boy, spying a blue, white and yellow ferry as it powers against the tide. “I can see bull sharks!” suggests another, prompting a laugh from the teaching staff. Not many schools have a helicopter pad on the roof, nor a giant pink bunny rabbit sculpture standing sentry near the entrance. Lady Cilento Children’s Hospital School (LCCHS) has both of these, and when its students are asked to sketch the school, these two features inevitably emerge on the page.

    For their final task, Sam turns these young minds toward imagining their future. “What do we want to be?” he asks them, prompting a flurry of ideas. Teacher? Doctor? Journalist? Soldier? McDonald’s worker? Power Ranger? “I don’t know what I’m going to be when I grow up,” says Gemma. She draws a nurse standing beside a bed-bound patient wearing a big smile. That’s her father, Damien. He has no hair because the medicine took it away. “The medicine’s yuck, but he has to have it,” she tells Sam. Little Gemma lives with her mother near the RNA Showgrounds, away from her Sunshine Coast home in accommodation subsidised by the Leukaemia Foundation, while Damien receives treatment.

    The students who attend this school are bound by a common experience of illness: either their parents’, their siblings’, or their own. They are from Emerald, Cairns, Chinchilla, Bundaberg and Hervey Bay; from every corner of the state. For some of them, it is their first visit to Brisbane, and the circumstances are less than ideal. Entire families are uprooted from their normal lives and relocated to temporary housing reserved for people in crisis. Their parents have got so much on their plates when they come here that sometimes the last thing on their mind is phoning a school, notifying a teacher about what might become an extended absence from their normal classroom. These tasks fade from view when the spectre of death suddenly appears in sharp focus. Into the breach rush 24 hospital school teaching staff, a compassionate, capable bunch of professionals adept at crafting an individualised education that will define these stricken children.

    The school’s impact is wide-ranging, and it sees a diverse population. In 2015, Lady Cilento hospital had 3159 registered students, more than two-thirds of whom normally attended state schools. Of that number, the largest cohort of 21 per cent (663 students) presented with medical conditions; 17 per cent (538) were there for oncology; 13 per cent (410) attended the school because a member of their family was ill, and nine per cent (284) were patients with the Child and Youth Mental Health Service –  which is also located on level eight at the hospital – while the remainder found their way there for reasons related to the likes of surgery, diabetes, rehabilitation and heart disease.

    More often than not, the hospital teachers’ efforts work wonders for the children and their families. During a midweek excursion to the Gallery of Modern Art at nearby South Bank, Mitchell Cawthray, 12, cautiously approaches a teacher watching over the group of about two dozen students as they eat lunch. He wears a black T-shirt that reads “The Force is Strong In This One”, reflecting an indelible truth of this blue-eyed boy’s tough character. His light brown hair is shaved close to his scalp, and when he turns his head, you can see the scar on the back of his neck where the life-threatening medulloblastoma tumour was removed from the top of his spine almost a year ago. “Are you having a good day so far?” asks the teacher cheerfully. “Great day,” Mitchell replies, nodding. He pauses, weighing his words carefully, then looks around to make sure none of his peers overhear his next words. With a shy smile, he says, “I’ve never really said this before, but I think I like school now!”

    ++

    Most children go through childhood without great complications, and without seeing the insides of healthcare waiting rooms for longer than it takes to receive an immunisation jab, to set an accidental bone fracture in plaster, or to go through the motions of a doctor’s check-up. Mitchell, Gemma and their peers are the unlucky few, and the LCCH treats Queensland’s sickest of the sick. All of the “first-world problems”, as Mitchell’s mum, Janine Cawthray, puts it, fade into irrelevance when your child is diagnosed with brain cancer.

    In Mitchell’s case, he and Janine relocated to Brisbane at Easter time last year for his treatment, while his father stayed home in Hervey Bay, managing their small business and caring for Mitchell’s sister as she completed Year 12. “I take my hat off to the teachers,” says Janine. “They not only have to deal with normal academic requirements as per the curriculum; they have to deal with a multitude of personalities – from parents, medical staff – as well as medical requirements and children’s individual needs. They also have to report back to the children’s mainstream school. They’re juggling all of that, and that’s a hard call, but they manage it very, very well.”

    In the middle of the building, on level eight, is a place where a familiar timetable reigns between the hours of 9am and 3pm each weekday. It is a place of whiteboards and colouring-in; of assigned readings and class discussions. It is a place of boring adult words such as literacy, numeracy, curriculum, assessment and “personal learning plans”. For some families, the hospital school quickly becomes the only constant in a life now marked by endless blood tests, chemotherapy and invasive surgery, and – sometimes – dramatically shortened horizons.

    None of these horrible things happen on level eight, however, where the LCCHS middle and senior classrooms serve an ever-changing cohort of students from Years 5 to 12. Nor do horrible things happen on the ground-floor junior school next door, on Stanley Street inside the old Mater Hospital building, where Prep to Year 4 students are taught. In young lives that have suddenly been dropped into seas of anxiety, pain and uncertainty, these two campuses emerge as towering islands of normality.

    There are no school bells here. No uniform, and no rules, per se, only three expectations: be safe, be respectful, and be responsible. Teachers are not known by stuffy honorifics; the students are on a first-name basis with their educators and support staff from the first day. Though visits to these islands of normality are usually short-term matters, these two school campuses can easily act as a home base for months on end, depending on circumstances.

    This unique style of teaching has its roots in doctor-soldiers and military nurses returning from World War I in 1918 and concerning themselves with the rehabilitation, retraining and education of limbless soldiers. From that point, it took only a short leap of logic to twig that children ensconced in hospitals required special schooling, too. The Sick Children’s Provisional School opened at the Hospital for Sick Children in the bayside suburb of Shorncliffe on August 11, 1919; it was the nation’s first such educational institution. Since then, it has been relocated several times. A purpose-built school at the Royal Children’s Hospital in Herston opened in 1978; in 2009, it celebrated 90 years of service to more than 60,000 pupils.

    Vicki Sykes was the longest-serving principal of Mater Hospital Special School in South Brisbane, which opened in 1983.  Appointed in 1986, she served 23 years before retiring in 2009; today, the junior school playground is dedicated in her name with a handsome plaque. In 1986, Sykes described her workplace. “Students come to school from the wards in pyjamas and wheelchairs,” she wrote in an unpublished memoir. “Some are on crutches or have their arms or legs bandaged. During the day some students may need to go off for operations or medical treatment. Teachers don’t know from day to day how many students will be coming to school.”

    In that sense, little has changed since the Lady Cilento Children’s Hospital School opened on December 1, 2014.  Its purpose is defined by Professor John Pearn in his 2009 history of Queensland’s hospital schools, To Teach The Sick. “Unrealised long-term educational potential has, in the past, been an under-acknowledged legacy of childhood illness,” wrote Pearn in the book’s introduction. “In the context of life’s fulfilment, such may be more serious than any medical after-effects.”

    ++

    The school’s average weekly enrolment is about 150 students, and the student-to-teacher ratio is about seven-to-one.  About half of the students are too ill to make it to either of the two campuses at Lady Cilento, so the teachers come to them, providing bedside tuition. They set daily assignments, and return regularly to check their progress. Depending on scheduling, these ward visits might only last 15 minutes if a teacher has a long list of inpatient appointments. But for the bed-bound students, they might also be the only minutes in a day where they are given a task and purpose that’s divorced from their unfortunate medical reality.

    When visiting a couple of beautiful sisters from Springfield Lakes who have been diagnosed with cystic fibrosis, a palpable sense of cabin fever permeates their immediate environment. Their world has shrunken to a cruel size. Little girls aged six and eight don’t belong in a small room separated by white curtains, behind a door that must remain closed at all times, and where visitors must wear gloves and gowns before entering to minimise the risk of transmitting infections.

    “Homework” is an imperfect word to describe the learning tasks set by these teachers, since the sisters’ entire lives are confined to this room. The hospital, for now, is both their home and classroom. Mid-lesson, a nurse enters to prick their fingers for a blood test. As the precious red liquid is squeezed from a tiny finger, the blonde girl calmly continues reading along to a picture book named Mr Gumpy’s Motor Car with her impromptu teacher, who leaves several worksheets for her to complete. She has long since been conditioned to something that would prompt tears from most other six year-olds.

    For these teachers, visiting inpatients on the wards requires a sense of persistence, positivity and optimism. Every day, these teachers see amazing and terrible things, such as degenerative neurological conditions that strip language and meaning from a young boy’s life with each passing week.

    From his bedside, it’s a short walk to visit a young girl in a wheelchair whose body hosts a flesh-eating viral infection that has left her face disfigured and her forearms resembling those of a burns victim, wrapped in plastic for her protection. Tourism is her passion, and so the ward teachers resolve to bring her homework that suits this interest.

    These teachers are not medical professionals. They cannot fix these problems or treat pain. They can, however, provide stimulation for young minds, if only for 15 minutes each day.

    ++

    After lunch on Thursday, the junior school students file into the flexi-room on level eight for school assembly.  Only Prep to Year 4 are in attendance, as the middle and senior grades are still on an all-day excursion to GoMA. Brianna Iszlaub, 11, with patchy tufts of blonde hair, couldn’t attend the latter as her blood count was down today. She stands beside a girl in a wheelchair as the two of them co-host the weekly event, beginning with an Acknowledgment of Country and an energetic, indigenous-flavoured rendition of the national anthem. “Thank you, please be seated,” says Brianna at its conclusion. School staff and a few parents are scattered around the edges of the dozens-strong group, while the students sit in chairs or on cushions.

    Once Brianna finishes reading from the prepared script, hospital school principal Michelle Bond says to her, “Good girl.” A short and energetic woman who radiates positivity, Michelle, 49, welcomes the younger students to stand up and present their handmade graphs based on a recent visit to a petting zoo downstairs. The principal – who led Royal Children’s Hospital School since April 24, 2006, and LCCHS since it opened – then presents a handful of awards: to an outstanding student who has shown consideration to his peers; to one who has overcome challenges; to one who has made a positive start after joining the school this week. The group sings happy birthday to a shy blonde girl. “Some of these kids would never be chosen to lead an assembly at their own school; they usually choose the school captains and the sporty kids,” Michelle tells Qweekend quietly. “I’ve had parents come and tell me that their child has never received an award before coming here. It’s lovely that we can do that for them.”

    The class’s guest for the day, University of Queensland PhD candidate Maddie Castles, cues a PowerPoint presentation loaded with photos from her recent visit to Namibia. The title slide shows a selfie of her grinning wildly into the camera while a giraffe munches on some leaves behind her. She tells the group about her job studying giraffe social interactions, or “who they’re friends with,” as she puts it. A teacher aide quietly brings a boy in a wheelchair into the room. He is barely conscious, his head held in place by brackets. As time passes, he shuts his eyes and dozes while his classmates leap up for a group photo with Maddie, who might be the first scientist they’ve ever met.

    Posted on the door inside Brianna’s Year 7/8 composite classroom is a photo of her before treatment. Her glorious, long locks are framed by a beaming face. The photo was taken when she first arrived at the school from Townsville in January, after being diagnosed with an aggressive lymphoma in late November. Her chemotherapy has stolen her hair and some of her energy. Sometimes she prefers to hide her changing scalp beneath a black beanie with devil horns. But none of this is discussed during school hours.

    Brianna’s teacher is Anna Bauer, 35, a bespectacled brunette with sparkling brown eyes who has worked in hospital schools for three years and now can’t imagine teaching anywhere else. “No one here will ask you a medical question,” she says of her classroom. “The kids are so tolerant … You can walk in with a nasal gastric tube and a drip tree, and that’s it. We might give the drip tree a name, like ‘Molly’, and then everybody gets on with what we’re doing. It’s what I wish the real world was like.” Working here sometimes demands that the adults develop coping strategies for their own emotional protection, too. “I have to believe that, when they walk out the door, they live happily ever after,” she says.

    In Anna’s current class, Brianna has cancer; the mother of a bubbly Bundaberg girl is being treated for leukaemia; and the fiercely intelligent girl who co-hosted assembly is temporarily in a wheelchair after two recent strokes. But the students she sees aren’t confined to physical illness. “I have so many kids with mental health issues who don’t look sick,” Anna says. “They walk around without baldness, or a nasal gastric tube, or a limp, or a drip tree. There’s no physical evidence, so there’s a real lack of recognition that there’s something wrong with your child. I’m not a parent yet, but oh my God – how awful must that be?”

    During Anna’s second week of teaching at the hospital, a student from the previous day didn’t arrive. When she asked a colleague about their sudden absence, she learnt they were being treated in the emergency department after attempting to end their life. “I took that quite badly,” says Anna quietly. That was when her happily-ever-after belief began to cement itself, as a self-protective measure.

    Some days are worse than others. “You’re on and lifting, all of the time,” says Anna. “But I find it quite humbling, and incredibly powerful, that it’s my job to make their lives feel normal. It can be sad sometimes, but most of the time, it is not; it is joyous, happy, friendly, loving and supportive. The children are sick, but I’m not a health worker. When I’m in here, and they’re so excited to see me, because I’m not a doctor or a nurse, there’s no time to be sad. You’ve got spelling and times tables to do, and we’re going to have fun while we do it.”

    Posted on the door inside Anna’s classroom, beneath the class photos of smiling children at eye level, is a laminated A4 page consisting of a paragraph of white text against a black background, framed by a pink border. I want a life that sizzles and pops, it begins. That first line popped into Anna’s head a little while ago, on a particularly bad day, when her class of six teenage girls were all in a low mood. “And I don’t want to get to the end, or tomorrow even, and realise that my life is a collection of Post-its and unwashed clothes, bad television and reports that no-one’s ever read,” it continues.

    The teacher was getting nothing out of them, that day, so she put the spelling lesson aside and assigned the girls a task: to write about what makes them feel better. Anna kicked them off with that first sentence, and encouraged them to fill the page. She did, too. “I want to see what I see through the lens of a camera and drink wine like it’s real grapes and wrap myself in warm towels that smell like my mum’s washing and dance to songs I don’t even like,” she wrote.

    The girls pasted the text into an online image editing program, fiddled with the design, printed the results and took them home to stick on their walls. These pages were intended to act as a reminder of all that is good in this world, especially on the blackest days. Anna stuck hers to the wall of a classroom where nobody will ask medical questions, in a building that none of the children particularly want to be in. Her paragraph concludes, “I want to wrap my hands around warm cups of tea with friends that will make me laugh so hard I wee a little bit, and I want every day to belly laugh with my people, glad and grateful, that I love the life I have.”

     

  • The Weekend Australian album reviews, December 2015

    I reviewed 15 albums for The Weekend Australian in 2015. Many of them were great, but the only five-star rating I awarded was to the below album, which was released in early August. The full review follows.

    HEALTH – DEATH MAGIC

    HEALTH - 'DEATH MAGIC' album cover, reviewed by Andrew McMillen in The Weekend Australian, 2015That this Los Angeles-based electronic pop quartet insists on capitalising all of its song and album titles speaks to the confronting nature of the music it creates. DEATH MAGIC is the group’s third album, and its best: a futuristic and immersive marriage of electronic beats and pop sensibilities. Its style on previous records was rooted in the abrasive repetition of noise rock, and while that scaffolding remains in place, HEALTH has spent the six years since its last album, GET COLOR, perfecting an aesthetic which is entirely its own.

    Since 2009, the quartet has composed an eerie, atmospheric score for a popular video game, Max Payne 3, and according to an interview published on Pitchfork in April, they “made this record like four times”. The rewrites were well worth it.

    This is among the most vital and exciting albums to be released in any genre in any year. It is a masterpiece of staggering depth and immediacy. Each track pulses with energy and the optimism of youth, yet its overarching lyrical theme is an obsession with the end of life: “We die / So what?” sings guitarist Jake Duzsik on fourth track ‘FLESH WORLD (UK)’. “We’re here / Let go,” he intones atop an insistent backbeat and snippets of warped, metallic squalls.

    Wedged among the unrelenting darkness are two anomalously poppy tracks, ‘DARK ENOUGH’ and ‘LIFE’, which appear back-to-back in the middle of the set list. “Does it make a difference if it’s real / As long as I still say ‘I love you’?” sings Duzsik on the former track, while on the latter he reflects, “Life is strange / We die, and we don’t know why”.

    For a bunch of guys in their early 30s, this preoccupation with death is curious, but as fuel for their art, clearly it has been a boon. The mood that surrounds these themes is far more ebullient than funereal. In acknowledging its mortality rather than denying it, HEALTH seems to have replaced existential anxiety with self-confidence. First single ‘NEW COKE’ is the album’s darkest arrangement, wherein Duzsik’s ethereal vocals state a mantra (“Life is good”) that’s offset by waves of engrossing electronic distortion, like a plane crashing in slow motion. In the middle of the track, there are a couple of brief moments of silence, before the diabolical noise returns anew.

    Stylistic decisions such as these are perhaps influenced by the notion of “the drop” in electronic dance music: compulsive snatches of anticipated euphoria which spur the mind and body into action. DEATH MAGIC is a tough album to categorise: half pop, half electronica and wholly immersive, it is the sound of four singular musicians mining a rich, untapped vein of material. Defiantly, proudly, this band sounds like no other in existence. What HEALTH has come up with here is a towering achievement best played very, very loud.

    I also reviewed the below albums for The Weekend Australian in 2015. They are listed in chronological order, with the publication date and my rating noted in brackets.

     

  • The Vine feature: ‘A Guide To Cannabis Law In Australia’, December 2012

    A feature for The Vine. Excerpt below.

    A Guide To Cannabis Law In Australia

    “Marijuana Use Most Rampant in Australia,” read a New York Times headline in January 2012. Cannabis – marijuana, weed, pot, hash; whichever other name you prefer – remains the most widely used illicit substance in Australia today by a big margin. Approximately 1.9 million Australians aged 14 years and over have used cannabis at least once during the past year; more than a quarter of a million smoke cannabis every day, according to data compiled by the National Cannabis Prevention and Information Centre (NCPIC). Keep in mind, too, that these figures were taken as part of the 2010 National Drug Strategy Household Survey; plenty more users were either unaccounted for, or chose to lie about their drug usage, so the true figures are probably even higher. This reality can be viewed one of two ways, depending on your personal politics.

    Either: it’s great that so many Australians enjoy the occasional puff, as its illegality is an arbitrary hangover from conservative generations past, and its negative effects are significantly less serious than those incurred by alcohol abuse or tobacco addiction.

    Or: it’s outrageous that so many Australians smoke up, as cannabis is a devil weed whose availability should be pushed further underground lest its psychological and subversive effects further corrupt otherwise sensible citizens.

    Illicit drug use is not a topic that attracts moderate views. Weaned on the powerful moralising of media sensationalism, political cowardice, and harsh words from the police force, many Australians are raised to believe that drugs are bad; the province of losers and law-breakers.

    Progressive views are slowly prevailing across the Western world, though, as many realise that the Nixon-led ‘war on drugs’ – which celebrated its 40th anniversary in 2011 – did very little to break the cycle of power, violence and addiction that has forever plagued illicit drug culture. (For a succinct primer on the topic, my brother Stuart McMillen recently published a 40-page comic, ‘War On Drugs’, which outlines why drug prohibition hasn’t worked.)

    Immediately following the 2012 Presidential Election results in November, cannabis users worldwide rejoiced at the surprising news that two states in the war-on-drugs heartland, Colorado and Washington, had voted to legalise recreational use under state law. Colorado users will be able to grow up to six plants; in Washington, users will buy from state-licensed providers, and the sale of cannabis will be taxed and regulated, much the same as alcohol and tobacco already is. If you’re over 21, the drug will be legal to sell, smoke and carry – as long as you don’t drive while high.

    Australian pot smokers wondered whether they might see a similar decision – if not soon, then at least in their lifetimes. TheVine snooped around on your behalf, with a view to determine Australia’s current cannabis laws on a state-by-state basis and look to its future legal status.

    Dr Alex Wodak, president of the Australian Drug Law Reform Foundation, points out that Australian states don’t have ballot initiatives like the one that led to the recent weed votes; in fact, most US states don’t. “Australia will not see ballot initiatives on taxing and regulating cannabis like Colorado and Washington states,” Wodak tells TheVine. “Our cannabis reforms started in the 1980s in South Australia. We have had two decades of creeping liberalisation of our cannabis laws at the state/territory level. I think this process will accelerate now, but that it will still take a couple of decades before Australia taxes and regulates cannabis in all states and territories.”

    Legal weed in Australia? “It’s now inevitable,” continues Wodak. “There are so many contradictions and issues undermining cannabis prohibition. Sooner or later, the bosses of one or the other major [political] parties will realise that it is in their interest to get there first. But all social policy reform is slow.”

    To illustrate, Wodak points out that 2012 is the 40th anniversary of South Australia becoming the first state to begin reducing the emphasis on the criminal law in relation to homosexuality. Jailing someone on the basis of the sexuality is a social policy that looks completely abhorrent and archaic nowadays. “I might be wrong,” he says, “but I think taxing and regulating cannabis will be slow to happen in Australia, and we will first go through many stages of watering down our criminal laws.”

    So what is the current state of Australia’s cannabis possession laws? The answers might surprise you. As The New York Times put it earlier in 2012: “The prevalence of marijuana use in Australia is widely accepted, if not openly condoned, and at least three states have moved to decriminalise the possession of small quantities for personal use.”

    For the full story, visit The Vine.

  • GQ Australia story: ‘Shock To The System: Electroconvulsive therapy’, March 2012

    My first story for GQ Australia magazine: a 4,200 word feature about the psychiatric treatment electroconvulsive therapy, otherwise known as ECT or ‘electroshock’. This story appeared in the Feb-March 2012 issue of GQ.

    Click the below image to read the story in PDF form (link will open in a new window), or scroll down to read the article text underneath.

    Shock To The System

    Electroconvulsive therapy has long been the stuff of cinematic nightmares. But after nearly four decades since One Flew Over The Cuckoo’s Nest, many are arguing it does much more good than harm.

    Words: Andrew McMillen

    As the young man is led into the operating theatre, the smell of salt water and sterilisation fluid hangs in the air. The room is unremarkable; all greys, blues and whites, just like any other theatre in hospitals across the country, except for a couple of innocuous-looking machines stacked on a bench. Twenty-five-year-old John Vincent doesn’t know it yet, but those machines would soon change his life.

    Helped onto a gurney, Vincent lies flat on his back as a clamp is placed on his index finger to monitor his oxygen levels. He feels the cold wipe of saline solution on his collarbone, biceps and forehead, before a nurse applies several electroencephalography (EEG) electrodes to trace his brainwave activities. Moments later, a general anaesthetic makes its way up his arm, and he drifts out of consciousness.

    Having been sedated, he doesn’t remember what happened next, but it goes like this. A specialist affixes an electrode to the middle of his forehead, and another one above his left temple, then switches on the Thymatrons – those machines in the corner – sending a series of short electric shocks coursing through his brain, bringing on a grand mal seizure. Fifteen seconds later, it’s all over. The current is switched off, the electrodes removed, and Vincent is wheeled into an adjacent recovery room.

    It might sound like a scene from a ’70s movie, from the days of roguishly experimental medical procedures, but this was Boxing Day 2010, and Vincent had just received his first course of electroconvulsive therapy (ECT) at Toowong Private Hospital in Brisbane. A psychiatric treatment most commonly used on those with severe depression, ECT – better known by its outdated term, electroshock – is also called upon to treat patients suffering from acute mania or, in Vincent’s case, bipolar disorder. And despite the popular public perception of ECT as a barbaric, archaic practice, the treatment is administered on a daily basis at both public and private hospitals all over Australia.

    Growing up, Vincent was a happy kid. He had lots of friends, enjoyed playing soccer, and loved going fishing with his younger brother while on regular camping holidays with the family. Then, aged 17, in his final year of high school, Vincent was diagnosed with bipolar disorder.

    As he got older, his mental illness became harder to manage. “John was existing, but he wasn’t happy,” recalls his mother, Tina, a kind woman in her early fifties with a fair complexion and green eyes who runs a small business alongside her husband. “He wasn’t right, and at some stage he decided to go off his medication. Unfortunately, with his type of bipolar – type one – when he goes off medication, he goes into a state of catatonia. Everything shuts down; no communication, nothing happens.”

    Things worsened as the years passed, and by late 2010, Vincent was living a life of isolation in Townsville, north Queensland. He’d withdrawn from the people around him: friends, family, even the younger brother he lived with. “You know those wildlife documentaries on TV, where they record the animals’ every move, behaviours and moods, and all that?” he asks, his hazel eyes burning with intensity. “I felt like I was an animal; like I was being surveyed.”

    This was a dark time for Vincent, who says he spent a lot of time in his room “trying to hide away”. He constantly felt as though there was someone outside looking through the windows at him, recording his behaviour.

    One Friday in December, his parents went to Mackay for their first trip away together in a year. The next morning, Tina and her husband received a call from their youngest son. “He didn’t think John was all that well,” she says. “We jumped on the first plane and came home. We spent all Saturday with John. He continued to decline into a catatonic state; not eating, not talking. It was almost like he was in a coma.”

    By 5pm, Vincent’s movements had become “robot-like”, with his body barely responding to the signals sent by his brain, and the famil rushed him to the emergency ward at Townsville General Hospital, before he was transferred to the mental health hospital. “It’s pretty sad, because there just aren’t enough facilities,” says Tina, remembering how they how desperate they were for a solution to their son’s illness. “We turned to friends in the medical profession, who gave us a great deal of support and help.”

    A man named Dr Josh Geffen was mentioned, who specialised in ECT at Toowong Private Hospital. Vincent had never heard of ECT before his parents brought it up, but since he was in such a low mental state at the time, he didn’t argue. “I just went with it,” he shrugs. “I cooperated, and followed my parents’ advice. I did what I was told.”

    He hardly remembers a thing about the journey. His mother continues: “We got John down to Brisbane straightaway, and when Dr Geffen saw the state John was in, the first thing he recommended was ECT,” she says. “We were pretty horrified; we’d heard stories from the olden days of ‘shock treatment’ and that sort of stuff. We hadn’t really given ECT a lot of thought. It’s a little bit frightening, because you really don’t know what’s involved. But Dr Geffen explained everything to us, showed us a DVD, and put our minds at ease. We consented to John having the ECT, and he agreed to it, too.”

    They got to work immediately. Doctors warned Vincent that the muscles in his arms, legs and shoulders might feel sore once he came to, after receiving the electric shocks. And indeed, he did feel uncomfortable for a couple of hours – he likens the muscle soreness to the day after a big gym workout – but says, “Afterwards, I felt fine. It took a while for the anaesthetic to wear off, but after that I was OK.”

    Vincent’s story is more common than you might think. Statistics from the Australian Institute of Health and Welfare show that in the 2009-2010 financial year, 26,848 individual ECT sessions were administered throughout Australia – although the exact number of people treated is unclear, as patients tend to have multiple sessions. “A typical course of ECT involves between six and 12 treatments,” explains Dr Aaron Groves, the director of mental health in Queensland, adding that, while ECT can be used on people of all ages, since depression is more common in adults than in children, around 80 per cent of treatments are on patients aged 30 to 80.

    Based on those figures, on any given day here in Australia, 73 people get hooked up to a machine and jolted with electricity in the name of medicine. What’s more, far from being a curiosity from the past that hasn’t quite died out, it’s actually on the rise. Why? Well, because it works.

    ++

    Electroconvulsive therapy has its roots in early schizophrenia research. In 1934, Hungarian neuropsychiatrist Ladislas Meduna saw improvements in schizophrenic patients after seizures were induced with chemicals such as camphor and Metrazol. Three years later, Italian neuropsychiatrists Ugo Cerletti and Lucio Bini discovered that these seizures could be more easily induced by electricity. In a TED.com presentation uploaded in October 2007, an American surgeon and author named Dr Sherwin Nuland relayed an eyewitness account of the first time ECT was performed on a human in 1937.

    “They thought, ‘Well, we’ll try 55 volts, two-tenths of a second. That’s not going to do anything terrible to him.’ So they did that… This fellow – remember, he wasn’t even put to sleep – after this major grand mal convulsion, sat right up, looked at these three fellows and said, ‘What the fuck are you assholes trying to do?’ Well, they were happy as could be, because he hadn’t said a rational word in the weeks of observation. They plugged him in again, and this time they used 110 volts for half a second, and to their amazement, after it was over, he began speaking like he was perfectly well.”

    “It eventually became apparent that it was a much better treatment for depression than schizophrenia,” says Dr Jacinta Powell, clinical director of mental health at the Prince Charles Hospital in Brisbane. “This is how these things develop: psychiatrists make leaps of logic, they try them out, and see whether it works.”

    What they hope for with any treatment is remission. So, how does ECT stack up against other methods of treating depression?

    According to statistics presented in May 2011 at the American Psychiatric Association Conference in Hawaii, 34 per cent of ECT patients were in remission after two weeks of treatment. Four weeks later, that had risen to 65 per cent; and after a full course of ECT, that figure reached a 75 per cent remission rate. Those success rates aren’t just good; they’re remarkable.

    So, why are we still so scared? Perhaps Dr Geffen [pictured right] – the man who treated John Vincent – would have some answers. A stocky, silver-haired man in a dark suit, he leads me into the theatre where John was first treated on Boxing Day. He drags in a couple of chairs from the waiting room, which is adorned with intricate paintings of wildflowers and a poster entitled ‘Understanding Depression’. We sit in the middle of the theatre and begin talking ECT. “Intuitively, it does seem like a worrying thing to do,” he admits, “to pass a dose of electricity through somebody’s brain in order to treat them.”

    And he’s right. A seizure-inducing electrical current sent through the brain, where all our memories, emotions, likes, dislikes, fears and secrets are stored; where our very personality is kept? The mind recoils in horror at the thought alone.

    That’s partly because, for the majority of us, who haven’t had any first-hand experience of ECT, our knowledge is mostly based on what we’ve seen in movies. Take One Flew Over the Cuckoo’s Nest – the 1975 Miloš Forman adaption of Ken Kesey’s 1962 novel.

    You’ll remember the scene when the main character, Patrick McMurphy, played by Jack Nicholson, is judged to be so disruptive to the daily routine of his fellow psychiatric ward patients that doctors see no alternative but to treat him with ECT.

    McMurphy is led to a bed, his hairline coated with a conductive gel and a piece of leather placed between his teeth. Electrodes are applied to each temple, and his brain is exposed to a current of electricity. There’s no anaesthetic, nor is the patient forewarned of what’s about to happen. McMurphy appears to be in severe pain, with several men restraining his wildly convulsing body. It’s unclear whether McMurphy’s treatment is an attempt to ‘fix’ him psychologically, or simply to punish him for being a trouble-maker, but it was a very convincing performance that won Nicholson an Oscar, a Golden Globe, and a BAFTA for Best Actor.

    “It’s a great movie. I love Jack Nicholson; he’s fantastic,” says Dr Geffen, with a grin. “It’s also nothing like modern ECT. It was set during a time when anaesthesia was already involved, so a bit of creative licence has cost us quite a lot of bad press.” He continues with his list of ways the film misrepresents modern ECT. “No treatment electrodes are placed on people until they’re asleep, because it’s not a very pleasant feeling if you’re coming in for your first treatment,” he says. “It’s much kinder for the person who’s anxious about what’s going on.”

    It’s also worth noting that the vast majority of treatments do not induce enormous, full-body convulsions like the reaction portrayed by Nicholson. In most cases, the only physical sign of the electrical current is a slight twitching of the patients’ fingers and toes.

    At the Prince Charles Hospital, Dr Powell shows me a segment from the 1990s-era television program Good Medicine, in which a greying man in his mid-forties is treated with ECT. The footage of his treatment is so incredibly mundane and unremarkable that I can’t help wondering what all the fuss and controversy is about. Particularly given the guidelines adopted by the Royal Australian and New Zealand College of Psychiatrists in 1982, which note that it’s “among the least risky of medical procedures carried out under general anaesthesia, and substantially less risky than childbirth.”

    “It’s a very effective treatment for very ill people,” agrees Geffen. “It’s more likely to get you into remission than any other treatment.” Success rates with medication when used as a first-line therapy are only 30 per cent, he says. After a year of trying different strategies, this may rise to around 60 per cent in a best-case scenario.

    And what about therapy for depression – you know, the kind where you lay on a couch and talk things through?

    “The type of depression we see here, people are too sick to be having much talking therapy. Not that talking’s unimportant, but that’s part of the post-recovery.”

    Yet somehow, even though lying on the therapist’s couch isn’t the right thing, and months of antidepressants aren’t very effective, people are instinctively more keen to stick to those methods than to volunteer to be subjected to a series of electric shocks.

    “A few things soften that,” says Geffen, ever the salesman. “The dose of electricity is quite small; 0.8 to 1 amp. I was treating an electrician, and I asked him, ‘How can I explain it to people?’ He said, ‘Well, it’s about 10 per cent of what a toaster puts out.’ Now I always tell people, ‘Don’t stick forks in toasters, please!'”

    Geffen breaks into a wide smile and continues, “Another way to put it is that the current is enough to light up a 25 watt bulb for about one second. Once or twice in the process, I’ll pass the electricity across my hand, and feel a little jolt. But it doesn’t throw me to the ground.”

    And of course, ECT isn’t the only instance of doctors using electricity to reset an organ that’s not operating properly; cardioversion, for example, applies the same theory to correct a malunctioning heart. “I do wonder, sometimes, why the person who cardioversed Tony Blair is the ‘cardiologist hero’,” Geffen says, “but I can be painted as a ghoul for trying to treat people’s depression.”

    ++

    Part of our reluctance to embrace ECT, though, may well be because, despite years of research, it’s still a bit of a mystery. We know it works best when used to treat severe depression, but when it comes down to it, we don’t really know why. “At one level, that’s true,” agrees Geffen. “We don’t fully understand all of the mechanisms of its action. However, that’s true of many treatments in medicine. We do know how damaging severe depression is to people’s brains and their lives. At another level, we’re understanding a lot more about how it works, as well as the key chemicals involved in depression: serotonin, adrenaline, dopamine, and this – being a powerful treatment – influences all of them. Most antidepressants work on one, or – at most – two of those. ECT is a potent stimulus for brain cell growth.”

    His sentiments are echoed by Dr Daniel Varghese, a Brisbane-based psychiatrist in both the private and public health fields. “I think it’s true to say we don’t really know why or how it works,” Dr Varghese says.

    “But then again, we don’t know why or how people get severe mental illness either, because the brain is clearly an inherently complex thing. That’s something that psychiatrists and people with mental illness have to deal with in a range of illnesses: we don’t really know why, but we do know some strategies and treatments that we’ve found to be helpful.”

    ++

    Of course, it’s important to make it clear that ECT is not a catch-all miracle cure for depression, and some of the fears surrounding its usage are real. It certainly has its fair share of detractors.

    On a chilly morning in the Brisbane suburb of Highgate Hill, I meet with Brenda McLaren, a spritely woman who loves to talk. Her face is riddled with deep wrinkles, which make her appear far older than her 57 years. Her memory is shot, however, and she has prepared notes in an A5 notebook ahead of my visit. Her relationship with ECT has not been an altogether pleasant one. She was first treated in 1988, as a severely depressed 34-year-old. At first she consented, as she wanted to get better and believed that the doctors at Prince Charles Hospital were acting in her best interests. Over 20 years later, she’s not so sure.

    Brenda smokes a cigarette on the sun-soaked front balcony of the Brook Red Community Centre where she works as a peer support worker, and reads her handwritten notes. In 1988, her youngest son was six. “I can’t remember him between the ages of six to 15,” she says. “In some ways, [ECT] must cause some sort of brain injury for that to occur. He talks to me about things, and I honestly don’t remember.”

    “My other children would come up to visit me at that time,” she says, “and I wouldn’t know who they were. This would happen quite regularly after ECT. This made them hate the whole system, which is still a big thing with them. It created relationship problems within the family. I’m not saying there weren’t already problems, but it didn’t help. Because… how can a mother forget her children?”

    She looks up with sadness in her eyes, and it’s clear the memory loss still hits her hard. “It made me feel very guilty. When you really think about it, in some ways you lose your identity,” she says. “You lose who you are.”

    “I would be the most forgetful person here,” she says of her peers at the Centre, which supports people living with mental illness. “I put things down constantly, and never know where they are. I lose things. I believe it’s affected that part of the brain that makes you remember things, long-term. I find it hard to retain information. I find it hard to bring information out. That’s why I’m reading this.” She points at her notebook.

    McLaren says she received “dozens” of courses of ECT in her life, the last of which took place around 13 years ago. “I know they do it as humanely as possible,” she says, “but I think it’s barbaric, and in some ways, it’s a form of torture. If I was told I needed ECT today, they would have to take me screaming. Because I will never sign to have ECT again. Ever.”

    ++

    In an adjoining room to the ECT theatre at Toowong Private Hospital, Dr Geffen and his colleagues have written some literary quotes on a whiteboard to keep them focused on the job at hand. “Diseases desperate grown by desperate appliance are relieved, or not at all” – William Shakespeare. “Diseases of the mind impair the bodily powers” – Ovid. “When you treat a disease, first treat the mind” – Chen Jen.

    I tell Brenda McLaren’s story to Geffen, interested to hear his thoughts. “I feel sorry for her,” he says, after listening carefully. “I believe her when she says that ECT has damaged her memory, and that this affects her sense of identity. Recurrent ECT of this nature is a difficult scenario; if she was severely suicidal or malnourished from depression it may have saved her life, although obviously at some cost.”

    What Brenda described is, he says, a mixture of the common side effect of peri-treatment amnesia – loss of memory of the period around treatment – as well as the rarer retrograde amnesia, which is the loss of memory for “weeks, months, even years” before being treated. “With modern techniques, the peri-treatment amnesia is less severe and retrograde amnesia is even rarer,” he says.

    That’s partly thanks to the more recent side-lining of a variation of the treatment, called bitemporal ECT, in which an electrode is placed above each temple (as seen in One Flew Over the Cuckoo’s Nest). ECT guidelines note that “bitemporal ECT is associated with greater cognitive impairment, but these effects vary from patient to patient. Any memory impairment is usually resolved by 4-6 weeks following ECT, but a number of patients report persistent difficulty with retrograde memory.” The other, now more popular, method is unilateral ECT, where one electrode goes above the temple on the non-dominant side of the brain, while the other sits in the middle of the forehead.

    We return to Brenda McLaren’s experiences. “The issue of difficulty learning new information some 13 years later is more problematic,” says Dr Geffen. “It’s not generally described in the literature, and may be contributed to by age, depression, and the impact of lifestyle factors like smoking. But,” he admits, “it is hard to rule out ECT as a factor.”

    Geffen has been immersed in this world of ECT for more than 15 years. “We start at 6.30am every Monday, Wednesday and Friday, and we’re done by 9am; 10am if we’ve got a long list,” he says. “It’s generally done in the morning; it’s a lot kinder to do it then, as our patients fast from midnight.”

    As he said earlier, it’s a treatment for the very ill, and here in this room, Geffen only sees those closest to the brink. I wonder whether the constant exposure to the severely depressed takes a mental toll on him. “When you see patients who are distressed coming in, or patients who have a really good response, you take that home with you and think about it a little bit,” he says, and then smiles. “My wife works in mental health, so it allows for a bit of pillow talk. She’s very familiar with all of this.”

    What does he say when asked what he does for a living? “I talk quite openly and freely to my children about what my job is, and explain to them about this,” he says, gesturing at his workspace, with a hint of pride. “Although it’s a stigmatised area, there’s nothing terrible that we do here. We help people who haven’t done anything wrong; they have a brain illness. In that sense, in my social life, I do carry on that view that you can de-stigmatise this.”

    ++

    John Vincent isn’t sure whether he received eight or nine treatments of ECT in total, as he, too, experienced peri-treatment amnesia. “I can’t remember a lot of things that happened when we were back at school,” he says with a shrug. “Birthdays, big events, I can’t remember so much. Things close to me I still remember, though.” Childhood camping and fishing trips, for example, take a while to recall, but his foggy mind does eventually reach back to find the details.

    It can be difficult, but he’s philosophical. “I’d rather feel happy, and more myself, than have memories,” he says with a tone of finality. “My health is worth more than having memories.”

    Vincent says his course of ECT made him feel more lively. “I’m not so anxious anymore. I’m not short-fused or jumpy. Now I feel more cooperative; I get along a lot more with people.” Not that ECT was a quick fix. “It was a gradual recovery. It wasn’t as though, when I got out, I was right as rain again. It took a while to slowly get to that stage where I felt comfortable.”

    His parents stayed at John’s bedside for 12 hours a day through his month-long stay at Toowong Private Hospital. His mother remembers that, within 24 hours of John receiving his first treatment of ECT, she and her husband could see a “definite improvement”.

    “John’s had very good results with it. It’s been really quite incredible,” she says. “It’s almost like having a flat battery in a car. You put the jumper leads on and give it a bit of a boost, and it comes back again.”

    She doesn’t really understand how it works, and she doesn’t care: she’s just glad to have her eldest son back again. It’s been two months since his last treatment. “He’s on track, and everything is going well. Geffen says, ‘If you go for three months and you don’t need any more ECT, and the drugs are keeping you level, everything’s good,'” Tina says.

    “We had no knowledge about ECT until John went into this meltdown and went into hospital,” she continues. “I think the more people talk about it, the better it’ll be. The more I can tell people, and the more open you are about it, the more it will become accepted.”

    As for Vincent, now that things are on the up, he’s looking forward to returning to work at his parents’ small business in Townsville. He’d like to settle down with a girl and he can see himself – one day – getting married and having kids, “but they’re a while away yet,” he says with a grin. Vincent isn’t sure what career path he’ll take – something to do with machinery, perhaps, as he’s always had an interest in that area – but he knows that, thanks to ECT, he’s in a better mental state to confront the future than ever before.

    *Names have been changed.

    Note: due to an error in the production process, a photograph of Dr Josh Geffen’s father, Laurence, appeared in the original article, rather than Josh himself. This error has been corrected in this blog entry.

    For more on electroconvulsive therapy, visit Wikipedia. If you are feeling depressed or suicidal, please contact Lifeline on 13 11 14, which is available 24 hours a day.