"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.

Grandad

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

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

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

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

"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*

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?

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

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

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