Steven Amsterdam is a palliative care nurse. He is also a writer with two novels and a collection of short stories Things We Didn’t See Coming, which won The Age Book of the Year 2009 award.
In his latest novel The Easy Way Out, the protagonist, Evan, is a nurse who assists people to die. It’s a topical theme, as a Victorian Parliamentary committee inquiry into end-of-life choices has recommended the Victorian Government legalise assisted dying for those suffering from ‘ a serious and incurable condition who are at the end of life’.
Mr Amsterdam spoke about his novel and his nursing work at the Melbourne Writers’ Festival, on a panel about ‘A Good Death’ with oncologist Dr Ranjana Srivastava.
On the Record conducted this interview with Mr Amsterdam after the festival.
Q: Was your choice of subject directly informed by your work as a palliative care nurse?
A: I wrote the book for a couple of reasons. I wanted to write something that captured some aspect of nursing from the inside and in palliative care I do community work.
It’s a very intense, close bit of nursing and I love it for that – you get to know patients, and because you see them repeatedly, they get to know you. So there’s a relationship that develops, which is specific to certain kinds of nursing.
It’s a strange job, community palliative nursing, because you go to somebody’s house and they’re dying, and then you go to somebody else’s house and they’re dying and somebody else’s house and they’re dying - and then you go get lunch. And then you go to somebody else’s house... That wouldn’t be viable without the team, without the relationship with the patient and without a sense of humour and I’ve been thinking about the sense of humour.
It’s not the Three Stooges type, it’s almost a philosophy in nursing. It makes the work manageable. You’re not making fun of the patients, it’s just the absurdity of life. It’s almost a healthy distance that makes the work doable.
And then, every now and then in my role - and not that often - you get someone who says ‘Can we just cut to the chase?’
Politically, I think assisted dying is a right people should have but at the same time, in here (points to his heart) I have two very strong responses when (a patient) says that. One is, based on our relationship and how much I know you and your family and how much you’re suffering, I think:
‘I would like to help’. At the same time, I think ‘I could not do that five times a day.’ And so really the book came from the split between the things we believe in, we might not necessarily want to do.
And I think society is kind of struggling with that right now and so I really just set out to interrogate that. I didn’t write the book because I had answers, I wrote the book because I had questions.
Like much of his previous work, Mr Amsterdam set out with a scenario and through an act of imagination, explored the questions the scenario raised. But to his bemusement, the bureaucratic structure he imagined might surround assisted dying practice was not dissimilar to that proposed by the Victorian Parliamentary inquiry.
It’s not hard to imagine how it could evolve into a role in the hospital and to me the natural place it would come from is palliative care. At the same time, the palliative care and assisted dying movement seem to have almost an antagonistic feeling towards each other, like they’re diametric opposites - whereas in some ways they’re on a continuum.
But again, (I asked the question) ‘Who are these nurses and doctors who are going to do this?’ And the Victorian inquiry (report) has a whole section on conscientious objection.
Andrew Denton, when speaking at the ANMF (Vic Branch) Delegates Conference about his podcast series on assisted dying, said that in the countries where assisted dying is legal, very few people choose to take this action.
One of the biggest safeguards is how much people want to live.
That’s one of his messages that I really like — underlining how infrequently it’s used and I think Oregon is a good example, where a doctor prescribes the drugs and patients take them home and take them or don’t take them.
The evidence shows that most people don’t take the drugs, they just want the option, and I think that’s a very good argument in favour.
Q: Was there any trepidation in choosing to write about a topic that was so close to your work?
A: Yes absolutely.
The whole time I was writing I was concerned that I’d come in and there’d be a note from the boss’s boss’s boss saying ‘Your services are no longer required because you’ve been identified with something we object to’ but one thing that’s been really satisfying with the reviews is that the book has been read in the way I intended it, which doesn’t always happen.
But the three or four main reviews I’ve had so far have gotten that I just want to look at it, without having an angle — really trying to shore up my political certainty with my emotional uncertainty.
The readers can reach their own conclusions. With all of my books, I’d rather they be a Rorschach test for the reader rather than a piece of dogma from me.