All posts tagged medicine

  • 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.

  • 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.

  • Backchannel story: ‘The Heroin Heroine of Reddit’, July 2015

    A story for Backchannel, the technology section of Medium.com. Excerpt below.

    The Heroin Heroine of Reddit

    How a former addict uses the internet to save drug users’ lives

    'The Heroin Heroine of Reddit' by Andrew McMillen on Backchannel, July 2015

    On a quiet night in late April, Brad Treseler slipped off to his bedroom at his family’s home in Cumberland, Virginia. His friends kept on chatting in the living room, but after a few minutes they began to wonder what Brad was up to. They found the 25-year-old slumped on the floor of his room, blue and unresponsive. He had overdosed on heroin and benzodiazepine.

    Brad’s friends cycled through the options. They could call 911, but the responders might not arrive in time and might tip off the police. Or they could run to the apartment next door and wake Treseler’s older brother, Bill. They knew that Bill had a small vial containing a clear liquid called naloxone, which can counteract the effects of an opiate overdose. In a panic, they opted to make the short sprint and bang on Bill’s door.

    Together, they carried Brad into the bathtub and cranked on the shower. Bill dipped a syringe into the vial and drew in the naloxone, then injected the the liquid into the fatty part of Brad’s thigh. Nothing happened, so Bill refilled the syringe and injected him again. Brad stirred, and opened his eyes to see his brother and terrified friends peering down at him. As he came to, he thought: This is what being dead is like.

    Brad had acquired two vials of the naloxone months earlier. Some states—including New Mexico, Washington, New York, Rhode Island, Vermont and California—allow it to be sold over the counter. But it is illegal in Virginia, so Brad received his shipment in the mail from an unlikely source: the online forum Reddit.

    Brad is an active member of the Opiates subreddit, a lively forum where queries about safe injection practices and rehabilitation are posted alongside tactics for hustling cash and coping with constipation, an unwelcome side effect of frequent opioid use. He saw a thread where a moderator known as the “mother of r/opiates,” named Tracey Helton, was offering to send clean needles to fellow Redditors. When he reached out to Tracey about the free needles, which were rare in his scene, she told him that the package included naloxone. Brad replied, “Oh man, that’s awesome! That’s a great idea!”

    Five days later, a yellow padded envelope arrived from San Francisco, where Tracey lives. Inside was a bag of clean syringes, two vials of naloxone and a post-it note with a hand-drawn smiley face. “I thought, ‘Holy crap!’ I didn’t send her any money. All I did was send her one little message,” Brad says. “Somebody out there cares that much.”

    To read the full story, visit Backchannel.