Every December a hospital communique concerning gifts “provided and received in the course of your work” lands in my inbox. It says, naturally, your patients are grateful but in accepting their thanks you must behave with integrity.
In a nutshell, public sector doctors can keep gifts worth less than $50. (The threshold for teachers is $100, which makes me happy.) Gifts between $50 and $500 must be submitted for limited approval. Gifts beyond $500 will not be approved. Distinguishing “high value” items (jewellery) from “low value” (a small bunch of flowers), the policy ends on a soaring note: “Ultimately, we are seeking to earn and sustain trust in our people so that we are best equipped to serve the community.”
To me, the reminder feels simultaneously poignant and moot. I work in an area of stubborn disadvantage. To some of my homeless, disempowered or despondent patients, $50 is a princely sum. It is the unaffordable one-way taxi fare to clinic and the difference between buying medication and not. It is the cost of a fraction of groceries from the “not quite right” outlet. And tragically, for some, it is the cost of a drug habit for which there is little systematic help except the revolving door of emergency.
My friends in private practice sometimes regale me with their gifts of gourmet food, box seats and beautiful books. I respond with mock envy, but in all honestly I would never trade places.
Here are some of my favourite gifts over the years.
Advances in medicine don’t reach the cafeteria, which is why my colleagues and I lug our cereal, fruit and leftovers to work. Without assigned breaks, let alone fine dining, outside food does wonders for the morale.
Every month until her death, a patient brought me two loaves of sweet Greek bread from a hideaway deli. She insisted that I save one for home, so I split the other with the office staff. An Italian matriarch united generations through Christmas baking. Over 10 years, my allocation grew until my conscience prohibited me from taking all the cookies home. To this day, my children reminisce about her. At Diwali, the festival of lights, a patient brought in Indian sweets in a nod to my heritage – the sweets fed dozens. Another never arrives without a mountain of delectable brownies; I can never tell whose delight is greater, hers at making me happy or mine at finding her well enough to cook.
Ironically, the patients who bring food have frequently lost their own ability to taste it, which is a testament to the sheer generosity and goodwill in the world if you are alive to it.
I once looked after a lady who survived a deadly cancer she was not meant to. A stroke confined her to a wheelchair, but she always reminded me that her brain and hands were just fine. As proof, she crafted me a thumb-size figurine of an angel “because everyone needs a bit of looking after”. To say I was moved is an understatement. That angel is nestled among the coins in my car, so tiny that she often gets lost but never for long because I always fish her out.
I once looked after a young refugee whose cancer diagnosis set in process a Herculean effort to help him settle into a disorienting healthcare system. Credit to exceptional nurses, he survived. They taught him to speak English, catch public transport, and ask for an interpreter.
Ten years later, he had the health, fortitude and funds to return to the dangerous border region that had once been home. From here, his wife brought back a beautifully embroidered salwar kameez, a traditional subcontinental dress. The couple shyly explained that the absence of a gift over many years was not for a lack of sentiment but an attempt to find something meaningful enough to say thank you. In an era of “click and collect”, this deliberate act of kindness stole my heart.
At the funeral of her war veteran dad, his daughter tucked his miniature copy of a poem into my hand. Latin for “things desired”, this work has spoken to me since I first encountered it as a medical student. One of the most considered gifts I have ever received, it lives in the driver-side door of my car. From here, it is an easy step to help myself to its perennial wisdom.
Go placidly amid the noise and haste, and remember what peace there may be in silence.
Gold before heading into hospital meetings.
If you compare yourself with others, you may become vain or bitter; for always there will be greater and lesser persons than yourself.
Show me a doctor who doesn’t need this.
And whatever your labors and aspirations, in the noisy confusion of life keep peace with your soul.
In my work, equanimity is as elusive as it is essential. On challenging days, a reminder to “keep peace with your soul” is a reminder to be a better fellow human being.
As I take stock of my gifts, I wonder what happens to those that must be surrendered. Who samples the expensive wine? Where does the artwork hang? Who tries on the jewellery? Or does the stuff just get dumped in the basement, waiting for a periodic “bonfire of the vanities”?
I guess I will never know or need to know – and that’s a good thing.
I cannot imagine my tiny angel consigned to the bowels of the hospital instead of keeping watch over me. Or my precious Desiderata tossed in a dusty corner instead of giving me daily succour. Who could possibly trace the sentiment behind my embroidered dress? Or smell the gratitude in the brownies?
At the end of the year, thanks to the gestures of my patients, my heart feels full but there is nothing to declare. The price of my gifts is well below the reporting threshold. It is their value that is incalculable.
Ranjana Srivastava is an Australian oncologist, award-winning author and Fulbright scholar. Her latest book is called A Better Death
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