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Abortion: Part 2 – Law and disorder
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Photo by: Warren Clarke. Dr David Grundmann...

It sounds like such a simple and sensible fix:  make Australia’s abortion laws clear and consistent, so doctors and their patients know what is legal and what is not, and women across the country have equal access to the procedure.

But it’s not simple and it may not even be sensible.

The AMA’s calls for clarity and consistency in abortion laws have acquired new urgency after recent controversial cases in NSW and Victoria.

But one expert in health law and ethics believes there are serious risks in asking for abortion laws to be spelled out, describing such a move as “unwise”.

Associate Professor Cameron Stewart, from the law department of Sydney’s Macquarie University, says the vagaries of the law enable doctors to make their own informed judgments in a complex area with many variables.

“The cost of having certainty is that you may need to have more regulatory control,” he says.  “[New laws] might be more prescriptive and more difficult to comply with.”

Although he understands doctors feel vulnerable, particularly in states where abortion comes under criminal law, he says their fear is ill-founded.

“The wobbliness is in favour of doctors,” he says.

“Doctors have a tendency to feel victimised, but it’s crap – the system is set up to protect them.  Criminal law presumes you’re innocent.  This is not an area of law where abortion practitioners should feel threatened.”

AMA president Dr Mukesh Haikerwal disagrees.  While he acknowledges any effort to address problems with abortion legislation is risky, he says it would be an improvement if doctors knew where they stood – even if the law became more prescriptive.

“If you’re working in a fog, and a practitioner is caring for a woman in this way and is at risk, I don’t think that is a tenable situation either,” he says.

Although it would  be “problematic” if clarifying the laws resulted in more restricted access to abortion, Dr Haikerwal says the current lack of clarity brings its own difficulties.  “I don’t think the position would be worse than now if it clarified doctors’ rights and responsibilities in this area.”

The AMA has stopped short of calling for abortions to be removed from criminal legislation, but Dr Haikerwal says if this brought clarity and consistency the AMA would support it.

“The issue is that, where abortion is deemed legal and is being carried out, that practitioners should not be at risk of being prosecuted,” he says.

“Because of the nature of the current laws, in some states that is a possibility.”

Decriminalisation is exactly where the AMA should focus its lobbying, according to Dr Leslie Cannold (PhD), senior lecturer at the centre for gender and medicine at Melbourne’s Monash University.  The AMA should stop pushing for nationally uniform legislation and aim for state based change, one jurisdiction at a time, starting with Victoria.

“It is exactly the right time to push for a repeal bill [to remove abortion from criminal law] in Victoria, because the Bracks Government is about to be re-elected and it is only at the beginning of the term of a new government that they will take this issue on,” says Dr Cannold, who is also a board member of Family Planning Victoria and a principal of Reproductive Choice Australia.

“If Victoria goes, there is a very good chance of repeals in NSW and Queensland, and then you’ve covered most of the doctors and most of the women in the country.”

Last month the NT became the second Australian jurisdiction, after the ACT, to remove abortion from criminal legislation, including it in the Medical Services Act with all other health-related legislation (see box * below).

Private obstetrician and NT AMA treasurer Dr Jenny Mitchell says moving the legislation out of the Criminal Code of NT has brought some peace of mind, but the new laws still lack adequate clarity.

“They only changed about five words in the whole Act when they moved it,” she says.  “[But] it’s good not having that big knife hanging over your head – that if someone gets their knickers in a knot, the police will come knocking on your door and charge you.”

The call for decriminalisation has also come from leading Melbourne obstetrician and ultrasonologist Associate Professor Lachlan de Crespigny, who write in the Medical Journal of Australia highlighting the inequity of Australia’s inconsistent laws and calling for “a single clear national law on abortion, both in early and late pregnancy”.  While acknowledging there would be “objections and difficulties in clarifying and unifying Australian abortion laws”, Professor de Crespigny said previous legislative reform on other state based issues showed it was possible. (1)

“Unifying laws would require states and territories to work together, presumably with Federal Government input,“ he wrote.  “The process would not be easy but could be achieved with sufficient co-operation and determination, as shown by the successful introduction of new laws on gun ownership and embryo experimentation.”

A spokeswoman for the Attorney-General’s Department says the Federal Government does not have power under the constitution to enact uniform national abortion laws.  Uniform gun laws were only passed after state and territory agreement at a meeting of the Australasian Police Ministers’ Council, while consistent laws on embryo experiments arose out of agreement in the Coalition of Australian Governments.

Either of these bodies could, in theory, bring about national conformity on abortion laws, as could members of the Standing Committee of Attorneys-General.  The standing committee could have done this through the subcommittee it set up to draft a national model criminal code.  However, in 1998 the subcommittee formally backed off on abortion, saying it was “not in a position to make a final report to ministers on … a recommended legislative position” and that “consultation proved that the issue is ultimately one for political decision”.

A former adviser to Federal Parliament, specialising in health and bioethics issues, Dr Natasha Cica (PhD), says chances of national legislative reform are “pretty much zero”.

“It would be possible for the states and territories to get together to achieve national reform, but that demands politicians’ will and, in the case of abortion that is most unlikely,” says Dr Cica, who prepared a comprehensive report on abortion law designed to be used as a resource for MPs debating the issue.

Member of the ACT Legislative Assembly Mr Wayne Berry proved he had the will when he lobbied successfully for abortion to be decriminalised in the ACT in 2002, but he too holds out little hope for consistent national reform.  “It could occur – at COAG there could be a broad agreement – but I doubt it would happen,” he says, suggesting a state based attempt at decriminalisation is the only way ahead.

But even that would take great time and patience, largely because politicians believe taking a stand on abortion issues can end their careers.  Mr Berry, though, found the opposite to be true in the 10 years he pushed for reform in the ACT, despite heavy lobbying from the Right to Life Association.

“The important thing that I learned from my experience as a campaigner for abortion law reform was that most in the community supported the actions I took and my stance earned their respect,” he told a recent Reproductive Choice Australia meeting.  “While anti-abortion campaigners are loud and well organised, they are out of step with the rest of the community.

“It is a mistake to view their loudness and organisational ability as a reflection of how the rest of the community will vote on the issue of abortion.”

Abortion provider Marie Stopes International works across four different legal jurisdictions in Australia – NSW, Queensland, WA and the ACT – and sees the problems caused by complex and unclear laws.  But Australian CEO Ms Suzanne Dvorak cautions against hasty moves for change.

“While it is important that the community discusses this issue, we need to be careful about jumping to what we think is the solution too quickly,” she says.

“National legislation, particularly the decriminalisation of abortion, could be the answer, but there may be other possible solutions that need to be explored before making that decision.

“It is important that the debate remains focused on upholding a woman’s reproductive rights.”

 Reference
(1)  MJA 2004; 181:201-03

 ENDING AN ANOMALY

There has been a bizarre anomaly in the NT’s abortion laws for the past 30 years.

The laws stated that only a gynaecologist or obstetrician could terminate pregnancies of 14 weeks’ gestation or less, while any “suitably qualified medical practitioner” could perform terminations up to 23 weeks.

Private obstetrician and NT AMA treasurer Dr Jenny Mitchell says this had prevented private clinics from operating in the territory, where the workload was being carried almost entirely by one obstetrician in Darwin.

But legal reform last month, which saw abortion laws moved from the NT’s Criminal Code to the Medical Services Act, have overcome the long-standing inconsistency.

The new law still requires an obstetrician or gynaecologist to be involved “where reasonably practicable” in any termination before 14 weeks, but Dr Mitchell says it now allows qualified GPs to perform these terminations and does not preclude the use of RU486.

 WHAT THEY SAID…

Queensland

Dr David van Gend is a Toowoomba GP who will not prescribe the morning-after pill or refer patients seeking an abortion.  He is Queensland secretary of the World Federation of Doctors Who Respect Human Life.

“The laws are inadequate, but in the current brutalised cultural climate, any change would be for the worse.  The laws should not be removed [from the criminal code], because they keep a social ‘truce’ between those who [believe] that it is wrong for adults to kill their young, and those who want … the unrestricted freedom to kill their young.

“The current [criminal code] arrangements … achieve that pragmatic truce, and to upset that balance would only heighten the social discord over abortion.  Prudent politicians know the laws are best left well alone.”

Victoria

Dr David Grundmann performs late-term abortions at a Melbourne surgery and earlier abortions in the four clinics he owns in Queensland and one in NSW.

“We treat our patients as normal medical patients, but the law doesn’t.  There’s no reason why abortion should still be in the criminal code.  I don’t think there should be any laws regarding abortion.”

Associate Professor Lachlan de Crespigny is a leading Melbourne obstetrician and ultrasonologist.  In 2004, he co-authored a Medical Journal of Australia article calling for clarification of Australia’s abortion laws, which included the following comments:

“Why should an ACT woman carrying a foetus with major abnormality at 20 weeks be entitled to a legal abortion yet if she lived in WA she would need to win approval from a government committee, while in NSW her access to abortion would be uncertain?”

 NSW

Dr Geoff Brodie is a medical director of Australian Birth Control Services and has two clinics in Sydney.

“[In NSW] the doctor must have an honest belief on reasonable grounds that … [it] would be detrimental to the woman’s health [to continue the pregnancy].

“Only one doctor’s opinion is necessary and the onus of proof is on the crown, which makes it even harder for someone to prosecute the doctor.  No jury is going to convict a doctor under normal circumstances.”

NT

Dr Jenny Mitchell is a private obstetrician and NT AMA treasurer.

“I think the law as it stands gives us a lot of scope because it’s not restrictive at all.  A lot of people would call for more clarity, particularly for termination where, in a life plan, a pregnancy isn’t what the woman wants, which is what the majority of terminations are for.  Technically it’s still not clear whether these terminations are legal or not.”

 

Abortion: Part 1 — The fear factor
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The AMA’s Dr Andrew Pesce looked on nervously as Sydney GP Dr Suman Sood was prosecuted under NSW abortion laws, and he fears the fall-put still.  It’s not that the association’s national spokesman on obstetrics considers Dr Sood to be an innocent doctor who didn’t receive a fair trial.  Rather, he’s concerned about the mind-set of others who also watched her trial with interest.

Dr Pesce says anti-abortion campaigners will ultimately determine the long-term significance of the Sood case.  He’s troubled by comments in the lay press suggesting her conviction was a victory, and that it’s just the start – there are many more abortion doctors to go.

“If anti-abortionists see this as a call to arms and start reporting other doctors as well, what will happen is that doctors will be genuinely fearful that they will be prosecuted, which is what the anti-abortion lobby wants,” Dr Pesce says.

If they create a climate of fear, more doctors will wonder whether providing the service is worth the risk.

“I think it would result in a lot of doctors withdrawing those services,” he says.

Dr Persce says doctors already feel vulnerable under the state’s abortion laws, which have been widely criticised as being too open to interpretation.  The Sood case offers no clarification because it was tried by a jury and, with jurors not required to document reasons for their decisions, the specific reason the termination was found to be illegal will never be known.

With Victoria also feeling the fall-out from a high-profile abortion case, there is a perception within that state’s medical community that its abortion laws are unclear.  Obstetricians are still coming to terms with a protracted medical board investigation of five hospital doctors that was instigated by a politician with a strong anti-abortion stance.

The Medical Practitioners Board of Victoria took five years to investigate the complaint about doctors from the Royal Women’s Hospital, who had terminated a 32-week foetus with dwarfism after judging the mother to be suicidal.  In September, the board announced it had found no evidence of unprofessional conduct.

Given the duration and profile of the case, one of the doctors cleared of any wrongdoing is concerned about its impact on obstetricians who provide later terminations when the foetus has an abnormality. The doctor, who cannot be named for legal reasons, surveyed 17 private obstetricians in Melbourne who perform such terminations and found seven of them no longer provide terminations as late in pregnancy as they did before the medical board investigation was announced.  All but one said Victoria’s abortion laws were not clear or appropriate, 12 were worried about the law being unclear and 10 acknowledged the lack of clarity affected their patient management.”

“It has become much harder for Victorian women to access abortion, after the diagnosis of a foetal abnormality, over the last five years,” the doctor says.  “It’s because obstetricians are feeling very vulnerable.”

“Doctors are compelled to think of their own risk in offering an abortion because of the uncertain laws.”

Melbourne epidemiologist Dr Julia Shelley (PhD) says the medical board investigation has not affected doctors’ willingness to provide early terminations.

“In terms of late terminations I’m sure there’s more caution,” says Dr Shelley, principal research fellow at the Australian Research Centre in Sex Health and Society at La Trobe University.

“I think there is some ‘twitchiness’ in Victoria, mostly because of the general climate federally,” she says, referring to Health Minister Mr Tony Abbott’s strong anti-abortion stance, the presence of the Family First party in the Senate and strong anti-abortion sentiment evident during the Senate inquiry into RU486.

This nervousness among doctors is typical of the fall-out where there is a legal or political controversy about abortion, Dr Shelley says.  In 2002, the Australian and New Zealand Journal of Public Health published her research documenting the extent Australian women travelled interstate for abortions and how closely this related to each state’s legal and political climate.  From 1984 to 2000 more than 2000 Queensland women travelled to NSW each year for terminations, her paper suggested.  There was a spike in the numbers in 1985, the year police raided abortion clinics in Brisbane and Townsville.

“The raids, during which medical records were removed from the clinics, were followed by the prosecution of two doctors for procuring an illegal abortion,” the paper says.  “The perception of termination of pregnancy as illegal and the level of media coverage of termination of pregnancy issues continued for many years following this event.”

Dr Shelley says the last time doctors became “twitchy” about abortion laws was in WA when two Perth doctors were charged under the state’s abortion laws.

“WA [doctors] had been operating in the same way as Victoria and NSW and felt things were stable and then several doctors were charged after the ‘baby in the fridge’,” she says.

A patient had been given her aborted foetus so she could conduct a culturally sensitive burial but, when one of her children told a teacher there was a baby at home in the fridge, it led to a police investigation and arrests.  The case sparked significant legislative change, with doctors refusing to perform terminations until the law was clarified, Dr Shelley says.

“Terminations became completely unavailable in WA for a period of some weeks while they got the new legislation through,” she says.  “In that time, several women were hospitalised after trying to perform their own abortions.

 ON THE ABORTION FRONTLINE

“If you want to have an abortion beyond 20 weeks, you’re probably going to have to come to Victoria to us,” says Dr David Grundmann, one of two GPs who perform late-term abortions at Croydon Day Surgery in Melbourne.

The number of women coming to the clinic for “late second trimester” terminations increases each year, reflecting greater unwillingness among doctors in other states to perform them, Dr Grundmann says.

“I don’t know for a fact, but it makes sense that any fear of prosecution doctors may have is going to decrease their willingness to help women achieve an abortion,” he says.

Dr Grundmann also owns four clinics in Queensland and one in NSW but only performs late terminations in Melbourne.  He says this is not due to Victoria providing any greater legal safety, but because such terminations take three consecutive days to perform and he does not spend enough time in other states.

He is confident the late-term abortions he provides for psychosocial reasons are safely within the law and has not been concerned by the Sood case in NSW or medical board investigation in Victoria.

Medical director of Australian Birth Control Services Dr Geoff Brodie says Dr Grundmann is filling an important role.

“It’s great that you’ve got a really good, competent operator that is able to act as a safety valve for the nation,” says Dr Brodie, who has two clinics in Sydney.  “You don’t want these women going to backyarders or doing self-harm, trying to do the procedure themselves.”

NSW clinics draw an “invisible line in the sand” in regard to doing terminations over 20 weeks, Dr Brodie says.

“There’s the law of diminishing returns after 20 weeks,” he says.  “If you stuff up, people start to say why in the hell are you doing the procedure.  The system starts to turn on you.”

Dr Brodie does not have the skills required to perform late-term abortions and chooses not to acquire them, for personal reasons as well as wanting to avoid controversy.

“I don’t want to be involved and be a target for these late, late stage terminations,” he says.

During the NSW Supreme Court trial of Sydney GP Dr Suman Sood – who was recently convicted under the state’s abortion laws – a patient gave evidence suggesting NSW clinics may be referring women to Queensland.  The woman said her cousin called eight or nine clinics in the state on her behalf, to see whether they could help her.

“She asked if it was possible to have an abortion over 20 weeks,” the patent told the court.  “She told me that they all said it was illegal to get it done here and, if I want it done, to go to Queensland.”

Dr Grundmann says it “simply isn’t true” that abortions for psychosocial reasons at this stage are illegal.

“From time to time we get people who come to us who are given this information, erroneously or out of ignorance, or may be maliciously so they [other doctors] don’t have to deal with them,” he says.

Some doctors’ religious beliefs also impact on patients, he says, citing the example of a country doctor in Queensland who told a woman it was not legal to have an abortion at 16 weeks’ gestation.  By the time the woman arrived at his clinic, she was 22 weeks’ pregnant.

“This is not an isolated situation,” he says.  “I’ve seen this a number of times.”

Marie Stopes International research from 2004 found Australian GPs were not always well informed about the legal framework surrounding abortion.

“More than half of the GPs who practise in states where an abortion may be legally performed to prevent serious social and/or economic consequences to the woman are unaware of this fact,” the research paper says.

“More than one-third of GPs readily admit that they do not fully understand the abortion laws in their state or territory and, in many instances, GPs’ stated understanding of specific legal requirements [does] not necessarily match reality.”

 LATE-TERM DISCRIMINATION

Doctors’ reluctance to terminate pregnancies after 20 weeks discriminates against some women because various foetal abnormalities may not be diagnosed until after this time, according to a leading Melbourne obstetrician and ultrasonologist.

Associate Professor Lachlan de Crespigny says it is also unfair to apply the 20-week cut-off to overweight or obese women, because there are often delays in diagnosing foetal abnormalities in these patients.

It is difficult to get clear ultrasound images, particularly of intricate areas such as the heart, when women are overweight, he says.  If a foetal heart abnormality is suspected at 20 weeks, the patient may not be able to see a cardiologist for a week and the cardiologist may then suggest an amniocentesis.

“It could easily take two weeks to have the full assessment,” he says.

Other abnormalities – such as hydrocephalus, dwarfism and microcephaly – may not be diagnosed before 22 weeks, even in women of normal weight.  The patient would then need time to digest the information and make a decision.

Women are generally devastated when an abnormality is diagnosed and will be further traumatised if they have trouble finding someone who will perform a termination, Professor de Crespigny says.

“These women who have the diagnoses of an abnormality make a difficult decision and then to get pushed from pillar to post [to achieve a termination] is just awful.  It’s grossly unfair.”

There is no clinical basis for a 20-week cut-off point for terminations, he says.

“Twenty weeks is used in the public debate a lot, but there there’s no foetal milestone [at this time].  It is arbitrary cut-off that discriminates against women who need a scan after that time to get optimal care.”

Warrior’s last stand
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Photo by: Warren Clarke. Dr Geoff Hittmann at his favourite watering hole.

Dr Geoff Hittmann opens the door of his Wollongong apartment and scares the hell out of me. It’s not just that he’s barefoot and in his pyjama pants, it’s that he looks like a big, hairy mountain man.

I’m early. He’s gracious and welcoming. One warm smile and the wild man is tamed.

Hittmann and his long, greying beard settle back into the lounge and he continues his morning routine. Three pieces of tape are stuck to the side of his TV cabinet and there’s a birds’ nest of bandages at his feet. He rests his grossly swollen left leg on top of a green Tupperware container and continues his strapping.

On 2 June, the 58-year-old GP was diagnosed with a brain tumour and given three months to live without treatment or a year if he opted for surgery, radiotherapy and chemotherapy. He chose treatment and has endured two and a half months of hell. But this morning, as he struggles into one shoe and one Velcro-strapped sandal, it is cellulitis, not the brain tumour, that’s giving him grief.

If you’re a regular reader of this newspaper’s letters page, Hittmann’s name is likely to ring a bell. He’s the proudly non-VR GP from Mt Kembla, NSW, who told the RACGP to “stick your VR where the sun don’t shine”, refused two chances to be grandfathered and thereby sacrificed an estimated $500,000 in potential earnings.

Whether you can make sense of his stance or not, it says something of his passion that he has raged against the RACGP since 1977 – when he says his concerns about hospital registrars being exploited and poorly trained were ignored by his college representatives.

Hittmann’s conscience won’t let him join the vocational register because he would see it as condoning the college. But, having shunned the register, he’s indignant non-VR rebates have remained stagnant, not even keeping up with inflation when even “pensions are indexed”. His letters to the editor rage about this “kick in the guts” and being terminally ill hasn’t distracted him from his theme.

“Before I fall off the perch, I want to bring some kind of justice and fairness to how general practice is run,” he says. “I’m not going to turn my back on it now and say stiff shit.”

In a shocking piece of timing, just before he discovered he was going to die, Hittmann had turned his life upside down so he could finally access the higher rebates. In May this year, Australian Doctor reported he was leaving the Wollongong suburb of Mt Kembla, where he’d lived for 29 years, and heading for Bourke, an area in need in outback NSW. He’d been there two weeks when he experienced a blank spot in his vision and ended up in hospital.

“Next thing I heard the ambos talking to the air ambulance,” he says. “They said I’d had a convulsion and they flew me to St Vincent’s [in Sydney]. Did an MRI and showed a brain tumour.”

Hittmann lights a cigarette and heads out to the balcony of the modern apartment where he lives with his partner of two years, Margaret Flynn. The son of a pharmacist from Sydney’s North Shore starting smoking “roll-your-owns” as a medical student, but swapped to “ready-rolls” when he got a job driving cabs.

He and Margaret have only been here a week and are still soaking up the mountain and ocean views. Margaret confides that it’s something of a miracle they have the place at all. She left her new teaching job in Bourke when Hittmann got sick and feared an unemployed school teacher and a dying doctor would not be considered desirable tenants.

But Hittmann has long been a legend in Wollongong. He called Lord Mayor Alex Darling and, within a week, a real estate agent was giving them a tour of the place. Mr Darling, who met Hittmann 15 years ago, says the doctor is widely loved and respected, particularly in Mt Kembla, where he’s known simply as “the Doc”.

“He’s a very natural person. There’s no airs and graces with the Doc. He’s a very good man. If you went to visit the Doc and you couldn’t pay, it wouldn’t worry him one bit. He’s a person you couldn’t help but like.”

Hittmann practised from his home, Bedside Manor, located directly opposite the Mt Kembla Hotel, and kept a prescription pad in both places. “If it was someone who had something they needed urgently and it was someone I knew, [having the pad at the pub] would save me a walk home,” he says.

 

It was camaraderie that pulled Dr Hittmann to the pub. Photo by Warren Clarke.

Dr Greg Mason, a general surgeon who used to work in Wollongong, says it is camaraderie, not drinking, that pulls Hittmann there. The GP regularly referred patients to him and would always start his introduction with “this patient’s a good mate of mine”. Dr Mason admires his clinical acuity and thorough approach to the job.

“If you get a letter that says, ‘Dear Dr Mason, please treat so and so for bleeding piles’ and I stick my finger in his backside and feel a big cancer, I know the GP hasn’t even looked,” he says. “That’s never happened with Geoff.”

Another of Hittmann’s closest friends is 40-year-old local radio announcer Phebe Irwin. They met – at the Mt Kembla pub, of course – after she moved to Wollongong 10 years ago.

She and other locals timed their visits to the pub around his routine. “The very first thing I do when I walk into the pub is look for Doc’s spot at the bar to see if he’s there,” she says. “It’s like when you wake up in the morning and look to see if the sun’s in the sky.”

She’s never succeeded in buying him a drink, though. He always shouts and, although he always has a beer in his hand, she’s never seen him drunk. Laughing, she recalls the time Hittmann hid near the finish line of the annual Mt Kembla foot race. When the first runners came into view, he burst out of nowhere and beat them all to the line.

When Ms Irwin’s boyfriend, Fish, died two years ago, Hittmann was the first person she called.

“I drove to the pub and he had a drink waiting for me,” she says.

“He said let Fish’s memory live on with you, so you can take the best things about him and make them part of your life.

“You can be feeling you want to kill yourself because your boyfriend is not around and he shows you reasons to keep on keeping on.”

Hittmann understands the pain of losing somebody you love. He remembers the exact time, 12 years ago, when police knocked at his door to tell him his son, Garth, was dead. Garth had been celebrating his 23rd birthday and gone for a spin on a motorbike with a mate. They’d been drinking and Hittmann suspects the bike had no headlight. They drove through a park, straight into a slippery dip.

“When my son was killed in that bike accident, I thought, nothing worse is ever going to happen to me now,” he says. “The coppers knocked on the door at 4.22am.”

In some ways, Garth’s death has helped Hittmann deal with his own grim prognosis.

“When my son was killed, I thought, I can’t do anything about it,” he says. “It’s happened. You’ve just got to get on with it.”

Although he has bawled as he thinks about dying, he’s found some solace in knowing there’s not much he can do about that either.

“I’ve always been a believer in, if it happens, it happens. If it’s good, it’s good. If it’s bad, it’s bad. You’ve just got to cop it.”

Being a doctor hasn’t eased the challenges posed by his treatment. He woke after his surgery at St Vincent’s Hospital with a 30cm scar across his head, when he’d expected something the width of his fist, and he was shocked by the memory loss that followed. Later, when his head was strapped tightly to the table for one of his first radiotherapy treatments, he had a panic attack.

His 29-year-old daughter, Bonnie Hittmann, took time off work to care for him and saw him at his lowest.

“Straight after the surgery he got easily agitated and upset and frustrated. He didn’t expect to have such memory loss and confusion, particularly with short-term memory and finding appropriate words,” she says.

He’d get one word stuck in his head for a day – usually something to do with his treatment – and he’d use it over and over. One day it was “X-ray”, Bonnie says.

“He might say, ‘What’s for X-ray tonight?’ instead of, ‘What’s for dinner?’.”

More recently he has had difficulty remembering names, so he can lack confidence about personal interactions, such as taking phone calls.

“With being such an independent and intelligent person, to becoming someone at the other end of the spectrum, needing help with his communication – that was very difficult for him,” Bonnie says.

Any problems with memory and speech are not obvious the day I meet Hittmann, apart from his constant apologies for his short-term memory loss. He certainly has vivid memories of the worst parts of his hospital treatment.

“They put a lumbar puncture in me. They gave me three goes in the ward and couldn’t get it through, so we went down to the X-ray department and they got it the fourth time,” he says.

He felt so miserable in intensive care after his surgery that he threatened to sign himself out.

“It was a waste of time,” he says. “No one was doing anything. They sent me in there with a nightie tied up at the back, a tube of toothpaste and toothbrush and that was it. There were no windows. You’re not allowed out of bed. It was two days of absolute hell. The lights were on all the time. I had a drip on both sides so couldn’t roll over to sleep.”

Strangely, after this tirade, he adds: “It’s the first time I’ve ever been a patient and most of the time it was good.”

Hittmann says he’ll never practise medicine again and there’s no point planning what he wants to do with his remaining days because he wouldn’t remember anyway. For now, he is more concerned with the recent past, questioning whether he made the right decision in opting for medical treatment and a prognosis of 12 months, rather than no treatment and three months of peace.

“It’s been over two months now and that’s been spent seeing doctors – two and a half months of hell,” he says.

“That’s not a life, mate. That’s not a life.”

He shows me the kitchen cupboard devoted to his medication.

“I woke up feeling good,” he says. “The sun was shining. I took 12 tablets and half an hour later felt like throwing up. Welcome  to good health.”

Bonnie says her father has always been matter of fact about where medical intervention should start and stop.

“His belief has always been it’s better to live a quality life for a short time, rather than live a longer life at the mercy of doctors’ treatment.”

On top of weighing the balance between quality of life and quantity, a sense of injustice haunts him.

“There are so many layers to his disappointment,” Bonnie says. “He thinks, ‘I’ve spent my whole life looking after other people, and now this happens’. And it happened after he made all of these really drastic lifestyle changes.”

The old injustice of non-VR rebates being so low continues to eat away at him.

“He’s always thought, if he keeps fighting it, some changes will occur and it will be worth it,” Bonnie says.

“Now, since he’s been diagnosed with the brain tumour, he feels as though he doesn’t have the time left to keep fighting.

“He’ll fight it to his death bed. But he’s extremely disappointed. He’s disadvantaged himself by fighting this, his whole life, and nothing’s come of it.

“He’s upset by that.”

Recipe for relaxation
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Watching Jeanne Little flap loudly across the shaky timber floor of her rustic holiday cottage, you realise that her overwhelming volume, energy and flamboyance isn’t just an act for the stage.

She’s looking coastal, as only Jeanne can, dragging the weight of a shell necklace she can hardly lift, a white toga with more fabric than a caftan, and her trademark eyelashes. Far from relaxed, she’s flitting around the house like a giant moth, occupying every corner at once.

“Come and sit down will you, Jeanne,” says exasperated husband Barry. “You’re like a bee in a bloody bottle.”

Jeanne’s finding it hard to wind down, having been on the road busily promoting her new cabaret show – a tribute to screen idol Marlene Dietrich, which starts touring nationally in February.

“It’s being discovered that I can do more than just say ‘Darling’ really loudly,” she says in her thick gravelly voice.

It is the first time in months that Jeanne and Barry have had time to visit the NSW central coast retreat they bought as a derelict shack about eight years ago. Set back from the beach in a lush and shady garden of deep greens, the cottage looks like a Balinese bungalow.

Jeanne left the interiors to Barry, who has 30 years’ experience as an interior designer. He was determined to retain the rustic charm, leaving original features such as the timber panelling up to dado level.

The cottage is a long way from the sparkling extravagance of Jeanne’s costumes. Made simply of fibro and timber with a galvanised iron roof, it sits on the original foundations of cement-filled kerosene tins. “The locals say this is the old way to build a beach house and it’s still the best,” Barry says.

Jeanne found a newspaper dated Christmas Day 1926 behind the original fuel stove and this leads them to think the cottage was the first built along the beach.

Their improvements included enclosing the unusually wide verandas and adding timber shutters to let the breeze flow through. Barry painted the old verandas and the exterior a dark bronze-olive green. “I wanted it to be a summer house,” he says. “I like things to blend in with the surroundings.”

In keeping with the summer theme are cane chairs from the Philippines with cushions covered in a tropical bird print. Swinging under the rafters are brightly painted birds from the couple’s travels through Mexico.

Birds are also a theme in the lounge, which has a triptych of squawking white cockatoos which Barry commissioned from a local artist with a request that the sulphur crest be left off. “Being an interior designer, he didn’t like the yellow,” Jeanne explains.

She laughs at similarities between herself and the aviary under glass. “I think Barry was influenced by that too, darling,” she says.

The settee, upholstered in Thai cotton, is covered in fruity coloured cushions. Rice bins from Burma make perfect coffee tables.

The original lounge was extended into the back veranda, leaving enough space for an Indonesian dining table and chairs. Barry included an element of fantasy with a Balinese wood coconut palm and one of his abstract paintings in which a luminous se green fades into a glimmering white. An ornately carved temple door from Bali makes an appropriate entrance to the cottage.

Barry and Jeanne’s only regret is that they no longer have the time to make the most of their beach house. “It’s just beautiful,” Barry says. “After the first day here, it feels as if everything has stopped.”

“It’s so relaxing,” Jeanne adds, “We’ve tried to work up here before, but usually wind up saying, ‘Let’s make a cocktail’.”

The land of the laws
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Photo by: Brett Stevens

WHEN talk-back radio star John Laws chats on air about his country lifestyle at Cloud Valley Farm, he adopts a tone so full of warmth it almost belies his more provocative and dogmatic persona.

Off the air, in a denim shirt and brown leather strides, relaxing with an afternoon drink on the broad veranda of his Georgian-style homestead, Lawsy looks content and right in his element.

“I come here because I love it,” says John, the highest paid personality n Australian radio. “I really relax, even though I run around cutting lawns and trimming hedges.”

He and his “princess”, wife Caroline, spend half of their time at their other home in Sydney’s exclusive Woollahra, just down the road from Prime Minister Paul Keating’s new house. “We never really know where we’re going to be,” John says, but admits he prefers life on the farm.

John and Caroline bought the 400ha property in the Yarramalong Valley, north of Sydney, about 15 years ago. At that stage there was no house or electricity and the land was covered in blackberries and dilapidated old dairies.

The couple commissioned Sydney architect Espie Dods to design a simple Georgian-style weekender clad in non-combustible weatherboard. But maintaining the house, garden and farm proved to be more of a lifestyle than a retreat. “We didn’t know how the farm would take over our lives,” Caroline says. “As time goes by, it’s become another home to us.”

So the couple dramatically improved the home, adding a massive bedroom, two bathrooms and dressing rooms. A sense of permanence was achieved with a brick façade, bagged and painted with Porters lime wash, and sandstone floors and skirting boards.

“We also put monolithic pieces of sandstone around each door,” says Caroline, who fell in love with the material while holidaying in Tuscany.

Entering the house through beautiful timber 19th century Spanish doors and passing an antique marble-topped consul table and mirror, an air of opulence and refined good taste is evident. It continues as you walk into the drawing room, where a French limestone fireplace dating from 1710 is so perfectly placed it seems designed for the home.

“It just embraced the original fireplace to perfection,” says Caroline, who still can’t believe her luck in finding it.

Listening to Caroline and John debate the best place for a new painting, their passion for fine art and antiques is clear. They began their extensive collection before they married and point out proudly that all but one piece was bought in Australia.

Threads of the original upholstery hang loosely from some of the antique chairs, but not the chair Caroline had reupholstered for John’s birthday in a bright fabric alive with birds. “It’s the boss cocky chair, which sits at the head of the table where he can rule his dynasty,” she laughs.

Caroline’s daughter, Georgina Carless, helped paint the main bedroom with a trompe l’oeil finish resembling 18th century French panelling. Dusty pink muslin curtains with loosely tied bows sit around the French windows.

Caroline even went to the trouble of matching the painted metal in the doors to the bronze in one of the couple’s pieces by Rodin.

The bed is swathed in acid-yellow fabric impregnated with gold. “It looks more opulent than silk, but it is cotton, so it will last,” Caroline says.

The bedroom leads into John’s dressing room and bathroom of tumbled-marble tiles. The dressing room features a gilded marble-topped table sitting between two Louis 14th antique chairs. Typical of their time, the chairs have a layer of lacquer over the original yellow leather. In keeping with the attention to subtle detail throughout the house, John’s stylised initials form a decorative pattern in braid on the window pelmets.

Caroline’s dressing room is a long-term dream realised. She always wanted a mirrored wall, with another mirror in a gold frame hanging from a big pink fabric bow over the top. The dressing room leads into Caroline’s bathroom, which has a faux marble painted finish on the walls. “It has the feeling of the luxury of marble, but at the same time it has lovely warmth and is comforting and soothing,” she says. “I had the bath deliberately lifted to make it look like an 18th century tub.” Above the bathtub, Georgina has painted a scene from a Roman wall.

The other room featuring Caroline’s feminine touch is her boudoir, which is literally covered in rose toile with Australian floral motifs. The toile was adhered to wallpaper so that the print could be continued over the walls and ceiling. Caroline likes the way the ceiling slants over the original veranda, as when she closes the curtains she feels she’s on the third floor of a French chateau.

John too, has a room representing his own space. His library, lined entirely with bookshelves, was the couple’s main bedroom before the extension. Caroline says the colour scheme was inspired by John’s motor bike. “He had just painted his Harley Davidson cream and he wanted to paint his library cream, so he got it,” she says.

The immaculately maintained gardens feature in Caroline’s gardening book, The Laws of Gardening. Although she is known for her horticultural prowess, she insists that John is just as passionate about the garden. “He works all the time in the garden. He’s taken to gardening as if he was born to it,” she says.

“Originally, every tree I planted sent him into quite a rage, because I was spending too much money, but now he’s far more likely to spend money on the garden than I am.”

Nestled in the hills a tranquil but accessible distance from Sydney, Cloud Valley Farm seems an ideal place to retire. But John rejects the thought. “I don’t see myself retiring, ever,” he says.