Recently while visiting Melbourne, we dropped into a milk bar near our hotel to buy The Saturday Age. The other customer in the shop — an old-looking man with wild, grey hair and sun-coarsened features — was asking something of the woman behind the counter. I couldn't hear what the request was, but her answer to it was an emphatic 'No!'
The man thumped his hands on the sides of his Vinnie's suit pants and, screaming a string of expletives and racist slurs, he pushed past me and out of the shop. My 14-year-old daughter, shocked more by the intensity than the content of his outburst, had shuffled behind me as he was leaving. 'What was that about?' she asked, his ranting still audible through the front window.
My wife put her hand on my shoulder. 'Welcome home', she said to me with a smile. In the 1980s we had both trained at the inner-city hospital around the corner where this sort of interaction was a daily part of our life. Here was a survivor of a population that had been forced to move elsewhere by the invasion of middle class people like us.
My daughter, though, was having trouble disguising the fact that she could smell something awful. It was the pungent odour of the down-and-outer and its ability to linger after its source had moved on, that sent me back in time.
A large proportion of our patients were homeless men and women, mainly alcoholic. A few of them were 'characters' who were good fun to interact with. But most were very sad or very mad and essentially unreachable. They would turn up in the Casualty department throughout the day and night and I would sew up their lacerations, bandage sprained limbs, plaster broken ones and, on occasion, get them ready for neurosurgery to remove a clot from around the brain. I became proficient in the management of end-stage liver disease. It was not until I was rotated to another hospital that I learnt that alcohol-related problems were actually a little exotic in the mainstream medical world.
The homeless were usually brought to the hospital after they had been found in trouble by the police or by the ambulance. They rarely wanted the help we gave nor offered any thanks when it was provided. Their inability to look after themselves was often interpreted by the doctors and nurses as a conscious refusal to do so. The myth that 'personal responsibility' was a panacea ruled in some medical minds, and this belief legitimated their contempt for these patients.
Regardless of their sex, race or poison, one thing was always the same. The rank combination of urine, tobacco and the grime from cobblestones made them smell like a public urinal. So they were called 'dunnies'. If you asked a colleague what the preceding night shift had been like, the response might be, 'Not too bad, just an infarct and a couple of dunnies'.
I heard the term the moment I arrived as a student in 1980 and it seemed to be peculiar to our hospital. It was used by most of the resident staff but I never heard any of the consultants use it. In the beginning I thought that the word was harmless and I probably used it myself a few times.
One day I witnessed a registrar being spoken to by one of the nuns. 'I never want to hear you speak of any of our patients in that way', she said in a quiet voice. There was never any dissent when a nun spoke. A reprimand of this nature was uncommon but devastating. Such public admonitions pushed the word further underground but it did not disappear.
What drives those who have chosen a career that is supposed to be about caring to demean some of the recipients of that care? Every medical culture does it — The House of God, a 1970s novel about a Boston intern, popularised the term 'gomer', short for 'Get Out of My Emergency Room', which described a similar group of hapless and/or obnoxious patients.
But ours was worse: we were not just saying you smell like a toilet (because that was true) but that you are a toilet. The paradox was that our hospital really did reach out to the homeless and prided itself on its equity of access. Other hospitals would probably have been far less tolerant.
What we call people, regardless of our underlying motivation, can determine the way we treat them. Today most of the intolerance that I observe in medical staff is directed at patients who inject drugs: most hold quietly intolerant opinions, and the publicly proffered attitude of some senior colleagues would make you question their right to hold the title 'doctor'.
The injecting drug user is sometimes a 'junkie' or 'addict' but it is the behaviour of the staff that betrays their feelings. Some doctors refuse to take these patients' symptoms seriously, occasionally with the disastrous consequences of delayed and missed diagnoses.
Young doctors always buffer the real stresses of their work with humour that may not be appropriate for the uninitiated. But I think with this one we went too far, and even at this distance I am embarrassed by it. I made a decision never to call anyone a 'dunny' after I overheard the registrar's dressing down, and I made sure that no-one who worked under my supervision subsequently did either.
We should not be afraid of trying to change the culture of our workplace. I just needed someone to tell me that I could.
Frank Bowden is Professor of Medicine at the Australian National University Medical School in Canberra.
Comments should be short, respectful and on topic. Email is requested for identification purposes only.
13 July 2009
Dr Bowden you are man of compassion and empathy towards these poor wretched souls. No one knows the life story of some these unfortunates who may have been successful in business , education or whatever. We don't know what's around the corner for any of us and we too may end up like the junky or the alcoholic. Life has many interesting twists and turns. Lets extend a helping hand to our least fortunate members of society because we too may join them.
13 July 2009
Dr Bowden, I believe most of us are guilty of using derogatory terminolgy when describing unfortunate members in our society, particularly when they don't appear to appreciate our help. When we depreciate others we actually degrade ourselves. Thank you for reminding us in very lucid manner of our responsibility to attempt to view others through God's eyes.
13 July 2009
Thing is Terry their souls are not any more poor or wretched than ours. Not bleeding heart stuff: just my hard won experience of meeting my friends Andrew Glenda and Johnnie on the office veranda most mornings last winter. At least the ones when they had not been carted off to hospital.Now they have disappeared to their next sleeping place and we just get the ambulance bills to be returned address unknown. Miss the guitar and the discourses on the beauty of creation....
13 July 2009
One is reminded of the statement attributed to John Wesley "There but for the Grace of God go I"
13 July 2009
A fine article. In his book, 'A Common Humanity', Raimond Gaita describes a nun he used to know when he he worked in a home for the mentally ill. The humanity she accorded the patients, when no one else did, was striking, and revealed a love that was peerless.
17 July 2009
My understanding of the word 'tolerate' is not 'to put up with'; but from the Latin, 'to include'.
There is a story regarding Bill Robinson, the alcoholic 'Mr.Bojangles' who died in a New York hospital.
One of his imitators died drunk on a park bench.
When the para-medics came to collect his body,his friend who was with him said,'Do you know who that man was?'
He went on to say,'That man could have been the best tap-dancer in the World; he just couldn't get the shit off his shoes.'
17 July 2009
Professor Bowden, people have been called "Dunnies" for much longer than that. I think it means a bit of a dill, but certainly the dunnies I treated/knew/know do not smell of urine and are not homeless, although there is no reason why they shouldn't be all those things. My husband and I referred to a friend just this evening as an "old dunny" a term of endearment for a colleague who has a home, is well off, doesn't smell of urine but is just getting old (so are we).
In general, looking back, I often called a person who had suffered the consequences of excesses in life (smoking, drinking, age) a dunny, but I think "a bit of a dill" would be my definition and it's not always derogatory.
27 July 2009
I run a homeless support centre in metropolitan Sydney and this article should be required reading for all the judgmental 'professionals' who interact with homeless and disadvantaged people.
It is a sad fact that most people would cross the street to avoid our kind of clients, when usually a kind word and an acknowledgement would be an overwhelming act of validation and kindness. Thanks for sharing and for your compassion and humanity.
27 July 2009
It is difficult to balance the right to a safe workplace against the imperative to show dignity and compassion towards those who may not have the same high standards or ideals as they seek to cloud facing reality by over indulgence. Yet homelessness is often forced on one through no fault of their own. This is accentuated for those separated from loved ones by a form of loneliness so difficult to shake. Yet often when one treats these people with grace a form of strength may arise leading to admiration at the choices made given a very restricted set of alternatives. A sampler experience could be not to shower/bath for 9 days or limit eating to one meal a day and assess one's feelings. We would appreciate their situation better. Then there is the uncertainty of where to sleep and how to present for the next welfare payment. My work in the outer east with that community have led to representations to various authorites that affordable housing is a key ingredient towards balanced social development when intensifying population usage of the urban spaces. The threat of homelessness to me was caused by business incompetence among some major players, and through my negotiation, that was admitted with admiration.