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!