"Now I Run " - Shannon Noll

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

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

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...

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...

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

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

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...

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

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

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

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.