Nam

Sweet jeebus it's great to be home. So, so many stories to tell, I'm a bit overwhelmed by it all. Never fear, trusty unordered listage to the rescue!

The Good

• Langkawi. I spent whole days lazing by the pool reading (The Kite Runner, thanks Chris' brother) and occasionally going for a dip. Gorgeous wide beach, not too overrun with tourists.
  
• Cheapass and delicious Malaysian cuisine. Roti canai, Rotiboy buns, ice kachang, teh tarik, coconut, fruit smoothies and juice.
  
• Cheapass Vietnamese food and drink.Best was banh mi thit (at Saigon's famous Nhu Lan bakery).
• More cheapness: got a stack of fake Moleskines notebooks and sketchbooks, stationery, drawing pencils, some medbooks and a supply of DVDs to last me the whole year and then some. West Wing here I come!
• A lot of fodder for an Amy Tan-esque novel that will never be written, about the flaming batshit that is Vietnamese family life.
  
• My Viet improved. I was thinking in Viet and even managed to write a letter (unsent) even if I managed to misspell "I" every single time, frigging diacritics. Remind me to bitch some time about the ridiculous grammatical caste system whereby there are no fixed personal pronouns so that at EVERY SINGLE ENCOUNTER you have to work out your interlocutor's age and status relative to yourself and thus a simple question like "can you please pass me a pen" turns into a tongue-tying etiquette death trap.
• Bonded with the mothership against common enemies. We're a team. I realised that for all the usual mother-daughter bickering, I'm fiercely loyal to her and vice versa.
  
• Motorbike rides, baby! Too bad that they've just brought in helmet laws meaning that my hair doesn't get to blow sexily in the polluted wind.
• Met some lovely people. Primo, Co H, a family friend of sorts, who gave me a personal guided tour of a Hanoi hospital and sheltered the five of us when we were kicked out of / ran screaming from Bac Q's house. I like her a lot - spirited, very sweet, with a cheeky humour. She was an almost painfully thoughtful and considerate hostess so that I was slightly stressed out at being on my best behaviour the whole time. Her husband Chu T was sweet as well. Probably will write more about them later - intricate and sad family circumstances. There was also Bac T's family in Hanoi. He gave me another hospital tour and kept teasing me in his incomprehensible northern accent. A good-natured bloke - I think he might be useful in dad's pro-democracy work. He's Everyman, made some astute and witty jokes about the political sitch. In Saigon there was the orthopaedic surgeon who took me to yet another hospital and patiently taught me how to stab people with sharp things. Basically did more hands-on meddy stuff in two days than in the whole of last year. Plenty of nice nurses there too who each taught me their own special technique, thoroughly confusing this hapless medkid. There's quite an art to getting drugs out of an ampoule I tell ya. Also in Saigon was another Bac T, an anaesthetist and Stepdork's childhood friend. Jolly and straightforward, such a change from the poisonous peoples in Hanoi (below).
  
• Personal Growth. Learned plenty about my own numerous flaws (temper, acid tongue, impenetrable reserve, selfishness, etc etc) and hidden strengths (2008 = Tina takes no more shit year). Learned what kind of person I respect and want to be like (see above), and what kind of person I have to avoid becoming (see below).
  

The Bad

• The initial awkward icy silence between me and the stepsisters. It lasted more than a week, but through our shared misadventures it's now thawed to a warmer truce. Not BFFs by a long way, but we can trade the odd joke or comment.
• Learned to give injections ie. caused already sick people more pain by my clumsiness. Oh and managed to spill some poor patients' meds and make a mess. Worse still though, was how I found my compassion gland switching off. I couldn't see every single person as an individual human being - there were so many, with such horrific injuries (ortho ward), and there was the language barrier, and they just lay there passively. Not that any of that is an excuse. I didn't engage with them, I broke every rule of bedside manner that Newie has so carefully taught.
  
• I'm a generally chilled out person, but somehow the stress of travel and family political bullshit reset my baseline mood to a constant pissed-offness, sometimes elevating to full-blown stinking rage to the point where I'm imagining smashing brick walls with a baseball bat and/or running into traffic.
• Vietnam bathrooms. It's called SHOWER CURTAINS people!! A piece of plastic to stop the water splashing everywhere so you don't get a wet ass every time you go to the toilet! It's not rocket science!
• Bac Ky (Northern Vietnamese) politesse. Related to the stupid pronouns above and also other linguistic formalities like forms of greeting and polite phrasing. But extends to how people are judged by their status - wealth, family position, education, age - and then treated accordingly (ie. like shit, if you aren't deemed worthy). It's bloody mediaeval. Even the nice northern people freaked me out with their politeness. God bless the frankness of English. NB. My paternal side is from the north but moved south after 1954 (fall of the French); my dad has never even been to Hanoi.
  
• Vietnam street juice ie. the dodgy patches of wetness on the street that are a mere centimeter of plastic from parts of my body. Definitely not pure water either - one time we caught a dog nonchalantly pissing in the middle of the pavement.
• Vietnam crowdedness and rule of the jungle. Spent Christmas eve in the middle of a throng of motorbikes and pollution. You risk your life every time you cross the street. You're a target for pickpockets and cheats wherever you go. Stepdork got his pants pocket slit (nothing important was in it) and at Saigon airport, the taxi registry guy stuck his hand into Stepdork's backpack and stole our camera! Huge screaming match shitball. Luckily mum had the presence of mind to look under the taxi and found the camera where he'd ditched it upon hearing Stepdork accuse him. This was about 15 minutes after we'd touched down in Saigon.
  

The Fugly

• Staying with Bac Q in Hanoi. Oh my flord. I never knew there could be so many incredibly duckwitted jerks in one family. I thought Chu H, Stepdork's brother in Sydney, was bad enough. His mental age is about 13. He's a doctor, "just a GP" but has made shitloads of money and lets everyone know about it. Buys (and boasts about) the most expensive of everything- he gives his kids Louis Vuitton bags and $20k first class plane tickets and zero parenting or attention. I've watched him for ten years and have never seen him show any evidence of thinking about anyone but himself. BUT WAIT, THERE'S WORSE. Bac Q. He's Stepdork's 60+yo cousin and a former maths professor. Oh my god. I had a bad first impression as soon as we came in- barely a nod of welcome. I started disliking him when in his first conversation with my mother he asked her point blank "what do you do? I mean, what did you study at university? what do you mean, you didn't even go to university?!". I left the room at that point. I started hating him when he started to patronise her while at the same time bossing her around the kitchen and telling her off like she was his servant or a child. This is my mum, who can turn men to quivering jelly by the mere force of her glare! And my contempt for him was cemented when he made a speech on his wife's birthday. A masterpiece of vanity. He managed to spare about two sentences to grandiloquise about her virtues and then proceeded to talk for twenty minutes about his own qualifications and the glory of his family line. He actually brought out the equivalent of a Viet Cong Who's Who and pointed out his father's entry and then catalogued all his children's academic achievements and the dollar value of his properties. I didn't know whether to laugh or bash my head into a wall. In fact Stepdork was filming the occasion and thinking it was our video camera, I pulled magnificent faces and eye-rolls - only to find out later that it was Bac Q's vidcam! Apparently he thought I didn't understand Viet and was just bored at the length of the speech. If only he knew. Even more contemptible was how there was an abrupt about-face in how he treated me and mum after he found out that my "aunt" (Co H) was a cardiologist and that I was a med student. How he started fawning then. There's more to the Bac Q story that lead to us fleeing his house, let's save that for next time.
  
• Ba Noi (stepgrandmother). Or, as I like to call her, B-I-T-C-H (to the tune of "Bingo was his name-o"). Dominates her husband and treats him like an infant- she actually forbade him to go get a coffee when he'd already gotten his coat and was almost at a door. "You won't be able to sleep so you will get skinny and then everyone will think you're a drug addict! And who will suffer? ME! Everyone will laugh at ME! How dare you be so selfish!" He's this gentle, quiet, harmless little man for whom coffee is the only escape from the witch. The worst was when we were leaving - both Bac Q AND she had to do some more speechifying. In her bit she repeated the whole "oh HOW I HAVE SUFFERED because of my husband" spiel again and then added a dig at my mum, who had taken pity on stepgrandfather and made him some coffee. She said she'd never liked my mum from the beginning but noooo, Stepdork was so disobedient. She also snarked at how having a university education was THE most important thing. This was in front of everyone, with mum and me and stepgrandfather all present! This was one of those internal baseball bat moments. I slightly regret not saying exactly what I was thinking. I did manage to finally interject "RESPECTFULLY, THAT'S ENOUGH WE GET IT GRANDMA, WE ARE GOING TO BE LATE FOR OUR APPOINTMENT". Later we heard that she'd bitched about my mum behind her back saying that she was a money-grubbing home-wrecker, which, if you know the history of my parents' divorce, is not only the worst insult but also the greatest irony. Apparently she also said I dressed like a beggar and that she'd slap me in my face for my intervention in a certain family crisis (more later on that). Just before we flew off, Stepdork phoned her again. Of course she was all hypocritically saccharine to us. I'm very proud to say I suppressed the urge to curse and instead beat her at her own slimy Bac Ky game with the following exchange in Viet (B = her, T = me):

B: I wish you happiness in the new year and hope you study well and get great exam results and--

T: Oh THANK YOU Grandma. You know I have to say how grateful I am that you have treated me JUST LIKE your very own grandchild.

B: You're welcome dear. Now when I come to Australia you have to promise to give me medical treatment!

T: Alas, I am a very stupid student. SO, SO STUPID. I guess you'll have to wait til S2 [ie. younger stepsister] graduates, she is far smarter than me.

B: No no no, [stepsisters' mother] has told me how brilliant you are, the girls always go to you with questions.

T: Oh, [stepsister's mother] and you are both TOO SWEET.

On balance, it wasn't THAT bad of a trip. Touristing-wise it was all deja vu since we basically retraced the trip mum and I took in 2004-5, only Langkawi was new. It was the people that made it maddening and interesting. The bitter drama just made more of an impression on me than the good stuff, but I'll take lessons from both. I've said it'll be a long time before I go back to Vietnam...I dunno now. Travelling in other countries, we only see the outside, have contact with other tourists and those who cater for tourists. More or less moving postcards. Only in Vietnam do we get plunged into the bubbling stew of human relationships with all the ensuing pain and humour.

Run rabbit, run rabbit, run run run

Dunno what that's got to do with anything, the tune is just stuck in my head.

Back from Melbourne last night, in Sydney now, and off to Malaysia in about 18 hours. Ah jetsetting. I meant to do a "2007 in review" post cos much batshit has happened this year, but I can't think on a Windows 98 16-colour monitor so will probably do a tipsy post on New Year's Eve Eve on our return.

So Merry Xmas in advance dear loyal readership (ie. Chris and Chez)! Will bring back heroin for you both.

Off to roti, illegal DVDs and cheapass med textbooks!

PS. UNGRADED PASS, baby! Wooooohooooo.

PayItForwardCrossing

Yet another 3am ramble. An hour when world-nudging delusions can actually get the edge over "omg this is SO OPRAH" cynicism.

The inspiration: zenhabits on bringing people closer.
The pitch: Pay it Forward concept breeds with BookCrossing technology.

PIF is a kindness pyramid scheme where A does a good deed for B, who pays the favour forward to 3 other people, who each pay it forward to 3 more, and so forth. BookCrossing is where people leave used books in public places, with a code and URL stuck in it. Whoever finds it can log in on the site and enter the code, then passes the book on, so you can track the progress of the book across the world.

So to merge these: a way of tracking good deeds. When you do something good for someone, give them a Post-It with "record your good deeds at payitforwardtracker.com" on it. The recipient of the favour registers what was done for them, and what they have done for others. They too give Post-Its to their recipients. Thus, theoretically, you get a map of the spread of good deeds and a community of altruists.

I can already see flaws in it actually, because the people most in need of good deeds, the disadvantaged, may not have internet access. Hmmmm. Maybe it could be entirely internet-based good deeds such as...I dunno, designing a graphic for free, or buying someone one of their Amazon wishlist items (nah, too consumerist) or mailing them stuff they can't buy from their own countries. Maybe it could be set up in an existing web community. Maybe the "act of kindness" needs to be a specific act - what is a universal good deed?

Come to think of it, the Jerry library is a pay-it-forward scheme and an idea with potential I reckons. Tis simple - each borrower mails the library set to the next. The key elements are:

• A "good" that is scarce and valuable, but not priceless. Here the content of the library DVDs was rare, but the physical DVDs themselves don't cost much and are easily replaced.
  
• Decentralisation and self-sustaining. There are 3 sets of DVDs (two US, one Australasia), each with their own list. The admin only has to add new people to the list and borrowers contact each other for address details. The system relies on the next borrower harassing the previous person to hurry up and send the thing.
  
• A small "paying forward" burden. I've probably spent less than $50 setting up the entire thing, and each person probably spends less than $10.

Now how to extend this idea to something slightly less obscure? The "good" needn't be something physical, but c'mon, snail mail is fun to receive. Stamps and envelopes are so retro!

Food for thought.

Oy, this blog was meant to be a place to forge (ha! double entendre) my identity as a student doctor, but it seems there aren't that many opportunities in med for these Giant Harebrained Ideas I seem to like. Or maybe I just haven't looked hard enough. We had CPR training this week and the guy showed us some horrible comparative stats on how many Aussies vs Seattle folk survive cardiac arrests. We suck. It was something like 7% vs 70% (don't quote me on that). The dude attributes that to the lack of CPR training and defibs here. If true, that is DUH. CPR is so easy. Here, go learn it. Hey, maybe the Thing That Is Passed Forward could be "teach someone" so it'd be a pyramid scheme of knowledge. It worked for Christianity, why not CPR! "Teach it forwards".

Yknow what this sounds like? Public Health. Is that where this is leading? P-values and policy-making?! eeep. Maybe should've stayed awake in Health Economics lectures this week. Reminder to self: write about breadth vs depth of impact, helping individuals vs groups.

Ok, pressing "Publish Post" now in anticipation of a "wtf is this crap I wrote?!" hangover tomorrow.

Culpa

I'm guiltier about my disengagement than the sardonic glibness below implies. To name something and to joke about it is to make excuses.

Read this.

Jesus.

6 hours of election coverage later...

...I want to claw out my brain. So, we have a PM named Kevin. I don't know how I feel about that. hehe.

Current feelings: totally unsurprised, a little hopeful, a little apprehensive, and ready to take the piss. Rudd is an awful orator, so passionless. Also, count the number of times he said "nation" and "future" in his victory speech. Dude, they're called SYNONYMS!

eg. "This task as well, to remain ever vigilant in defence of our nation's national security."

Nation's national security! That's almost Bush league. Kevin '10, if you need a snarky apathetic speechwriter, I stand ready to serve.

I'm even vaguely sorry for John Howard (though I do not forget - oh yeah, VSU was dumb too!). My mum is in mourning. I don't really understand her almost visceral hatred of Labor and emotional attachment to the Libs. The Team A vs Team B battle isn't meaningful to me. I think the more crucial battle is The Little People vs The Powerful.Why be blinded by party loyalty? We've got to be vigilant against manipulation and use the powerful for our needs rather than vice versa. Everyone should be a swinging voter.

In response to one of Chez's points- with the balance of power, I think that the senate/reps division is more important than state/federal cos if one party dominates both houses, it's a legislative free-for-all (see also: Work Choices). So I'm very interested to see how the senate seats pan out - go go random third parties! With state/fed, I reckon that the states will act in their own interests rather than according to party lines (see also: kerfuffle over water policy) so there's no great threat to balance.

PS. Voted below the line again for the senate cos damned if I'll let other people decide how my preferences flow! 79 boxes, man. Gotta say, when you get beyond the top few parties, it's all a bit "eeny meeny miney mo". I may have accidentally voted for the Shooters' Party above the Carers' Party. Um, oops. Down the end it gets to "do I hate Pauline Hanson more than Fred Nile?" (Think I split the bottom spots between them)

The Election

So Chez wants me to write about the election. To be honest I've been paying attention to the form of ads more than the content (verdict: almost uniformly crapola). I'll be voting, as I think most people do, on vague gut instinct. I know, I know, the West Wing fan and former PoliSci/Law kid in me is ashamed at my lack of engagement but....INTEREST RATES ARE BORINGO! I can only bring myself to care about politics when interesting moral questions are at stake. I'll care about the economy when I actually have money. I think my leanings were set back at the time of my political awakening, circa Tampa. And what I remember from that period was the cynical fearmongering. The Pacific Solution was the most assbackward absurd policy ever. Labor was gutlessly me-too at that time though, I recall. WorkChoices also seems dodgy - where was this mentioned before the last election?

Sooo where does that leave us? I was a Democrats fan til they slowly went under - they're a little bit less lefty-loopy "pass the peace pipe yo" than the Greens. But I will prolly vote Greens anyway, preferencing Labor, reserving the right to bitch about whoever wins. Unless someone hands me a particularly pretty how-to-vote card tomorrow.

Man, I can just see Martin Sheen shaking his head sadly at me right now.

Updates

• Feh is the new favourite word of the week.

• It sucks being the lone singleton in a house of couples. Cue violins!

• Talked to my dad about the crazy grandpa thing a while ago. There's been some progress made on the "go to the damned doctor" front especially since my great-uncle has just come over from America and has been harping on at him. Today he had an appointment but backed out at the last minute - still, baby steps.

• On the JFSS/BMP project, I've decided that maybe it wasn't the blinding flash of genius that I always think my ideas are (snort). Sent it off to the National Rural Health Network who should be natural allies in this, and their council considered it and decided against. Sent me some (rather hollow) reasons why.
  

  The NRHN supports conference funding being available to BMP students, and does not believe that this should be replaced by other schemes. BMP students are currently eligible to apply for JFSS scholarships under the same criteria as other students and so the aims of the JFSS program ie to increase the number of rural practitioners is open to all interested students, are best met...The NRHN believes that should be avoiding comparison with JFSS, or attempting to get a BMP allocation of JFSS scholarships. The NRHN believes that we should be pushing for rural mentoring on an individual or small group basis, and expressing a need that face-to-face meetings with mentors is important. It would be hoped that face-to-face encounters would include some clinical time, but merely seeing the work environment may be sufficient to convince BMP holders to stay with the programme and not buy their way out.

  Bolded bit translated: "shut yo piehole, ignoramus!" Ok I concede that group mentoring is a good idea I didn't think of. But jeebus, they think EXCURSIONS are sufficient to deter students from bailing. And "pushing for rural mentoring" - hello, John Flynn is already in place and set up for that! Feh I say. Come to think of it, maybe my idea isn't pure inspiration, but their arguments aren't strong. It seems more like conservative guarding of their own position and protecting the sacredness of the JFSS (which isn't actually under threat, gah). Maybe I communicated badly. Will I take it any further? Meh. Drawing is funner. Being told to STFU grates though.

• On HES, Mauritius was my first choice but the grapevine says that even interns there hardly get to do any meddy stuff, just trail in the wake of senior docs taking notes and doing scutwork. So that's up in the air again. Que faire! ?
  

• My housemate's boyfriend doesn't know which party Rudd and Howard belong to. The election is in a week. He is a med student. Errrr. And dear Millionaire woman, "wherefore" is WHY!
  

• Translated said housemate's letter for her HES in Madagascar to French this evening. And discovered that a) my français has gone down the crapper despite NINE HARD YEARS of study and b) despite a), translation is one of those things I love doing and can lose track of time. Even Latin. Hell, especially Latin, cos even though it's sometimes frustrating - "WTF is the verb doing 5 lines down from the subject?!" - at the end you get the "woah, I just understood something thunk up 2000 years ago and it's still funny or moving or beautiful despite my godawful mangling" feeling. I was always more into the process than the result...don't ask me anything about Tacitus now.
  

• Went shopping at Charlestown today. And in possibly the nerdiest development ever, the most exciting time was when I bought some 4B and 6B pencils for my new inner artiste. Resisted the temptation of sexy thick-papered sketchbooks because there's no guarantee I won't get bored of this hobby in like 3 days (as you can prolly tell, I have hot flushes of passion which quickly fizzle). When we got home, my friend and I plonked ourselves on the couch and sketched. Very therapeutic.
  

Pencil > sword

That's what I'm listening to at the moment. My mum copied some of her CDs to iTunes on her work computer, which I used to back up my collection. This is the music of my childhood - maybe not this exact song, they all sound the same to me. It evokes lazy summer Sundays at home, just mum and dad and I pottering around the house. I never listen to this stuff of my own accord but I'm always tickled when it comes up on random.

Two things have sort of rocked my world lately. First, I decided I'm learning to draw. Came across some excellent sites that say that anyone can draw and I figure it's just a perceptual and motor skill that needs to be practised. Talent schmalent. We shall see if my decidedly unvisual brain (see also: total inabilty to read a map or navigate any of the three cities I call home) can get the hang of it. There are these classic drawing texts available online by Andrew Loomis - oldschool but awesome. With the "Fun with a Pencil" one, you start drawing decent-looking cartoons within the first five minutes so tis very positively reinforcing. Just started last night and already it's changing the way I see things. Suddenly the view from my window is no longer just of my grungy neighbour's yard, but made of shapes. The sky is divided by the vertical lines of my Venetians, intersected at right angles by power lines. The best thing is that it's a hobby that only requires a piece of paper and pencil, superbueno. Slightly less involved than hang-gliding and less risk of gruesome death by gravity. Quite a bonus.

The other thing is mind mapping. I've always pooh-pooh'd it because it's so messy and imprecise. In Year 10 our teacher made us do essay brainstorming with spider maps and it was torture. I told her I think linearly and in hierarchies (internal: LIKE A RATIONAL PERSON) and she said she knew, I was too boxed in, that's why I had to try and EXPAND MY MIND and I said yes yes ma'am (internal: feh, BA hippies). But now I find they're actually useful, and more accurately reflect how people think. Sooo...Ms Tulk / BA hippies 1, moi 0.

La vie est spiffy at the moment. Exams done, nice weather, clean clothes and room, food in the house. Ahhhh. MedBall was...interesting. Good food and far too much good drink. Too much = 4 in 9 hours, stupid acetaldehyde dehydrogenase. Maybe those puritans are onto something. A firstie had to be ambulanced because of alcohol poisoning and we saw a drunk girl bashing up her boyfriend. She tried to steal our cab, but the cabbie was on our side- not knowing that moments earlier, my friend and I were plotting what to do if I had to puke (window? move my stuff to her bag and chuck in mine? luckily, neither plan had to be tested). Heh.

Oy, another pointless post. Can't give you a nice dovetail ending all the time peoples. Learn to draw is the point maybe.

Can't sleep

Cbf studying either. So so sick of my notes.

Let me tell you how med is ruining my youth and health. My room looks like a warzone and the kitchen bins are overflowing so that there's a tide of garbage gradually encroaching on the kitchen floor. Our resident cockroach population is booming. I can't remember the last time I had a fresh vegetable or fruit, slept 8 continuous hours, went to bed before 3am, or had any exercise. Today's diet consisted of instant noodles cadged from housemate Alex (who I thought was Israeli, but disappointingly isn't), fruity roll cadged from housemate Katrina (training to be a nutritionist!), Coke Zero cadged from housemate Mincho (#1 supergenius in all of med who is also cool, funny and nice so we can't even hate him) and packet pasta from my own collection. Usually not such a leech, but supplies are low. Somehow in my twisted mind procrastinating on the computer is ok cos I can start studying any moment, but going to the shops is verboten. There is no logic. On the plus side, haven't started talking to myself yet. HOWEVER, in about 9 hours....FRRREEEEEDOM! Dear god, pass my sorry ass.

Alex and I share a bathroom that connects between our rooms. Classic setup for slapstick, n'est-ce pas? A couple of days ago there was an almost-incident when I stripped off and bounded into the bathroom only to see that he had left his door open...and he was in his room! I will leave it to your sordid minds to imagine the rest of the story.

Random thought for the day: knowledge of other people's characters is never fact, it's just a hypothesis that's tested and tweaked every time you interact with them. Mostly I'm never that wrong. Even people I think are awesome never fail my ridiculously rosy image of them. There might some kinda cognitive bias there, but I think I'm open to all evidence. Then there are some peeps for whom hypotheses are totally useless!

Plenty of people are bad cooks....

...but it takes a special talent to screw up boiled eggs. I am talented.

Quack hacks

So I've been surfing the productivity blogosphere while.....procrastinating on my work. Ferric, innit.

HAHA ferric, ironic, geddit? I will go kill myself now. We only children have to amuse ourselves.

Did you know there is a significant proportion of the human (hipster) population addicted to Moleskine notebooks? (googling "Moleskine porn" came up with this) I would be one of them, but I'm too stingy. My friend did give me this bright red silk one for my birthday once, which I used as my Vietnam travel journal. A little red book in one of the last bastions of Communism, oh the wittiness! They are sexy though. Not communists, Moleskines. Well I'm sure there are some sexy communists. Fidel does it for me.

I had a point somewhere...the productivity and the lifehacking blogosphere. Apparently there are shitload of blogs telling people how to improve their lives every day in every way. Came across a post by Scott H. Young about holistic learning, which involves interlinking ideas between subjects and understanding the concepts behind knowledge by visceralisation and metaphor. Food for thought indeed, cos I feel I've lost the knack of studying deeply and internalising concepts. I wondered if his ideas could be applied to the study of medicine, which has a lot of rote memorisation and arbitrary info (looking at you, anatomical pathology).

But the gist I took from it was that medicine shouldn't be as hard as it is. It's just that the teaching, both in books and lectures, is horrible. Just one effing thing after another. Often no overviews of the topic, no attempt to present narrative and links rather than bare facts. People don't think in lists! The only thing I've come across that is remotely sensible is the Made Ridiculously Simple series which has silly cartoons and visual mnemonics (eg. the spider of Willis).

So, an idea for a blog: Quack Hacks, or Medicine for Dummies. Med is the combination of a number of disciplines, each of which can be deconstructed and which have their own tricks. Pharmacology, for example- I wish I'd been told at the beginning that all you really have to know at first/second year level is name, mechanism, uses and side effects (inc contraindications and interactions). And for the blocks we're doing this semester, neuro/endo/psych, drugs can be grouped by neurotransmitter, mechanism or disease. I haven't figured things out in other areas yet, like biochemistry, which is a blur of cycles and loops. Wtf.

Yeah, no good ending here. Go back to drooling over Chairman Mao, that fox.

Maybe Daddies

(dry-blogged from Sydney a few weeks ago)

So I was telling my mum how I semi-fancied Pharm Guy, but didn't know wtf to do and my instinct was to run away (yep, my genes are doomed). Anyway, we got to talking about her conquests. Dudettes, she started at EIGHT. Boys were chasing her from then. One guy followed her home from school from age 11 to 16, waiting years before even talking to her. She was a svelte little thing, with enormous doe eyes that gave her a look of perpetual innocent wonderment, it's little surprise that they were all trying to woo her. I dunno how she spawned the clumsy lu

She named three people who were her "might have beens". First was that stalker suitor. They'd finally started talking and things were going well. Except then the Communists came in and he was thrown into jail for years, because his family was wealthy and owned a chain of petrol stations. She too was sent away. It might also have been because they were involved in some fledgling anti-VC activities - student meetings sort of thing, hardly La Resistance. She got out soon enough, and didn't wait for him. He's now married to a friend of great-aunt #9 (my great-grandparents were busy!). Rumour has it that he told his wife he would've married my mum if she'd waited.

The second was another boyfriend who vuot bien'd (boatperson'd?) before she did. He arrived at the same Malaysian island as my other great-aunt #8, the one my mum is closest to (she's only about 5 years older). Unmindful of the spies and not thinking that my mum would soon escape as well, he chased skirts all day long. Needless to say, my great-aunt passed on word of his behaviour and her disapproval. When my mum arrived in Australia, he camped outside her door for days but she refused to speak to him. Turns out he is the brother of my childhood GP, married now as well. Mum says she saw him once in a pho restaurant - I was there too apparently, but she didn't say anything!

The last was the most serious. He was in the same engineering course as my dad and to hear her tell it, they were almost on the brink of marriage. He'd already asked her. However, great-aunt #8 disapproved of him, and mum didn't like his horrid mother. At the same time, my father was courting her shamelessly. He'd invited himself along to one of their picnics - later he cut out pictures of himself and her from that day and grafted them together. My great-aunt was very keen on him, possibly because my grandparents were very charming. My grandfather, a supplies officer in the war, hadn't yet lost the plot and was very gentlemanly, even if he looked down on less educated people like my mother. Grandma is and was an awesome mother-in-law, not to mention woman. More on her some other time. Anyway, things came to a head when a false rumour spread that my mother was pregnant. Knowing that it couldn't be his, and that my dad's side were making a move, the guy backed out quietly. Mum was angry he didn't even put up a fight, so she let him go. She found a photo of them all on that picnic day, in a boat. It shows a lanky, geeky fellow looking at the camera, as is my mum. She's blocking the faces of the two other girls there who were invited because of my dad's presence. He, of course, is looking at her. The rest is history. They married when she was 20, he 25. Six years on when she was pregnant with me, she saw the guy on the tram, then never again.

I'm not sure how reliable these stories are. I'm sure they're coloured by the bitterness of what came to pass. The photo-graft is interpreted as a sinister portent and the ruthless courtship as a sign of caddishness. She blamed my great-aunt. I told her to take some responsibility, because she did make a choice. I don't know though. It's impossible to compare her and me. While she was more knowing about boys and had to survive in the more dog-eat-dog world of Vietnam, it sounds like she really was a wide-eyed ingenue at age 20.

We ended up looking through some of the other photos as well, from my mum's childhood. Pretty amazing that they've survived war and crossed oceans. They speak of a different world. Black and white mostly, some garishly colourised. There are many of my uncle Lanh, who was lost at sea. He was the second-youngest, practically raised by my mum, the eldest child and only daughter. She says he was the best of her brothers. Their pictures are there too, features hardly changed over the years. I see echoes of my cousins' faces. There's a cute one of them all lined up, with the youngest still in my grandma's belly. Five kids and widowed at around 30. My grandfather is absent from the album altogether.

It's amazing how much the world has changed in basically a historical eyeblink. My mum describes an old-fashioned society. Even though this was the 60's, boys and girls would hardly kiss before marriage. They went on bike rides together, that was courtship. Who could envision internet dating then!

Bella vita

I've been having a mid-exams holiday the past few days. Should probably be studying for the MCQ's on Thurs and Fri but whatever. The worst is over!

No really good stories to share (actually yes I do, coming later) but yesterday I went for a walk at the beach on my lonesome, on a whim. First day it hasn't been bucketing down for about a week and the longest exposure to the great outdoors I've had for waaaay too long. Gorgeous. Blue sky with a mild breeze, not too warm, lots of families and old people and their pets. I smiled at some babies, some dogs smiled at me. I saw strange rocky area where there were three dead birds within a five metre radius and wondered what had happened to them. Hunters? Caught up in the storms? Flu? (back away) Two were seagull size, but another was larger. I wanted to say cormorant, but names of birds, like those of trees and flowers and geological features, are things I only know in books. One of my distant life goals is to associate these names with pictures, so that when viewing the natural world I have a greater conceptual vocabulary instead of "that's a purdy...green thingy". I saw people flying, swooping in the sky on hang-gliders and some form of seated parachute and was tempted to fork out cash right then and there to feel the freedom of it.

I walked for an hour and thought what a great thing it is to have a young, healthy (if unfit) body and a clear mind, and no serious cares in the world, and the future ahead. I made plans for a reshuffling of my life once the exams are over - just how to get organised and study smarter and spend time on what's important. And I decided I love Australia, not in a flag-waving way, because borders are arbitrary and ridiculous. Just the peace and beauty of the country, a beach walk on a Saturday afternoon.

It is a truth universally acknowledged...

...that a single man in possession of a BPharm must be in want of a wife.

At my step-cousin's 5th birthday party today (fairy themed, if you must know, and the first time I've been out of the house in a terrifyingly long time), I met the kind of guy my mother would love me to marry one day. The essential criteria being:

• Vietnamese. Glory of glories.
• Pharmacist. A Doctor (*cue sounds of ethnic parentals swooning*) would be preferred, or a dentist, cos we don't have any in the family and we want fillings on the cheap, dammit! But the hierarchy goes Y Nha Duoc (med, dent, pharm - ask any Viet and they will know this holy trinity) and 3rd place would do. Think of the ten thousand pounds a year! Marry out of the law, commerce, health or engineering faculties, on the other hand, and you'd be personally reponsible for the Apocalypse.
  
• Mostly harmless.
  

And probably prioritised in that order as well. On the plus side, he was nice enough, tall, had a deep voice, and could play with kids. On the minus, he was in need of deodorant. But you know what they say about judging a book by its...odour.

One of my theories about why there seem to be craploads of Asian female Janeites is that we are STILL LIVING in the land of 19th-century rigid unspoken social conventions. Girls are still groomed to have "accomplishments" - piano-playing, BMeds - and concerned relatives are still plotting about how to marry them off advantageously. P&P tells us we can find twue wuv even within the confines of convention. Plus ca change, plus ca doesn't.

A view of a room

Yeah, nudging the world's going to have to wait. The whole universe has shrunk to the size of my study. I've got to figure out a way of passing exams without locking myself indoors for a month and going mad and fat and reading for 16 hours at a time. Seeing as I'll be having exams until about age 30 at the very least, god help me. It might involve...hmmmmmm...not procrastinating until the very last minute? Duh! I say this every semester.

Things keeping me sane:

.....I got nothin'. Actually, the piano and geetar. Today I realised I am grateful to my folks for all those years of lessons. It's a great thing to be able to sit down at a piano and play something randomly for yourself.

I had an idea once for a short story set in the future when instead of getting a jail term, criminals get sentenced with a neurological condition. Like bank robbery: Parkinson's, 3 years. Paedophilia: life with ALS, aka what Stephen Hawking has, with a sadistic robot carer. I did a science assignment on that in Year 10, and I don't know how people can stand it. You gradually lose the ability to move, while retaining your senses and intelligence. You can live like that for decades. The cruelty of it. If there is a deity: what the frig?!! Our teacher made us look into how neuro conditions affect people, and I came across a blog by an ALS patient (though I didn't know to call it a blog then). He'd begin every post with "things I can't do" and "things I can still do". One list kept getting longer, the other shorter. Tried to find it again and couldn't, but there are plenty like it, just google. It's almost unfathomable. Going from being an everyday person with a mortgage and job and kids and hoping you have a quiet, decent life, to your existence revolving around things like...how to swallow food. How to shift yourself in bed. Whether your wife who cares for you 24/7 is about to crack. Or you are that wife and this wasn't what you dreamed of being when you grew up. These could be people two doors down from you going through this hell. The heroism and bizarreness and tragedy and sheer unimagineable variety of normal human lives...bloody baffling, innit?

Baaaaack to the grindstone.

*PC disclaimer (I believe it too) - I know disability isn't all helplessness and despair. Diving Bell and the Butterfly much.

That is the question

1. Why must I rediscover the awesomeness of GarageBand in the middle of exam cramland? That's a Mac music editing program thingo, for you WinTel peoples. I could play with it for hours. You can compose songs with a ton of different tracks and there are built-in licks or whatever they're called. Plus you can record real instruments and then monkey with them- I got my humble acoustic to sound like Santana. Too bad it doesn't actually improve your playing.

2. Given GarageBand's awesomeness, why does the iBook not come with a microphone jack? Stupido.

3. How can tomatoes possibly be a fruit? I refuse to believe it. Biology be damned.

It's t-7 and I've still got like 3/4 of the course to slog through. My bargain with Allah is that if I pass this semester I will study hard over the summer. No really, I will. Not out of dedication or love of humanity, just to attenuate the soul-crushing humiliation that will inevitably come with clinical rotation pimpage.

Actually, haven't really been stomped on that badly so far, even with Mr "Nystagmus? I don't deal with that shit!" Neurosurgeon. He did torture a guy in my group, but I was spared. I wonder if it was because I bluffed my way through some obscureish questions (L'Hermitte's phenomenon was one of his pets) or rather because I'm quiet, Asian, female, and wear glasses. Probably the glasses.

PS. Tarisai is off! Muahahah yes! heh

Pax by PBJ + Stoppard rules the universe

A little bit of inter-cultural-peace rhetoric on the "reverse domino effect" and peanut butter and hummus and I get all squishy. Via the Queen of Jordan. Where has HuffPost been all my life? And is there some even better international-oriented version?

Other procrastinatory finds:

• 52 tips for happiness. Not quite - oh who am I kidding - EXACTLY as new-agey as it sounds, but makes good points. Also, the key to dying happy.
  
• A blog by a med student who dares to say he hates it. I likes my humour like I likes my chocolate: dark, bitter and Jewish. (what?)
  
• PostSecrets, an oldie but a goodie. People baring their souls on postcards.
• Another medblog, The Underwear Drawer by an anaesthetics resident, the third Asian female doctor type on my blogroll. She's a caustically hilario writer and comic-artist and by the sounds of it a brilliant doctor (an Ivy grad iirc) and also the mother of a kills-me-with-the-cute 2yo bubba and the wife of a dashing opthalmologist. Doesn't that sentence alone give you an inferiority complex? Curse these overachieving supermoms (somehow supermum doesn't sound right).
  

I find I've been hesitating to post cos I'm worried that I'll come off as self-centred or pretentious or lame or maudlin or dumbarsed. Hence the vacillating between banal and high-falutin' posts. BUT the very concept of a persoblog is pretty much self-centred and pretentious anyway so why not just suck it up and deal. My excuse was that a dead tree journal makes me write shitely (/shitelier) and the echo-chamber nature of it drives me round the bend and I get lazy, so an audience would help...yeah whatever, it's totally narcissism baby!

Nuffa that meta crap. The phrase that's been rolling around my cranium for a while is this: "nudge the world". I thought that was my own, by the way, til I Googled it and found that in fact that it had been implanted in my brain by Tom Stoppard. I always suspected he ruled the universe. It's from Henry's cricket bat speech in The Real Thing, where he's talking about the power and beauty of language, how words strung in the right order can change minds and even the world. Which I believe is true, but also a teensy tiny bit snobbish because in the play he's talking about how the other dude can't write to save his life. What I believe is that even words strung in the wrong order can be Archimedes' lever or his place to stand on or however that probably apocryphal quote goes, cos it's the concept that matters. Nowadays the power of the your average Joe Blow to nudge the world is unprecedented. The internet for one. If you make a YouTube video that strikes exactly in that sweet spot of popular interest, you can move, inspire, entertain (or more often, disgust) an audience of tens, hundreds of thousands by mere word of mouth. And it doesn't have to be a complicated idea either, as the Free Hugs guy shows. The world is nudgeable in so many ways. Sure, one person influencing geopolitics and climate change is a tad tough (though not impossible), but even a concept like PostSecrets...I can't put my finger on why I think it's so powerful, something to do with empathy and common vulnerabilities and connecting strangers. And look at Wikipedia, wow. What a batshit and revolutionary idea that was.

Beyond the internets, I have fewer examples but I still believe in the force of an idea, no matter who it comes from. Say you're struck by inspiration and tell your step-cousin-in-law who tells a friend who knows a parliamentary aide who tells the Prime Minister about it in his lunch break...who knows, nations could shift. Actually, my own papa has nudged the world, though not by dint of a single blinding idea, but by sheer dogged determination. He's probably one of the most effective agitators in the entire diaspora for democracy in VN and for the welfare of Viet refugees (yes there were still Viet refugees in limbo even in the naughties - how many decades after the war?). He's gotten people out of detention centres and that's not even his day job. So from creating a blog with a premise that touches people, to lobbying ministers and media, there are endless possibilities for anyone with a shiny idea and/or passion and balls.

The next obvious question is if anyone to nudge the world, what can I do? It's frustrating and tantalising. I think....dammit, I know that I'm not a half bad pot-banger. The problemo is finding The Idea and The Cause. Operation Fanatic and Operation Dr Quinn didn't quite fit the bill. The former taught me a shitload and gave me confidence that I could take an idea and run with it and I had a ball, but its scope was severely limited. It was ultimately a passive exercise. The format still has potential though: a newsblog is a powerful thing, distilling and filtering information at a time when attention is a scarce resource. As for the latter, it's an idea I can get behind because of its sheer obviousness, but honestly, the issue is hardly the closest to my heart. So...what? That is the 64 million dollar question. I'm sleepy now so will ruminate on this later no doubt, but for now let me turn the question to the audience. You there. Screw the Queen of Jordan: how can you - or we - nudge the world?

Carbon footprints in the sand

This blog is so psycho, from angst to Idol to silly videos and back. Multipersonality disorder much!

I just realised what a hectic year there is ahead. Here's the plan:

• Oct 21 - Nov 16: last week of lectures, exam cramming & exams ie. hermitude for 4 weeks
  
• Nov 17 - 25: 1 week clear, maybe go to Melbourne or mini road trip
  
• Nov 26 - 30: Year 3 prep week
• Dec 1 - 7: 1 week clear
  
• Dec 8 - 30: possible trip to the Motherland via Malaysia via Gold Coast (budget Air Asia wot) with the steps... awkward galore.
  
• Dec 31 - Jan 23: 3.5 weeks clear, visit Melb if I don't go in Nov.
  
• Jan 24 - Feb 7: do the Dr Quinn John Flynn thang in Airlie Beach
• Feb 8 - 10: 3 days to prepare for Year 3 and move back into sharehouse
  
• Feb 11 - June 29: kill self in what's said to be the hardest academic semester to date (derm, opthalm, the REST OF MED that we haven't learnt yet) - with 2 weeks' midsem hols in April
• June 30 - Jul 13: midyear 2 week break, probably go to Melbourne and show Kezface around Syd
  
• Jul 14 - 20: GP week in some random rural town
• Jul 21 - Sept 7: jump into the deep end in first ever clinical term in Armidale for 7 weeks. Total 2.5-3 months of rurality.
• Sept 8 - 28: 3 weeks midsem holidays, prepare for Health Equity Selective
  
• Sept 29 - Oct 24: thrown into deep end again for HES in Mauritius? Vanuatu? Northern Territory? Mexico, Malawi?! Must get this organised soon.
  

Come to think of it, the last year has been Melb, Syd, Newie (lather rinse repeat) + Albury + Brisvegas, Gold Coast + Tahiti, NY, Niagara, Toronto, Ontario, Montreal, Quebec City, Boston, DC. The mind boggles. I've gotta plant a tree or something.

In fact why shouldn't I spit up some HES thoughts here and get ideas from the gallery. Criteria are:

1. Clinically challenging. HES isn't officially a clinical placement, but it's 8 weeks and there's only so much observation of health systems you can do! Don't just want to bum around on a beach all day either, which some people have done. But also don't want to go to a place where the only tools you have are...I dunno, a handsaw and sewing kit. Cos that would be a teensy bit scary.
   
2. Mind-blowing ie. somewhere out of my comfort zone, with a totally different perspective ie. somewhere un(der)developed. As with #1 I'm not sure how I'd cope - a mollycoddled burban girl alone! At this point backpacking Europe would already be challenging, let alone Malawi. But mebbe it'd do me good to go somewhere that scares me pantsless.
   
3. Something that makes the most of the "one chance to do whatever the hell you want to" aspect of HES. I imagine that the rest of my career will be pretty conservative - if I'm cautious now, I'll only be more reluctant to do something batshit after graduation with the added pressure of repaying my bond and HECS and mortgage and whatever grownups have to worry about. HES is different from travel cos you get to see the non-touristy side of things. With NT, this is our only real chance to go in the course. I'm ruling out VN cos my great-uncle has plenty of contacts there and I could go any time.
   
4. Reasonable rouble-wise. NT is government-funded, so far above the others. Vanuatu is cheapo, a hop skip jump from Syd. Mauritius is ok since there are often Air Mauritius deals. Latin America is the most rouble-unfriendly due to airfares. Pacific Islands or Asia would be alright.
   
5. Safe. The guy who talked to us about Peru got pulmonary oedema from altitude....errr. No rape, shooting, or flesh-eating bug infections either. That'd be nice.
   
6. Language. One of the reasons why Latin America was on the top of the list. Love Romance languages, always wanted to learn Spanish properly and when else am I going to? But as the calendar above shows, when am I going to have the time to cram Spanish beforehand? My one semester of Span 101 won't hack it. Another steep learning curve in addition to the meducation I have to survive. Ay caramba. Though my housemate is going to Madagascar with 8 hours of French under her belt! So anyway, some country that speaks English, French, or something easy to pick up, like pidgin. That sort of rules out Asia.
   

Ahhh tis exciting, so many possibilities. I think #1-#3 are the most important, though roubles and safety are preconditions. Educational, mindblowing, one-off.

Can of worms

Just had a chat with dad about the grandpa situation and put the hard word on about taking it seriously. Dad said that there's been a change lately, he's been staying in bed all the time. He thinks he's getting weaker and weaker. At the time I said "well, all the more reason to get some medical attention!". But I wonder if I'm doing the right thing, imposing my shiny new (paternalistic Western) medical POV on my family, like some born-again fanatic "saving" the natives from their heathen religion. Slapping on labels and shepherding the sick onto steel conveyor belts of The Healthcare System- is this where it's all leading? When I think of the bleakness of the psych hospital, hell even of general hospitals and nursing homes, and compare it to our experience...the choice isn't obvious. Ong Noi has had a place in our home and family, despite all the ruckus, despite all that my grandma has had to put up with. He's had love and respect, which is a sight more than some psych patients, all but discarded by their families.

No dammit, it's not dichotomous. It's not Barren Institution vs Loving Ethnic Family Environment. Western medicine can co-exist with the latter. And it's not fair to put the whole burden of care on grandma. A co-operative and understanding Viet doctor is what's needed, preferably a family friend.

Argh writing makes me think in thèse antithèse synthèse like it's about some theoretical dilemma, not my own flesh and blood. Inhumanly. I've never been close to grandpa, grandma's the one I've looked up to and adored. She practically raised me. With him there's been a sort of distance. God, I've just realised what a little shit I've been. I treat him with tolerance at best, and at worst, contempt. Yes he is by turns patronising, imperious, demanding and unreasonable...but what personal grievances do I have? What could possibly justify that sort of treatment? And I realise now that I also do this with some other people. I should know better. I DO know better. It's the changing of entrenched behaviours that's the problem.

I dunno whether I'll have the balls to press "publish".

Heh

Alright, taking the video down now from paranoia. Sucks to be you if you missed this masterpiece!

No brainer

Spinning clockwise = right brain dominant
Anti-clockwise = left brain

At least according to the sages at the Herald Sun.

Strangely enough, I see her spinning clockwise even though I am a wordy right-hander with the visuospatial skills of Helen Keller. Ask the guy from my year whose car I backed into yesterday. hehe. His $45 000 2-month-old pride and joy Subaru WRX (which apparently means something impressive to boys) no less. No damage I think (/hope)!

Anyway, what side brain are you peoples?

J'accuse

Ever since we started doing psych, there have been uncomfortable flashes of recognition while reading lists of symptoms. And with them a growing burden on my conscience. Basically, I'm starting to suspect my grandfather has some form of psychotic disorder. It's been going on for 20-odd years, and my poor grandma has been suffering alongside him. For years everyone's dismissed it as just "grandpa being grandpa". As he refuses to see a doctor, there's been no attempt at diagnosis let alone treatment. Seriously he's an 83yo man who hasn't seen a doctor since maybe his 50's. The whole family has been complicit by ignoring the problem.

The evidence for:

• He has almost daily episodes of shouted ranting at neighbours and conspirators against him. Possible auditory hallucinations?
  
• He believes they ("they" being the Jewish mafia and suchlike) cause his aches and pains, and electronic devices in the house are used to monitor and control him. He's called my dad in the middle of the night to warn him about this kind of thing. He believes that chemicals are bad and refuses any kind of medication. Although he is otherwise rational, my dad has tried arguing him out of it many times to no avail. Fixed Firm False beliefs = delusions of persecutory flavour, as well as passivity.
• He didn't leave the house for years at a time, used to not pick up the phone, has no friends. Social withdrawal.
  
• He doesn't have signs of delirium or dementia: no fluctuating consciousness or orientation, nor obvious progressive cognitive deterioration.
• My uncle Bac Dai also had some psychiatric condition. I never met him because he lived in Vietnam, but from what I've been told, he was "like your grandpa". He died of dysentery in 2003 because he refused medical care. Fair enough, he also survived VC re-education camps and the war so who knows what exogenous factors might be involved, but it's at least a possibility that there's a genetic link.
  

The evidence against:

• From what I've heard, all this began when he was in his 60's, which is pretty far beyond the normal age of onset for schizophrenia (mid teens to 30's).
  
• In between episodes, he is pretty functional: lucid, intelligent, witty, courteous to guests. I think one of the reasons why nothing has been done is because only grandma and I have seen the worst; dad only comes over for brief visits, when he's on his best behaviour.

I talked to my mum about it, she said something like "I TOLD your dad to do something about it AGES ago and he never listened, but you know what a useless bastard your father is". I talked to dad about it, asked if it was a form of negligence that we haven't forced him to get medical attention? Because it certainly would be if it was a physical condition and not a mental one right?And it's no excuse that he didn't want to see doctors because he's hardly fit to decide that for himself. Dad started talking about the legal criteria for negligence and I wanted to hit my head in despair because it isn't a matter of bloody abstract principles, it's about how our whole family has turned a blind eye to suffering that could have been prevented or at least mitigated by treatment. What if it's something that could have been managed by surgery or drugs or hormone replacement or dietary supplements? Dad said it probably wasn't something organic since his personality had tended in this direction all his life-- though in that case personality could be a predisposing factor in a psych condition! What if a simple blood test could have saved 20 years? My grandma, a warm and bright and sociable woman, has isolated herself because she can never invite friends home for fear he'd blow up and shame her in front of them. If he'd been diagnosed, she might've had access to a carer's pension. If he'd been cured, she might've had a different life. What if, what if.

It's my responsibility. Living with my grandparents through my teens, I was close enough to know the worst. I was woken at 5am by his rants and heard him yelling awful things at my grandmother during his episodes. I remember thumping the walls to get him to shut the f up, and being glad when grandma quietly manoeuvred him so that he would be out of earshot while I studied, bearing the brunt of it herself. I'm not proud of that. Now, at a physical distance and with the more objective perspective of medicine, I can put a name to it as a problem that could be solved. The question is what to do next. He's 83. Should I shatter the status quo and stir familial shitstorms and force dad to force grandpa to see a doctor? It's a callous question, but is it worth it, when he might have only years to live? When antipsychotics might not even work and have all sorts of side effects? I know these are excuses. Maybe it's time someone stopped making them.

Back from the wilderness

With plenty of Deep Thoughts pent up from blogging exile, but for the moment let's stick to more important matters: Ben was voted off Idol! Waaah. In fact my top 2 were in the bottom 2 today. This does not bode well for the federal election.



RIP Benzo!

Speaking of the election, wtf is with the craptacular ads? There are better ads for home loans and zit cream than there are for the FUTURE OF OUR COUNTRY. Even other public awareness campaigns are better, par exemple: speeders have small...pinkies. You would've thought that someone would've made a hip YouTube ad for Kevin 07 along the lines of the Mac vs PC one.

Juggling mountains, real time

(This is from before the hols, forgot to post it)

So often you come across a list of symptoms and signs in a book, dot points to memorise for the exams. Receptive aphasia = Wernicke's area, expressive = Broca's, conductive = arcuate fasciculus. Easy enough. Wernickes are Wordy without making sense. Brocas have Broken speech. And then you find yourself at the bedside, running over the longwinded neuro exam in your head and launching into your well-rehearsed introductory "hi Mr X I'm a 2nd year med student and would it be ok if my friends and I asked you some questions everything you say is confidential and of course please let us know if you're uncomfortable at any time" speech....only to find that Mr X, though awake, isn't even looking at you or appearing to listen. Sudden panic. What about consent? how are you meant to proceed without a history? this isn't how it's meant to go! Then you collect your wits and think what this might mean. Is he deaf? Is he unable to understand? Does he have psychiatric problems? You try verbal and written questions, "could you close your eyes? what is your name?". Unblinking, he doesn't reply, despite several attempts. You notice his face is drooping on the right and lightbulbs start flashing. Mixed aphasia, facial paralysis...left hemisphere stroke. Lateral cortex, maybe middle cerebral artery? What next, coma scale score?

The registar comes with the answers, and shows you the physical exam tests you should be doing. Heaps of positive results. So, spasticity is when you bend his arm and it comes to a sudden stop. Hyperreflexia is when the lightest tap makes his arm jerk. Hemianopia is when he doesn't notice your fingers wiggling in one bit of his visual field. Inattention is why he didn't respond to you at all from the right side of the bed, but reacted a bit more from the left. The reg leaves. You're pretty proud you came up with a correctish diagnosis, plus seeing these signs in real life is frankly darned cool- things are starting to click. The panic has subsided, thanks to the comforting jargon and procedures.

Well, almost. You're still uneasy about what to make of this man. It doesn't seem right to speak about him as if he wasn't there. He's unable to understand you or say a word. Still, he's awake, can shift the blankets to warm himself, and seems to register your voice if not its meaning. How much does he understand? Is all communication lost to him, or just verbal language? If it is all language, can he even think? Is he trapped inside his mind, unable to express his indignation at being unceremoniously poked at by three young women? Can he be depressed? Does he retain his personality? Should you explain what you're doing, even though it seems to be useless? Some of these questions come much later when there is time for reflection, because on the spot you are preoccupied with figuring out what on earth is going on. Feeling a bit ridiculous, you look him in the eye to say "thank you Mr X" and pat his hand. Your friend snorts.

Outside, you look at his notes. He came to hospital for an elective operation, in decent shape albeit with some of the generic risk factors for stroke, cholesterol and blood pressure and all that. He didn't recover from the procedure as expected, and somehow - you're not sure if it's related or not - he ended up with this stroke, locked within himself. Among the pages and pages, a note from a social worker. It says how his wife was informed about how he will be severely disabled and would be best in professional care. She refused. He could be cared for at home in their back room. It is a few words embedded amongst measures of his vitals and physical exam results. Suddenly he's no longer a clinical puzzle, or a collection of cool signs, but a husband whose wife loves him enough to keep him by her though communications is impossible. Now you understand why there is a photo at the foot of his bed, a portrait of him with his dog, the man he was before he became a patient.

So much to blog, such crap technology

First setback- it's a no on my proposal from DoHA.

There are no plans to alter the current arrangements in the John Flynn Scholarship Scheme. As per my last email, your feedback is appreciated and has been noted.

And this is all the reply I am to expect? I might wonder why, with so little effort at civility, I am rejected! I don't want appreciation but action, you nitwit. Bureaucrats, pah. Hehe. Well, this was only the opening salvo, hardly expected success. Next step is to get some bigger allies to throw their weight behind the idea and bang the pot at a MP or several.

Meanwhile, such a busy day yesterday with taking the cousins a-touristing around the city all day and standing for 3 hours at Sideshow = footsore as hell! Twas hilario though. The set had a proper carnival burlesqueish atmosphere and all the acts were awesome - my ribs were sore as they should have been. We got to see Sarah Blasko, the Umbilical Brothers, Tripod, the Sandman, etc. Not bad for the price of an email! Moment of the night: hearing Paul McDermott tell one of the roadies (or whatever they're called in teeveeland) to fetch him a beer "to ease the fear" before singing, and the roadie whispering the order into his mike! He was more abrasive than I expected, though his off-record persona was pretty much like his TV self, just with more swearing. Bloody man took 3 takes of the finale song- the clapping took on a note of sarcastic exasperation at the end I think!

HOLIDAYS!

Omg, how wanky was that last post. I shouldn't write at odd hours of the morning. Annnyywhoo......it is FINALLY midsemester holidays! Even if it's hardly even "mid" and there are 5 weeks to exams. After that, common week for 3rd year preparation and then the proper holidays and summer. Mmmmm. I'm planning to cram up on med over the summer though, cos we're getting to the pointy end where it's not enough to say "b-but we weren't taught about lung cancer! you can't possibly have it!". Time to take some responsibility for learning. We'll see how my good intentions last when there's the temptation of the beach and fun books and movies.

Excitement plus: going to see Miss Ho Chi Minh City with maman and Sideshow with the girls this week for our 5 seconds of fame.

PS Port Adelaide is getting slaughtered, bwahaha. Finally a Victorian AFL winner!

Pretentious rhetoric as promised

I was thinking how I would woo students to the army, instead of the halfbaked incentives they served up to us. Try this for size:

We live in troubled and uncertain times, and the role of Australia's military is changing. We face shadowy threats and shapeless enemies. No longer are there battle lines and gallant charges like in our forefathers' days. And in today's world, armies must not only fight wars but also build peace, often at the same time. More than ever, we need bright young men and women of discipline, courage and conviction to stand between the nation we cherish and chaos, and help build this better world. This is the challenge that your generation faces. In enlisting, you rise to this challenge.

Stirs the blood a bit more than "we will pay for your uni fees and you get to do superfun training" no? Possibly this is partly stolen from the West Wing. Scary, though, how easy it is to fall into the rhythm of patriotic clichés. Scarier still, all of the above is hard to argue against, except with those harrowing field-hospital photos. Oh I know, you can make friends! save the world! go to exciting new places! sans gun. Join MSF and save babies in some godforsaken country, plant a tree, write a freaking folk song.

I wish for once, our better natures might be appealed to. Pollies, stop aiming for our hip pockets and our knee-jerk fears. Speak of grand ideals, make us rise above ourselves. Quote JFK, damnit! I know that a danger of that is of draining language of meaning - is the word "freedom" untainted any longer after "freedom fries" and "Enduring Freedom"? - and manipulating people by pulling at the heartstrings. But I'd be willing to take the risk to be inspired.

I'm not sure how lofty rhetoric would be taken in Australia though. Seems that America and England have a history of oratory, whereas here maybe people would just take the piss. Something to do with tall poppies or our laconic wit or twangy accent or suspicion of hot air, praps. Whether those are indeed universal Australian characteristics is of course debateable! Maybe it's more that, say, opposed to the US, we don't have a national destiny. America appears to retain the sense of its own mission to be a Beacon of Democracy and Freedom and whatnot. I mean right and left might disagree on whether they should lead by example by bolstering civ libs at home or by forcibly removing undemocratic regimes, but it's the same principle underneath, innit?

I'm batting above my weight here. Hoo well, what's a blog for but to waffle. [Oops. You punch above your weight, not bat...duh! Sports metaphors, pfft]

Oh. My. Sweet. Jeebus.

Guess where I just came back from? I'll give you three choices:

a) strip club
b) army recruitment
c) Scientology meeting

If you guessed b), you are correct. Even though a) and c) are more likely to have any luck in getting me to sign up! We were told that there would be emergency resus training and hands-on intubation practice and free taxpayer funded food and interesting speakers. Lies, damned lies! Instead, we got 5 minutes of DR ABC in a tent and a 3-hour YOUR COUNTRY NEEDS YOU spiel. In fact, they didn't even tap into our pro patria mori sentiments, they were just all like "oh join the army, make friends and money, see the world, get fit, have lots of fun". They forgot "be a political pawn and conform and suspend your civil liberties and oh yeah KILL PEOPLE". There was a stark reminder of reality when a doctor guy showed pictures of soldiers with their legs and faces blown off. Not immune to that yet.

It's not that I don't respect our troops. Civic duty and self-sacrifice, I tip my hat to that. Both my grandfathers were army, and all the military people I know personally are warm, smart folk. There are several ex-service med students in my year, one of whom is this twinkle-eyed former airman, future obs-gyn whom I call Jolly Dude, cos he's so cheery and cute. Methinks med attracts the idealists, hence the significant proportions of hardcore evangelists and military. Yes, the people themselves, all good. But still I've got some innate aversion to the crushing discipline and uniforms and unquestioning following of orders and parading with guns. Spare me the transparent propaganda, fer crying out loud. They wanted our addresses and phone numbers- um HELL no!

Hm, I am actually a little surprised. When they said that the ADF is an equal-opportunity employer, I wanted to say what about those dirty homos, you hypocrites? Assuming that they had the same "don't ask don't tell" farce as in the US. But I held my tongue, and as a conscientious blogger I Googled the topic before launching into a self-righteous tirade. Found this from the Gay Military Times. It turns out the ADF are rather more liberal-minded than I gave them credit for- the ban against gays was lifted in 1992 (and the sky didn't even fall - slightly biased source, that). So ADF, grudging props from - well not quite a pacifist, but at least a skeptic.

Anyway. This is what happens when you follow free food! You'd think I'd have learnt my lesson by now. There was the free sausage that lead to storming a uni in an anti-VSU protest, the free pizza that lead to half-arsedly helping organise Spectrum, then that fateful lamington that lead to joining DarcySoc before even seeing Pride and Prejudice which lead to giant flaming shitballs, and Albury freeness which lead to JFSS and potentially to A Country Practice. Yep. Soooo basically the price of my soul is a Krispy Kreme or two.

Heh, I forgot. There was meant to be catering except the people didn't turn up so they had to order pizzas in...! Catering logistics...large weapons...security...do I even need to connect the dots?

Like an ACTUAL dumb blonde

Sometimes stereotypes are true! Quotes from our clinical tutor:

1) "There are only two people who can make the blind see and the lame walk. One's a neurosurgeon and the other you see on the Sabbath".

2) "Did you see that black car out the front? Anyone? The black turbo Merc bzzbzzbzzbzz 0-to-100kph-in-3.7-sec bzzbzzbzzboycartalkbzzz? Yep, that's mine."

3) "Oh, you guys are still in the caring phase. We neurosurgeons leave the caring to less qualified people."

!!

Wilkommen amigos!

There's something so revealing about writing which makes me feel like I'm standing in the school hall naked.

(Well you didn't need that image, did you)

Nevertheless, if you can't get naked in front of your friends, who can you get naked in front of?

(And now you can wash your brain out with soap)

If you're wondering,

Herr Metamorphosism or Mamzelle Intueri, you are blogrolled cos I have fangirled you from age 17 off and on and now I'm 21, hot damn, and I still want to be a doctor like one and a parent like the other and a writer like both, if wishing made it so.

And Chris, update yours fer once!

Actually no, gave up Being A Writer cos that is way too intimidating and makes me backspace backspace backspace every second word. That's for people with stories. But not being a writer is no reason not to write, right? (say that 5 times fast)

Rural evangelism

So, I have been touched by inspiration. Dirty thing. No, I had this simple idea months ago at the Albury rural conference, but am finally getting my ass into action. Using pot-banging skills I acquired in rather different circumstances in fact- ta Jerry, ailing bushies will thank you one day (I bloody well hope)!

First I have to explain the plethora of acronyms about to be used. I hold a Bonded Medical Place (BMP), which means that for the privilege of plonking aforementioned ass in the hallowed halls of Newie Uni med school, the government owns my soul for 5 years. I still have to pay HECS fees like everyone else and there are no scholarship cookies. It used to be that I had to work 6 years in a District of Workforce Shortage (which can be anything from outer metro to beyond Whoop Whoop) after my fellowship, or else spit out $100 000 in repayment to the government. That meant I was bonded til about age 36. Yes, THIRTY-SIX YEARS OLD. Now the contract's changing so that the bond is only 5 years AND I can do half while training as long as it isn't inner metro, which means only 2.5 years of post-fellowship servitude (so make that 32.5 years old, still within baby-making range). Hallelujah! God only knows why the government decided to be nice to us. They also put in a new BMP Support Scheme run by the Australian College of Rural and Remote Medicine (ACRRM). It involves online education modules and e-mentorship and the true carrot, conference attendance: travel, accomodation and registration for FRRRRRREEEEE! I already took advantage of conference funding to go to Albury- mainly cos it was FRRRRRREEEEE! And along the way somehow got provisionally converted to the rural cause. Sort of.

The other thing is the John Flynn Scholarship Scheme (JFSS), also run by the ACRRM. You send in an application and from those, people are interviewed for a scholarship. You basically do work experience with a rural practitioner for 2 weeks per year for 4-5 years to get a feel for medicine out bush. And get paid $500 for each week, along with FRRRRRREEEEE travel and accomodation! (sense a theme here?) I got one of these scholarships, by secret fenimine wiles or something.

Who can put 2 and 2 together? My idea is this: they should allocate some extra JFSS places for BMP students. Simple. Same tough application process, but BMP's get a slight leg up from the unwashed masses. Pros: for BMPs, there's the FRREEEEE and the $$$$$ and the mentorship and the experience. For the government, they get potential rural recruits. It's not preaching to the converted because BMP students are not absolutely bound to go bush, we have a choice to go into outer metro areas as well. And even if later BMPs are pushed to rural areas by competition, then the JFSS will have prepared them. Instead of resentful BMP doctors flung blindly into the bush, you get people with some rural know-how. BMPs are ideal targets for the JFSS because many are from city backgrounds and don't know much about rurality, although they are likelier than normal HECS students to have to work out bush. In short, fun and profit for students (who otherwise get hardly any love in this BMP deal with the devil), for the government and the taxpayer, and for the poor sick rural folk.

And how is this all to be funded? Note how both the conference attendance and JFSS involve cost of travel and accomodation. The only difference is the cost of conference registration vs cost of paying mentors and communities, who get a stipend to support John Flynn scholars. THUS. The funding for extra JFSS places can come out of the BMP Support Scheme's conference wallet and redirected to this JFSS-4-BMP thing. Conferences are cool and all, but I would bet cold cash that students would be keener to get hands-on clinical experience than sit and be lectured at for a week, even if it's in glorious Albury-town. And it's better value for the government, since the JFSS plays into their rural conscription strategy unlike conferences which have nothing to do with recruitment at all. PLUS ACRRM runs both the JFSS and BMP support!

It's bloody win-win and cost-neutral and the infrastructure is already in place! How can anyone not see the perfection of this? I've written to the NRHN's BMP rep to try and get their support since they seem a natural ally, but he's a bit cool about the idea. I suspect that he's not even that pro-rural; he just sent me this long letter about the government's Grand Rural Conspiracy which isn't even exactly relevant to the proposal. You'd think the National Rural Health Network (peak body of university rural health clubs) would be all over this, n'est-ce pas. I mean I myself am not fully rah-rah-rah "gimme a R! gimme a U! etc" rural evangelist but I am all fired up about this because imho it is elegant and so freaking obvious. I've also contacted the ACRRM and Department of Health and AMSA peoples and plan to send word out to fellow BMPs to get support, via the BMP newsletter run by the department. I have a mind to bang the pot at the Health Minister Himself and his Labor counterpart; it is an election year after all. This had better work! I will lose faith in reason and democracy if it doesn't. I mean apart from the West Wing.

Suicide for breakfast

Today I had suicide (lectures) from 9-10 and again at 11-12, on about 2 hours' sleep from staying up all night reading Child of the Prophecy, the 3rd in a fantasy trilogy that doth murder sleep. Afterwards, I went home and was handcuffed with plastic bags by a crazy Canberran, just because she was bored. I finally had to give in and use my teeth on the plastic bag which is gross because anything in public places in our house is likely to be cockroach-tainted. Then I did laundry, braving the hip-high weeds and bees and unseen monsters lurking in our garden to hang up my clothes. Then I printed off a book and had a nap.

And today was a good day!

We're in that golden period of grace that lasts maybe a month or so, when the weather is warming up and the skies are blue and still the giant flesh-eating mosquitoes that inhabit Newie Uni haven't figured out that people are starting to wear short sleeves again. There are swarms of invisible flying things occasionally, but they're ok as long as you breathe through your shirt. You don't want invisible flying things breeding in your lungs/intestines after all.

IV caffeine + 2 weeks of darkness

Reading about the goings on at the Toronto filmfest, I've decided that "attend a film festival" is going to be on my life to-do list. Get a pass and spend two entire weeks queuing and watching movies and stargazing day and night, fuelled only by caffeine and popcorn. In total ignorance of film as an art, but hopefully enlightened by the end.

Just my kind of crazy! I've proven that I am ace at the whole "waiting insane amounts of time to see things" thing: New Year's in NY and Sydney, Jazz and Classical in the Domain, Martin-Placing during the Sydney Festival for tix to see Ralph Fiennes. He was determined to evade me, how rude. I want to do Shakespeare in the Park some day as well, cos spending a day hanging in Central Park in summer with drama geek peoples sounds awesome. Not to mention the free tix.

In other news, there but for the grace of god...disturbing.

Mountains

It's 4am and I just had to purge my brain of the thought that has been clanging about for weeks. The idea is this: the task of becoming a good doctor is a lifetime's work, and an honourable aspiration. It is also something I am still not sure I can accomplish, because to be a good doctor is to juggle mountains (to use a totally obvious metaphor).

On one hand, you must master the vast body of scientific knowledge, numerous disparate fields of both ancient and developing knowledge. Anatomy, biochemistry, embryology, physiology, pharmacology, pathology, genetics, microbiology, immunology, histology. Whole careers are dedicated to subspecialties in these domains; you have to know them all, at least to a basic level. Many things make sense, others must be hammered into your memory by sheer bloody-minded force. You need an almost obsessive thirst for facts and an innate logical wiring. In first year I thought that medicine was in some ways less intellectually rigorous than the humanities which require critical thinking, generating ideas. That's still true, but now I have greater respect for the many fat detailed books that have to be crammed into my small head with its penchant for big-picture intuitive concepts.

On the other hand, there are clinical skills, that ambiguous art of learning from touch and hearing and observation, distinguishing and integrating subtle signs, recalling obscure connections between them, matching them to the sciences, keeping your mind open to rare possibilities while honing in on the most probable, decision-making in the face of uncertainty based on epidemiology and evidence and experience. At the moment I don't trust myself; it all seems so subjective.

Finally, there is the human side. All the above facts and skills must be internalised so that you can see the individual patient as a whole, not a cluster of symptoms but as nothing less than a fellow human being with all the dignity and vulnerability that term implies. You must connect, empathise, reassure, instruct, question, attempt to understand the landscape of their lives. You must see them clearly with both objectivity and compassion, and respect them. What's more, acknowledge your own weaknesses and fears. You have to keep an eye on ethics and its scarier big brother, Teh Law. You have to maintain humility while projecting and indeed having self-confidence. You are privileged to have contact with people in extremis and experience a broad spectrum of the human condition. This is the bit of doctoring that convinced me to take the blind leap from BA/LLB to BMed. We'll have to see if it's good enough.

It is a rare doctor who manages to keep all three aspects in the air at the same time, even in the higher echelons of the profession. Common in our tutorial rooms are the well-intentioned doctors, certainly caring, but a little sloppy with factual details. In our lecture theatres and in hospitals, often you find doctors who have conquered those first two mountains and even create new knowledge - but who lose sight of the person behind the clinical problem. There is also a thread of self-pity among medical students and doctors, I've noticed. Hell, I've been guilty of it myself. The training is difficult and long, the price of mistakes are high...but all the same, as I read elsewhere, it's nothing compared to being on the cold end of the stethoscope or scalpel. And it's an honour to be trusted with someone's health or even life.

I have seen doctors I can admire, though. The latest is a professor I am crushing at the moment (intellectually only!). He teaches eloquently - it's not grandiose, just lucid and precise - and has dry understated humour, but most of all has that indefinable humane quality. It manifests itself in the way he talks to, and not merely about, a patient in a clinical presentation; how he touches her arm gently instead of manipulating her like a lump of meat. I have learned to identify good doctors. Becoming one? I still have many doubts and fears, but insha'allah that's what aquackening will chronicle.

Course, there will also be posts consisting of lists, rants, annoying alliteration, navel-gazing, swearing, pretentious rhetoric, indecision, woe-is-me whining, groanworthy jokes, and abuse of the English language (et français o español si j'en ai envie, porque tengo que les practiquer), etc. Just so you're warned.