The Resident Experiment

"Now I Run " - Shannon Noll

2007-12-27T06:52:00.001-08:00

Tell me how the circle ends
There's no beginning
Everything that came before
Will come round again
And I look in the mirror
My fathers eyes look back at me

He gave me a road to choose
He gave me freedom
And I pray I'm strong enough
To walk in his shoes
And I hope that I become
Half the man he'd want me to be

Cos I feel you guiding me
Showin me the way when I'm misdirected
I know your not here but I feel connected

Chorus
Cos everything that I am
Comes from a better man
And all that I've said and done
Can't rewrite my history
Right there for all to see
I'm just my father's son
Taught me to walk, now I run
Now I run

Sometimes when I lose myself
In my weakness
I can feel the touch of his
Unmistakable hands
And they're pushing me forward
Back into the circle again

And I hope my son sees in me
The kind of man that he was to me

Chorus

And everything that I am
comes from a better man
And all that I've said and I've done
Can't rewrite my history
Right there for all to see
I'm just my fathers son
Taught me to walk, now I run
I run

Merriment minus one

2007-12-27T06:06:00.000-08:00

Last year I blogged about the awkwardness I felt at flying home and being greeted at the airport by a demented father. This year there was none of that. Only Mum waiting at the airport on her own to pick me up. How things change.

The house showed signs of his absence. The usually immaculate lawn was unkempt (although generously cut by a family friend), the garage looked abandoned, even the dog was lonely without his master.

I went to see him in the nursing home. He was slow and shuffling. He looked calm, but not enjoying life. He asked me about work and whether I had a girlfriend. He told me about how he was going and all his medical problems and I reassured him the nurses would look after him. He told me about all the things he wanted to do when he got home, not realising he wouldn't be going home... ever.

I gave him his Christmas present and he stared at it in confusion. "How do I open it?" I showed him how to unwrap a Christmas present, one fo the most basic things in life that even infants manage to master with glee at Christmas. He just sat there confused.

As we walked to the car I could see Mum was quiet and upset. I slung my arm around her and she burst into tears. We just stood there, words would be meaningless at times like these.

When I got home we had Christmas dinner, minus Dad. Although we had my sister's fiancee, it wasn't the same. Dad was the head of the family and we were like the roast turkey (headless). Mum tried to enjoy herself but who could blame her for feeling sad. She couldn't bring herself to watch the Carosl on TV. It would only bring up too many sentimental memories and make her cry.

I went out to the yard and cut some branches off a tree. We always have branches that need cutting, but it was always Dad who did this kinda thing. Usually he and I would spend father-son time together doing yard work, but this time it was just me. I picked up his tools, the ones passed onto him by his father and repaired a bench that he had constructed. As I drilled and hammered in the garage it all seemed so surreal. Memories of Dad talking to me about the deep things of life in that garage came flooding back. It was like I was an observer watching him teaching his son in the way he should go. I wished I could return to those days. To have one last deep conversation with him and thank him and say good bye.

What does it mean to honour your father? Is it about obeying them? Is it about loving them unconditonally as they age as they have loved you as a child? How do you honour your father when all that remains of him are fading memories of the man he used to be?
As we sat around at Christmas my sister asked me another question. Would I walk her down the aisle?

My heart kinda skipped a beat. These were Dad's roles, his moments. Giving permission for marriage and giving away his daughter at her wedding. I can only imagine how many times he watched his daughters as they grew up and looked forward to the day he could walk them one last time. I felt like I was robbing him. But my sister and mother insisted. Dad wouldn't be able to cope with the wedding. It would get him too agitated and he wouldn't be able to come. With sadnes, after much deliberation, I said yes. I can honour my father by stepping into his shoes, fulfilling functions he cannot, and protecting and loving the women in my family.

This is for you Dad... I miss you heaps

Engaging Times

2007-12-27T05:39:00.000-08:00

I got a text message from my sister's boyfriend asking to meet up for lunch. It was the first time he'd talked to me without my sister around so I checked with my sister to find out if anything was up.

Turned out that they'd been talking about marriage after 6 months of dating and he wanted to ask my Dad for permission. Given that Dad was in a nursing home and Grandad was a little bit scarier, my sister directed him to ask me as the 'responsible male' in our family to confront.

I called Mum that morning to talk to her. She had never met him, but trusted my judgement. Talk about pressure! I'd met him a few times and he seemed to check out. He seemed to genuinely care for my sister and was a guy who other guys looked up to and respected. He knew how to cook a BBQ and made mean Tacos/Burritos/Enchiladas (being Mexican and all) I'd seen my sister grow up a bit since dating him and knew he would look after her.

So after praying about it, I arrived early at the cafe to have a man-to man chat. I never envisaged I'd have to have this kind of conversation for many years to come. I began to think how terrifying it must be to ask and tired ot think of how to make things as easy as possible for the nervous guy.

He arrvied on time (always a good sign for a protective brother) and we went insdie and tucked into some food. There was the necessary small talk. I asked him about his college studies and he asked me about my work. I gently offered him a way in. "So how's things going with my sister?"

The relief washed across his face as he realised he could get to the point. He cleared his throat and began his spiel. He described their relationship and how much he loved my sister. Hearing the warmth and affection in his voice I knew that this was something serious and something good. He was edging closer and closer to the question. The poor guy... I could palpate the tension and knew what he was about to ask, but I had to let him get to it himself...to pre-empt would strip him of his victory.

"I want to ask for your permission to ask your sister to marry me"

I paused for a second, with admiration for this brave man's dignity and then replied in affirmation. I told him of my respect for his asking and of our family's blessing.

I then sat with him and prayed for them both, for their marriage to be a blessing to each other and to all who they come into contact with. As we rose, he said to me "You know, you're the first person who's ever prayed for the both of us... thankyou..."

2 months later he sat down with us at the family Christmas dinner table and met them all. I remember that after my last sister was born I was so livid that God had denied me a brother. God is not slow in keeping his promises as some understand slowness. In 1 year's time I will have a new brother-in-law and can't wait to welcome him to our family.

Another one...

2007-12-27T05:07:00.000-08:00

They were back. Dressed in their shiny burgundy vests and with their cheesy smiles they looked more like caterers than undertakers. I got a tap on the shoulder from a nurse; "Do you have time to come outside for a second?"

I quickly scanned around to see if someone else could attend to this duty but alas there were no other males on and I felt kinda it was a job that a gentleman should step up to.

So I pressed the button on the airlock and walked outside into the cool summer night. The sun had just slipped over the western front and there was an eerie twilight ambeince. The tall lanky guy in the vest cranked open the door and slid out a big body bag zipped up tight.

"What's the story with this one?" I asked, not really wanting to know the answer to this morbid question.

"Hung himself 2 days ago... cops only found him today"

I kinda quikcly started mentally picturing how bad it could look so that I wouldn't be too shocked. I'd heard bad stories about how they can look.

The smell from the bag was not particularly pleasant. The stench of death lingers in one's nose for hours. He unceremoniously ripped back the plastic to reveal a pale head staring back at me. They hand't even bothered to close his eyes. His tongue hung out the side of his head, protruding in defeat.

It was a strange scene in the ambulance bay. Me, the caterer and the dead guy. He looked about 40 years old or so. Pale and cold. Lifeless and limp.

I did the obligatory listening for vitals and confirmed what we all knew anyway. He was dead.

I signed the necessary paperwork, washed my hands and went back inside the airlock to the land of the living. Back to patients who still had some chance and who although smelt bad, did not smell of death.

Back...

2007-12-25T05:39:00.000-08:00

I needed a break from blogging. Time to just keep life to myself and stew over life internally.
But it's time to finish the blog with a few last posts before putting this baby to rest.

So please enjoy the final few posts....

Lifestyles of the rich and the famous

2007-11-03T23:13:00.000-07:00

For the past few months my sister has had a pretty cool job. She was headhunted to be a nanny for the kids of one of the country's top paid Hollywood stars. And so for the past few months I've been hearing stories of the glamorous lifestyle of Sydney's Hollywood scene. The backstage antics, the film set dramas and the famous celebrities she gets to meet as a perk of being a nanny to the stars.

So last night after getting back form Whoop Whoop I thought I should catch up with my sister and see her for the first time in 10 weeks. We went to Starbucks and chatted but unfortunately she had to work again that night because her boss was going out to a function.

"But do you wanna come over and watch a DVD? I'd just have to check with the boss to make sure it's ok"

1 hour later she called back to say her boss said I could come over to watch DVDs with my sister and that we coudl help ourselves to their wine and beer selection.

I picked up some choclate and a DVD and raced over to the exclusive address. As I walked to the door, my eyes saw the sign above the door. The name of the mansion struck a bell... it was the city's most expensive mansion (the one that set the property record in 2002 with $28 million and is now worth $60) Yikes!

I walked inside what looked like the foyer of a world class hotel. Except that this was a home. The marble floors shone, the staircase was French in design, the artwork on the walls so bizarre. I stepped shyly into the kitchen, not wanting to touch anything lest I break it.

My sister offered me a beer from their industrial metal fridges which held more varieties of beer than my local pub. I was then taken on a personal tour by my sister of Australia's most prestigous house. The boat house and water taxi ramp were bathed in the harbour glow and moonlight. The swimming pool was calm and serene as the rain fell upon it casuing little ripples everywhere. The yard was immaculately kept lush green lawn and the playground bigger than most public park's.

The interior fo the hosue was indescribable. Surrond sound built into every room providing an ambient soundtrack ot the tour. A $70,000 table that I couldn't even bring myself to touch for fear of spoiling it. Views that drew in the harbour city and looked over the tranquility of the bay. Wardrobe rooms that were 3 times the size of my bedroom. Bathrooms that looked like Hollywood make up artists canvasses. A private 20 seat cinema in the basement.

We sat down in the main bedroom to watch a DVD so we could keep an eye on the kids. The wall folded back to reveal a large flatscreen TV with surrond sound. We watched our DVD and drank Heineken.

After the movie finished I grabbed the rubbish and helepd my sister carry it downstairs. As I turned around I spun right into her boss, who had just arrived home.

His face looked exactly like I had seen on the big screen. The surrealism I felt made me nervous. I felt my pusle shoot up and my face flush.

"Um ... hi?... my name's J. Pleased to meet you?"

He was taller in real life than I had imagined. A huge man with huge stature who commanded a presence. He shook my hand and made for the fridge to grab a late nigth snack. We stood around, his wife, him, me and my sister and chatted briefly about childhood immunisation, my sister's job and her whether she could have time off for a honeymoon if she ever gets married. I felt so weird, standing next to someone so famous in his kitchen as we chatted about the everyday thing of life. He and his wife commented on how alike my sister and I look. "Is that a good thing?" I nervously joked. He joked with his wife "Stop picking on the poor guy... you've only just met him" Wow! He stood up for me? Haha!

In 5 minutes time we left them and my sister and I went home and I had had my brush with fame. I'd been invited to his house, had a beer at his place and had a chat about common stuff with a very down to earth celebrity.

I wonder why some people seem to be so down to earth and yet so famous?

Farewell Whoop Whoop

2007-11-03T22:44:00.000-07:00

January 2006 - a young doctor left the big smoke to start his internship up at Whoop Whoop Hospital. The beginning of his medical career, he was nervous and green. Keen... but wet round the ears. He knew the theory of patient management (supposedly) but had never actually put it into practice. Somehow he fumbled through those stressful days as his training wheels came off and he ran on his own for the first time.

Blog entry Monday 6th Feb 2006:
"I was being 'beeped' non-stop.. had no time to think about the decisions I was making... I was on autopilot but had no idea what I was doing... I no longer became an exercise in patient survival... it became an exercise in MY survival.
Burnt out I trudged down to handover to the evening RMO then walked home to the empty house ... it was awful... it was one of the most terrifying days of my life... and I wanted to quit..."

Fast forward 18 months and it was kinda fitting that my 2nd last term working as a doctor was back at Whoop Whoop. The wards were the same, the patients just as sick, but the doctor had made it. Internship had broken him, but he had fought back. Residency wasn't easy, but he was still alive and thriving once more.

The ward overtimes were just as hectic, but this time he was composed and able to triage the chaos better. The cannulas went in first time 90% of the time (instead of 10% last year) The nurses no longer intimidated him, instead he intimidated them.

Looking back I've come a long way profesisonally since last year. I've learnt an incomprehensible amount of medicine (more than medical school) and feel competent enough to act on my clinical judgement and know when to call for help.

Once again the social life in Whoop Whoop has been great. The other exiled doctors with me have bcoem my 2nd family. We've lived together, worked together, played together, eaten together and we'll always have many fond memories of the beach and the pubs.

At the start of this term I was exhausted, physically and emotionally burnt out and in need of rest. As I end this term I am thankful for the best 10 weeks of the year so far and step boldly into the dungeons of ED (urgh!)

They come in threes...

2007-10-31T13:41:00.000-07:00

To finish out my last week in Whoop Whoop I've been put on night shift. Just me and around 200 patients who all want to exsanguinate on me overnight.

The first few nights were great, very few sick people and enough time to sleep for 3 hours per night. However such times are rarely sustained. Tonight things took a nose dive.

Started the shift with the evening intern coming to handover late as she had been caught up in a MET call resulting in a patient dying. She hadn't had a chance to clear the wards of jobs before handover so left me with a hospital full of 'stuff' to be done.

I trudged up the stairs and began sifting through boards of tasks for me to do. IV fluids needing prescribing, medication chart rewrites, cannulaes to be inserted. It wasn't long before I got my first call.

"We need you to come and look at this patient. He's not for resuscitation or ICU but for full medical intervention. He's unresponsive and has sats of 88% on 2L NP oxygen"

I arrived to find Mr A unconscious and unresponsive even to pain (not a good sign). His notes indicated that he had been rathe runwell and as the medical team could do nothing more for him, they were going to transfer him to 'rehab' to die. I examined him, detrmined he was probably sedated form benzodiazepines and in fluid overload with APO secondary to CCF. Gave him a whack of frusemide, upped his oxygen and called his wife to come in as his prognosis wasn't great.

Over the next 3 hours we battled to get fluid out of him, his IV access failing and his oedematous hands not willing to give me a vein to stab. I paged the medical registrar 3 times for advice with no response. Battling on my own with a patient who I knew had little chance of recovery. Thinking through every possiblity for any slim chance to help this guy make it through the night.

3 hours later, after fighting as much as we could, I found msyelf trying again to get venous access and as I stabbed his arm in futility, the nurse next to me said "Um doctor, I think he's gone"

Sometimes you fight and it's just not good enough. Sometimes modern medicine just cannot stave off death any longer. Sometimes people just die.

As I sat back (partially in relief and partially in shock) I watched as his frail wife broke down in tears and began beating him on the chest. "How could you do this to me? How could you leave me alone?" She began yelling at his corpse, pouring out her grief and anger at his death. I couldn't do any more, so I did the necessary examination to certify him, then left to fill in the paperwork and death certificate.

Then just before sunrise I got another phone call. "Hi just wndering if you can come and certify a death on our ward? A guy who had his fingers amputated this week"

"Not Mr R? I've been seeing him for the past few weeks? Wans't he ok?"

"He's not okay anymore... we found him dead on our morning rounds"

This guy had been operated on by our team earlier in the week and had been on the improve. His obs were stable all night long and he didn't complain of any symptoms other than a bit of finger pain from the operation. As I walked into his room, his familar face looked different. Pale and cold. Devoid of life.

After filling in his paperwork I went to the roof of the hospital to watch the sun rise over the valley. The fresh dawn air assaulted my face and I watched the slow crawl of cars making their way and starting their days. Despite the darkness of night, despite the death and futility, the sun still rises. The dawn still comes. Its funny how on night shift I wont see any deaths until one night, when they all come in a bunch. And always in 'threes'.

After I called the bosses to inform them in the morning of their patients demises, I walked out of hospital and crawled into bed. Feeling like I'd lost the battle, but knowing I'd win the war. At times like these, you can succumb to fatalism... the patients are all gonna die one day.. why bother fighting so hard? Or you can fight to improve the life of each person you meet. You may not be successful, but you've tried. And once in a while, very occassionally, you might make a difference. To not be content with the brokeness of this world and to fight for something better.

Scrubs Finale

2007-10-29T07:48:00.000-07:00

All good things must come to an end. Including surgical terms.

As a student I never liked surgery. Having failed anatomy 3 times as a student (I really should have spent more time studying instead of working in a pizza shop) it was a re-enactment of the embaressment I felt at not being able to describe the course of the brachial artery or the relationships of the hypothenar muscles of the hand. In clinical years surgery did not offer much to the lazy med student (ie me) Relegated to stand in the corner, we were occassionally lifted from obscurity to hold a retractor in some yoga like position for hours on end with no view of the actual operation being undertaken. My surgical mentors as a student were larger than life characters with ego's that had their own reputations.

Prof was one of them. A man whose stature was fitting for his ego. An old school surgeon from the mother country who despaired of the declining quality of medical education being offered up in the colonies. He would carry around a giant blow-up hammer and a water pistol with which he would punish his students for the most minor transgressions. We all feared going to his tutorials. We would be grilled about bizarre Xrays only to find out later they were not of humans but of sheep! He would berate us for being 'space cadets' and threaten to send us out to Wagga Wagga to work. One of my friends refused to go to Prof's tutorials for fear of embaressment or dismemberment. A surgeon to be feared, a man larger than life.

However despite his abrasive manner, he was a brilliant surgeon. A man dedicated to his craft and to excellence in everything he (and his junior doctors and students) he would take on the cases no one else would. Those patients relegated to the 'inoperable' category would be given a chance (however slim) on his list. He would operate for 24 hours straight and then come to teach us despite his lack of sleep.

I will always remember him telling us about his experiences as a student. When he was in our position he was asked by his mentor to look outside the window.
"What do you see on the lawn son?"
"Sparrows sir"
"That's right my boy, sparrows.... not bloody albatrosses!"

Point of the story: common things occur commonly in medicine... don't go looking for rare/obscure diagnoses all the time (life is not like House)

Many years later I find myself donning a pair of scrubs for the last time. Finding a nice pair of green tie scrubs, making sure the knot is firm (so my pants don't fall down mid-operation) grabbing a hair cover bandana and tying the ninja-like face mask loosely. Washing my hands 3 times ever so carefully, first with the scrubbing/nail brush and then twice working from the hands down in a meticuluous manner, making sure to not touch anything and to let the water run proximally down the arms. Backing into the door with arms raised like holy objects and gloving and gowning in a familiar theatre.

The pinging of the anaesthetic machines, the smell of the antiseptic prep, the sound and smell of diathermy burning through vessels. The bizzare names of retractors and forceps. The psychic nature of the scrub nurses who hand the surgeon his tools. The banter between the surgeon and anesthetist about their shares/kids/cattle*

It's a welcome haven from the incessant paging of the ward, an opportunity to 'do' something practical and see immediate results. A chance to 'fix' something with your hands and use your muscles.

During the past few weeks I've moved my way up so that in my last few weeks I was allowed by the bosses to apply the skin grafts to the wounds and staple them on. Then I was allowed to close the wound after a fem-pop bypass and stitch everything in place.

Then to put the icing on the cake, it finally came... the King of all vascular operations... a leaking abdominal aortic aneurysm. Statistically 50% of people with a leaking AAA don't come out of hospital alive. AAAs are ticking time bombs... and when they start leaking you know that the final countdown has begun. The boss let me scrub in and 30 minutes later we were covered in blood and securing the aorta and distal arteries. A simple graft was placed in the lumen and 1 hour later the patient was alive and in recovery. Someone who could have been dead that night would now live to fight another day.

It's humbling and amazing stuff! In the past few years surgery has let me pull babies out of abdomens, transplant kidneys, reimplant infant ureters, remove multiple appendices/gall bladders and do emergency bowel resections at 3am (just to name a few). There's an adrenaline high that comes from cutting people open, fixing up their insides and putting them back together again.

But now, I have gone to theatre for the last time. I've finished all my surgical terms and it's time to move on...

Good bye surgery... and thanks for the memories!

* we had a very interesting discussion about the prices of stud bulls whilst repairing a hernia the other day... very intriguing

Freak of Nature

2007-10-27T09:02:00.000-07:00

In the last month at Whoop Whoop, there has been a fair amount of meterological happenings.

One day as we were chewing our undigestable free lunch from the hospital cafeteria, we heard the sound of banging on the roof. The banging turned into pounding and the sky turned a dark grey before we suddenly saw a storm of hail come raining down past the window.

Small at first... gathering in momentum, frequency and size. There was no time to react, no time to move our cars. All we could do was watch. And watch we did. For 30 minutes the hail pounded out of the sky and savaged the ground. Man made and natural were destroyed alike, the hail showing no discrimination between tress and cars.

Once the storm cleared we ventured outside, the ground full of golf ball sized ice covering the ground like a layer of popcorn. We walked to our cars to see the roof of every single car in town puckered like the dimples on a golf ball. No car was spared unless it was garaged. No window facing south was left intact.

The next day the government declared it a natural disaster zone.

However yesterday the sky turned an ominous dark shade and those clouds began to reform for round two. I dashed to the shopping centre for refuge and watched as the rain and hail returned to town, beating down against the city in fury and mocking its inhabitants.

Apparently the storm produced a freak tornado that lashed a nearby village with winds up to 150kmph. Vortices of destruction and chaos.

It's humbling that even in the 21st century we can land people on the moon, communicate in real time with people in other countries, yet are subject to the forces of nature. We are still human and frail and at the mercy of forces greater than ourselves.

Forces that seem to be writhing in pain like a woman in labour.

The Adventures of Batman and Robin

2007-10-20T20:21:00.000-07:00

We have had a patient on our ward with a nice slowly healing leg ulcer which has required lots of VAC pumping meaning he's been on our ward a long long time now.

My registrar and I walked in at 7:05am on our daily ward round and were greeted by him:

"Well if it isn't Batman and Robin!"

The title's kinda stuck now... so Dr M and I have become the dynamic duo of the surgical ward. The first team to round (cos we usually have more patients and sicker ones too) and often the last to leave, we rid the city of surgical pathology.

I must say though that I've been very blessed to have a good registrar this term. He doesn't order many medical consults (which really saves me from getting grilled by the overworked med reg's) and is often willing to help me out if needed with my menial jobs. After our rounds we call a "Crisis Meeting" and have coffee/hot chocolate accompanied by scones/chocolate dotty cookies and read the daily newspaper whilst basking in the sun and discussing the latest goss.

We've gone to the gym together after work, played indoor soccer after work and had multiple meals together. We're a team in the true sense of the word.

So now he's taken it upon himself to try to set me up with a) a med student, b) a physiotherapist and c) a pharmacist. And apprently it's a competition between Team Surgery (Batman and Robin) vs team Medicine ("Ian-Thorpe's-slightly-less-metro-twin-brother") to see who can impress the barbie doll pharm chick. (I'm bowing out before the race even begins... but my reg won't listen)

Every morning I have a freshly printed patient list ready for him from the printers downstairs (which for some reason print the list in a different way to the printers upstairs??) I anticipate his thinking now so that on the ward I'll pre-empt his management plans and even have arranged management before he gets out of theatre.

If we finish theatre early we'll drive in his Audi downtwon to grab coffee or do some chores and if we're stuck in theatre I'll go buy sushi for him and the senior surgeon. Like battle hardened comrades on the frontline of the war against disease, we forge good strong mateship that grow over 'doing stuff' together. This is how guys relate... by doing stuff... like playing sport or amputating limbs.

I've only got 3 more days left on the team before I start my nights... so it's with much sadness that Robin will have to leave Batman on his own adventures and fight crime by night whilst the caped crusader cuts people open by day.

Grandad

2007-10-15T05:46:00.000-07:00

I finally managed to organise my 2 days off up in Whoop Whoop. Only problem was 3 other doctors also decided on taking those days off. So instead of taking the whole day off, I had to come in at 6:30am and work till 11am to sort out my patients and make them stable so Dr Dolittle could take over their care.

I raced home, packed my bags into my hail-punctated car* and drove off into the windy hill roads towards the north. Just over an hour later I reached my Grandfather's home. Nestled in a former volcanic crater and along a meandering river, it was set in an idyllic village that time forgot.

We had a quiet lunch and retired to his living room to sip tea and discuss all of life's problems. Over the next 4 days we talked about anything and everything. The looming election, the soccer, love, family, my dad's impending death, my mother, my sisters, my job, my future, our faith, the price of bananas, the fuel effiency of hybrid cars. Nothing was vetoed and everything seemed so much simpler after being processed in his wisdom. His age supplied a calming effect to all my worries. His knowing smile assured me that my troubles were not unique.

He told me his own stories of his former youth in the London Metro police force. Breaking down doors, arresting inebriates and protecting women from violence. Political correctness and practical jokes. Wooing women and riding motorbikes.

He did not look his age. His youthful humour and energy for life hid his decaying body and concurrent illnesses from me. I saw a man before me worth imitating. A man who had fought many battles in his life and persevered. A man who stood up for what was right and was preparred to count the cost. And at the end of it could dispense advice to his green grandson.

I don't know how much longer he'll have on earth. With my father's failing cognition, I value Grandad's input as a male role model all the more. I drove back down the hillside today refreshed. Thankful to God for such great men in my family who have been such a blessing to me.

Thankyou Grandad!

* Whoop Whoop was subjected to a freakish hail storm which inflicted over 10 million dollars worth of damage and resulted in 643 repairs to various homes/businesses. Alas my beloved car was ravaged by golf ball sized icecubes and every single panal bears the marks of the storm. The insurance people tell me it'll be at least 3 weeks before they can get to look at her damage. My poor baby... =(

Loneliness

2007-10-01T04:21:00.000-07:00

Just landed back in Whoop Whoop after a weekend back in Sydney (sort of).

It was refeshing to eat some decent Asian food and drink some much-missed bubble tea. To see buildings taller than 2 storeys and to catch up with people I hadn't seen for a while.

I spent the weekend with hundreds of other people. I spoke to so many different people about so many different things.

And yet as I left my home to go to the airport, a profound loneliness set in.

Perhaps I was emotionally drained from the weekend, perhaps I was scared about the big changes I'm about to embark on in my life... or perhaps I just feel like a lone soldier being sent back behind enemy lines to bear another 5 weeks of fighting.

Guess it's time to fight the good fight...

Random Radiology

2007-09-25T05:52:00.000-07:00

In all the excitement of playing basketball with my registrar and attempting to learn to surf I somehow hurt my knee.

For a whole week I refused to walk the 5 flights of stairs to our ward and insisted on taking the elevator (much to my registrar's disdain). I moaned and whinged about my ageing frail body, even though I'm still the youngest doctor in the hospital (thanks to post-graduate medical course interns).

So eventually my registrar had had enough. He dragged me down to Emergency and bellowed "I have an important surgical resident here who needs a medical record number, please triage him!"

30 minutes later I was getting some Xray's and wishing they'd gave me a lead belt to protect my future children from the stray rays.

Given that I don't drink milk and bind any calcium in my serum with the phosphate from my Coca-Cola infusion, I was suprised to see that I've ossified quite nicely in my skeletal maturation.

What do you guys think?

Return of the Resident

2007-09-24T02:51:00.000-07:00

Having survived the hordes of overtime shifts thrown at them by evil Admin Man, the 'terns and residents of Whoop Whoop Hospital started to gain ground over their foes.

A major loss was encountered when their beloved medical registrars were inadvertantly booked on the wrong flights back to Sydney, resulting in threats to create a new poop-shoot for Admin Man if he ever tired such an evil ploy again.

However, Dr J found himself subject to 2 consecutive 16 hour days with overtime leading to immense frustration. Myriads of cannulaes and chest pains drove him mad. Living on far too little sleep almost had him beat, until his surgical registrar stepped in and rescued him.
"I think we need to hold a Crisis Meeting* downstairs"

The weekend arrived upon the young doctors just in time. The local culinary establishments of Whoop Whoop (and surrounding villages) were pillaged for their bounty and the the vats overflowed with wine.

And so began the weekends of never-ending happiness. (WONEH)

The WONEHs were a mythical beast that were rumoured to exist in Whoop Whoop. If one of the heroic doctors were able to capture this beast, he/she would be revitalised with youthful joy and bliss, carefree happiness and vanquising of all their foes (at least for 48 hours). They were elusive, rare and most of our young heroes even doubted their existence.

It was by chance that our intrepid young team stumbled across their first WONEH. They left Whoop Whoop in their valiant steeds and journeyed far and wide towards the great sea in search of their prey. They came acorss a small village along they way where they found their first pointer towards what was to come. A great feast laid out before them with steaks twice the size anything they had encountered before and desserts laiden with chocolate and strawberries. Their journey almost ended there, shipwrecked by these Sirens of gastronomy.

They dragged their warm tummys away and journeyed on. Over rolling green hills and meadows, the vast blue sky above. They finally reached the tip of one peak to be greated with the crystal blue sea's beckoning glow.

Very soon, they were unpacking their goods and running towards the beach. Dr J was entranced by the picturesque-ness of it all. Diving into the sea as it enveloped him, the cold chill of the salty spray woke him up. It reminded him that he was alive.
But more was to come.

His colleague swam up to him and offered him his surfboard. And 5 minutes later Dr J was mounting the board and valiantly making a fool of himself attempting to emulate his fellow brothers.
Still more was to come.

A set of 4 wooden wickets were defiantly driven into the sand and they all taught their Norwegian counterpart the finer details fo the game known as cricket.

A picnic basket emerged to put Yogi to shame. Our weary heroes were fed as they toasted each other and drank to good times.

They dragged themselves to a lighthouse to watch the sun bid them farewell and usher them into a night of fun.

They adjourned down the hill to the beachside pub, grabbing a few quick drinks in before attending the local cinema for a motion picture.

They had many many other adventures that weekend, more than they could possibly fill in one story. They were joined by their registrars in violent games of basketball, went to the local markets with physiotherapists and sucked in the air of freedom.

Away in this utopian paradise they shed their pain and anguish and just enjoyed the world given to them. Their aching joints were filled with strength, their crushed spirits were lifted and their 1,25-deoxycholecalciferol** deficient skin was burnt.

Life couldn't get any better than this... or could it? (Stay tuned to find out)

* Crisis Meeting = our secret code for coffee break so that the minions of darkness that wish to page our beepers do not know of our absence
**Vitamin D (from sunlight)

Time

2007-09-24T02:28:00.000-07:00

"For everything there is a season, and a time for every matter under heaven:
a time to be born, and a time to die;
a time to plant, and a time to pluck up what is planted;
time to kill, and a time to heal;
a time to break down, and a time to build up;
time to weep, and a time to laugh;
a time to mourn, and a time to dance;
time to cast away stones, and a time to gather stones together;
a time to embrace, and a time to refrain from embracing;
time to seek, and a time to lose;
a time to keep, and a time to cast away;
time to tear, and a time to sew;
a time to keep silence, and a time to speak;
time to love, and a time to hate;
a time for war, and a time for peace."
(Ecclesiastes 3:1-8 ESV)

Life is not always about absolutes or ideals. Sometimes actions may be right or wrong in differing circumstances. Reducing the complexity of the world's intricacies is dangerous when done blindly. It takes discernment to be able to decide what to do when formulas no longer apply.

Society is kinda at odds with the poetry above. We all live by the mantra that war is always bad and that casting away, mourning and breaking down are intrinsically evil. None of us are immune, conflict is out and passivity is seen as the 'more excellent way'. There no longer exists the option of 'tough love'.

Why can't we be comfortable enough to embrace conflict as a sometimes necessary way of refinement? Why can't we endorse that sometimes refraining from something can be to our advantage? Have we become so self-indulgent that we can no longer hear the word "No"?

It's amazing the solace you find when you can embrace the change of seasons and be content with the negative actions sometimes demanded of us.

Cos eventually all things come around. After the mourning comes the laughter, after the war comes the peace.

Life may be frustrated, but that's cos it's heading somewhere better.

The New Adventures of Dr Dolittle & Dr Donothing*

2007-09-10T03:42:00.000-07:00

Once upon a time in a place far far away called Whoop Whoop there lived two intern doctors. They were not of Whoop Whoop although one of them wished she was. Her name was Dr Dolittle and she worked at the local hospital with Dr Donothing at the local hospital. In her former mispent youth, she had been a hippie and bided her time dancing in the meadows and learning about the sustainable creation of vegetation.

However over the years, times had changed and she had been squashed into the mould of a public hospital system that showed little regard for her care-free dreams.

Her friend was Dr Donothing, a name given to him by former psychiatric inpatients who devalued his worth and mocked him daily. yet despite the constant taunts he remained optimistic; for he too had a secret ambition: to be a indie-pop rock star.

Whilst many medical students spent their free time cramming the causes of proximal myopathies into their brains, he had ventured into the brave new world of music and sought his fame in a band whose name cannot be repeated due to this blog being G-rated.

They had both been banished from their castle known as The Zoo and sent many days travel by horse to work in the cold dungeons of Whoop Whoop. Along their travels they teamed up with Dr J, another disgruntled Doogie-Howser wannabe and set forth to rule their new roost and enter into battle against the evil forces of disease and medical administration.

Twas not long before they met their first foe, an evil overlord named Admin Man whose sole quest in life seemed to be the destruction and oppression of these young sojourners. He denied them overtime pay and made them go through a number of deadly quests in order to achieve financial renumeration. He then beset upon them a plague of overtime shifts designed to break all but the brave.

On different days the JMOs would face up to their fears and with pager in one hand and stethescope in the other, slaying the hordes of nurses as them lunged at them with nagging voices. Blood pressures would come crashing down, but the doctors were now too wise for such things and would counteract this move with their own magic fluid bolus. The nurses would throw medication charts and the mighty pen of these brave souls would demolish their attack. Chest pain stood no chance against nitrates being administered in tri-route fashion (s/l, IV and top).

And so day by day the doctors overcame their fears, they overcame rather than being overcome. The nagging did not cease, the incessant paging would not desist and yet they would laugh it all off over a pint at the local Irish pub.

And so after a long and fearsome battle they all found themselves in a little haven away from Whoop Whoop. A village nearby where they could salve their wounds, eat brunch in their own pace (void of the pager beep) and whinge about nursing ineptitude.

And so they lived to fight another day... their stories have just begun.

* I'm serious, they have called themselves this... it's brilliant!

A New Start?

2007-08-25T06:54:00.000-07:00

Picked up a book my flatmate left lying aorund the other day entitled "No More Christian Nice Guy"... it calls itself a manifesto against the masculine identity criss that plagues our world (and also Christians). I'm only half way thru it but already it's accuracy is resonating with my experience so much I can't put it down. So instead of blogging about work I'm gonna post up some of my fav quotes from the book so far for your blog readers to comment on.

I'm interested in what both the guys and the girls think... cos this book seems to make sense of a lot of crap that is just beginning to click in my head.

A woman likes her Christian boyfriend, but can’t deny the lack of some necessary spark. She feels horrible, perhaps even ashamed that it’s not there; wonders if there’s something wrong with her, not him. She practices in her mind those dreadful words to say and hear: “Can’t we just be friends?” or “You have a great personality, but…” the CNG thinks to himself, Dogs have personalities too. He secretly loathes that this always happens to him, and he blames God (though he tries to be nice about it) How come Nice Guys don’t get the girl? he asks himself in smoldering resentment (while still forcing his painted-on smile). (Page 25)

Abandonment deals a young boy’s heart one of the deepest wounds imaginable; he will most likely come to believe he is unworthy to receive love and affection. As a result, an adult Nice Guy spends much of his life salving this wound, often through the consumption of women, both emotionally and sexually. However, since Nice Guys don’t possess what women really want and need, such as masculine support, strong protection, and emotional passion, they are destined to lose at love. (page 77)

Because Christian men are encouraged to be compliant, malleable, and without relational requirements, they often lack the ethos and charisma that attract a woman’s heart. Pete, a CNG from California, is coming to terms with how this message short-circuits his desire for intimacy: “I wanted a woman’s approval so much that I would do anything for them. Women just don’t respect this quality in a man.” (page 99)

Not requiring respect from others and having no true opinion is not the way to love. Christian Nice Guy: Stop trying to be a woman’s best friend. Stop stripping yourself of the masculinity that draws her toward you. Most of the men who posses this energy aren’t jerks; you possess the same power they have, but you wrongly think it’s off-limits to you. Don’t settle for being envious; find that energy, that power, that passion, then embrace it and apply it. (page 102)

What do you think?

Adrenaline

2007-08-12T05:55:00.000-07:00

Been working myself silly over the past few days, exacwerbated by the new registrar who although nice, is still adjusting and thereby requiring me to do some of her work.

This weekend was yet again another 25 hour work fest (12.5 hours per day) topped off by the development of what I think is a viral LRTI beginning to consolidate my lung parenchyma. So I've been trudging from paediatric ward, to nursery, to maternity ward, to operating theatres to ED... sniffling, complaining and just generally exhuasted.

It was a sunny winter's afternoon today and I was looking out the window wishing I was like a normal person who had weekends and wasn't stuck in an Emergency Department. Then the triage nurse came bolting out of her cave, "Where's the Paeds*? We've got a category 1 coming in!" At that point my heart sank. Category 1 means they are dying and need to be seen as soon as they hit the hospital. And so we gathered a posse of doctors and nurses and ran off to the Resus Bay to await our arrival. We got some garbled info over the radio system from the ambo's. A 10 month old baby with swollen lips and shortness of breath after being fed peanuts for the first time.

Crap... anaphylaxis.

Apparently the baby was slippping in and out of consciousness, hardly breathing and worsening by the minute. My heart sank even further.

Soon the ambos burst thru the door carrying a limp figure. His lips would put Angelina Jolie to shame. He let out a whimpering wheezing sound... not even a cry.

The ED reg (the only more senior doctor there) attempted in vain to get a vein. She looked at me and told me that I would be able to get one since I was the paediatric RMO (oh boy...) I prayed hard that this cannulae would work and thankfully I got it first go (a rarity for a 10 monther)... I've never been more excited to see blood spurting into the flashback section.

Training took over and next thing I know I'm ordering salbutamol nebs, IV adrenaline, IV hydrocrotisone, IVFs and po loratidine. Then we wait.

The pulse oximetry shows an improvement in the oxygenation... the ECG dots show a tachycardic surge as the adrenaline hits the myocardium... the wheeze turns into a whimper and then evolves into a scream as the baby's body reacts to the adrenaline and then the sound every paediatric person loves to hear....

Crying!

After a while the baby started to pick up and was able to breath on its own without additonal oxygen. The steroids kicked in 4 hours later (thanks to the delayed effects of RNA expression) and as I walked out the door to go home I saw his beautiful white eyes for the first time. I realised that during the entire resuscitation he hadn't opened his eyes once. But now his bright white scleras beamed back at me and I realised that I'd made a difference.

I had been in charge of the resus and although there were definite places I could have done things better... now that baby is alive (and not dead) thanks to me (in some part). Although the baby had been pumped full of adrenaline, I felt that I probably had just as much surging thru my veins.

It was so exhilirating to bring this limp baby back from the brink and yet so scary. This is the pinnnacle of medical coolness. The reason why I like medicine. Like honestly, how many desk jobs let you do cool stuff like that?

* I have no name... I am just called "The Paed" as if I am the past tense of micturition. I'm sure it's a nurses way of subverting some subliminal form of control over us.

NFR

2007-07-26T08:22:00.001-07:00

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

2007-07-25T07:45:00.001-07:00

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

2007-07-11T05:55:00.000-07:00

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

2007-07-09T02:45:00.000-07:00

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

2007-07-06T20:29:00.000-07:00

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

2007-07-01T07:06:00.000-07:00

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.

Week 2 - Momentum

2007-06-19T01:15:00.000-07:00

After a brief stopover in Sydney where we attended the charming wedding of two of our uni friends (even the rain looked good as it ghosted the Harbour Bridge in a greyscale photo tone) we picked up our friend C (my pseudo ex-wife*) and hopped on a plane to Hong Kong.

We got an overnight flight so we would maximise our time in HK and be able to sleep on the plane. But C and I ended up watching movies all night long and poor B didn't fare much better. When we walked out of the airport the humidity smacked us like a wall of hot air coming out of some invisible giant hair dryer. We grabbed a cab and arrived at our hotel which is supposedly 3 star only but when we arrived we found concierges and marble floored bathrooms which was a welcome relief after a long flight. We cranked on the air con and grabbed a quick nap before donning our tourist backpacks and cameras and setting off to explore the "Pearl of the East"

Our first meal was Yum Cha in a really tall building overlooking the city. It was a taste of more to come... quantity, variety and not a hint of Westerness. With chopsticks in hand we devoured our way thru countless dishes and worked our way thru a few pots of tea.

The first night we trekked up to Soho to check out the night life. A rather upmarket trendy place full of bars and restaurants, we saw more guilos** there than Asians and ended up settling on Thai for our first dinner. C invited her friend along who turned out to be a rather attractive Hongkee doctor who proceeded to tell us all about HK and what was good to see etc. We then went with our local guide to a dessert place to have some sweets and the owner there saw the profuse sweat on my face (due to the humidity) and concluded we needed something 'cold' and began to potter around and babble on about how she was such a great restuarant owner cos she invited some new dessert (it was very cute).

We arrived back late at night to our room and pulled out Bohnanza. The Bean Game holds a special place in my heart after playing it 2 months non-stop in Taiwan on my elective so it was only fitting that whilst in Asia we played. So each night would conclude with a sometimes nice sometimes vicious game of bean trading and planting. Occasionally this was accompanied by a very cheap beer from 7-11 (costing $2 AUS for a Heineken longneck) to cap the evening.

The next day we arose a bit later than planned to catch a ferry across to Lantau Island to see the Giant Buddha. The day before we went, the famous cable cars that take you to the top had been closed down because one of the cable cars had derailed and plummeted into the ground. So we took a bus instead.

After climbing to the top we were drenched in sweat and joined the throngs of tourists running inside the Buddhist museum to find refuge in the air-conditioning. We ate a vegetarian lunch and saw 2 flakes of Buddha's ashes (not that impressive) then headed back to the Peak to have dinner and see the night skyline of HK. We caught the world's steepest tram ride (almost 45 degrees) and reached the top where we went to Madame Tussaud's Wax Museum (and had my photo taken with John Howard and others). We had way too much fun acting like 4 yr olds and posing with stars. Although it was raining we managed to have a period of clear skies where we took our standard touristy shots of the city blanketed in neon and light.

Wednesday we took a ferry across to Kowloon and as it was "Free Museum Day" we went to the Space Museum and Museum of HK history. After being thoroughly educated in the Chinese space program and the evils of the Opium Wars and British imperialism, we bolted to the harbour to see the laser light show where the office towers were transformed into a quasi-video game. Afterwards as we were wlaking along the foreshore we came across a free pop concert to commemorate the 10th anniversary of the British handover of HK so we grabbed a seat and clapped along to random people singing in Cantonese and Mandarin until it began to bucket down rain and we had to bolt off to cover.

We then decided to go to the Ladies Market (and no that's not a place where you pick up a mail-order bride***) in Mongkok to shop around. Reminiscent of the night markets in Taiwan, we were assualted with cries of "Copy watches... copy T-shirts" as the hawkers attempted to pry our Western dollars from us.

Thursday to break the rhythm we deided to do a day trip to Macau. On our way thru immigration we got asked to be in some tourism survey and scored a free HK tourism pin (yay!) however as we got there we realised our friend T (one of B's friends from church who was in HK too) had left his passport at home. So B and I forged ahead on the ferry and met him when he arrived. Macau would best be described as the Las Vegas of Asia. Casinos on every corner and light up like a Christmas treee. It was Portugese ruled until recently and so we went to visit an old fort (with canons still intact) and the ruins of a church and monastery. The church overlooked a long flights of European steps that had Western lamposts on either side and if you looked briefly at the scene you would think you were in Europe with the cobblestone roads. However either side of this European architecture were Chinese houses and shops creating a fusion of Eastern and Western culture. After seeing the sights we decided to eat in a casino and decided that in order to avoid exorbant prices we shoudl eat on the lowest floor possible. And so we rocked up in shorts and joggers with our backpaks on to a place called '8'. We asked if we coudl see a menu but somehow found ourselves being ushered into a door and then walking through a dark corridor with fountinas to find ourselves in a black marbled restaurant. The entire place was black except for the chandelier that hung from the roof and touched the pool of water near our table. Even the table and the waitresses Asian dresses were pitch black giving the place a very cool feel. As we were the first to arrive we were given a nice table and we had one waitress for each of us guys and they would put our napkins in our lap and take away your dirty chopsticks and plates whilst you weren't looking or whilst eating out of your bowl. The service was amazing and the waitresses even more amazing (we still refer to "Yumiko, Sandy and Pink" as our best memories of HK even though they were in Macau). After eating 5 Asian courses and polishing off a bottle of red we still only ended up paying $30 Australian each so it turned out to be a lot cheaper than we thought. We caught the ferry back to HK and cruised over to meet C and some more of her doctor friends and had a few drinks at a very chilled bar. it was great just to sit down, drink and chat to fellow medics about the similarities and differences and just chew the cud with them for a bit. It was good to just reflect and realise that it's good to be young and just go out and have fun. After that evening C concluded we need to go out more in Sydney to which B and I heartily agreed.

Friday involved a trip to Stanley to do some heavy duty shopping. Managed to score 2 pairs of jeans for $25 each and a pair of Nikes and another pair of shoes for $25 each too. We then headed back to the city to do some electronic shopping and after much deliberation I decided to get that HD digital video camera and managed to save myself $800 and bargain enough to get a free tripod, carry bag and 6 free cassettes. In the evening C was catching up with other people so B and T and I went and tried some local KFC (with waffle shaped fries, rice and mushroom sauce?)

Saturday was spent doing some last minute shopping and B bought 14 shirts for work and I managed to finally find a HMV and made a beeline for the section entitled "Mandarin Pop". 30 minutes later I was walking out the door with more Jolin Tsai, Stefanie Sun, Anglea Zhang, Cyndi Wang and Leehom Wang to annoy my poor flatmates with. We check our bags in at the train terminal and then raced over to the airport on the MTR (why can't Sydney get this?) and flew back home (again watching too many films and not sleeping enough).

It was such a densely packed week and yet was so much fun. It made me realise why I love Asia. The food, the people, the buzz, the noise.

I found myself overwhelmed and disorientated and I loved it. Silence is not desired and restaurant are full of the bustling and chatting of people from all walks of life. The cities that never sleep and the characters that inhabit them. I came back completely exhausted but loved every second of it.

One week of tranquility, one week of over-stimulation.

I came back a happy egg; and of course no trip to Asia would be complete without at least one bout of gastro. And so I finish this looong post cos I need to dash off to the loo again (still sick) and step back into the mundane ebb and flow of life, refreshed and alive again.

* For those of you who haven't read my earlier blog posts here's how it works. In my 4th year of med school I was shafted out to the country for 6 weeks with one of the girls in my year named C. She and I used to argue about stuff all the time and another friend said that we fought like an old married couple. So we joked that our trip to the country was our 'honeymoon'. Anyways to cut a long story short we ended up being referred to as the 'husband and wife' team in our hospital. The whole time though she had a boyfriend and so I decided that she had been 'cheating' on me by having a boyfriend on the side when she got married. And so I divorced her. And hence I now have a pseudo-ex-wife named C.

** Derogatory term for white people.

*** Although a certain Jap-Korean guy I know will argue for the validity of Christian mail order brides

Week 1 - Tranquility

2007-06-19T00:37:00.001-07:00

Back in late last year when we had to put in our preferences for annual leave my mate B and I decided to apply to get 2 weeks off in the middle of the year to go on holidays together. Initially we were thinking about a trip to Vietnam but due to unforseen circumstances (ie a wedding smack bang in the middle) we ended up doing a 2 week split and spending one week on the Gold Coast and 1 week in Hong Kong.

So after leaving the cosy Geri's Rehab ward, I packed my bags with some clothes and books and we hopped on the plane to take us away. We hit the tarmac in Queensland and already the tension and worries of life were fading away. It'd been a rough month but the beach beckoned like a Siren calling us to forget reality and come to her.

We stayed at the same place I used last year on my week off. The backpacker's was a great cheap option cos not only was it cheap, but it was 50 metres from the main bit of Sufer's Paradise beach.

The average day included a breakfast of either a) bacon and eggs or b) a Boost juice which was subsequently followed by a leisurely stroll to the beach where we woudl unfurl our towels and bask in the sun reading books, listening to music and talking about the deep things of life. After a late lunch (and each meal had to be eaten at a different restaurant (no doubling up was allowed!) we would walk 4 km north (or south) then turn around and walk 4km back, casually discussing a range of topics. We would then scour the streets for a suitable establishment to eat at (including one candlelit dinner) and then retire to our room to watch TV and read.

We alternated this with the occasional swim, ten pin bowling, movie outing or shopping expedition which became more frequent as the weather turned sour. The average amount of sleep ranged from 10-12 hours per day.

Friends asked "Why didst thou not attendeth the nearby Themed Parks?" to which we replied "That be not the reason for which we traversed" They would again lament "Couldst thou not have done unto all these things in Sydney and needeth not to go unto Queensland to undertake this?" and we would answer "That be not the point"

The purpose of that first week was to relax. To not be in contactable range of commitments in Sydney. To have nothing to do except eat drink and be merry* To read good books** and lose myself in the music of my iPod. To breath deeply and smell the roses***

Tranquility. Peace. Relaxation. Rest.
We are made to rest. Our bodies need to shutdown every day to recuperate and repair. Our work is interuppted every week to have a weekend of 'not working'. Rest is as fundamental to the human condition as work and tribulation are.

Time to gain energy (physical, mental and emotional) Time to enjoy the good things in life. Time to reflect and realign life.

I came back having thought about everything, done very little and gained much.

* For tomorrow we die

** Including lots of THE Good Book

*** Okay that's goin a bit too far and is pretty tacky? Haha

A long hiatus

2007-06-18T21:24:00.000-07:00

No this is not a post about hernias (for those doctors out there who associate hiatus with to the body)

Well it's been a long time in between drinks hasnt it?

Was asked the other day why I hadn't been blogging. Not really sure how to answer that one.
Partly I've been busy and haven't had spare time to compose my thoughts. Partly I've been devoid of anythign profound to say. Partly I've been emotionally drained and not felt like posting anything (sometimes silence is a form of communication?)
But I'm back now and Jimbo v2.0 is now up and running (powered by Intel Core Duo processors)
So a quick summary of whats happened since my last post:

1) Geris Rehab rocked! Having a ward to myself was so refeshing (rather than covering 4 wards with outlying patients) got to know the ward clerk, nurses, physios, OTs and social workers and by the end was really sad to leave. So they bought me a cake to say goodbye and gave me a card. I'll miss their antics and chatting with the neuropsychologist about life's woes. My consultant was really good at her job and I actually learnt a lot more about good patient care from her which I'll hopefully not forget too quickly. My reg started to get used ot me by the end and would finish ward rounds early if he saw I was getting frustrated with hearing about old people's bowel habits.

2) Got hooked on Chaser. This show is one of the highlights of the week as the crazy boys from the ABC tear down every cultural cliche in Australia and attack politicians. It makes me laugh till my sides hurt and at the end of each episode I find myself longing for more.

3) Guy-Love ("There's nothing gay about it in our eyes") Been catching up with lots of the guys and realising the commonality of all life's problems. There's been much frustration and angst and consumption of steak/beer and anything else that bonds guys in mateship and tribulation.

4) Dad's getting worse. Buying turf in a drought. Going up to randoms in restaurants and talking to them. Wetting himself at church and refusing to change his coiled clothing. Week by week he slips further and further. Mum gets worn more and more. Although it sounds horrible, I am praying for a fast resolution to this.

There's tonnes of other stuff but right now I'll leave it as a brief summary and go on to write about my holidays!

Venom

2007-05-04T07:47:00.000-07:00

Thank God for Friday and the fact I could go and see Spiderman 3.

Came out of it feeling rather angry. I wasn't sure why... I'd really enjoyed the movie (although it was a bit comic book corny in places) A smart friend noted it was probably cos it stirred up some recent issues that've been simmering below the surface.

Angst at being pushed away. Painful decisions to lie to in order to spare others more hurt. A friend's grudge held for a long ago betrayal. It's stuff we all deal with at some point in our lives.

But there was one addition that I thought made this film better than the prior sequel...

Venom!

Dark, brooding and deadly. At odds with the world because he is at war with himself. Spiderman realises that there is the blackness inside all of us. The humiliation and the loss of control lead Spidey down a dark path... and brings forth the alter ego.

Lately it feels like life just gets darker and darker. The reality of suffering and this broken world just seems to seep into our marrow as the days go by. Do we decide to let it rule us? Or will we rip off the black suit and fight for truth, justice (and the American way*)? The anger and darkness of life can either grow us or grow over us.

I know its corny comic book ethos... but it's true:
We always have a choice... our choices make us who we are.

* What was with the lame shot of the American flag in the movie? Served no point whatsoever!

It's gettin hot in here...

2007-05-04T06:55:00.000-07:00

Sitting at my desk doing some paperwork when the sharp shrill of the fire alarm went off. Within 2 seconds all the fire doors in the ward slammed shut and the whooping wail of the ‘Emergency Evacuation Tone” blared from all directions.

Given the number of false alarms in our hospital we sat around and waited for the noise to stop. But it didn’t. The indicator on the wall said the alarm triggered was on our floor.

The nurses eventually straggled out of their meeting to come and reassure the patients they would not die (at least not today) and then I noticed it. 2 of the nurses were peering out the window looking at the street below. “I can see them… FIREMEN!” Next thing I know the nurses are running around checking their hair in the mirrors and straightening the folds in their clothes. Apparently it turns out the firemen are a fine catch in a nurse’s eyes and so the 3 single attractive nurses (aged 23-30) on our ward readied themselves for the kill.

We heard the noises of people running up the stairs and I watched as around the corner lumbered (in slow motion) a large moustache endowed 60+yr old man with a BMI of 30. The look of disappointment in the nurse’s faces was worth capturing on film… their faces dropped through the floor and they started turning to go back to their meeting until…the last fireman straggled in from the stairwell. Younger than his counterparts and not sporting a beer-belly he couldn’t avoid the peripheral vision of the lead nurse who spun around with a beaming smile and said “Hi I’m M and I’m single… and so are these other 2 nurses!”
The fireys soon realised the fire alarm was not set off by someone’s nicotine addiction the door in the meeting room the amount of hot air trapped in the room set off the fire alarm’s heat sensor”. How perfect! Stick a bunch of nurses in a room and they set off the fire alarm with all the hot air that’s blowing around.

As the firemen trudged back to their chariot, the nurses smiled and waved coyly at them. “Nice to meet you… come back soon!”

Short Notice

2007-05-04T01:01:00.000-07:00

It was just another balmy autumn day. Skipped breakfast (again) for the sake of another 10 minutes in bed and darted off to start the day.
10am swung by and the temporary consultant waltzed onto the ward. "Don't worry guys, I'm busy today so you can do your ward round alone... oh and J by the way, our team is due to present a case today at the case conference so can you photcopy a discharge summary onto an overhead and present that in 2 hours time? Thanks"

A semi-delerious panic syndrome set in as I realised I had 2 hours to see 22 pateints and somehow find something interesting to entertain the masses at the lunchtime meeting. Last week's case had been a non-stop extravaganze with the team's consultant presenting the case in conjunction with the registrar and intern and with powerpoint slides and lots of cool eosin stained histopathology pics.

The round blitzed its way along the corridor flying through patients with a cursory glance to make sure they were opening their bowels and managing their waterworks. I glanced at my watch as we finsihed in record time. 20 minutes to photocopy some kind of presentation. I found a mildly interesting case (ie one that didn't involve a fall or fracture) and quickly rammed it through the photocopier.

Rocked up to the meeting to find 30 people scoffing down food and waiting with baited breath for me to present. But somewhere along the line the need for an overhead projector had been omitted. And so Dr J was forced to stand up like a kid on speech day and read out his bodgy discharge summary. The physios, the OTs, the social workers and the doctors looked as bored or confused as 1st year arts students. I felt the rush of blood going to my cheeks as they ripened with embaressment. I hoped that by speeding up the reading of the discharge the earth would somehow swallow me up and save me from this public humiliation.

As soon as it was over I darted back to my seat at started muching on some free drug company food. "Such an idiot J!" I berated to myself. Why did the boss have to give me virtually no notice?
Meh!

The Clock Keeps Ticking...

2007-04-21T06:27:00.000-07:00

"Life’s but a walking shadow, a poor player
That struts and frets his hour upon the stage
And then is heard no more: it is a tale
Told by an idiot, full of sound and fury,
Signifying nothing" (Macbeth)

Been watching more Death Note. Except it's not the same. One of the main characters has been killed off and its like the show is missing half it's value. They paid no tribute to him, they paused only ever so briefly for his death and then kept going on as if nothing had happened. I found myself aghast that this would happen. Surely the script writers woudl have made more of a big deal? Surely he would come back somehow?

But he didn't. The plot kept moving on and years passsed by as if he had never existed. The cruelty of time - that forgets those now gone.

It's been almost a year now since Dad was fired from his job. Not once has anyone from his office come and visited him. Not once have they called and said hello. Undoubtedly some fresh faced grad is sitting in his desk, the desk that Dad inhabited for decades. Time has moved on and left him behind.

But it's the same with all of us. Next year when I leave hospital, another keen intern or resident will fill my place and life will go on as if I'd never been there. I could move home to the country and my room in the city would be filled by someone else.
It's a humbling existence we lead. We are here one minute and then we're not. And within a year or two our memories are erased from the earth and time marches on.
"Remember also your Creator in the days of your youth, before the evil days come and the years draw near of which you will say, "I have no pleasure in them"; before the sun and the light and the moon and the stars are darkened and the clouds return after the rain...and desire fails, because man is going to his eternal home... and the dust returns to the earth as it was, and the spirit returns to God who gave it. Vanity of vanities, says the Preacher; all is vanity." - Qoheleth

Fear

2007-04-20T09:02:00.000-07:00

"Fear attracts the fearful" (Darth Maul)

Everyone's afraid of something. Kids are afraid of the dark, afraid of the bogeyman, afarid of being lost in a shopping centre.
Women are afraid of "abandonment, isolation, loss of love"*
Men are afraid of "engulfment, anything that threatens to rob us of our power and control"*

People fear incompetence, they fear singing in public, they fear being singled out and embaressed, they fear being brainwashed, they fear being targetted for marriage, they fear losing their security, they fear losing their independance.**
We fear growing old, we fear losing loved ones, we fear own own death and build picket fences around death in order to whitewash its true grim reality.
Our lives are plagued by fear. Our lives are lived out in fear.
Why are we so afraid? Is it the expectation of loss? Is it irrational or is it justified? How should we respond to our fears? Is fear always good? Is fear always bad? Can we become desensitised to our fears? Or will they always come back to haunt us?
Fear. Such a primitive response. The sympathetic nervous reaction to perceived threat. An adaptive evolutionary mechanism to ensure survival of the fittest?

If we're honest with ourselves, beneath the layers of protection and barriers we put up, we all fear something.
What do you fear?

* Fire in the Belly, On Being a Man. Sam Keen.

** Why Men hate Going to Church. David Murrow.

Frida?

2007-04-03T02:57:00.000-07:00

Chilling at home tonight when a female voice called down the hallway "Um hello? Anyone home?"

Realising we'd left our front door open again and any random stranger could waltz in, I scurried out to see who was invading our den of masculinity (and uncleanliness). Turns out it was a visitor for my japanese flatmate, but someone who I also knew through mutual friends and who apprently my 'other' flatmate knew through aother circumstances. And so we stood around chatting about the random things that can really only pop into one's head when standing in the hallway.

"So you're wearing a T shirt that says "Minnesota"... you ever been to Minnesota?" asked our visitor.
"Um no not really, my sister used to be a nanny there for this guy who worked at Company-That-Makes-Medical-Stuff (CTMMS)"
"Oh really! Cos I work for CTMMS in Sydney and that's why I asked... cos I've been to Minnesota on business!"

Small world...

Turns out her job is to promote the new adhesive material we use to stick down our cannulas (drips) with. It sounds pretty cool. They're even making a see through type dressing so you can see how a wound is healing without havign to remove the dressing and risk infection/wound breakdown! How cool is that! (well I think it is haha - so I told her to send me a copy of her presentation)

Then we began talking about the strange English names that FOBs* take for themselves when they move to Australia. Such as "Wailee" and "Frida" and "Spanky" (what the??)

Anyways, in less interesting news, I am now working in "Geriatric Rehabilitation". And I've never been happier!** Ward rounds start around 8:45 and leisurely cruise up and down the corridor seeing our old bats*** and asking them the ever so delicate questions that distinguish geriatrics from other medicine:
"So who lives with you at home?"
"Have you opened your bowels today?"
"Who's the Prime Minister?"

My consultant is on a personal mission to rid the world of temazepam**** and in her crusade has declared our ward 'Benzo-Free' which means all the patients sleep terribly and look like zombies. But they're happy. Which means I'm happy.

Our ward was recently refurbished 2 months ago and is still looking brand new. We have a proper doctors office to hide in. We have lunch (being able to eat during the day is a cool concept!)

And the best bit is that at 4;59 I can start packing my bag and walk out the door at 5pm on the dot.

Some people say Geris Rehab is awful. That it's too boring and too much paperwork. Those people can have theri crazy hours on cardiology wards or early morning surgical ward rounds and days of holding retractors. I still get paid as much as they do whilst I gaze out the window and stare at the view of the Bridge.

*FOB = Fresh-Off-Boaters. Foreigners (usually Asians) who act so differnet they can be classed as having just hit the shores of Australia.

** Well working at least... med school was always a hoot... and maybe first term last year doing psych.. but I don't think that ever counted as 'work'.

*** On our geriatric ward we have 4 guys and 18 girls - who said there was a 'man-drought' in Australia?

**** temazepam is a benzodiazepine commonly used as a 'sleeping pill'

Personality

2007-03-31T23:28:00.000-07:00

The other night at City Extra a bunch of us decided to go online (as they had free WiFi) and do one of those lame personality tests.
Can't say I've ever given much credibility to them before until I read some of my friend's ones and realised they were fairly good assessments. And so apparently I have been labelled an "ENFP - Extroverted/Intuitive/Feeling/Perceptive ("The Inspirers")"

"As an ENFP, your primary mode of living is focused externally, where you take things in primarily via your intuition. Your secondary mode is internal, where you deal with things according to how you feel about them, or how they fit in with your personal value system.

ENFPs are warm, enthusiastic people, typically very bright and full of potential. They live in the world of possibilities, and can become very passionate and excited about things. Their enthusiasm lends them the ability to inspire and motivate others, more so than we see in other types. They can talk their way in or out of anything. They love life, seeing it as a special gift, and strive to make the most out of it.

ENFPs have an unusually broad range of skills and talents. They are good at most things which interest them. Project-oriented, they may go through several different careers during their lifetime. To onlookers, the ENFP may seem directionless and without purpose, but ENFPs are actually quite consistent, in that they have a strong sense of values which they live with throughout their lives. Everything that they do must be in line with their values. An ENFP needs to feel that they are living their lives as their true Self, walking in step with what they believe is right. They see meaning in everything, and are on a continuous quest to adapt their lives and values to achieve inner peace. They're constantly aware and somewhat fearful of losing touch with themselves. Since emotional excitement is usually an important part of the ENFP's life, and because they are focused on keeping "centered", the ENFP is usually an intense individual, with highly evolved values.

An ENFP needs to focus on following through with their projects. This can be a problem area for some of these individuals. Unlike other Extraverted types, ENFPs need time alone to center themselves, and make sure they are moving in a direction which is in sync with their values. ENFPs who remain centered will usually be quite successful at their endeavors. Others may fall into the habit of dropping a project when they become excited about a new possibility, and thus they never achieve the great accomplishments which they are capable of achieving.

Most ENFPs have great people skills. They are genuinely warm and interested in people, and place great importance on their inter-personal relationships. ENFPs almost always have a strong need to be liked. Sometimes, especially at a younger age, an ENFP will tend to be "gushy" and insincere, and generally "overdo" in an effort to win acceptance. However, once an ENFP has learned to balance their need to be true to themselves with their need for acceptance, they excel at bringing out the best in others, and are typically well-liked. They have an exceptional ability to intuitively understand a person after a very short period of time, and use their intuition and flexibility to relate to others on their own level.
Because ENFPs live in the world of exciting possibilities, the details of everyday life are seen as trivial drudgery. They place no importance on detailed, maintenance-type tasks, and will frequently remain oblivous to these types of concerns. When they do have to perform these tasks, they do not enjoy themselves. This is a challenging area of life for most ENFPs, and can be frustrating for ENFP's family members.

An ENFP who has "gone wrong" may be quite manipulative - and very good it. The gift of gab which they are blessed with makes it naturally easy for them to get what they want. Most ENFPs will not abuse their abilities, because that would not jive with their value systems.

ENFPs sometimes make serious errors in judgment. They have an amazing ability to intuitively perceive the truth about a person or situation, but when they apply judgment to their perception, they may jump to the wrong conclusions.

ENFPs who have not learned to follow through may have a difficult time remaining happy in marital relationships. Always seeing the possibilities of what could be, they may become bored with what actually is. The strong sense of values will keep many ENFPs dedicated to their relationships. However, ENFPs like a little excitement in their lives, and are best matched with individuals who are comfortable with change and new experiences.

Having an ENFP parent can be a fun-filled experience, but may be stressful at times for children with strong Sensing or Judging tendancies. Such children may see the ENFP parent as inconsistent and difficult to understand, as the children are pulled along in the whirlwind life of the ENFP. Sometimes the ENFP will want to be their child's best friend, and at other times they will play the parental authoritarian. But ENFPs are always consistent in their value systems, which they will impress on their children above all else, along with a basic joy of living.

ENFPs are basically happy people. They may become unhappy when they are confined to strict schedules or mundane tasks. Consequently, ENFPs work best in situations where they have a lot of flexibility, and where they can work with people and ideas. Many go into business for themselves. They have the ability to be quite productive with little supervision, as long as they are excited about what they're doing.

Because they are so alert and sensitive, constantly scanning their environments, ENFPs often suffer from muscle tension. They have a strong need to be independent, and resist being controlled or labelled. They need to maintain control over themselves, but they do not believe in controlling others. Their dislike of dependence and suppression extends to others as well as to themselves.

ENFPs are charming, ingenuous, risk-taking, sensitive, people-oriented individuals with capabilities ranging across a broad spectrum. They have many gifts which they will use to fulfill themselves and those near them, if they are able to remain centered and master the ability of following through. "

What do you guys think?

Deal or No Deal?

2007-03-29T07:34:00.000-07:00

Today finally switched our internet plan over. Every month we've been running out of data limit about 2/3 of the way through and been stuck on slower than dial up speeds for the reaming 10 days. It kinda got annoying and so we upgraded to a bigger plan with roughly 50% more data download to keep Youtube fully functional. I was expecting to pay another $30 but it turned out to only cost us $5 more. I was kinda puzzled until the Indian call operator explained why. "Well sir, the plan you now have is our new plan, but beforehand you had your phone bundled with us and we gave you 100 free local calls to the value of $30 and now you get the extra data for $5 but lose the 100 free local calls" He then proceeded to ask me what the weather was like outside as he fumbled through his computer system trying to work out what button to press to fix my internet. "Um it's been raining?" "How long for sir?" "Um since I WOKE UP????" (kinda becoming a bit too intrusive in his bid to avoid awkward silence over the phone and impress his boss)So now we have full speed internet. But in order to gain that I have had to sacrifice our free local calls. But I calculated we only spent $2.30 last month on that so we really gain more with the internet. It's a matter of weighing up the options and making a trade-off.

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Been watching more Death Note tonight. Now a blonde female character has been introduced who falls deeply in love with the evil killer (aww how sweet!). She too gets his killing powers but she wants more. She wants ot be more powerful and have the 'shinigami' (death god) eyes which will enable her to kill anyone. But in return for this power, she must trade half of her remaining life span in order to win her 'love' over with her new powers. She weighs it up and decides her new boyf is worth giving up half of her remaining years and makes a rather important trade-off (if only she knew what was around the corner! Ah Misa!)

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Life is about trade-offs. We think the toil of studying hard at uni is worth it to get the job we want. We think the pain of slaving away at our job is a worthwhile trade-off to ensure we get the nice big house with the dog and 2 kids we want. We think the time we spend away from our family is a fair trade-off in order to 'have' a family. Sometimes we make good trade-offs (like better internet) and sometimes we make bad ones (like selling your life for power or love). Are our trade-offs worth it? Or have we blindly entered into them without evaluating where we are going?

"He is no fool who gives what he cannot keep to gain what he cannot lose" - Jim Elliot (murdered missionary to Ecuador, aged 29)

Death Note/Nite

2007-03-29T07:10:00.000-07:00

Thanks to my Japanese flatmate, I have recently become hooked on a manga-turned-anime series called "Death Note". Thankfully Youtube have put English translated episodes up online so I can keep up to date and not have to bother my flatmate for a word by word translation.

The premise of the show is that a young man (Light Yagami) falls into possession of a notebook with supernatural powers. Whenever he writes someone's name in the book, they die of a heart attack. This notebook is known as a "Death Note" which belongs to the death 'gods' of Japan (the Shinigami) who usually use these books to rid the world of people when their time is up. However, Light-kun decides he can do a better job and decides to altruistically rid the world of all the bad or undesirables. The rest of the world soon notices that the crims are being bumped off at an alarming rate and start to panic. And so along comes 'L', the mysterious international detective whose job it is to outwit and discover the true identity of the killer now nicknamed "Kira". It's a psychological thriller and very well thought out. Each week I can't wait to hear the theme song and get my next installment. The psychology of death and dying.

................................

It was a night shift just like any other. The week of ward nights had so far been a dream run. Averaged about 2-3 hours of sleep interuptted only by phone orders for fluids and sleepers. Dr Z had commented how it was her 'calming effect' on the wards which made it thus. I laughed. And so began the Friday night shift. The beginning of an 3 day weekend (due to hospital days off). The night started with a constant stream of pages asking me to come and review people who weren't doing too well. Someone in pulmonary oedema, a Down's Syndrome guy who needed venous access but wasn't gonna let me anywhere near him with a needle. The usual kinda stuff that fills night shift.

And so as I was pinning down this guys forearm to pop in the cannula, I heard the nurse next door spurt out, "Um doctor... I don't think this lady's breathing anymore."
Argh!"Well do you wanna call a Code Blue for me then!!!!" (Frustration at nurses lack of initiative quite evdient in tone of voice)

Ok J... remember ABC.... ABC! (I told myself again and again)"Can someone get me a bag and mask! And the crash trolly while you're at it!" (just in case they didn't realise we'd need one - can never assume they'll 'get it')
Airway - Guedels airway inserted.
Breathing - bag and asmk commenced and handed over to nurse.
Circulation - pulseless in the carotids - CPR commenced

I put my hands on this 90 yr old ladies chest and with the first chest compression felt the CRUNCH as all her osteoporotic ribs shattered under the weight of my body. I started furiously pumping away, praying that the arrest team would arrive soon.

Thankfully before the first minute had elapsed they were on site with paddles and drugs and I was relegated from team leader to chest compression boy and let the registrars play with atropine, adrenaline and DC shocks.

But it was too late. She had been gone for too long. She was dead.
I had given her the best possible chance I could... but sometimes that's just not enough.

And so I wrote the first Death Note of the night as my registrar called up her husband to inform him of his wife's 'passing awayy. Turns out she lived 4 houeses down the road on my street. She probably walked past my house during the day on her way to the shops.

The ink has just dried on the Death Certificate, when the pager beeped. It was the surgical ward. "Sorry Dr J, we just need to to come and declare a patient dead." I went down and began the same process of 'declaring' death on this patient with a known leaking Triple A. And no sooner had I finished that one then another page... with another death.

By the time that shift finished, within 24 hours, I had declared 5 people dead. My own 'Death Note' episode, except that I was writing their names on paper retrospectively.

NB - this was a post I wrote in the past month that I was unable to publish due to internet problems, so it occurred about 4 weeks ago (sorry for the delay - but better late than never)

How to Save a Life

2007-03-23T03:07:00.000-07:00

"Every night around the nation, a small but dedicated group of young men and women leave their homes as the country is engulfed in nightfall and begin their journeys. They are our sons, our daughters, our brothers and sisters. They are the Night doctors of the public health system and this is their story...

Dr J is a 24 yr old resident doctor at The Zoo. Like many other of his colleagues, he has just completed his internship and is currently undertaking his set of ward nights where he will be placed in charge of half of a major tertiary referral centre between the hours of 10:30pm and 8:30am. During the day the hospital is teeming with hundreds of doctors but at night it is just him, the intern covering the other wards and one medical registrar running the wards.

His night begins with a call from the renal ward. They have a patient who was recently transferred out of ICU who needs some attention. He has had a major bleed inside his brain and is now complaining of a headache similar to the previous bleeding. However before our young doctor can asses this man, he is called away to the cardiothoracic ward where a post-operative patient is having an abnormal heart rhythm.

Whilst giving the nurses on the wards further instructions on how to control this mans heart rhythm, Dr J is again called, this time by the cardiology ward to assess a patient who is bleeding profusely.

When he arrives he learns that this man has dementia and today has had a pacemaker inserted into his chest. Dr J carefully peels back the dressing to find that the wound has actually re-opened up and this patient is actively bleeding.

[cut to ad break]

"Welcome back to our look into the lives of young night doctors and their trials and tribulations. When we left our young Dr J, he was trying to save his patient from bleeding to death by applying prssure to his wound, however after 30 minutes the wound is still bleeding and it looks like he will have to take more definitive action
[cue dramatic music]
Dr J has run down to the Emergency Department and gotten hold of some suturing kits to stitch up the wound to stop the bleeding. With careful precision we cleans the bleeding and pulls the open wound together and immeadiately the bleeding stops. Another great save by Dr J. But before he has time to bask in the satisfaction of helping another patient he is whisked off to see another surgical patient who might have a clot in her lungs..."

You'll have to excuse my bad homage to RPA style TV shows... but ward nights have been rough. Compunded by the fact that when the cardiology morning nurses found out I'd stitched up a bleeding pacemaker site the conversation went a little south:
"Um Dr J, you did call the cardiology registrar before you stitched him up didn't you?"
"Um no..."
"Please tell me you asked the med reg first then?"
"Ahhh. no?"
"[Expletives that can't be repeated] Oh no! Dr Cardiology-boss is gonna freak out! He only ever uses pressure to sto the bleeding... he NEVER stitches them up! He's gonna go nuts!"

You kinda feel like you're helping people and doing your job well and then you get a nice big kick in the head to remind you that you're still just a resident and belong at the bottom of the pecking order. I can understand if this boss was annoyed with me cos I did something dangerous, but the fact is that this patient was bleeding and I did what many other doctors would have done... just not to his preference.

The politics of hospital make this job SO worthwhile... only 9 months to go!

The Sound of Music

2007-02-03T19:04:00.000-08:00

Recent additions to the CD collection:

Norah Jones - Not Too Late
Back in 2002, I tuned into an alternative radio station and heard this pristine voice singing "Don't Know Why". I waited to find out the name of this artist and promptly bought Norah's first album before she hit the mainstream. I even considered going to her Australian Tour before she became big. Kinda wishing I had now! Either way, her second album didn't impress me as much (although still very good) and so I held out hopes that maybe on her 3rd outing she'd bring back some of her jazz covers and woo me once more. Unfortunately she's gone down the folky road and so it's a ncie album, but not the Norah I fell in love with so many years ago.

Human Nature - Reachout:Best of Motown

Although I am prone to boy band pop, Human nature don't usually do much for me until I heard their covers of my mother's era of musicology. It's nice to hear old classics with a crisp CD quality recording and a new arrangement. Ended up singing along with a mate to these babies on the way up to Mt Tomah the other day. "I got sun-shine.... on a clou---dy day!"

Regurgitator - Jingles

Blast from the past with a band who had some really good snappy hits. I never owned any of their music as a teenager (I think my mum wouldn't have allowed me to) but it's nice to pull out those classic high school hits like "Polyester Girl", "! (The Song formerly known as)", "Happiness" and "Fat Cop". The antiestablishmentarianism* of their songs is sublime, kinda venting my repressed teenage desires to rebel (which was in stark contrast to my bland tame reality).

Robbie Williams - Swing When You're Winning

Not to be confused with a similarly titled pop album by the same artist, SWING is very different from SING. I was amazed a few years ago when I heard Robbie crooning some lovely jazz numbers (a few of which became popularised ie Nicole Kidman and he on "Sumthin' stupid" and his Finding Nemo End Credit "Beyond the Sea") My flatmates all owned the album but when they left I was devoid of these classics and so managed to score it at a bargain $9 price!

The Cat Empire - Self Titled

2 years ago on Australia Day, my flatmate and I went into Darling Harbour and stodd overlooking the AquaShell as thousands of crazed fans moshed/partied/raved themselves silly to these ska/reggae/jazz ditties. Words can't really describe how good one feels after listening to their funky tunes... but it ended up with about 10 crazed fans throwing themselves into Darling Harbour and moshing in the water whilst trying to avoid the water police's tin boat. Ah.. memories!

Music is such a vital part of life. It provides the soundtrack for remembering the past and adds the colour between the lines of events.

"Our weapons were our instruments, made from timber and steel

We never yielded to conformity but stood like kings

In a chariot that's riding on a record wheel"

* I just HAD to use the longest word in the English dictionary at SOME point didnt I?

Scrubs - Musical

2007-01-26T22:32:00.001-08:00

What I WISH would happen in hospital each day.

Medical TV

2007-01-26T22:17:00.000-08:00

Every once in a while, a non-medical person will enquire:

"So is being an intern/resident really like on E.R./Scrubs/Grey's Anatomy?"

Hahahaha! "You have NO idea!"

Whilst of course the working life of a doctor is not all fun and games and often a lot of paperwork (which doesn't make for good TV), there are often a lot of truth in these depictions of medical life.

The constant jokes about bodily fluids/products/organs, the larger than life personalities, the lack of social skills all stem from a dark reality hidden behind the facade of the blue scrubs.

Medical types are usually quite bright and so where there are doctor's there is humour to be found. Those bizarre topics of conversation on Scrubs? Here's one of my own form the other night in ICU:

"So did you see that guy on the news? He got half eaten by a shark!"
"Which half? Like how do you get half eaten by a shark?"

"Obviously its the top half that's left... cos you can do without the bottom half!"
"Can you? How much of your body could you have eaten off and still survive?"
"That's a good question.. like you'd need heart and lungs and brain... but I guess you could do without legs and reproductive organs.."
"And you could get rid of your kidneys and go on dialysis?"
"Good point... and you only need a sliver of liver... so we can scrap half of that... and maybe get rid of the bowel/GIT and use TPN feeding?"
"Yeah... I wonder which half of that guy is left... I hope he has some liver..."
"Yeah me too"

Sometimes I feel like I'm on TV... kinda like the Truman show. And as night shifts go on into the dark hours before dawn... the conversation get more and more bizarre.

However I must say the following video below really sums up what I feel like doing one day in the Zoo.

Enjoy!

Not-So-Intensive Care Unit

2007-01-24T19:01:00.000-08:00

Good morning blog-readers and welcome to the new and improved Dr J!
2 weeks of annual leave have left me a new man; "full of happy thoughts... all the time!"*

In a quirky twist of fate (and a lot of manipulating via multiple phone calls almost bordering on harassment) I ended up doing a 4 way term swap which means instead of being thrust back into ED, I found myself arriving back to The Zoo on night shift in cardiothoracic intensive care (CTICU).

When I found out I would be covering CTICU on nights by myself I kinda panicked! I had done a total of 2 days ICU as a student and learnt nothing from it. I didn't know what the beeping noises or tubes did. I had never done cardiothoracics either and didn't know what a LIMA or IABP** were.

When I arrived I found a big trolley with a drape over it parked next to my patients. It read "Open heart trolley - Emergency Only". Not a good sign! I found the CTICU fellow, a rather nice British doctor who quickly allayed my fears.

"Have you ever done ICU before?" I sheepishly shook my head.

"Sorry, yesterday I was an intern, today I'm a resident"
"That's a bit rough... no worries, how about I sit down with you and I'll teach you in one hour everything you need to know about CTICU"

One hour later I felt comfortable enough to handle anything life threatening and actually understood PEEP, PAP, SVRI, CI, MAP and how to handle inotropes in patients who'd had open heart surgery.

Armed with dobutamine, noradrenaline and a set of the best nurses in the hospital, I felt well armed to deal with anything urgent that may arise during the night. As the fellow left, I was ready to keep these people alive until morning.

5 minutes after the boss left, the nurses looked at me strangely, "You DO know there's a room for the resident to sleep in overnight don't you?"

I looked kinda puzzled... what resident? Oh that's right... I'm no longer an intern!

The nurse in charge took me up to the cardiology department and showed me a small room tucked away with "Staff Only" printed on the doorway. Inside was a lavish bedroom with a nice freshly made bed and an ensuite with shower. Who said taxpayer's money was poorly spent?

6 hours later I awoke. It was half an hour till handover time so I scurried back to CTICU to print out morning blood results and tidy things up. The morning resident appeared right on time and I was home in bed soon after.

Getting paid to sleep. This is the life!

3 nights later it's a similar picture. Sleeping 6 hours average per shift and getting paid to do so. Tonight we might not even HAVE any patients left in the unit.

And so begins PGY2... after this week I get a 'week off' to compensate. This term I will end up working a total of 5 weeks due to working nights. 5 weeks off! And none of them annual leave!

Welcome to residency!

* "Kung Pow - Enter the Fist"
** Left internal mammary artery and Intra-aortic balloon pump

Holidays

2007-01-09T23:23:00.000-08:00

The sun is filtering thru my window. The kids next door are playing in their pool. The birds are calling to each other. The planes are flying overhead.

This is the life.

A well earned break and what am I doing? Sitting around in Sydney!

To be honest, it's actually a perfect start to the clinical year. Lazy summer days and plenty of sleep. A beach trip yesterday to check out the 'scenery'. A shopping expedition with the ex-wife. A movie in the evening. A book to read whilst having a bath (ok, it's a drought.. but once in 6 months isn't that bad).

Plans to watch the tennis tomorrow, catch up with some friends, eat good food.

Little things that remind me I am still a human (and thankfully no longer an intern).

Maybe I should learn how to ride a horse so I can meet lovely ladies like the one in the picture?

Coming soon...

2006-09-19T05:33:00.000-07:00

Stay tuned in January 2007 for the new adventures of Dr J as he finishes his internship and begins the big bad world of residency.

25% more fun, 75% more waffle and 37% more pay (I hope)!

Only at http://theresidentexperiment.blogspot.com