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Br J Gen Pract. 2004 December 1; 54(509): 972–975.
PMCID: PMC1326141

The Duty to Die Cheaply

‘If there is a doctor on board the aircraft, please identify yourself by pressing the attendant call-button. I repeat …’

Heads craned up and down the cabin: who needed a doctor? And where? Doctor Philip Shaw — 3A, Business Class — craned his head for one reason only: in the hope that a better Samaritan might reach up for the call-button first. How long could he decently wait? He was out of practice — epidemiology left no time for the sharpening of clinical skills. Worse, he had been drinking.

The announcement ended abruptly, the river of Vivaldi flowed again through his headphones — light classics, channel 4, inflight entertainment. He rapidly drained his third complimentary Scotch and glanced at his watch: the second hand slipped a cog, then another. Worst-case scenario: cardiac arrest, four minutes to brain death. Could he afford to wait even one more second? He had waited no more than five when an attendant leant in over him, clutching a passenger manifest.

‘Doctor Shaw? Doctor Philip Shaw?’

He lifted his hand and pressed the call-button above his head, absurdly, automatically. The red call-light glowed, fingering him publicly. You got me. His neighbours in Business — charcoal suits and silvered heads mostly — turned and examined him; he tried not to make eye contact.

‘I'll come quietly,’ he said.

The cabin attendant was all whispered, suppressed agitation. ‘Doctor, one of the passengers is rather unwell. If you could follow me, please …’

He rose immediately and followed her back into Economy, running a gauntlet of stares. 25C, aisle seat. The victim — male, overweight, grey-peppered beard — appeared ominously still. The two adjacent seats had been emptied; the ejected passengers stood in the entrance to the rear galley, trying not to watch, yet of course watching. The purser — a painstakingly groomed older woman who had earlier fetched Philip his drinks — was bent over the victim, pressing a mask to his face. A young male attendant was wrestling with the valve of an oxygen cylinder. The cylinder distracted Philip momentarily; it seemed for some reason to have been designed according to aerodynamic principles, a tiny version of the aircraft itself, clean-lined and slender, lacking only wings.

‘This is Mr Brice, Doctor,’ the purser said.

The victim was long past introductions. He was also past oxygen. Kneeling in the aisle, Philip checked the neck pulses — absent. A clammy sweat covered the brow — heart attack, almost certainly. The pupils were fixed and dilated.

Various emotions washed through him, among them a definite gust of relief. The late Mr Brice had been dead for some time, well before the intercom's first summons.

He reached across and gently twisted shut the oxygen valve. His eyes met the purser's; she held his gaze.

‘His neighbour thought he was asleep,’ she said simply.

Philip, made superfluous by death, stepped back into the aisle. The routines of the cab crew that followed seemed well practised: the seat was reclined, the seatbelt lengthened and buckled about the victim's big body, his two flaccid hands placed carefully in his lap. Lastly, the head, face, and upper torso were draped with a cabin blanket.

The woman in the row immediately in front of the dead man — a young, harried mother travelling with two small girls — turned, disbelieving. ‘You're going to leave him there?’

The purser's tone was smooth and soothing. ‘Space is at a premium, madam. There is the galley, but — you will understand — health regulations forbid’.

Busy with her daughters, the woman may or may not have heard the reply. ‘I said face the front, Simone!’

Philip had a joky, slightly drunk suggestion. ‘Is there room on the flight deck?’

The purser affected not to hear. Philip was tempted to try another joke — some variation on flying on autopilot — but the words would not quite come together. Those quickfire Scotches on an empty stomach were beginning to fuzz his brain. He needed a fourth.

‘Well, if there's nothing else I can do …’

It seemed there was. The purser plucked at his sleeve, subtly detaining him.

‘Doctor, I realise it's an imposition, but the flight is fully booked, and it would be a great help if you would agree to sit with the, ah, patient.’

Philip stared into her face, surprised for the first time that day, though not unpleasantly. The unexpected had become a rare commodity in recent years; he was learning to savour it.

‘You want me to sit with a dead man?’

‘Just for the remaining minutes of the flight.’

He glanced at his watch. ‘That would be … ninety remaining minutes? Give or take.’ He felt loosened by the Scotch, even a little reckless, but the purser remained unfazed.

‘Doctor, please. We could hardly expect someone, ah, inexperienced, to sit with the deceased.’

Philip glanced about the cabin. Fait accompli: the two displaced passengers had vanished forward, a Business Class upgrade, at his expense.

He squeezed in past the fat, shrouded body — no simple matter — and eased himself into the window seat. ‘There might be an undertaker on board,’ he said to the purser. ‘Perhaps you could make an announcement.’

‘Please, Doctor, if you could fasten your seatbelt.’

The purser vanished, but the attendant who had earlier summoned him from Business Class was now leaning in — a younger woman wearing a fixed, cheery smile, her hair tugged back into the tightest of plaits. ‘Can I get you anything, Doctor?’

‘Flyspray?’

Her smile remained cheery, as if tethered by the same tight drawstrings that bound back her hair.

‘Sorry,’ he excused himself. ‘But if you don't laugh, you cry.’

The woman in 24C turned her head again. ‘Excuse me, but I'd like to change seats. I really don't think my children can be expected to sit here in front of that poor man.’

‘I'll see what I can do,’ the attendant promised.

‘I'll have a Scotch,’ Philip got in before she left. ‘And my valise, please.’

‘Of course, Doctor.’

‘In the overhead locker. 3A.’

More Scotch arrived, a jug of water, ice, and a whispered apology to the concerned mother of two. ‘There is simply no other seating available, madam.’

Philip unscrewed the mini-bottle — Johnny Walker, Black Label, nothing special — and drank it neat. The first shot burnt his mouth pleasantly, the next smoked down into his chest, relaxing him, and somehow warming his heart en route. His cold heart, according to some. He smiled over the intervening shroud at a young woman seated across the aisle; she glanced away.

‘Another?’ He waved the little empty bottle, trying to catch the attendant's eye, but now she was pushing the lunch trolley working backwards, row by row, offering meal trays. As she neared the rear of the cabin, there appeared to be fewer takers.

‘Would you care for some lunch, madam?’

‘Hardly!’ the woman in 24C said.

‘And the children?’

‘They're not hungry either.’

‘But, Mum —’

‘Hush. We'll have something at Grandma's.’

‘But I'm hungry.’

The trolley rolled on, level with Philip.

‘I don't suppose you'll be wanting any lunch, Doctor?’

He looked up into that determined smile. ‘In fact, yes,’ he said. ‘Please. And some wine.’

She handed him a shrink-wrapped plastic tray reaching across high above the body. He handed it straight back.

‘Business Class,’ he reminded her.

Her smile remained cryptic but there was something in the eyes: definite distaste. Was it the company he was keeping?

He smiled to himself, amused by the notion.

‘And might I have another drink while I wait?’

She passed down another Black Label, topped up his jug of water and plastic cup of ice, then wheeled her trolley past.

The purser arrived shortly with the menu card and, reaching across the shrouded body with difficulty, set a starched linen napkin on his lap. The card seemed difficult to read for some reason, hard to bring into focus, but he chose the fish — barramundi — and the sauvignon blanc, and when the food arrived ate hungrily enough, the flow of digestive juices released, as always, by alcohol. Pots of coffee were offered about as he tucked into the crème caramel, but the passengers in the vicinity of the body once again refused to partake.

He ordered a cognac after the meal had been cleared, and reclined his chair fully, feeling weirdly, weightlessly happy, a lighter-than-air machine himself, floating inside this larger flying machine. He unsealed the headphones in the seat pocket, slipped them on and tuned to channel 4. Albinoni this time, or some such tranquilliser. He tried to listen but the ear-pieces were uncomfortable, hard little Economy Class rubbers, lacking foam padding, and he soon removed them.

A small girl's face began to appear by increments above the top of the seat in front, blonde fringe first, wide possum eyes, thimble nose. He passed her the chocolate after-dinner mint from his tray, pressing a finger to his lips. ‘Ssh.’

Her face ducked out of sight, only to reappear, by slow degrees, a few seconds later, her mouth wearing an uneven coat of chocolate lipstick.

‘Boo!’ he said.

She giggled; her head ducked down again, and again slowly re-emerged. He played the game twice more before tiring of it. His own children, teenagers now, had long cured him of the joys of repetition. The fourth time the little face poked above the seat, he reached across to his dead neighbour and flipped aside the corner of blanket that veiled its face.

The child's wide eyes widened even further; she vanished as if jerked down into her seat. This time she failed to reappear; he could hear a mother's whispered scolding.

He looked sideways at Mr Brice, unmasked. With his own chair reclined, he found himself at eye level with the corpse, just the raised middle seat between them. He reached over and reclined that seat also, affording a better view. The dead man's face, pale and cooling, had relaxed, freed from any emotional expression. Liberated, was the word that sprang to Philip's mind. The eyes had the dull, milky look of death. Only the beard — soft, springy, grey-flecked — still looked alive, which of course it was. And no doubt growing, slowly.

‘So,’ Philip said aloud, slurring the sibilants a little, ‘What if I need a piss?’

No answer. The pressure of the seatbelt against his full bladder was increasing; he hoped he could hold on. He replaced the shroud, drained his cognac, and tried to attract the young attendant's eye. Was she avoiding him? She had clearly formed a wrong impression; he felt an urge to defend himself. I was going to answer the summons, he wanted to tell her. I was merely waiting for someone better qualified. He banged the empty glass down on the tray, making the point. My practice hasn't been made of patients for a long time, he explained — if only to himself — but made of paper. A house of index cards. And electronic bytes. Electronic bricks: cost–benefit statistics, survival-rate data. Quality-of-life indices. Moreover in the past I have always answered the call. I fly a lot; there have been a lot of calls. And not only in planes. The theatre, the movies …

Why can't it be someone else's turn? he wanted to demand of her. Because even when I do report for duty, other people f*** it up. Including your colleagues, Miss Thin Lips. Let me tell you of the time I was flying Adelaide–Frankfurt and the dread call came. Congestive heart failure, an old dear drowning in her own foaming fluids …

He closed his eyes and was thrown back, giddily, to that day, that flight. He had pressed an oxygen mask to the woman's face — still she had choked. The remedy had been obvious: she had needed to lose a litre or two of fluid from those lungs. In that overbooked jumbo at least one passenger would very likely be carrying diuretics, he had reasoned. Yet the cabin crew had refused to broadcast a plea for ‘water tablets’. Against company policy, Doctor. We cannot risk being sued for incorrectly prescribed drugs.

He had suggested — with some venom — that the only alternative was to fly at a lower altitude. And so the huge ship, as much zeppelin as jet-plane, had lumberingly descended, on medical advice, to three thousand feet, and remained there, at enormous cost in fuel consumption, for the rest of the flight, and the drowning woman had survived.

His reward? Danke schön, Herr Doktor, and a bottle of wine. Not even an upgrade out of cattle class. Wood class, in German.

He opened his eyes. A bottle of wine might at least help him get over his current assignment: babysitting the dead. He turned back to his travelling companion. The first corpse he had seen, years before, came back to him through the thickening fog of cognac and Scotch. The strangeness of the dissecting room, its unspeakable sights all marinated in the indelible stink of formalin. He had not been the only novitiate to rush from the room that first morning and throw up. There had been cold pork for dinner at home that night, weirdly — but also brought up, warmer, later.

‘Such a sensitive boy,’ his mother had often defended him to his father.

‘Made of sterner stuff now,’ he murmured, drunkenly, to his mute companion.

And felt an immediate, slight catch in his throat. It seemed a sad thing, that lost sensitivity. Where had it vanished? Or had it, in fact, vanished? If he was sensitive enough to grieve for lost sensitivity, then surely he hadn't, in fact, lost it.

The paradox tickled him; he chuckled drunkenly, recovering already from the brief, foolish outbreak of sentimentality.

‘Ladies and gentlemen, Captain Baker again from the flight deck. I realise the trip has been, ah, difficult for many of you, and I apologise for any inconvenience. As you will understand, the circumstances were beyond our control. But we have made good progress and will shortly be commencing our descent into Canberra.’

Philip leant forward and peered out through the perspex window — nothing but cloud. The pressure on his bladder was becoming more urgent; in need of relief he tried to rise from his seat but was jerked back. Something was gripping his waist; he strained against it and was again tugged back. He glanced down. Of course. He released the seatbelt clasp and slid over into the middle seat.

‘Excuse me,’ he said, and stood and lifted one leg over the dead man's leg, but failed to find solid ground on the far side and unbalanced backwards, finishing sprawled across the middle and window seats, an armrest pushing painfully into his back.

‘Doctor?’ The purser was leaning in.

‘Just in time,’ Philip said. ‘Another Scotch, danke schön.’

‘We've had some complaints, Doctor. Might I suggest something soft? And if you could fasten your seatbelt.’

‘I'll fasten my seatbelt,’ he said, ‘if you get me another Scotch.’

‘I'm sorry sir. That's not possible. But we'll be landing soon. And further refreshments will be available in the terminal.’

‘It's for my throat,’ Philip said. ‘A slight tickle. I need a Scotch to soothe my throat.’

He rearranged himself into a sitting position in the window seat; the purser calmly leant across and fastened his seatbelt.

‘Perhaps a nap, Doctor.’

‘If you read me a story first,’ he said. ‘And I'd like one of those cute little colouring-in kits.’

‘Please, Doctor, I know it's difficult. But it won't be long.’

Through rising giddiness, he remembered that he had meant to work during the flight. The first draft of his paper for the Trans-Tasman conference needed fine-tuning: ‘The Civic Duty to Die Cheaply’. It was in his valise, wherever that was. His heavy eyelids slid shut, the giddiness worsened. Work was clearly beyond him, the title of his paper too absurd anyway, too comically unlikely given his current predicament.

He forced his eyes back open. Would Holly be waiting at the arrival gate? He hoped so; he suddenly felt in need of her physical presence. Her hands, her voice, her heart. Her warm heart. He reached for his mobile phone, still safely holstered on his belt, turned it on and punched his home number. Was he in range? Apparently. Something was ringing.

‘Hello?’

‘Sweetheart? It's me. We're about to land. Where are you?’

A brief silence, then an icy voice, ‘Is that you, Philip? Are you drunk again?’

‘Drunk with love.’

The voice moved beyond iciness into permafrost. ‘I won't be picking you up at the airport, Philip. This is Mary, not Holly. We've been divorced for five years, remember?’

The young attendant was again at his side. ‘Doctor, we don't permit the use of mobile phones while the aircraft is in flight. I must insist.’

‘Just a minute, Thin Lips. I'm in the middle of a conversation—’

But Mary had hung up. He chuckled at his absentmindedness. How had he managed to dial the old number? Ingrained habit? He remembered those first months after he had left Mary and the boys, of how he would often find himself parked outside the house, driving home from the hospital on autopilot, his mind elsewhere. He had never told Holly of these innocent episodes, sensing that she would be hurt, or would read some absurd deeper significance into them.

The purser's voice was suggesting preparations for landing. Philip obediently raised his seat, and the middle seat, but his companion's controls were beyond his reach.

‘Please return your corpse to the upright position, sir,’ he said, and giggled.

The aircraft rocked, descending through cloud; one of Mr Brice's hands flopped out from beneath the blanket and onto the middle seat. Anything was suddenly possible. Philip, dazed, reached out and clasped it. The fingers were cold; he remembered again the room-temperature coldness of that first assigned cadaver, years before. A woman of eighty, eighty-five. He remembered lifting the linen covering aside for the first time, terrified. He remembered the immense difficulty of making an initial incision into the white-leather skin. He had willed his trembling hand to move that day, to grasp the scalpel and cut. Then tease apart the tissues with his fingers — blunt dissection, in the argot. His thin gloves had done nothing to disguise the greasiness of the exposed flesh.

He squirmed, reliving his squeamishness. Who could say he was insensitive — at least when he had been drinking? The smoky magic of Scotch — it always found him out, sniffed out his dormant self like a dog. He had spent a year teasing that old lady apart, a year in which horror had slowly been replaced by fascination — and, finally, by awe. Was he getting sentimental again? About a corpse? Better sentimental than squeamish. Such a marvellous structure, that frail body. Form so perfectly matched to function. And with a spare of everything packed in. Lungs, kidneys, ovaries. Hands, feet. Ears. Eyeballs.

A spare of everything, at any rate, except a heart.

The rumble of landing gear being lowered distracted him from his drunken reverie. The itch had left his throat, but there was surely time for one last drink. He reached up his hand and pressed the call-button. No response. He pressed again, and when there was again no response, apart from that tiny red light, he kept his finger pushed against the button, firmly.

From The List of All Answers: Collected Stories published by Viking Australia, 2004. Printed with the kind permission of the author. Australian books, including those by Peter Goldsworthy, can be ordered from the Australian Online Bookshop: www.bookworm.com.au.


Articles from The British Journal of General Practice are provided here courtesy of Royal College of General Practitioners