Academic literature on the topic 'Long Beach, Calif. Memorial Hospital'

Background: The pharmacy profession continues to evolve and shape itself with increasing complexity. With this escalating complexity, pharmacist clinical competency needs to be addressed within each healthcare practice setting. The objectives of this study were to describe a unique pharmacist competency program and evaluate its satisfaction at two community hospitals. Methods: Long Beach Memorial and Miller Children’s Hospital of Long Beach are tertiary community hospitals with 308 total beds for Millers Children’s Hospital and 462 total beds for Long Beach Memorial. A unique and intensive pharmacist competency program has been established at these hospitals for over 20 years. The content of this program was assessed and a survey was conducted in March 2011 to ascertain pharmacist satisfaction. Results: The unique pharmacist competency program was structured in the form of age-related, hospital-wide and unit specific modules, pharmacy-regulated therapies (PRT), and a Pharmacy Skills Day that provide updates on PRT and other pharmacy-related topics. Forty-two of 61 (69%) pharmacists responded to the survey. Mean age of pharmacists was 38.8 ± 11.5 years, 36% were male, 86% completed residency training, and 12% were board-certified pharmacotherapy specialists. Over 80% of pharmacists agreed that the program was informative and supportive of their daily patient care activities. Although the program was well-received by the pharmacists, there were facets of the program that needed improvement, including resources for continuing education opportunities and additional modules for competency. Conclusion: A unique pharmacist competency program at two community hospitals was described. The program was well-received by the pharmacists, and, more importantly, ensured continuous professional development in pharmacy practice.

Private hospitals with nonemployed, volunteer medical staffs face a special challenge in meeting the patient-care needs posed by a mass casualty incident (MCI). Although most disaster response systems focus on emergency department and trauma management, such systems often do not provide for the need to triage existing inpatients to create room for incoming casualties, for continuity of physician care for those patients, as well as for MCI victims in case of major disaster. Such systems must also provide a mechanism for ethical and appropriate rationing of limited resources during a MCI. Community hospitals without 24/7 in-house physicians must provide a mechanism for physician care for patients in situations in which access to the hospital may be limited by the disaster (eg, major earthquake or flood). This article describes a system established at Long Beach Memorial Medical Center, a 740-bed not-for-profit hospital with a volunteer medical staff, to ensure continuity of physician care in a major disaster. To our knowledge, this is the first published report of such a system.

Background Innovative approaches, including LEAN systems and dashboards, to enhance pharmacy production continue to evolve in a cost and safety conscious health care environment. Furthermore, implementing and evaluating the effectiveness of these novel methods continues to be challenging for pharmacies. Objective To describe a comprehensive, real-time pharmacy dashboard that incorporated LEAN methodologies and evaluate its utilization in an inpatient Central Intravenous Additives Services (CIVAS) pharmacy. Methods Long Beach Memorial Hospital (462 adult beds) and Miller Children's and Women's Hospital of Long Beach (combined 324 beds) are tertiary not-for-profit, community-based hospitals that are served by one CIVAS pharmacy. Metrics to evaluate the effectiveness of CIVAS were developed and implemented on a dashboard in real-time from March 2013 to March 2014. Results The metrics that were designed and implemented to evaluate the effectiveness of CIVAS were quality and value, financial resilience, and the department's people and culture. Using a dashboard that integrated these metrics, the accuracy of manufacturing defect-free products was ≥99.9%, indicating excellent quality and value of CIVAS. The metric for financial resilience demonstrated a cost savings of $78,000 annually within pharmacy by eliminating the outsourcing of products. People and value metrics on the dashboard focused on standard work, with an overall 94.6% compliance to the workflow. Conclusion A unique dashboard that incorporated metrics to monitor 3 important areas was successfully implemented to improve the effectiveness of CIVAS pharmacy. These metrics helped pharmacy to monitor progress in real-time, allowing attainment of production goals and fostering continuous quality improvement through LEAN work.

Abstract Abstract 4246 Background: Analysis of administrative databases indicates high acute health care utilization in 18 to 30 year old patients with sickle cell disease (SCD). Thirty-day re-hospitalization rates are higher in SCD than any other disease studied. Administrative databases may misrepresent clinical care due to coding errors. We undertook a study of acute health care utilization in a community-based healthcare system that provides comprehensive pediatric sickle cell care up to age 21 years of age, but without a dedicated adult clinic in place. Methods: This study is a retrospective chart review (1/1/2009-12/31/2010) using discharge ICD-9-CM codes for sickle cell disease in primary or secondary diagnoses at Long Beach Memorial Medical Center/Miller Children's Hospital. To assess clinical care for SCD in our community, we examined 14- and 30-day readmissions and Emergency Department (ED) encounters following an index admission. Results: We identified 174 unique patients and 563 acute care encounters (readmission plus ED visits). Median patient age was 15 years (range 7 days to 65 years). There was a female predominance (96 female;78 male). Insurance coverage distribution overall was 67.5% public, 26.6% private, 3.9 % uninsured, and 0.5% unknown. The percent of patients with at least one 14-day and one 30-day readmission was 7.2% and 14.5% of those 10 or less (n=55), 10.9% and 16.4% of those 11–20 (n=55), 41.0% and 51.3% of 21–30 year old (n=39), and 16% and 28% of those over age 30 years (n=25). The ED treat and release rate within 14 days of discharge from an inpatient hospitalization was 9.5% of acute care encounters and occurred entirely in the over 30 yr old population. The overall rate within 30 days was 9.9% (6.3% acute care encounters in </= 10 yr olds, 0% 11 to 20, 2.5% 21–30, and 14% for over 30 year olds). The median number of 30-day acute care encounters for the entire population per patient per year was 1.62; 1.22 in </= 10 yr olds, 1.28 for 11–21 yr olds, 2.41 for 21–30 yr olds, and 2.0 for those over 30 yrs old. A few patients (5.2%) had 11+ encounters in a two-year period – the majority (67%) were 21–30 years old. Acute care encounters per patient per year in public vs. privately insured patients were: 1.30 and 0.95 for ages </= 10 yrs (80.0% public insurance), 1.27 and 1.32 for ages 11–20 (58.2% public insurance), 2.70 and 1.69 for ages 21–30 (74.4% public insurance), and 2.77 and 1.20 for those over 30 years old (60% public insurance). The six uninsured patients (1 each 11–20 and 21–30 yrs old, 4 >30 yrs old) had 1.2 encounters/patient/year. Length of stay and discharge diagnoses did not differ between the index admission and readmission in any age group. Acute care encounters within 30 days vs. index hospitalization were due to pain (90% vs. 92%), surgery (3.1% vs. 3.7%), acute chest syndrome (2.5% vs. 1.9%), childbirth (1.8% vs.0%), and for other reasons (2.5%, 2.5%). Conclusions: We confirmed previous database studies that the highest rate of 14- and 30-day readmission and the highest number of acute care encounters/patient/year occurs in 21–30 year olds. A small number of patients, the majority aged 21–30 years, account for >11 encounters in the two-year study period. There were more encounters for 21–30 and 31+ year olds for those publicly vs. privately insured. There was minimal use of the ED to treat and release following a hospital discharge in SCD patients under the age of 31. Dissecting the multiple reasons for the high number of encounters and rehospitalizations may result in decreasing acute health care utilization by persons with SCD, especially for patients greater than 21years old. Disclosures: No relevant conflicts of interest to declare.

In the last months of his life, 86-year-old Albert Facey became a best-selling author and revered cultural figure following the publication of his autobiography, A Fortunate Life. Released on Anzac Day 1981, it was praised for its “plain, unembellished, utterly sincere and un-self-pitying account of the privations of childhood and youth” (Semmler) and “extremely powerful description of Gallipoli” (Dutton 16). Within weeks, critic Nancy Keesing declared it an “Enduring Classic.” Within six months, it was announced as the winner of two prestigious non-fiction awards, with judges acknowledging Facey’s “extraordinary memory” and “ability to describe scenes and characters with great precision” (“NBC” 4). A Fortunate Life also transformed the fortunes of its publisher. Founded in 1976 as an independent, not-for-profit publishing house, Fremantle Arts Centre Press (FACP) might have been expected, given the Australian average, to survive for just a few years. Former managing editor Ray Coffey attributes the Press’s ongoing viability, in no small measure, to Facey’s success (King 29). Along with Wendy Jenkins, Coffey edited Facey’s manuscript through to publication; only five months after its release, with demand outstripping the capabilities, FACP licensed Penguin to take over the book’s production and distribution. Adaptations soon followed. In 1984, Kerry Packer’s PBL launched a prospectus for a mini-series, which raised a record $6.3 million (PBL 7–8). Aired in 1986 with a high-rating documentary called The Facey Phenomenon, the series became the most watched television event of the year (Lucas). Syndication of chapters to national and regional newspapers, stage and radio productions, audio- and e-books, abridged editions for young readers, and inclusion on secondary school curricula extended the range and influence of Facey’s life writing. Recently, an option was taken out for a new television series (Fraser).A hundred reprints and two million readers on from initial publication, A Fortunate Life continues to rate among the most appreciated Australian books of all time. Commenting on a reader survey in 2012, writer and critic Marieke Hardy enthused, “I really loved it [. . .] I felt like I was seeing a part of my country and my country’s history through a very human voice . . .” (First Tuesday Book Club). Registering a transformed reading, Hardy’s reference to Australian “history” is unproblematically juxtaposed with amused delight in an autobiography that invents and embellishes: not believing “half” of what Facey wrote, she insists he was foremost a yarn spinner. While the work’s status as a witness account has become less authoritative over time, it seems appreciation of the author’s imagination and literary skill has increased (Williamson). A Fortunate Life has been read more commonly as an uncomplicated, first-hand account, such that editor Wendy Jenkins felt it necessary to refute as an “utter mirage” that memoir is “transferred to the page by an act of perfect dictation.” Sidonie Smith and Julia Watson argue of life narratives that some “autobiographical claims [. . .] can be verified or discounted by recourse to documentation outside the text. But autobiographical truth is a different matter” (16). With increased access to archives, especially digitised personnel records, historians have asserted that key elements of Facey’s autobiography are incorrect or “fabricated” (Roberts), including his enlistment in 1914 and participation in the Gallipoli Landing on 25 April 1915. We have researched various sources relevant to Facey’s early years and war service, including hard-copy medical and repatriation records released in 2012, and find A Fortunate Life in a range of ways deviates from “documentation outside of the text,” revealing intriguing, layered storytelling. We agree with Smith and Watson that “autobiographical acts” are “anything but simple or transparent” (63). As “symbolic interactions in the world,” they are “culturally and historically specific” and “engaged in an argument about identity” (63). Inevitably, they are also “fractured by the play of meaning” (63). Our approach, therefore, includes textual analysis of Facey’s drafts alongside the published narrative and his medical records. We do not privilege institutional records as impartial but rather interpret them in terms of their hierarchies and organisation of knowledge. This leads us to speculate on alternative readings of A Fortunate Life as an illness narrative that variously resists and subscribes to dominant cultural plots, tropes, and attitudes. Facey set about writing in earnest in the 1970s and generated (at least) three handwritten drafts, along with a typescript based on the third draft. FACP produced its own working copy from the typescript. Our comparison of the drafts offers insights into the production of Facey’s final text and the otherwise “hidden” roles of editors as transformers and enablers (Munro 1). The notion that a working man with basic literacy could produce a highly readable book in part explains Facey’s enduring appeal. His grandson and literary executor, John Rose, observed in early interviews that Facey was a “natural storyteller” who had related details of his life at every opportunity over a period of more than six decades (McLeod). Jenkins points out that Facey belonged to a vivid oral culture within which he “told and retold stories to himself and others,” so that they eventually “rubbed down into the lines and shapes that would so memorably underpin the extended memoir that became A Fortunate Life.” A mystique was thereby established that “time” was Albert Facey’s “first editor” (Jenkins). The publisher expressly aimed to retain Facey’s voice, content, and meaning, though editing included much correcting of grammar and punctuation, eradication of internal inconsistencies and anomalies, and structural reorganisation into six sections and 68 chapters. We find across Facey’s drafts a broadly similar chronology detailing childhood abandonment, life-threatening incidents, youthful resourcefulness, physical prowess, and participation in the Gallipoli Landing. However, there are also shifts and changed details, including varying descriptions of childhood abuse at a place called Cave Rock; the introduction of (incompatible accounts of) interstate boxing tours in drafts two and three which replace shearing activities in Draft One; divergent tales of Facey as a world-standard athlete, league footballer, expert marksman, and powerful swimmer; and changing stories of enlistment and war service (see Murphy and Nile, “Wounded”; “Naked”).Jenkins edited those sections concerned with childhood and youth, while Coffey attended to Facey’s war and post-war life. Drawing on C.E.W. Bean’s official war history, Coffey introduced specificity to the draft’s otherwise vague descriptions of battle and amended errors, such as Facey’s claim to have witnessed Lord Kitchener on the beach at Gallipoli. Importantly, Coffey suggested the now famous title, “A Fortunate Life,” and encouraged the author to alter the ending. When asked to suggest a title, Facey offered “Cave Rock” (Interview)—the site of his violent abuse and humiliation as a boy. Draft One concluded with Facey’s repatriation from the war and marriage in 1916 (106); Draft Two with a brief account of continuing post-war illness and ultimate defeat: “My war injuries caught up with me again” (107). The submitted typescript concludes: “I have often thought that going to War has caused my life to be wasted” (Typescript 206). This ending differs dramatically from the redemptive vision of the published narrative: “I have lived a very good life, it has been very rich and full. I have been very fortunate and I am thrilled by it when I look back” (412).In The Wounded Storyteller, Arthur Frank argues that literary markets exist for stories of “narrative wreckage” (196) that are redeemed by reconciliation, resistance, recovery, or rehabilitation, which is precisely the shape of Facey’s published life story and a source of its popularity. Musing on his post-war experiences in A Fortunate Life, Facey focuses on his ability to transform the material world around him: “I liked the challenge of building up a place from nothing and making a success where another fellow had failed” (409). If Facey’s challenge was building up something from nothing, something he could set to work on and improve, his life-writing might reasonably be regarded as a part of this broader project and desire for transformation, so that editorial interventions helped him realise this purpose. Facey’s narrative was produced within a specific zeitgeist, which historian Joy Damousi notes was signalled by publication in 1974 of Bill Gammage’s influential, multiply-reprinted study of front-line soldiers, The Broken Years, which drew on the letters and diaries of a thousand Great War veterans, and also the release in 1981 of Peter Weir’s film Gallipoli, for which Gammage was the historical advisor. The story of Australia’s war now conceptualised fallen soldiers as “innocent victims” (Damousi 101), while survivors were left to “compose” memories consistent with their sacrifice (Thomson 237–54). Viewing Facey’s drafts reminds us that life narratives are works of imagination, that the past is not fixed and memory is created in the present. Facey’s autobiographical efforts and those of his publisher to improve the work’s intelligibility and relevance together constitute an attempt to “objectify the self—to present it as a knowable object—through a narrative that re-structures [. . .] the self as history and conclusions” (Foster 10). Yet, such histories almost invariably leave “a crucial gap” or “censored chapter.” Dennis Foster argues that conceiving of narration as confession, rather than expression, “allows us to see the pathos of the simultaneous pursuit and evasion of meaning” (10); we believe a significant lacuna in Facey’s life writing is intimated by its various transformations.In a defining episode, A Fortunate Life proposes that Facey was taken from Gallipoli on 19 August 1915 due to wounding that day from a shell blast that caused sandbags to fall on him, crush his leg, and hurt him “badly inside,” and a bullet to the shoulder (348). The typescript, however, includes an additional but narratively irreconcilable date of 28 June for the same wounding. The later date, 19 August, was settled on for publication despite the author’s compelling claim for the earlier one: “I had been blown up by a shell and some 7 or 8 sandbags had fallen on top of me, the day was the 28th of June 1915, how I remembered this date, it was the day my brother Roy had been killed by a shell burst.” He adds: “I was very ill for about six weeks after the incident but never reported it to our Battalion doctor because I was afraid he would send me away” (Typescript 205). This account accords with Facey’s first draft and his medical records but is inconsistent with other parts of the typescript that depict an uninjured Facey taking a leading role in fierce fighting throughout July and August. It appears, furthermore, that Facey was not badly wounded at any time. His war service record indicates that he was removed from Gallipoli due to “heart troubles” (Repatriation), which he also claims in his first draft. Facey’s editors did not have ready access to military files in Canberra, while medical files were not released until 2012. There existed, therefore, virtually no opportunity to corroborate the author’s version of events, while the official war history and the records of the State Library of Western Australia, which were consulted, contain no reference to Facey or his war service (Interview). As a consequence, the editors were almost entirely dependent on narrative logic and clarifications by an author whose eyesight and memory had deteriorated to such an extent he was unable to read his amended text. A Fortunate Life depicts men with “nerve sickness” who were not permitted to “stay at the Front because they would be upsetting to the others, especially those who were inclined that way themselves” (350). By cross referencing the draft manuscripts against medical records, we can now perceive that Facey was regarded as one of those nerve cases. According to Facey’s published account, his wounds “baffled” doctors in Egypt and Fremantle (353). His medical records reveal that in September 1915, while hospitalised in Egypt, his “palpitations” were diagnosed as “Tachycardia” triggered by war-induced neuroses that began on 28 June. This suggests that Facey endured seven weeks in the field in this condition, with the implication being that his debility worsened, resulting in his hospitalisation. A diagnosis of “debility,” “nerves,” and “strain” placed Facey in a medical category of “Special Invalids” (Butler 541). Major A.W. Campbell noted in the Medical Journal of Australia in 1916 that the war was creating “many cases of little understood nervous and mental affections, not only where a definite wound has been received, but in many cases where nothing of the sort appears” (323). Enlisted doctors were either physicians or surgeons and sometimes both. None had any experience of trauma on the scale of the First World War. In 1915, Campbell was one of only two Australian doctors with any pre-war experience of “mental diseases” (Lindstrom 30). On staff at the Australian Base Hospital at Heliopolis throughout the Gallipoli campaign, he claimed that at times nerve cases “almost monopolised” the wards under his charge (319). Bearing out Facey’s description, Campbell also reported that affected men “received no sympathy” and, as “carriers of psychic contagion,” were treated as a “source of danger” to themselves and others (323). Credentialed by royal colleges in London and coming under British command, Australian medical teams followed the practice of classifying men presenting “nervous or mental symptoms” as “battle casualties” only if they had also been wounded by “enemy action” (Loughran 106). By contrast, functional disability, with no accompanying physical wounds, was treated as unmanly and a “hysterical” reaction to the pressures of war. Mental debility was something to be feared in the trenches and diagnosis almost invariably invoked charges of predisposition or malingering (Tyquin 148–49). This shifted responsibility (and blame) from the war to the individual. Even as late as the 1950s, medical notes referred to Facey’s condition as being “constitutional” (Repatriation).Facey’s narrative demonstrates awareness of how harshly sufferers were treated. We believe that he defended himself against this with stories of physical injury that his doctors never fully accepted and that he may have experienced conversion disorder, where irreconcilable experience finds somatic expression. His medical diagnosis in 1915 and later life writing establish a causal link with the explosion and his partial burial on 28 June, consistent with opinion at the time that linked concussive blasts with destabilisation of the nervous system (Eager 422). Facey was also badly shaken by exposure to the violence and abjection of war, including hand-to-hand combat and retrieving for burial shattered and often decomposed bodies, and, in particular, by the death of his brother Roy, whose body was blown to pieces on 28 June. (A second brother, Joseph, was killed by multiple bayonet wounds while Facey was convalescing in Egypt.) Such experiences cast a different light on Facey’s observation of men suffering nerves on board the hospital ship: “I have seen men doze off into a light sleep and suddenly jump up shouting, ‘Here they come! Quick! Thousands of them. We’re doomed!’” (350). Facey had escaped the danger of death by explosion or bayonet but at a cost, and the war haunted him for the rest of his days. On disembarkation at Fremantle on 20 November 1915, he was admitted to hospital where he remained on and off for several months. Forty-one other sick and wounded disembarked with him (HMAT). Around one third, experiencing nerve-related illness, had been sent home for rest; while none returned to the war, some of the physically wounded did (War Service Records). During this time, Facey continued to present with “frequent attacks of palpitation and giddiness,” was often “short winded,” and had “heart trouble” (Repatriation). He was discharged from the army in June 1916 but, his drafts suggest, his war never really ended. He began a new life as a wounded Anzac. His dependent and often fractious relationship with the Repatriation Department ended only with his death 66 years later. Historian Marina Larsson persuasively argues that repatriated sick and wounded servicemen from the First World War represented a displaced presence at home. Many led liminal lives of “disenfranchised grief” (80). Stephen Garton observes a distinctive Australian use of repatriation to describe “all policies involved in returning, discharging, pensioning, assisting and training returned men and women, and continuing to assist them throughout their lives” (74). Its primary definition invokes coming home but to repatriate also implies banishment from a place that is not home, so that Facey was in this sense expelled from Gallipoli and, by extension, excluded from the myth of Anzac. Unlike his two brothers, he would not join history as one of the glorious dead; his name would appear on no roll of honour. Return home is not equivalent to restoration of his prior state and identity, for baggage from the other place perpetually weighs. Furthermore, failure to regain health and independence strains hospitality and gratitude for the soldier’s service to King and country. This might be exacerbated where there is no evident or visible injury, creating suspicion of resistance, cowardice, or malingering. Over 26 assessments between 1916 and 1958, when Facey was granted a full war pension, the Repatriation Department observed him as a “neuropathic personality” exhibiting “paroxysmal tachycardia” and “neurocirculatory asthenia.” In 1954, doctors wrote, “We consider the condition is a real handicap and hindrance to his getting employment.” They noted that after “attacks,” Facey had a “busted depressed feeling,” but continued to find “no underlying myocardial disease” (Repatriation) and no validity in Facey’s claims that he had been seriously physically wounded in the war (though A Fortunate Life suggests a happier outcome, where an independent medical panel finally locates the cause of his ongoing illness—rupture of his spleen in the war—which results in an increased war pension). Facey’s condition was, at times, a source of frustration for the doctors and, we suspect, disappointment and shame to him, though this appeared to reduce on both sides when the Repatriation Department began easing proof of disability from the 1950s (Thomson 287), and the Department of Veteran’s Affairs was created in 1976. This had the effect of shifting public and media scrutiny back onto a system that had until then deprived some “innocent victims of the compensation that was their due” (Garton 249). Such changes anticipated the introduction of Post-Traumatic Shock Disorder (PTSD) to the Diagnostic and Statistical Manual of Mental Disorders (DSM) in 1980. Revisions to the DSM established a “genealogy of trauma” and “panic disorders” (100, 33), so that diagnoses such as “neuropathic personality” (Echterling, Field, and Stewart 192) and “soldier’s heart,” that is, disorders considered “neurotic,” were “retrospectively reinterpreted” as a form of PTSD. However, Alberti points out that, despite such developments, war-related trauma continues to be contested (80). We propose that Albert Facey spent his adult life troubled by a sense of regret and failure because of his removal from Gallipoli and that he attempted to compensate through storytelling, which included his being an original Anzac and seriously wounded in action. By writing, Facey could shore up his rectitude, work ethic, and sense of loyalty to other servicemen, which became necessary, we believe, because repatriation doctors (and probably others) had doubted him. In 1927 and again in 1933, an examining doctor concluded: “The existence of a disability depends entirely on his own unsupported statements” (Repatriation). We argue that Facey’s Gallipoli experiences transformed his life. By his own account, he enlisted for war as a physically robust and supremely athletic young man and returned nine months later to life-long anxiety and ill-health. Publication transformed him into a national sage, earning him, in his final months, the credibility, empathy, and affirmation he had long sought. Exploring different accounts of Facey, in the shape of his drafts and institutional records, gives rise to new interpretations. In this context, we believe it is time for a new edition of A Fortunate Life that recognises it as a complex testimonial narrative and theorises Facey’s deployment of national legends and motifs in relation to his “wounded storytelling” as well as to shifting cultural and medical conceptualisations and treatments of shame and trauma. ReferencesAlberti, Fay Bound. Matters of the Heart: History, Medicine, and Emotions. Oxford: Oxford UP, 2010. Butler, A.G. Official History of the Australian Medical Services 1814-1918: Vol I Gallipoli, Palestine and New Guinea. Canberra: Australian War Memorial, 1930.Campbell, A.W. “Remarks on Some Neuroses and Psychoses in War.” Medical Journal of Australia 15 April (1916): 319–23.Damousi, Joy. “Why Do We Get So Emotional about Anzac.” What’s Wrong with Anzac. Ed. Marilyn Lake and Henry Reynolds. Sydney: UNSWP, 2015. 94–109.Dutton, Geoffrey. “Fremantle Arts Centre Press Publicity.” Australian Book Review May (1981): 16.Eager, R. “War Neuroses Occurring in Cases with a Definitive History of Shell Shock.” British Medical Journal 13 Apr. 1918): 422–25.Echterling, L.G., Thomas A. Field, and Anne L. Stewart. “Evolution of PTSD in the DSM.” Future Directions in Post-Traumatic Stress Disorder: Prevention, Diagnosis, and Treatment. Ed. Marilyn P. Safir and Helene S. Wallach. New York: Springer, 2015. 189–212.Facey, A.B. A Fortunate Life. 1981. Ringwood: Penguin, 2005.———. Drafts 1–3. University of Western Australia, Special Collections.———. Transcript. University of Western Australia, Special Collections.First Tuesday Book Club. ABC Splash. 4 Dec. 2012. <http://splash.abc.net.au/home#!/media/1454096/http&>.Foster, Dennis. Confession and Complicity in Narrative. Cambridge: Cambridge UP, 1987.Frank, Arthur. The Wounded Storyteller. London: U of Chicago P, 1995.Fraser, Jane. “CEO Says.” Fremantle Press. 7 July 2015. <https://www.fremantlepress.com.au/c/news/3747-ceo-says-9>.Garton, Stephen. The Cost of War: Australians Return. Melbourne: Oxford UP, 1994.HMAT Aeneas. “Report of Passengers for the Port of Fremantle from Ports Beyond the Commonwealth.” 20 Nov. 1915. <http://recordsearch.naa.gov.au/SearchNRetrieve/Interface/ViewImage.aspx?B=9870708&S=1>.“Interview with Ray Coffey.” Personal interview. 6 May 2016. Follow-up correspondence. 12 May 2016.Jenkins, Wendy. “Tales from the Backlist: A Fortunate Life Turns 30.” Fremantle Press, 14 April 2011. <https://www.fremantlepress.com.au/c/bookclubs/574-tales-from-the-backlist-a-fortunate-life-turns-30>.Keesing, Nancy. ‘An Enduring Classic.’ Australian Book Review (May 1981). FACP Press Clippings. Fremantle. n. pag.King, Noel. “‘I Can’t Go On … I’ll Go On’: Interview with Ray Coffey, Fremantle Arts Centre Press, 22 Dec. 2004; 24 May 2006.” Westerly 51 (2006): 31–54.Larsson, Marina. “A Disenfranchised Grief: Post War Death and Memorialisation in Australia after the First World War.” Australian Historical Studies 40.1 (2009): 79–95.Lindstrom, Richard. “The Australian Experience of Psychological Casualties in War: 1915-1939.” PhD dissertation. Victoria University, Feb. 1997.Loughran, Tracey. “Shell Shock, Trauma, and the First World War: The Making of a Diagnosis and its Histories.” Journal of the History of Medical and Allied Sciences 67.1 (2012): 99–119.Lucas, Anne. “Curator’s Notes.” A Fortunate Life. Australian Screen. <http://aso.gov.au/titles/tv/a-fortunate-life/notes/>.McLeod, Steve. “My Fortunate Life with Grandad.” Western Magazine Dec. (1983): 8.Munro, Craig. Under Cover: Adventures in the Art of Editing. Brunswick: Scribe, 2015.Murphy, Ffion, and Richard Nile. “The Naked Anzac: Exposure and Concealment in A.B. Facey’s A Fortunate Life.” Southerly 75.3 (2015): 219–37.———. “Wounded Storyteller: Revisiting Albert Facey’s Fortunate Life.” Westerly 60.2 (2015): 87–100.“NBC Book Awards.” Australian Book Review Oct. (1981): 1–4.PBL. Prospectus: A Fortunate Life, the Extraordinary Life of an Ordinary Bloke. 1–8.Repatriation Records. Albert Facey. National Archives of Australia.Roberts, Chris. “Turkish Machine Guns at the Landing.” Wartime: Official Magazine of the Australian War Memorial 50 (2010). <https://www.awm.gov.au/wartime/50/roberts_machinegun/>.Semmler, Clement. “The Way We Were before the Good Life.” Courier Mail 10 Oct. 1981. FACP Press Clippings. Fremantle. n. pag.Smith, Sidonie, and Julia Watson. Reading Autobiography: A Guide for Interpreting Life Narratives. 2001. 2nd ed. U of Minnesota P, 2010.Thomson, Alistair. Anzac Memories: Living with the Legend. 1994. 2nd ed. Melbourne: Monash UP, 2013. Tyquin, Michael. Gallipoli, the Medical War: The Australian Army Services in the Dardanelles Campaign of 1915. Kensington: UNSWP, 1993.War Service Records. National Archives of Australia. <http://recordsearch.naa.gov.au/NameSearch/Interface/NameSearchForm.aspx>.Williamson, Geordie. “A Fortunate Life.” Copyright Agency. <http://readingaustralia.com.au/essays/a-fortunate-life/>.

There have been a number of Australian memoirs written by adoptees over the last twenty years—Robert Dessaix’s A Mother’s Disgrace, Suzanne Chick’s Searching for Charmian, Tom Frame’s Binding Ties:An Experience of Adoption and Reunion in Australia, for example—as well as international adoptee narratives by Betty Jean Lifton, Florence Fisher, and A. M. Homes amongst others. These works form a component of the small but growing field of adoption life writing that includes works by “all members of the adoption triad” (Hipchen and Deans 163): adoptive parents, birthparents, and adoptees. As the broad genre of memoir becomes more theorised and mapped, many sub-genres are emerging (Brien). My own adoptee story (which I am currently composing) could be a further sub-categorisation of the adoptee memoir, that of “late discovery adoptees” (Perl and Markham), those who are either told, or find out, about their adoption in adulthood. When this is part of a life story, secrets and silences are prominent, and digging into these requires using whatever resources can be found. These include cookbooks, recipes written by hand, and the scraps of paper shoved between pages. There are two cookbooks from my adoptive mother’s belongings that I have kept. One of them is titled Miss Tuxford’s Modern Cookery for the Middle Classes: Hints on Modern Gas Stove Cooking, and this was published around 1937 in England. It’s difficult to date this book exactly, as there is no date in my copy, but one of the advertisements (for Bird’s Custard, I think; the page is partly obscured by an Orange Nut Loaf recipe from a Willow baking pan that has been glued onto the page) is headed with a date range of 1837 to 1937. It has that smell of long ago that lingers strongly even now, out of the protective custody of my mother’s storage. Or should I say, out of the range of my adoptive father’s garbage dump zeal. He loved throwing things away, but these were often things that I saw as valuable, or at least of sentimental value, worth keeping for the memories they evoked. Maybe my father didn’t want to remember. My mother was brimming with memories, I discovered after her death, but she did not reveal them during her life. At least, not to me, making objects like these cookbooks precious in my reconstruction of the lives I know so little about, as well as in the grieving process (Gibson).Miss Tuxford (“Diplomée Board of Education, Gold Medallist, etc”) produced numerous editions of her book. My mother’s is now fragile, loose at the spine and browned with age. There are occasional stains showing that the bread and cakes section got the most use, with the pages for main meals of meat and vegetables relatively clean. The author divided her recipes into the main chapters of Soups (lentil, kidney, sheep’s head broth), Sauces (white, espagnol, mushroom), Fish (“It is important that all fish is fresh when cooked” (23)), Meats (roasted, boiled, stuffed; roast rabbit, boiled turkey, scotch collop), Vegetables (creamed beetroot, economical salad dressing, potatoes baked in their skins), Puddings and Sweets (suet pastry, Yorkshire pudding, chocolate tarts, ginger cream), Bread and Cakes (household bread, raspberry sandwich cake, sultana scones, peanut fancies), Icings and Fillings, Invalid Cookery (beef tea, nourishing lemonade, Virol pudding), Jams, Sweetmeats and Pickles (red currant jelly, piccalilli) and Miscellaneous Dishes including Meatless Recipes (cheese omelette, mock white fish, mock duck, mock goose, vegetarian mincemeat). At the back, Miss Tuxford includes sections on gas cooking hints, “specimen household dinners” (206), and household hints. There is then a “Table of Foods in Season” (208–10) taking the reader through the months and the various meats and vegetables available at those times. There is a useful index and finally an advertisement for an oven cleaner on the last page (which is glued to the back cover). There are food and cookery advertisements throughout the book, but my favourite is the one inside the front cover, for Hartley’s jam, featuring two photographs of a little boy. The first shows him looking serious, and slightly anxious, the second wide-eyed and smiling, eager for his jam. The text tells mothers that “there’s nothing like plenty of bread and Hartley’s for a growing boy” (inside front cover). I love the simple appeal to making your little boy happy that is contained within this tiny narrative. Did my mother and father eat this jam when they were small? By 1937, my mother was twenty-one, not yet married, living with her mother in Weston-super-Mare. She was learning secretarial skills—I have her certificate of proficiency in Pitman’s shorthand—and I think she and my father had met by then. Perhaps she thought about when she would be giving her own children Hartley’s jam, or something else prepared from Miss Tuxford’s recipes, like the Christmas puddings, shortbread, or chocolate cake. She would not have imagined that no children would arrive, that twenty-five years of marriage would pass before she held her own baby, and this would be one who was born to another woman. In the one other cookbook I have kept, there are several recipes cut out from newspapers, and a few typed or handwritten recipes hidden within the pages. This is The Main Cookery Book, in its August 1944 reprint, which was written and compiled by Marguerite K. Gompertz and the “Staff of the Main Research Kitchen”. My mother wrote her name and the date she obtained the cookbook (31 January 1945) on the first blank page. She had been married just over five years, and my father may, or may not, have still been in the Royal Air Force. I have only a sketchy knowledge of my adoptive parents. My mother was born in Newent, Gloucestershire, and my father in Bromley, Kent; they were both born during the first world war. My father served as a navigator in the Royal Air Force in the second world war in the 1940s, received head and psychological injuries and was invalided out before the war ended. He spent some time in rehabilitation, there being letters from him to my mother detailing his stay in one hospital in the 1950s. Their life seemed to become less and less secure as the years passed, more chaotic, restless, and unsettled. By the time I came into their lives, they were both nearly fifty, and moving from place to place. Perhaps this is one reason why I have no memory of my mother cooking. I cannot picture her consulting these cookbooks, or anything more modern, or even cutting out the recipes from newspapers and magazines, because I do not remember seeing her do it. She did not talk to me about cooking, we didn’t cook together, and I do not remember her teaching me anything about food or its preparation. This is a gap in my memory that is puzzling. There is evidence—the books and additional paper recipes and stains on the pages—that my mother was involved in the world of the kitchen. This suggests she handled meats, vegetables, and flours, kneaded, chopped, mashed, baked, and boiled all manners of foods. But I cannot remember her doing any of it. I think the cooking must have been a part of her life before me, when she lived in England, her home country, which she loved, and when she still had hope that children would come. It must have then been apparent that her husband was going to need support and care after the war, and I can imagine she came to realise that any dreams she had would need rearranging.What I do remember is that our meals were prepared by my father, and contained no spices, onions, or garlic because he suffered frequently from indigestion and said these ingredients made it worse. He was a big-chested man with small hips who worried he was too heavy and so put himself on diets every other week. For my father, dieting meant not eating anything, which tended to lead to binges on chocolate or cheese or whatever he could grab easily from the fridge.Meals at night followed a pattern. On Sundays we ate roast chicken with vegetables as a treat, then finished it over the next days as a cold accompaniment with salad. Other meals would feature fish fingers, mince, ham, or a cold luncheon meat with either salad or boiled vegetables. Sometimes we would have a tin of peaches in juice or ice cream, or both. No cookbooks were consulted to prepare these meals.What was my mother doing while my father cooked? She must have been in the kitchen too, probably contributing, but I don’t see her there. By the time we came back to Australia permanently in 1974, my father’s working life had come to an end, and he took over the household cookery for something to do, as well as sewing his own clothes, and repairing his own car. He once hoisted the engine out of a Morris Minor with the help of a young mechanic, a rope, and the branch of a poinciana tree. I have three rugs that he wove before I was born, and he made furniture as well. My mother also sewed, and made my school uniforms and other clothes as well as her own skirts and blouses, jackets and pants. Unfortunately, she was fond of crimplene, which came in bright primary colours and smelled of petrol, but didn’t require ironing and dried quickly on the washing line. It didn’t exactly hang on your body, but rather took it over, imposing itself with its shapelessness. The handwritten recipe for salad cream shown on the pink paper is not in my mother’s hand but my father’s. Her correction can be seen to the word “gelatine” at the bottom; she has replaced it with “c’flour” which I assume means cornflour. This recipe actually makes me a liar, because it shows my father writing about using pepper, paprika, and tumeric to make a food item, when I have already said he used no spices. When I knew him, and ate his food, he didn’t. But he had another life for forty-seven years before my birth, and these recipes with their stains and scribbles help me to begin making a picture of both his life, and my mother’s. So much of them is a complete mystery to me, but these scraps of belongings help me inch along in my thinking about them, who they were, and what they meant to me (Turkle).The Main Cookery Book has a similar structure to Miss Tuxford’s, with some variations, like the chapter titled Réchauffés, which deals with dishes using already cooked foodstuffs that only then require reheating, and a chapter on home-made wines. There are also notes at the end of the book on topics such as gas ovens and methods of cooking (boiling, steaming, simmering, and so on). What really interests me about this book are the clippings inserted by my mother, although the printed pages themselves seem relatively clean and uncooked upon. There is a recipe for pickles and chutneys torn from a newspaper, and when I look on the other side I find a context: a note about Charlie Chaplin and the House of Representatives’s Un-American Activities Committee starting its investigations into the influence of Communists on Hollywood. I wonder if my parents talked about these events, or if they went to see Charlie Chaplin’s films. My mother’s diaries from the 1940s include her references to movies—Shirley Temple in Kiss and Tell, Bing Crosby in Road to Utopia—as well as day to day activities and visits to, and from, family and friends, her sinus infections and colds, getting “shock[ed] from paraffin lamp”, food rationing. If my father kept diaries during his earlier years, nothing of them survives. I remember his determined shredding of documents after my mother’s death, and his fear of discovery, that his life’s secrets would be revealed. He did not tell me I had been adopted until I was twenty-three, and rarely spoke of it afterwards. My mother never mentioned it. I look at the recipe for lemon curd. Did my mother ever make this? Did she use margarine instead of butter? We used margarine on sandwiches, as butter was too hard to spread. Once again, I turn over this clipping to read the news, and find no date but an announcement of an exhibition of work by Marc Chagall at the Tate Gallery, the funeral of Sir Geoffrey Fison (who I discover from The Peerage website died in 1948, unmarried, a Baronet and decorated soldier), and a memorial service for Dr. Duncan Campbell Scott, the Canadian poet and prose writer, during which the Poet Laureate of the time, John Masefield, gave the address. And there was also a note about the latest wills, including that of a reverend who left an estate valued at over £50 000. My maternal adoptive grandmother, who lived in Weston-super-Mare across the road from the beach, and with whom we stayed for several months in 1974, left most of her worldly belongings to my mother and nothing to her son. He seems to have been cut out from her life after she separated from her husband, and her children’s father, sometime in the 1920s. Apparently, my uncle followed his father out to Australia, and his mother never forgave him, refusing to have anything more to do with her son for the rest of her life, not even to see her grandchildren. When I knew her in that brief period in 1974, she was already approaching eighty and showing signs of dementia. But I do remember dancing the Charleston with her in the kitchen, and her helping me bathe my ragdoll Pollyanna in a tub in the garden. The only food I remember at her stone house was afternoon tea with lots of different, exotic cakes, particularly one called Neopolitan, with swirls of red and brown through the moist sponge. My grandmother had a long narrow garden filled with flowers and a greenhouse with tomatoes; she loved that garden, and spent a lot of time nurturing it.My father and his mother-in-law were not each other’s favourite person, and this coloured my mother’s relationship with her, too. We were poor for many years, and the only reason we were able to go to England was because of the generosity of my grandmother, who paid for our airfares. I think my father searched for work while we were there, but whether he was successful or not I do not know. We returned to Australia and I went into grade four at the end of 1974, an outsider of sorts, and bemused by the syllabus, because I had moved around so much. I went to eight different primary schools and two high schools, eventually obtaining a scholarship to a private girls’ school for the last four years. My father was intent on me becoming a doctor, and so my life was largely study, which is another reason why I took little notice of what went on in the kitchen and what appeared on the dining table. I would come home from school and my parents would start meal preparation almost straight away, so we sat down to dinner at about four o’clock during the week, and I started the night’s study at five. I usually worked through until about ten, and then read a novel for a little while before sleep. Every parcel of time was accounted for, and nothing was wasted. This schedule continued throughout those four years of high school, with my father berating me if I didn’t do well at an exam, but also being proud when I did. In grades eight, nine, and ten, I studied home economics, and remember being offered a zucchini to taste because I had never seen one before. I also remember making Greek biscuits of some sort for an exam, and the sieve giving out while I was sifting a large quantity of flour. We learned to cook simple meals of meats and vegetables, and to prepare a full breakfast. We also baked cakes but, when my sponges remained flat, I realised that my strengths might lay elsewhere. This probably also contributed to my lack of interest in cooking. Domestic pursuits were not encouraged at home, although my mother did teach me to sew and knit, resulting in skewed attempts at a shirt dress and a white blouse, and a wildly coloured knitted shoulder bag that I actually liked but which embarrassed my father. There were no such lessons in cakemaking or biscuit baking or any of the recipes from Miss Tuxford. By this time, my mother bought such treats from the supermarket.This other life, this previous life of my parents, a life far away in time and place, was completely unknown to me before my mother’s death. I saw little of them after the revelation of my adoption, not because of this knowledge I then had, but because of my father’s controlling behaviour. I discovered that the rest of my adoptive family, who I hardly knew apart from my maternal grandmother, had always known. It would have been difficult, after all, for my parents to keep such a secret from them. Because of this life of constant moving, my estrangement from my family, and our lack of friends and connections with other people, there was a gap in my experience. As a child, I only knew one grandmother, and only for a relatively brief period of time. I have no grandfatherly memories, and none either of aunts and uncles, only a few fleeting images of a cousin here and there. It was difficult to form friendships as a child when we were only in a place for a limited time. We were always moving on, and left everything behind, to start again in a new suburb, state, country. Continuity and stability were not our trademarks, for reasons that are only slowly making themselves known to me: my father’s mental health problems, his difficult personality, our lack of money, the need to keep my adoption secret.What was that need? From where did it spring? My father always seemed to be a secretive person, an intensely private man, one who had things to hide, and seemed to suffer many mistakes and mishaps and misfortune. At the end, after my mother’s death, we spent two years with each other as he became frailer and moved into a nursing home. It was a truce formed out of necessity, as there was no one else to care for him, so thoroughly had he alienated his family; he had no friends, certainly not in Australia, and only the doctor and helping professionals to talk to most days. My father’s brother John had died some years before, and the whereabouts of his other sibling Gordon were unknown. I discovered that he had died three years previously. Nieces had not heard from my father for decades. My mother’s niece revealed that my mother and she had never met. There is a letter from my mother’s father in the 1960s, probably just before he died, remarking that he would like a photograph of her as they hadn’t seen each other for forty years. None of this was talked about when my mother was alive. It was as if I was somehow separate from their stories, from their history, that it was not suitable for my ears, or that once I came into their lives they wanted to make a new life altogether. At that time, all of their past was stored away. Even my very origins, my tiny past life, were unspoken, and made into a secret. The trouble with secrets, however, is that they hang around, peek out of boxes, lurk in the corners of sentences, and threaten to be revealed by the questions of puzzled strangers, or mistakenly released by knowledgeable relatives. Adoptee memoirs like mine seek to go into those hidden storage boxes and the corners and pages of sources like these seemingly innocent old cookbooks, in the quest to bring these secrets to light. Like Miss Tuxford’s cookbook, with its stains and smudges, or the Main Cookery Book with its pages full of clippings, the revelation of such secrets threaten to tell stories that contradict the official version. ReferencesBrien, Donna Lee. “Pathways into an ‘Elaborate Ecosystem’: Ways of Categorising the Food Memoir”. TEXT (October 2011). 12 Jun. 2013 ‹http://www.textjournal.com.au/oct11/brien.htm›.Chick, Suzanne. Searching for Charmian. Sydney: Picador, 1995.Dessaix, Robert. A Mother’s Disgrace. Sydney: Angus & Robertson, 1994.Fisher, Florence. The Search for Anna Fisher. New York: Arthur Fields, 1973.Frame, Tom. Binding Ties: An Experience of Adoption and Reunion in Australia. Alexandria: Hale & Iremonger, 1999.Gibson, Margaret. Objects of the Dead: Mourning and Memory in Everyday Life. Carlton, Victoria: Melbourne U P, 2008. Gompertz, Marguerite K., and the Staff of the Main Research Kitchen. The Main Cookery Book. 52nd. ed. London: R. & A. Main, 1944. Hipchen, Emily, and Jill Deans. “Introduction. Adoption Life Writing: Origins and Other Ghosts”. a/b: Auto/Biography Studies 18.2 (2003): 163–70. Special Issue on Adoption.Homes, A. M. The Mistress’s Daughter: A Memoir. London: Granta, 2007.Kiss and Tell. Dir. By Richard Wallace. Columbia Pictures, 1945.Lifton, Betty Jean. Twice Born: Memoirs of An Adopted Daughter. Middlesex, England: Penguin, 1977.Lundy, Darryl, comp. The Peerage: A Genealogical Survey of the Peerage of Britain as well as the Royal Families of Europe. 30 May 2013 ‹http://www.thepeerage.com/p40969.htm#i409684›Perl, Lynne and Shirin Markham. Why Wasn’t I Told? Making Sense of the Late Discovery of Adoption. Bondi: Post Adoption Resource Centre/Benevolent Society of NSW, 1999.Road to Utopia. Dir. By Hal Walker. Paramount, 1946.Turkle, Sherry, ed. Evocative Objects: Things We Think With. Cambridge, Massachusetts: MIT P, 2011. Tuxford, Miss H. H. Miss Tuxford’s Modern Cookery for the Middle Classes: Hints on Modern Gas Stove Cooking. London: John Heywood, c.1937.