NFR

Another interesting day at work.

Started with an ED nurse saying "If I wasn't married I'd marry you... actually if you'll pay for my divorce I'll marry you.. you're my type!" She's from the Shire, and makes jokes about white supremists... not my type! (although she is threatening to wear a white pointy hat to the hospital's 'multi-cultural-dress-up-day' and I don't think its do do with Harry Potter)

Then my registrar handed over the patients on the ward and ended with; "Oh by the way there's a baby due to be born overnight I should tell you about. It's got Trisomy 18 which means its not really compatible with life. We don't expect it to survive very long so when you get called to go to the birth you're not to give any active intervention" (ie you get to sit and watch the baby die if it's not coping) We had spoken to the parents. They were in agreement. The 1 year survival of babies with this disease is 5% and those that do survive have very very poor quality of life with huge disabilities. But that said, it was kinda discomforting to be told to go to the birth, but not to do anything beyond a bit of passive oxygen. No intubation, no IV fluids. Just let nature take it's course. The only reason I would be going to attend the delivery as a paediatric doctor would be to watch. I honestly dunno how I feel about that. It goes against everything I entered medicine for. To be out of control and have no options left at the start of life is awful.

Thankfully the baby didn't come during my shift, but it was a busy night anyway. A nearby hospital was overcrowded and so started shipping kids to my ward. Only problem being that we had no spare beds ourselves and so I was left with 6 kids on 4 beds (don't ask me how that works, I still don't get it) in ED plus another one on an ambulance trolley and a cranky paeds nurse refusing to allow me to send my patients to MY ward.* I was juggling them all at once and trying to work them up and work out what was wrong with them. Had an Asian boy rock up with a fever, red hands and feet, red cracked lips, injected pharynx, cervical lymphadenopathy and purpuric lesions on his feet. Just on initial examination, my heart sank, looked like a case of Kawasaki Disease.

Kawasaki Disease is a 19 in 100,000 incidence vasculitic disease. My boss had grilled me on it yesterday and so when I saw it sitting in front of me I remembered what it looked like from the one case I had seen as a student and admitted this kid pronto. Although the fever hasn't been there for 5 days, I'm putting my money on the diagnosis of Kawasaki's and hope I can write him up for my case presentation (how nerdy!) Would have been nice if the patient didn't show up on such a busy day though.

Anyways, here endeth my long day and in 24 hours I will have finished my 13 day fortnight and can rest. Sigh...

* I'm sure she must have been a midwife in a former life cos all the other nurses on my paeds ward are gems... absolute angels in disguise

The Setup

Having been roped into a 13 day working fortnight, I trudged into work on Saturday to meet my consultant for the morning ward round. We worked our way thru our ward and then did the morning tour of the nursery to check out our 'bili-babies' cooking under the lights. As we fnished up for the day my boss offered to buy me coffee and so I gratefully accepted and we purchased some cafeteria quality beverages and sat down. Usually this sort of thing is not that uncommon on a weekday, a token gesture of thanks from the boss for our hard work. But I was very taken aback that the boss (who is by no means a workaholic) would take time on a Saturday (when he could have gone home to his wife and kids) to buy me coffee, sit down and have a chat.

And so we talked. We talked about careers (as every consultant seems to want to brainwash their JMO into doing their speciality), family, social life, love life and the rugby (such a consultant thing to ask about). He asked about my father and being a paediatrican knew nothing about it, but could sympathise seeing as his father-in-law had Alzheimers. He seemd very taken aback that I was so young for a resident and asked all the details of my accelerated education.

Later that afternoon I was sitting in the nursery when a midwife started chatting to me. "Dr X says that you're only 24? Is that true?" Somehow the cat had been let out of bag. "I have a daughter who's 23... she's a bit of a hottie... you should see her... she has a boyfriend, but I don't like him... I like you... I'll bring in some photos of her for you to see"

Today I rocked up to work and my registrar giggled in her high pitched NESB voice over the phone "Can you come ot the nursery? One of the midwives has some photos she wants to show you... " Thankfully an emergency Caesarean tied me up in theatre long enough for the midwife to finish her shift but when I arrived I found the other RMO, my registrar, my consultant and a coven* of midwives discussing my age and my apparently impending nuptials with the midwife's daughter.

I turned an awkward shade of red and looked at the floor.

That very lunchtime, I had had lunch at my old hospital (the Zoo) with Dr E and Dr T. Dr E (fresh back from her honeymoon) said she wants to set me up with some nurses on her haematology ward.

Do I have some kinda sign on my head saying "Desperate and dateless"? Is it a sign of people's admiration of me? Or their pity of me?

* I have decided the best collective noun for midwives is the one used for witches. Grrr they make my blood boil!

24 hours

Last night was my last night shift for the week and as it was relatively quiet I had time to sit and reflect on life. Life always seems so much more abstract when its dark and your sitting alone in the early hours of the morning waiting for dawn to breach the quiet.

For the past 4 weeks I've been working in paediatrics (kids medicine) and it suddenyl dawned on me that finally it had come. The day I had looked forward to. I was living my dreams. You see, 10 years ago when I was 14 yrs old and doing work experience at a hospital, I bumped into a paediatrician who took me aside to talk to me about medicine. At the time I knew I wanted to do something that helped people, something with science (cos I was a nerd) and medicine seemed like a good mix. He gave up about 30 minutes of his time to talk with me about the training process for medicine and the various specialities available at the end. Being a naive 14 yr old I was kinda apprehensive about anything to do with old people so his chosen profesison of paediatrics appealed instantly. I determined that night that I wanted to be a paediatrician and so began the next 10 years of my life. High school, med school, internship and residency all flew by to lead me to the point where in the black of night I sat in a cold hospital ED and finally lived out my dream. I'm finally working in paediatrics. My dream has been reached.

At that point, I was briefly interupted by the nurses who were beginning to devolve into politically incorrect comments again about all non-Australian born doctors being terrorists. I tried to imagine them with white pointy hats and flaming torches running around Sydney.

I then opened up a book I've been meaning to read for ages but never had a chance to. And I manged to finish it in one night. "The Outsider" - by Albert Camus. The existentialist novel that one a Nobel prize for literature and helped define a philosophical movement fueled by the irrationaility of life. Meursault will not pretend. He refuses to give in to societal norms of emotion, love, grief or remorse. When faced with the death sentence, he gains a perspective on life that helps him see the truth of the reality and futility of life and pretence. To quote Camus's Afterword "Lying is not only saying what isn't true. It is also, in fact especially, saying more than is true and, in the case of the human heart, saying more than one feels. We all do it, every day, to make life simpler."

However the bit that really resonated with me was how the protagonist reacted to his mother's death. Or perhaps more accurately, how he did not react. He is accused in court of being a criminal for not crying or showing remorse (which society would expect of him). But to him, he enjoys the beauty of the beach or the warmth of Marie and that means he has no time for such meaningless or pointless things such as grief. It made me wonder... cos sometimes I find myself identifying with Meursault and his situation. I tire sometimes of feeling bad about Dad and his impending death. I find myself talking about it as if it's as common as going to the movies or getting my hair cut (if I had hair).

I walked out of ED as the sun rose feeling deeply introspective. I hopped in my car and began the 5 hour car trip home (not a good diea after a long night shift... but I made it home safely) On the way home I stopped in to the psychiatric ward to see my Dad. Having worked in psychiatry it was a familiar sight. The colourful paint job to disguise the true purpose of the facililty. The 2 staged locked doors to prevent escapes. The circular architecture to promote an 'open' environment. The swagger of people with extra-pyramdial side effects. I asked a nurse if I could see my father. They looked at their patient list trying to recognise a name. It was obvious they were a typical psych nurse and had about as much functional cognition as the patients do.

Finally we opened the door to his room and there he lay. Sleeping. Sedated out of his mind on anti-psychotics and mood stabilisers. After much rousing he finally got up and it took a while for him to register who I was. As soon as he realised it was me, he grabbed his bag and started throwing his clothes into a bag. A sinking feeling wahsed over me as I realised he though I had come to liberate him from hospital. It took about 20 minutes to explain to him that he couldn't go home.

He made a wobbly effort to get up and began a slow shuffling gait charecteristic of his pharmacotherapy. He took me on a tour of his new temporary home and introduced me to some of his new friends he'd met and even converted. He 'shouted' me a Coke from the vending machine - echoing long ago memories of our father and son times spent bonding over 2 cans of Coke. This time however, it was my turn to listen to him and give up my time to be with him.

We talked about family issues and relatives who'd become enagaged. But only after I had explained to him who those relatives were. Eventually it was time for lunch and so I escorted him to the dining room so I could use this as a distraction to leave. He would have none of it and demanded to walk me to my car. The ensuing struggle left me having to sneak out and him banging on the glass with the look of the betrayed on his face. I turned my back on him. I turned away from the pounding and calling and kept walking. I couldn't turn around again. I wouldn't be able to deal with it.

Camus may have had no compassion, no feelings, no meaning in suffering; but I cannot. My dreams have been realised. My aspirations have been achieved and now my Dad's dreams are being pulled apart like a fraying thread. He was so helpless and I had to walk away. I'm sleep deprived, I'm confused and I have no idea what to do.

Phoenix

The past few weeks have been awful.

Work has been terrifying to the point that I feel like I want to vomit before I go. I'm unsupervised for 2/3 of the shifts I do and in charge of making the decision to admit sick children during winter when meningococcal is at its peak. I'm terrified of the one that will present atypically and pray daily that none of the kids I see will come to any harm. I'm out of my depth and having huge troubles finding blue threads of venous tissue to attempt to stab for blood.

Dad has gotten worse. We had a complaint from a neighbour that he was urinating in the street which subsequently led to him being admitted to a psychiatric hospital. It's hard watching your male role model and hero being consignedto a humiliating end with no dignity. Death has no regard for Dad's honour. We're trialling some SSRI's and risperidone to calm him down but it's going to have to result in some changes when (and if) he goes home.

And yet throughout all this I took comfort in my friends and relationships. People who I knew would always be there for me. And yet one of the closeset ones is now gone. I feel alone, unattractive and like a fool. The hopes I had were a joke and just another let down. And the loss of the closeness of the friendship stings. None of it makes sense.

As a guy, I like to have some degree of control in my life. To be able to make plans and live out dreams. But when those are crsuhed what do you do? When life is dictated to you rather than by you. Without hope, life becomes just a set of responsibilities and obligations.

To be honest, it's been a very dark few weeks. The cold, dark wet of the weather reflects the inner soul. Ahedonia sets in and the black cloud is straining at the door to be let in. And the urge to keep fighting dwindles.

And yet despite all this, the spark does not go out. Barely holding onto a hope unseen, I have been brought through the storm to rise above it. Just because life is not determined by me does not mean that life is out of control. It's just being controlled by someone bigger and more powerful.

Some people like to refer to His control as 'guidance'... to be honest I think that's a suboptimal term. Most of the time we don't 'choose' our path, it is dealt out to us and we just have to choose how to deal with it. Rather than guidance I would prefer to call it 'dragging'. Sometimes we get dragged through awful stuff, only to find it makes us stronger, that it thrusts us onto our knees before one who simultaneously instills fear and peace in the hearts of thsoe that belong to Him.

I find myself now still so deeply hurting and crushed and yet filled with a strength and resolve that is supernatural. In light of life's events, not in spite of life's events, I will run harder and faster and more closely with Him. Life is not alright (far from it) and yet I am alright. Like a phoenix, we rise from the ashes.

"Let now our hearts burn with a flame,
A fire consuming all for your Son's holy name"

Thought of the week

Sometimes it seems the world has glimpses of insight into the reality of life. Perhaps they are more realistic about the fallen nature of this world than the idealism that many of us hold. Often I think we look forwards without recognising the reality of the broken world we live in. And perhaps we actually allow old worldy ideas to permeate our thinking and dress them up as 'traditional conservative' beliefs without them having any such substance.

Either way these two articles were quite interesting:

http://au.todaytonight.yahoo.com/article/39941/none/arranged-marriages-better

http://blogs.smh.com.au/lifestyle/allmenareliars/archives/2007/07/tests_and_how_to_pass_them.html

I know some guys who have approached their elders requesting arranged marriages and yet most girls I meet recoil with horror at anything short of "Pride and Prejudice". Guys who get told off by their sig other for "not changing" make changes and then are told they are too weak for not standing up for themselves.

What's your opinion?

Robots

When I was a kid, my sisters and I each had our own special placemats at the dinner table. Whilst theirs were usually floral or pink and covered in feminine icons such as Barbie, mine was a faded and yet treasured piece of lino. It was simple in design, a bold slogan next to a picture depicting the heroes of all boys born in the 80's.

TRANSFORMERS

Fast forward to 20 years later and the little boy has now grown up (or has he?) The hushed crowd sit in silence as the Dreamworks logo is enveloped in a mechanical sound effect which is so familiar to a generation of children. The screen goes black and the electronic voice begins to tell the story of Cybertron, a world devastated by war which has offloaded it's warfare to the peaceful planet called Earth.

2 hours later I sit stunned. It is almost the same kind of silence experienced after attending the Star Wars III midnight premiere. A lost part of my childhood brought to fruitition thanks to ILM* and the silver-screen. Words cannot do justice to the art that befell my eyes.

Perfectly crafted steel transforming into human-like robots on a quest to destroy the evil forces of the Decepticons. Dialogue that flowed so smoothly and brought the cinema to rapturous laughter. A soundtrack that pulsated life into the drama and events. A storyline that stayed so true to the original that its minor flaws are irrelevant.

Sweet childhood memories of playing with Transformer toys. The tinny 80's stacatto theme song. I ended up seeing in twice in 24 hours. It left me with a long lost piece of my upbringing and with a joy that I haven't felt since the 80s.

Transformers... more than meets the eye!

* Industrial Light and Magic - the special effects company started by George Lucas to push the boundaries of what can be done on celluloid. Home of lightsabers and all things cool.