Cody, forty years old
Cause of death: Drugs
Cause of life: Live for moments, not things
There are two tough days in any life – the day you realise your dreams cannot be achieved and the day after they have been. Cody’s life had everything, yet it meant nothing. So, he disappeared into the red dust of Australia to find something. My life meant everything, yet I too went walkabout to look for something different.
Cody’s story has been told many times over since foreign visitors arrived on Australia’s shores and decided to call it home. His great-great-grandad had escaped the coal-stained poverty of my home in South Wales for the gold-fractured riches of New South Wales 9,000 miles away. The coal that sustained the Industrial Revolution was called black gold, yet for families digging it from the scarred Welsh ground it brought little shine to their lives. But the yellow gold found in Australia could transform a life of hardship to a life where you get to choose your own future.
Fast forward three generations and an 18-year-old school dropout called Cody also found his riches underground in the mines of Western Australia. History may not repeat but it sure does rhyme. The world’s insatiable appetite for new technology led to a lithium rush, found by decimating the homeland of Australia’s First Nations peoples. Teenagers like Cody had little reason to study at school when they could instead earn more than their teachers by driving trucks around the ripped-up red dust landscape finding this new white gold.
Cody did make a promise to himself when leaving school – work hard, work smart, keep your head down until you have all the things that his family never had. He imagined the future day when he would be happy – sitting in his nice house, looking at his quarter-acre plot of land, wearing an expensive watch, talking on the latest phone powered by the lithium he was mining, driving a scorched land red truck to his boat, then coming home to a double fridge full of food all while wearing his bright white trainers, downing a cold beer. It would take Cody twenty years of graft to get there. And the day he arrived, soon after turning forty, he died from discovering it still wasn’t enough.
I met Cody in the emergency unit of the Royal Perth Hospital. This inner-city hive of ill health is a melting pot of technology, caring staff and social deprivation. The human effects of colonial population exploitation are laid bare for all to see, where drugs, poverty and loss of liberty are as common as high blood pressure. And often the main cause. Despite the turmoil, the hospital’s motto ‘Servio’ is very true – I worked with an incredible group of people who cared about the community, the place and the future. It is an extraordinary place.
Life hadn’t always been like this. In school, Cody loved sport. A talented sprinter and basketball player, falling in with the wrong crowd put a stop to that. His life slowly revolved around the five people he was spending the most time with. We often forget the influence that what surrounds us can have on our lives. Think about the people, places or cultures that you are surrounded by, immersed in. They have probably become part of your normal backdrop, the air you breathe. You may have become them. And if you are very different from them, forcing a square peg to fit round holes can end up damaging the peg, not the hole. And think about the conflicts in life, the people you argue with. Sometimes, increasing the distance can quell damage. Or, as George Bernard Shaw said, ‘Never wrestle with pigs. You both get dirty and the pig likes it.’
In school surrounded by his crew, soon came the detentions. Then he was dropped from the basketball team. Then a fight turned bad. Then the police. Seeing a poster at the local park advertising a highly paid job, needing only a driving licence, in Australia’s mining industry, Cody was in the wrong place at the wrong time.
His job driving trucks around remote mining communities, flying in for three weeks and flying out for one, brought Cody no real satisfaction other than a healthy bank balance. The weeks at home were spent hungover, at all-night parties, spending lots of money and fearing for the next morning. This did bring fleeting pleasures but when the shine had faded from Cody’s new gold watch, Cody was lost. He started drinking more and more. Beer turned to spirits. Spirits turned to drugs.
‘It was my birthday. I woke up that morning, it should have been the best day. My new truck was delivered, and I was off work for two weeks. I thought I had everything, but then I realised I had nothing.’
So, he drank, smoked, injected, snorted and died in some red dust-covered scrub land surrounded by strangers. Happy birthday. What Cody didn’t know is that sometimes when you are in a dark place, you think you’ve been buried but you have really been planted.
‘I have seen many a man turn his gold into smoke, but you are the first who has turned smoke into gold.’ These were the words Queen Elizabeth I reportedly said to Sir Walter Raleigh 400 years ago after he introduced tobacco to the English court. This plant, Nicotiana tabacum, which hails from the highland Andes – likely Bolivia or northern Argentina – dates to around 6000 BCE. By 5000 BCE, the Mayans were already incorporating tobacco into their religious rituals – smoking, chewing and even using it as an enema.
Christopher Columbus initially dismissed the value of these tobacco leaves upon his arrival in the New World. It was one of his Spanish crewmen, Rodrigo de Jerez, who recognised their potential in 1492 after discovering them in Cuba. The modern cigarette, as we know it, emerged in 1830 when the South American ‘papelate’ gained popularity in France.
Our modern relationship with smoking mirrors the ancient practices of the Mayans. For some, it is a quasi-religious ritual, a solace from daily life. Yet tobacco is the most dangerous plant in the world, with smoking standing as the leading cause of preventable death globally. Annually, smoking accounts for nearly 8 million deaths, 10 per cent of which are due to second-hand smoke. Tobacco-related illnesses are responsible for one in five deaths, with smokers typically dying ten years earlier than non-smokers.
Substance misuse accounts for a third of intensive care admissions and 40 per cent of the associated costs. Of these, nearly 15 per cent are tobacco-related, outpacing alcohol at 9 per cent and illicit drugs at 5 per cent.
Cody hadn’t planned to die. He was just looking for meaning in alcohol, then crystal meth and then cocaine. As the clock of his life ticked on to age forty, like many of us (like me) he had an existential crisis. Many people in their twenties want to be a millionaire. Yet most millionaires want to be twenty again. Working in the intensive care unit, where death is all around me, I’m reminded that the things that matter most are not things at all. For many, it will take an extreme life event or a big birthday to get to this realisation.
The amount of drugs needed for Cody to emulate meaning in his life was more than his heart’s coronary arteries could take. His last snort of cocaine melted into the blood vessels in his nose, then sped in Cody’s blood stream to his brain’s limbic system to produce a fleeting sense of connection. But the drug then arrived at his heart, causing it to clamp down like the rock-crushing machinery Cody drove through the mines. This spasm cut off the blood supply to his overexcited heart that was already hungry for oxygen. Cody had a massive heart attack, a cardiac arrest, and died. As his drinking buddy repeatedly pressed on Cody’s chest doing CPR on the 40-degree summer’s day, the drug’s effects slowly wore off enough to allow his heart to beat again. Twenty minutes later, Cody’s struggling body was in the emergency unit where I first met him.
As my life clock ticked past forty, I hadn’t planned to emigrate. Our family had many of the modern luxuries at home that Cody had aspired to, albeit without the Australian weather. I loved my job as a doctor and writer. My family were close by, my friends even closer. My wife loved her job teaching in a primary school in the local village. Our daughters were settled in school. We had a dog we loved and a cat that hated us. And all of this meant something. We had meaning. We were safe. Settled. Life was predictably good. And that was the problem.
In his book Look Again, the American academic Cass Sunstein argues that a fulfilling life, the so-called good life, is textured by three vital elements: things, meaning and variation.
The tangible ‘things’ that ground us – our environment, possessions and physical aspects of our daily interactions – are important. These elements offer a comforting consistency, a cornerstone of stability that, much like the life support machine in my intensive care unit, forms the baseline from which we navigate the complexities of existence. This second dimension goes beyond the physical, encompassing our values, beliefs, and the purpose we derive from our connections and experiences. Although there can be no one definition of what meaning means to different people, we all need ‘it’, whatever it is for us. This meaning doesn’t need to be bold or grand. It can be as simple as the small herb garden we tend, the sports team we coach, the job we find fulfilling, the children we care for. However, it’s the third element that Sunstein posits as crucial for a vibrant life that made us emigrate – variation. Far from being a risk or a stressor, uncertainty and diversity in experience is an important part of being. This variation isn’t just about seeking novelty. It’s about enriching our cognitive landscapes and enhancing adaptability. By integrating varied experiences into our lives, we prevent the stagnation of our thoughts and feelings, fostering a dynamic interplay between comfort and challenge.
Like many families, we had emerged from years of lockdowns, uncertainty and restrictions. As well as killing more than 7 million people worldwide, Covid-19 also killed variation for many. During that period, our family had a diary filled with blank spaces where it used to show weekends away and long-haul flights. But some of that time was bizarrely liberating due to the variation it brought, especially with my wife and I working in education and medicine. In many ways, I had never travelled so much or had so much variation. I didn’t need my passport for any of these trips: they all took place in my own hospital.
As a new consultant years before, the first thing I did was take a mystery tour of my own hospital. I pressed the top button in the lift, going to the seventh floor, before walking into and out of every corridor I passed. I soon found specialties that I hadn’t known existed, equipment I didn’t know we had, and people I had never met. I did the same on each floor down until I became subterranean.
Before the pandemic, that hospital tour had faded from my memory. The Intensive Care Unit I worked in had thick walls that were hard to leave, thanks to the protection they gave to patients and staff. And yet, shelter also brings shade. It stops light from shining on new ideas and better ways of working. Covid-19 changed all of that.
We soon found that intensive care was not one location but many. Coming to work was like visiting new places. Again, I travelled around the hospital: to respiratory wards, to the children’s hospital, to wherever I was needed; and sometimes to the chapel, where I was not. Again, I spent time with new people as well as old friends, across the rickety bridge between specialties. Cross-disciplinary working meant that we moved between worlds and didn’t become so easily frustrated with each other. It wasn’t all rosy, of course, but, like making friends on a holiday, we knew that it wouldn’t last for ever, so we all made the most of the good times.
These trips around my own hospital, and into the working lives of others, have been hugely valuable. Although I didn’t exactly walk in someone else’s shoes, at least I now know what shoes they wear and where the shoe cupboard is.
Coming out from the pandemic, we all thought we would go mad with travel plans. Yet the reality was different. Travel was still tough, expensive and overbooked. Life actually became more predictable rather than less. Rather than emulating the post-war boom of the ’50s and ’60s, our post-Covid life was actually stagnant. The luxury of being too safe. We were bored.
And then an email landed in my inbox during a tough October. That week I’d received a pension tax bill, been shouted at by a stranger for my views on vaccination, done multiple consultant night shifts paid at plain rates, missed my dad’s birthday to attend a research conference and prepared for a teaching session that no one turned up for. I wasn’t burned out – I still enjoyed my job, my colleagues and the patients. I was instead missing the last piece of a good life: variation. Sometimes radical change is easier than subtle change.
So it was painful to read the opening paragraph of an email promising academic promotion, better conditions, endless sunshine, good coffee and a health system that was doing well. It wasn’t really these aspects that were attractive. It was the radical change in itself. This was painful to read because I knew that we had to give it a go. Because it offered variation. The problem was that the job offer was 9,000 miles away, in Australia.
I read this email during a rare time of being forced to do nothing other than think. Although I think I’m a reflective person, the mirror only really comes out when I need to make something out of the reversed image. Perhaps there is something to write or a student to speak with. Reflecting for a purpose can feel sickly. It can be cathartic, but it isn’t healing.
So I never expected to have a deeply emotional experience, with a tear in my eye, while sitting on a plastic chair in the middle of a basketball court. But I did. Perhaps it was because I’d just finished a night shift. I’d just spoken with another family where grief had unexpectedly knocked on the door of an otherwise uneventful Tuesday. Perhaps my vagus nerve had reacted to the minor prick from my Covid vaccine booster I had a minute earlier. More likely, it was because I’d just spent an uninterrupted fifteen minutes thinking about how the past year had consumed me, my family, and my whole world.
When was the last time you sat down and did nothing for fifteen minutes? I mean nothing. For me, it was probably when I was ten years old. The second-best thing about having my Covid vaccine was the fifteen enforced minutes when I had to sit down and wait to check there were no side effects, without a phone, with only my thoughts. I did nothing, yet something happened. I was surrounded by Army volunteers and redeployed health staff in the middle of a leisure centre, whose purpose was now more directly linked to health than ever before.
Grasping at nothing is hard, so I started remembering. I remembered the first patient with Covid we had cared for. I remembered the first patient who had died. I saw my fingers pressing the numbers of that first phone call that started and ended with ‘I’m sorry’. I also remembered the smiles, the energy of dealing with a new disease, the speed of progress and research, and the tight squeeze of teamwork. I could taste the late-night pizza on the way home from another long shift. Sleeping in another room from my wife and telling my daughters that ‘Daddy is safe’, not really knowing if it was a lie. I remembered a friend telling me that no day lasts for ever, but then realising that there are a lot of days in a year. But, most of all, I remembered hope. The hope that not only would tomorrow be better but so too would the day after and the day after that. Even if it wasn’t better, it would still be tomorrow.
Finally, I touched my sleeve on the corner of my eye. I hadn’t been sure if it was a tear, but it was. Fifteen minutes had passed. I stood up, my plastic chair was wiped down, and the next person sat on it. And then I realised that reflection for reflection’s sake can be cathartic and perhaps even healing. And then I replied to the email asking me to go to Australia. ‘Yes.’
After long family discussions, complex visa and equivalence processes, tearful leaving parties and packing up our family home, we left. And, after working in Australia, meeting Cody and many others, I can honestly say that most ‘things’ there were better. The email was right: academic promotion, better conditions, sunshine, good coffee and a health system that was doing well. In fact, there are many things that the NHS could, and should, learn from its distant, sun-kissed cousin. Changes that could help manage the current outbreak of strikes and dissatisfaction in the NHS, whose principles are as important, and as right, as ever. Yet we eventually came home. Why? I’ll tell you by the end of this book.
Feeling homesick in Australia, I spoke to good friends by phone that I call my 2 a.m. crew – the people you know will pick up if they see your name on the phone to help no matter why or when. I remember clutching for Wales by watching the actor Michael Sheen perform Dylan Thomas’s Under Milk Wood live on stage at London’s National Theatre, streamed over the internet. It was a bridge to another place, to my home that felt so far away. And bizarrely one year later, I would be back at home, working as a medical adviser with Michael Sheen as he played the Welsh politician Aneurin Bevan, founder of the NHS, in a play at the National Theatre in London, written by my friend Tim Price. Life is luck. A million lotteries.
It was a role reversal when I met Cody a year after his death. On a bright sunny day in Old South Wales, rare rays of yellow light streaming through the window of my office, speaking on a video call with Cody wrapped in an oversized hoodie during a grey Australian winter. He looked cosy, he looked well and happy. Clean for nine months, his employer had given Cody a second chance. He still had many of the physical things that he had aspired to. But his gold watch was in a box behind him and instead on his wrist was an electric model powered by the lithium he had dug from the ground. Cody needed a watch with a sports mode to help with the rediscovered meaning in his life and the lives of others.
‘Getting clean was fine,’ he said. ‘Staying clean was always going to the tricky bit. That’s why I’m now working with kids to stop them getting there in the first place.’
He had learned that life was not a bucket to filled with stuff but a fire to be kindled. The bright white trainers that were sticking off the end of his bed when I had first met Cody had a bigger back story. As a kid Cody loved basketball. At 6-foot-2, long and flexible, he was a great player, made for the sport. He led his school team, spent the purple-skied evenings at neighbourhood courts, but work soon stole all his time for living. His love for trainers first came from their function on the court. But this morphed into fashion where function was a by-product.
In the time since Cody died, he found an old basketball in his garage and headed to his local court. First, he was alone, missing the hoop far more times than scoring. But soon Cody connected with others who were similarly hanging out. It was here he read the second poster that would change his life. Rather than advertise a well-paying job, this one asked for people’s time for free. ‘Coach needed for local youth basketball team,’ it read. Cody nervously went along the next weekend, lacing up his trainers for their true intention for the first time in years.
‘We came third in the whole of WA [Western Australia] last year!’ Cody said, with a wide smile, almost allowing himself to be happy, to be proud of something.
But meaning didn’t stop there.
‘To stay clean, you have gotta pour yourselves into something else.’
So Cody approached the drug rehab centre that had helped him to start their own team. Now every Sunday, a smorgasbord of tall, short, fit, fat, great and terrible players turn up. They rarely win. But they have all won a sense of meaning, no matter how small, to bring life back into their life.
‘I can’t wait to get back from work away nowadays. I head straight to the court, see how my friends are doing and get coaching. I love it. In fact, I’ve got a game in ten so I’m going to have to shoot, sorry!’ Cody said, looking at his lithium-powered watch. Then he was gone.