Petach Tikvah, Israel
|Untitled blue face, Acrylic on Canvas, 50/70 cm, 2017. Painting by Daniel Wein. Published with permission of the artist.|
Wally Moon was a legend who stood at least 1.90 meters tall. The most striking things about him were his appearance and his gruffness. When I met him during my residency he was in his early sixties. He had a magnificent girth, fuelled by quantities of non-politically correct food—even then in the 1980s. He could not have weighed less than 130 kilograms but was surprisingly light on his feet and sure in his gait.
Once we went for dinner to the home of an oncology fellow who served a delicious vegetarian meal. Well, Wally took one look at it, sniffed, muttered something about rabbit food, and I am sure started thinking of fish and chips on the way home.
His gruffness was a complex admixture, like a well-seasoned slow-cooked rabbit stew. He did not tolerate fools gladly. For him, a fool was someone who pretended to know, but did not; who thought money was more important than medications; and who treated the disease but ignored the person.
Wally’s prickly pear exterior was designed to scare off the faint-hearted and the fools. The toughness was also to defend against the endless losses of an oncologist who specialized in palliative medicine. It was his bright-blue eyes that twinkled which gave his game away. But you had to be in the right position at the right moment to see that sparkle.
Wally was the senior oncologist at the Austin Hospital in Melbourne when I met him. Oncology was in its infancy then and he was self-educated. He told us that in the early days he would go down to anatomical pathology and view all the cancer patients who had been autopsied—which was most. Wally said he learned an enormous amount that way.
Wally was unkempt with fraying clothes and last week’s dinner on his shirt. He was definitely not odiferous, so this was another external message. Do not look at the cover of the book but make an effort to look inside, get to know the patient, and then make a comment or judgment. I used to go down to the cafeteria with him for a coffee break and a yarn. He would get the coffee from the machine, black, and put six (or was it eight) sweeteners in his cup. He would then ceremoniously withdraw his felt pen from his pocket, stir the coffee, lick dry the pen and return it to his pocket not quite un-self-consciously (though eminently practical), and proceed to enjoy the saccharine-sweet drink. He was not affected in his manners. He knew exactly what he was about. He had been through ups and downs, a bit of a country larrikin at heart, but he had sorted out the hierarchy of his values and concluded what was important and what was not.
He grew up in the country and I imagine played football and cricket with abandon and a fierce will to compete. He had the once-upon-a-time Australian attitude of she’ll-be-right-mate together with a larrikin courageousness that was needed to explore the far reaches of the continent.
Wally was born in 1919 just out of the nineteenth century and within cooee of Australia’s Federation on January 1, 1901. He graduated from the University of Melbourne Medical School in 1945.
Wally had a nose for suffering. He initiated the methadone clinic for drug addicts at the Austin Hospital in Melbourne. He got together a team—social worker, pharmacist, nurses, and me, and we would stay after work. In retrospect, I realize how utterly naïve and sheltered I had been. The addiction, the self-destruction and the social mayhem were an education in and of itself. Between puffs on his cigarette, Wally would tell the addicts, gruffly, the truths of life. Whether they listened or not was up to them. When I think about it thirty years later I suppose the best we could offer was palliative care. The treatment was the obligation of coming every day for a 100mg methadone dose to be swallowed at the pharmacist’s window with orange juice.
|Untitled, Acrylic on Canvas, 50/70 cm, 2017. Painting by Daniel Wein. Published with permission of the artist.|
Wally smoked prodigiously. He taught me the meaning of a chain smoker. I remember to this day him taking out another cigarette to light it with the one he was about to finish. With not much hair on his head he had a generous mustache that drooped by the corners of his mouth and was as crooked as a dog’s hind leg. The center of his mustache was nicotine yellow. He would smoke in the ward and by the bed of the patient. Those were those days. He knew about cancer and smoking. He had, one supposes, an addictive personality—food, cigarettes, work.
I do not know what eventually took him but I do know he had bladder cancer and an abdominal aortic aneurysm which was successfully operated on. When he discovered it, he asked me to place my hand on his abdomen to feel it—of course, I could not feel it, but that was the way he was. And I know he exercised before the operation although I think he had a natural constitution tougher than most.
I used to go sailing at the Jolly Roger School of Sailing on Albert Park Lake in inner Melbourne. One Sunday who should I meet there, but Wally—a good friend of the owners. He was exercising—walking up and down two steps—not flights of stairs but steps. He did this repeatedly in preparation for surgery. It worked. He lived to be eighty—a good innings.
He was a Catholic, I a Jew. We did not discuss openly our beliefs except one time he asked me about life after death. I had never thought about it—both because of my age and because it is not central to the Jewish religion. He told me he thought the after-life was like sitting in front of a television set just looking. I was too puzzled and ignorant to respond. A pity.
Over the years I have rued that opportunity. I think it was my reticence at intimacy and the sense that a boss and a student have boundaries. But he was trying to show that there need not be artificial boundaries. He was correct.
The old cancer ward used to be located in the now demolished Victorian wooden wing of the Austin Hospital at the back of the campus. Wally was consulting on an elderly patient who was frail and frightened. Wally went to her bedside, knelt down on the ground, not without difficulty, so that he could be level with her eyes, and delivered the bad news. I have never forgotten that lesson. He once asked me to interview a cancer patient in front of other doctors and students. So I sat down and practiced what he preached. He was satisfied and said I did him proud.
Wally was a practical doctor, not frightened of trying things out. He was always challenging the pharmacists—like the time on old alcoholic was nearing the end and had pretty bad delirium tremens. We probably had haloperidol then and diazepam. But Wally ordered intravenous alcohol, and the old alcoholic finished his career happily with a pint in his hand. Or, when he started using intravenous heroin to relieve pain and suffering.
We are a species of story-telling. But then there is the message. Thinking back, Wally was teaching us in his way that the person is what is important. Be they a cancer patient or a drug addict. And that communication with the person is the Holy Grail. In order to communicate well, we have to know people—their psychology, their cares, their dreams, their fears.
I imagine Wally now, sitting in front of the telly watching the Boxing Day cricket test between Australia and England, with a beer in one hand, a ciggie in the other, with his first love next to him just wiling away the time after a great innings.
Vale Walter “Wally” Moon, 1919-1999, medical doctor of passion and integrity.
SIMON WEIN, MD, graduated from the University of Melbourne and completed training in Medical Oncology, Psycho-oncology, and Palliative Medicine. After eight years in Palliative Medicine in Melbourne, he moved to Israel and started up the Palliative Care Service at the Davidoff Cancer Center twelve years ago. His main interest is striking the balance between psychopharmacology and talking therapy for distressed cancer patients. Having trained a new generation to take over, he is looking forward to retirement with his wife, garden, books, and building projects.