Damned if I Do (8 page)

Meanwhile, I was increasingly finding my feet at Royal Darwin Hospital. An incident that sticks in my mind is meeting the notorious murderer
Daniel Heiss. In 1991 Daniel, and another man,
Peter Kamm, were sentenced to life in prison for the 1989 murder of
Dean Robinson, which took place south of Darwin when Daniel was only twenty-three. The murder was considered particularly gruesome because the shallow grave the men dug was not deep enough for Robinson's head, which was left exposed, only to be set alight and then covered with an anthill.
1

I first became aware of Daniel Heiss when I arrived one day to commence a 6 a.m. shift in casualty and saw a rope made of knotted sheets hanging from a smashed tenth-floor window. Curiously, the rope ended at around the first floor, and I wondered what was going on. I would later learn that Daniel had used the sheets to make what would be the first of two escapes during his twenty-three-year incar­cera­tion. The audacity of the hospital escape effort caught my ­attention and I was very interested when I finally met Daniel, some two years later.

Daniel had come into hospital for investigation following a stomach complaint, and was handcuffed to a trolley in the examination room. I was undertaking my anaesthetic term and was sent to review him for surgery. We had a chat as I tried to take blood, which was next to impossible, since he was handcuffed to the trolley by both ankles and wrists, something I'd never seen before: total overkill. After what amounted to a stand-off, I finally convinced the prison guards to grudgingly release one of his arms. I liked Daniel—who was polite and had a good sense of humour, but sadly resigned to his plight—and I felt for him in his humiliation.

Daniel would make a second escape in 1995, and evaded police capture for twelve days, by living rough in Darwin's rural area. In typical Territory style, he came to be seen as having something of a Ned Kelly persona, with people even
leaving food out for him. Given that more than two ­hundred police were involved in the search, this public support for Daniel says something about the resentment Territorians commonly show towards authority. I would later join the com­munity support committee that was lobbying for Daniel's release on parole after seven failed applications and I often visited him in jail. Daniel's co-accused,
Peter Kamm, was granted parole in April 2010. In my mind, locking a person up for life is a form of torture and serves no purpose. I was disgusted when the Country Liberal Party used Daniel's image for a law-and-order election campaign titled ‘Life Means Life', as Daniel had done his time. He finally got parole in June 2011 and I was very pleased to have been involved in a small way. One of Daniel's paintings now hangs in my office and I see him when I'm in Darwin.

In the year I met Daniel, I was also appointed as the ­hospital's
medical photographer, with the job of making a photographic record of wounds and injuries and documenting many of the medical cases that came through the ­hospital. Photographing the rare croc attacks, box-jellyfish stings and other medical phenomena, much of it in the mortuary, took up half my time; the rest was spent as a doctor in accident and emergency. Then things came unstuck. Because of my background in physics, I was also the hospital's
radiation protection officer. When I arrived at work one day, I was stunned to see a notice instructing all medical staff to report for training sessions on what to do in the event of a nuclear accident and emergency. The notice went on to explain that this was necessary because the US nuclear submarine
USS
Houston
was arriving in Darwin Harbour the following week. Despite being radiation protection officer, I'd heard nothing of any radiation-exposure training ­session, and the idea that staff could be brought up to speed on this crucial matter within twenty-four hours was ludicrous. I was critical of the nuclear industry, and a Darwin visit by an American nuclear warship looked like just another item on that ­country's long litany of sins.

I made a public statement as a spokesman for the newly formed Darwin branch of the ‘
Medical Association for the Prevention of War' and my complaints went out the same ­evening on ABC radio's
PM
program. Then hell broke loose. I was accused of breaching the
Public Service Act
, and the Department of Health issued a statement contradicting what I'd said about the hospital's preparedness for nuclear emergencies. Although the
USS Houston
came and went, it was to be three weeks of bitter dispute before the
Northern Territory Department of Health finally apologised to me. It was seen as a great victory, and we all thought that would be the end of it.

A few weeks later, I took the opportunity to give evidence to a Senate committee that was looking at Territorian views on disaster planning and I spoke about the hospital's unsatisfactory arrangements. The next day, my old adversary from rangering days,
Mike Reed, now the Territory Health Minister, issued an ominous press release finishing with the line: ‘If Dr Nitschke doesn't like the situation, I have no doubt the Royal Darwin Hospital will be able to scrape by without him.'
A few days later, I got a letter from the hospital, telling me that my services as a doctor would not be required when my contract finished in two months.

This was unprecedented. Royal Darwin's doctors' ­contracts were always renewed, and doctors were always in short supply. There followed months of wrangling, with a threatened strike by junior doctors, inquiries into the incident from the
Department of Health and the AMA, with findings suppressed for fear of libel, and finally an investigation by the
Senate Privileges Committee into whether I had been discriminated against in my employment on the basis of evidence I had given under privilege. In its final report, the Senate Committee stopped short of finding this, but asserted that a remedy should follow due to ‘those who have punished Dr Nitschke for what should have been his right as a citizen'.

An AMA report on the difficulties at Royal Darwin was carried out by
Dr Peter Arnold of the New South Wales branch of the AMA and produced a mixed set of conclusions. There were apparently things in his report that were favourable, but also some criticism. The phrase ‘enemy of the people'—the title of an Ibsen play— was used, with the implication that I fell into that category. I say ‘apparently', because the AMA refused to release the report, claiming it mentioned people by name and was potentially libellous. The content of the Arnold report was only revealed when it was eventually tabled in the Northern Territory Legislative Assembly by the then Labor opposition leader
Maggie Hickey.

It was time to up the ante and demonstrate against this conspiracy between the AMA, the hospital and the public ­service. A small group of doctors made a banner that said
‘
free speech?
' in letters more than a metre tall. As hospital photographer, I had keys to the roof and it was decided to unfurl the banner from there on a Sunday night. The hospital was eleven storeys high and a Darwin landmark; first thing on Monday morning, the banner would be seen for miles around.

I gave the keys to the others and they put the banner in place. After everyone had come back down from the roof, the lock on the door was superglued to prevent the ­security staff removing the banner as soon as it was noticed. The next morning it was seen and talked about and photographed, and stayed there until eleven o'clock, when security finally drilled out the locks and got onto the roof to remove it. But it had served its purpose.
Time
magazine published a photograph of the
‘
free speech
?'
banner and an article that described the underlying issues and the sense of injustice that had provoked it.

What a shitstorm erupted. Suspicion fell on me, because of my battle with the
Health Department and my ­possession of the roof keys. I pleaded ignorance, and had a good alibi. While it was never established who was involved, my keys were confiscated and that was the end of my privileges as hospital photographer. The claim was made that the disabling of the locks meant there was no access to the lift shaft and that if there'd been an emergency in the hospital, hundreds of lives could have been lost.

All this took a toll on me and on my relationship with
Tristan, who, not long after, packed up and moved back to Adelaide. This was not the end of our relationship but it was the end of us living together as a couple. As for me, with
Reed in charge of NT Health I could foresee another stalled career, just as in the Parks Service. It felt like sweet justice in 1997 when, as deputy chief minister, Reed—who always pushed an anti-gay agenda—was caught out buying pornographic videos,
Highway Hunks
and
Hot Firemen
, from a Sydney sex shop, only to claim they were for the purposes of ‘research'.
2

The hospital bureaucracy and I were never to reconcile, and I had no wish to go back. I decided instead to set up an
after-hours general practice—
Ausdoc Mobile. At first I had a partner, another doctor,
Lynton Stevens, who'd also just left the hospital, but he returned to Adelaide. So I carried on alone setting up the business.

In my new Holden Barina, I took to the streets of Darwin to provide after-hours medical care to anyone who wanted it. It was soon clear that the main consumers of the service would be the city's drug users and sex workers. Territory law made it a crime to prescribe drugs for those addicted, and any medication using opiates had to be for a patient in pain. Drug users who were ‘hanging out' when supplies were short or they were broke could not lawfully be helped, and would inject anything they could in desperation. I saw the ­provision of
clean opiates to those addicted as a clear example of harm minimisation and often provided them with methadone syrup.

I also wrote
prescriptions for morphine tablets, which would help an addict get through withdrawal, as long as they were prepared to tell me that they were experiencing pain. I later found that some of my prescriptions were being shared, or sold on the black market, and I was told to come in for an interview with the
Health Department, that I was prescribing too much morphine.
Tristan, who knew more about the system than I did, told me I was getting not a briefing but a warning.

The work took me all over Darwin and the nearby rural area, from family homes with sick kids, to some seedy and fairly dodgy places, like the area down by the wharves. Some of the people on the fishing boats were heavy drug users and I'd be down there on the boats at midnight with my bag. Although I was carrying drugs with me and was threatened a few times, I never came to physical harm. People sometimes got angry and wanted more than I was prepared to provide, but generally accepted my explanation. I did take precautions. As this was before the days of mobile phones, I relied on a running sheet showing where I was going to be at what time, and I made it clear to the people I was seeing my whereabouts were known. The closest I came to being hurt was when I went into a place in a very poor part of Darwin where there were a lot of drug users and, more dangerously, a lot of drug dealing. A fierce dog, a pit bull, sprang at me. Its chain brought it up just a few inches short of my throat, but its claws ripped my shirt to shreds. I still sweat when I think back about that.

Under Marshall
Perron, the Northern Territory government policy on drug use was utterly hypocritical. It ­basically claimed that there were no local Territory drug addicts, only drug-using visitors from out of state. This meant the Territory didn't have to provide any residential rehabilitation services. In a bizarre policy dreamed up by then Territory Minister for Health,
Fred Finch, the government's solution was to put suspected drug users on buses to get them back to their interstate homes. Inevitably, this would have applied to many of my patients. Unbelievably, Finch tried to get this policy passed through the Northern Territory Legislative Assembly and Minister Finch tried to implement it. One of my patients became the first to receive his one-way ticket south but Greyhound refused to take him. I then contacted southern media and explained what was happening.

‘You're joking,' the reporter said.

The report went out on
AM
. The story had overtones of what was done in the racist southern states of the US, and an embarrassed Territory government had to abandon the idea.

To get around the restriction on my writing of
opiate prescriptions, I set up a video-conference link with
Lynton Stevens, who was now a doctor in Adelaide. That was 1995, long before today's e-consultations. My sample patient explained to Lynton that he was addicted to narcotics. After listening to the story and asking some questions Lynton then faxed us a prescription, something he could legally do in South Australia. It was a stunt to draw attention to the absurdity of the Territory's drug laws. By this time I'd become friendly with Fairfax's Darwin correspondent
Gay Alcorn, and a report drawing attention to these drug laws ran nationally in
The Age
and
Sydney Morning Herald
.

I don't know how long I could have gone on in that role as a Darwin after-hours GP. But it didn't matter, as ­something would happen soon that would change my life forever.

 

PART II

NINE

First in the world

Bring the machine around on Sunday afternoon and I'll die around two.

Bob Dent, 1996

M
ax Bell, a taxi driver in Broken Hill, was sixty-seven years old and had stomach cancer. About two months before the
Rights of the Terminally Ill Act
was due to be enacted, and I was still doing my
mobile
after-hours medical practice, he contacted me. He was in a very bad way; surgery on his stomach had left him with constant nausea, vomiting and an inability to eat solid food and he had heard about my support for the new euthanasia law in the north. He told me of his life during one memorable out-of-the-blue phone call. He asked if the Territory law might work for him and I said I thought it would; after all, he was terminally ill, with no hope of ­recovery. So, I flew down from Darwin to Broken Hill and met him. With
Tristan now back in Adelaide I had been spending some time in Broken Hill, as she was doing ­regular locums there as a paediatrician and I really liked the place.

When I met Max, I saw how very sick he was. We again discussed the possibility of him using the ROTI law. Now that he had a glimmer of hope, Max took matters into his own hands; he had his pet dog put down, put his house up for sale and drove his cab, under huge duress, to Darwin. Dying was his intention, but in fact he hadn't quite given up all hope. He had an idea in the back of his mind that the tropical warmth, sunshine and beauty of the Top End might just heal him.

Max was a feisty character. He'd been a pro-golfer, a boxer and a bodyguard and he'd packed his golf clubs and boxing gloves for the trip to Darwin. It irks me that you have no control over the way you are portrayed after death. The stage play
Last Cab to Darwin
, by
Reg Cribb and
Jeremy Sims, trashes Max's life and reputation. Cribb said that his play was based on the real-life character of Max Bell, but he created a womanising drunk. In the play, I am depicted as a conniving, death-loving doctor. The awful times that Max and I shared didn't deserve this treatment. But then, it's common for dramatists such as Cribb and Sims to be more interested in the effects of their ‘art' and their own careers than on any real attempt to understand the truth.
1

Anyway, the drive north really knocked Max around. He was desperately ill and on his arrival I had him admitted to Darwin Hospital, as I set about getting the necessary signatures of a palliative care specialist, a surgical specialist and a psychiatrist, as the law required. What they had to do was quite simple: a doctor had to certify that Max was dying, that his palliative care options had been explained to him and that he was of sound mind. They didn't have to endorse euthanasia, they just had to certify that this poor bastard was dying, something you could tell at twenty paces. I rang every doctor I could think of but couldn't find a single one in any of the above categories who was willing even to see him. To his credit,
Marshall Perron visited Max in hospital, but no doctor would.

The
AMA's campaign had put the fear of god into the medical fraternity, whose concern for their own legal safety seemed paramount.
Chris Wake, its president, had ­successfully spread the rumour that doctors could be charged retrospectively if the ROTI
Act were overturned. It was clear the issue itself had doctors running scared.

After three weeks, and still very sick, Max had had enough of waiting. He signed himself out of hospital, clambered into his old Commodore taxi and, after staying a night at my place, set off on the 3000-kilometre journey, vomiting his way back to Broken Hill. He was furious with me for not warning him about the pitfalls of his Darwin plan. His parting words were, ‘You didn't do your homework, boy.'

There was no way I could leave things that way. I went to Broken Hill a week later and, with some of his friends, helped Max get reasonably comfortable in his house, which we'd managed to get taken off the market. All his possessions had been sold though, so we had to get him a bed and some kitchen items, and looked after him. I had my swag and camped in his lounge room. Nurses from the hospital came and went.

One day he said to me, ‘I want you to have the car.'

He knew that I was using Tristan's car, an old Sigma. I said I was fine, but he insisted. I told him he could put this in his will if he wanted to, but he had already filled in the transfer of ownership form. I took it to the Motor Registry and used the car—the Commodore taxi—for the next fifteen years. With its meter still installed in the dashboard, I would often feel Max with me as I drove.

I stayed with Max until he was so weak he had to move into palliative care in Broken Hill Base Hospital. Delirious on morphine and with no control over the process, Max died over a period of three days, in just the way he'd dreaded.

So from Max, there were multiple lessons learnt, about laws, the character of doctors, palliative care and politics. But another lesson was more positive. Earlier on,
Murray McLaughlin, a journalist on the ABC's
Four Corners
program, had asked me if I knew anyone intending to use the Territory Act. I put him in touch with Max, and
Four Corners
went to Katherine, to film Max as he arrived and on his drive north, and later in Darwin. The result was a powerful
Four Corners
program entitled ‘
The Road to Nowhere', which revealed Max's terrible suffering and went to air just as he was making his return trip.
2

The day after the program
screened, a surgeon called
Jon Wardill rang me. He had been one of the many doctors who had refused to see Max and sign his papers.

‘I've just seen
Four Corners
, about your patient.'

‘Yes,' I said.

‘I felt like shit,' he said.

‘Yeah, well …'

‘If it ever happens again, ring me.'

Wardill's reaction was a shock and emphasised to me the power of the image. Journalist
Gay Alcorn had written some powerful stories about Max and his time in Darwin for
The
Age
newspaper, but it was the live action on the ­television screen that hit home. If this taught me one thing, it was never to underestimate the impact of television in portraying a human story
to change opinions.

* * *

Jon Wardill got his chance sooner than he might have expected.

Bob Dent, a Darwin resident, was a carpenter, a fiercely independent character, whose life had been reduced to what he called ‘a rollercoaster of pain' by five years of prostate cancer and its treatment. Bob saw the
ROTI Act as a gift—a way to end his suffering and die with dignity, with those who cared for him. He contacted me and asked for my help.

By this time my interest in voluntary euthanasia was such that I had read much about the subject, and had learned about American doctor
Jack Kevorkian's involvement in assisted suicide, in particular the machines he invented to help people die. His first was the ‘
Thanatron', a mechanical device
consisting of three bottles suspended from a metal frame for dispensing lethal drugs, via an intravenous drip, into a patient's vein. Kevorkian's other machine of note was the ‘
Mercitron' (or mercy machine), which was a gas mask connected to a canister of carbon monoxide. Both devices provided in-built patient control in the act of dying, something I agreed with. I had decided to see if I could improve on Kevorkian's machines.

With the help of
Des Carne, my friend from the days in the Sydney squat, I had built what I called the ‘
Deliverance Machine'.
3
It consisted of a laptop computer that automated the delivery of the drugs through a line to a venous cannula. The person who wanted to die had to answer three questions that appeared on the laptop screen:

1 Are you aware that if you go ahead to the last screen and press the ‘Yes' button, you will be given a lethal dose of medications and die?;

2
Are you certain you understand that if you proceed and press the ‘Yes' button on the next screen that you will die?;

3
In 15 seconds you will be given a lethal injection … press ‘Yes' to proceed.

If the wrong button were pressed, or a button pressed outside of a specified time limit, the program would stop and need to be restarted.

This was, in effect, doctor-assisted suicide, as opposed to voluntary euthanasia, and it had the great advantage of allowing the doctor to step aside, leaving the patient in complete control of the process. It also took the doctor out of the patient's personal space and allowed them free access to their loved ones. Bob Dent saw it as the answer to his problem. But there was still the question of getting doctors' signatures in order to comply with the law. I remembered
Jon Wardill's pledge and rang him.

‘Now's your chance,' I said.

His reply was crisp. ‘Bring him in.'

Even with a leading surgeon's signature secured, it wasn't easy to get the others we needed to complete the ­
requirements. I rang practically every psychiatrist in Australia. Among the myriad excuses I heard were, ‘I agree with you but I simply can't because I'm pregnant', or ‘I want to help, but my wife won't let me.'

A colleague suggested I ring
John Ellard, a Sydney psychiatrist. I hesitated to do this, remembering him from Sydney medical school days, where he was a formidable presence. But in desperation, I did eventually ring, and Professor Ellard immediately said he'd fly to Darwin and see Bob.

‘What about the
College of Psychiatrists?' I asked, wondering how he'd deal with his peers.

‘
I am the college
,' was his simple reply. In August 1996 Professor Ellard travelled to Darwin, saw Bob and signed the necessary papers.

Finally, I could tell Bob that everything was in order. He was a Buddhist, and he'd been to the Darwin temple to say his farewells and give his thanks. He said, ‘Bring the machine around on Sunday afternoon and I'll die around two.' Then he added, ‘Come to lunch.'

On Sunday morning I packed up the equipment (I'd tested it more times than I could count), and drove to the suburb of Tiwi, where Bob and his wife
Judy lived. I've described the lunch in some detail in many a media interview, including on
Andrew Denton's
Enough Rope
program on ABC television in 2008.
4

The lunch, which took about an hour, was something of an ordeal, though I was the most agitated person there. We ate ham sandwiches and drank stout and, as I told Denton, my mouth was like sand. I almost choked on my sandwich and had only the smallest sip of stout, just enough to keep my mouth wet so I could speak. While it's hot in Darwin in September, it's not as hot as it gets; yet I remember my shirt was drenched in sweat. Conversation was difficult, as it is when a person is about to die. I felt I had to watch every word I said; I tried hard not to reference the future because, for Bob, there wasn't one. We watched an AFL game on TV, and then Bob left the room and laid down on the lounge on the veranda.

To say I was nervous as I prepared the machine would be an understatement. Surprisingly, the needle of the cannula slid easily into Bob's vein the first try. That doesn't always happen and I'd been worried there might be a problem. I then connected up the syringe of lethal barbiturates and booted up the computer, and stepped away.

‘Are you sure, Bob?' I said.

His answer was to lean towards the computer and press the button that asked the first question about the process. He then pressed the button again, and again for the last time. As the fifteen seconds it took for the delivery of the drugs ticked away, I realised that my shirt was dripping with sweat.

I had two thoughts: I was glad that Bob was getting the peaceful death he wanted but I was also acutely aware that this was the first time something like this had ever happened. And, as I watched from the other side of the room, I knew that nothing would ever be quite the same again.

Bob sighed as his wife held him and he fell into a deep sleep. With her still holding him, he died in just a few minutes. We sat there, still and silent, for about half an hour. Slowly, she lifted her hand in a gesture, and I came over and confirmed that Bob was dead.

I must have removed the cannula and packed up the machine, but I have no clear memory of doing so. Then I left. I had a book of death-certificate forms and I signed one for Bob. The regulations to the Act stipulated that the cause of death be entered as the underlying disease; the legislation recognised that people didn't want ‘suicide' on their death certificates. In Bob's case, I simply entered ‘prostate cancer', accompanied by ‘respiratory arrest', which is an accurate description of the effect of the administered Nembutal and Pancuroniun, although the drugs didn't get a mention.

Outside, I took a deep breath and slowly drove home. There was a suspicion in Darwin that the law may have been used and I started to get phone calls from the media, asking me to confirm or deny the rumours. I wanted some time.
Judy Dent was shaky and not ready for the media frenzy that we knew would follow, and wanted to wait. I went along with this and was pleased to have some time to calm down and collect my thoughts. I remember getting a call from
Kerry O'Brien, of the ABC's
7.30 Report.

He said, ‘I know the law's
been used. Will you talk about it?'

I said, ‘No.'

‘Are you saying the law hasn't been used?'

‘That's right,' I lied.

O'Brien has never forgiven me for that. A similar ­situation developed much later after the death of
Norma Hall, adventurer Lincoln Hall's mother, at which I was present. This matter is covered in
Killing Me Softly
, but what is not mentioned there is that it almost cost me a friendship.