Roxanne

I've been wondering why on earth there are clip-clopping high heel sounds above my room at the hotel at odd hours of the night. This evening, I get in the lift with a very cheerful man in business attire. My gaze wanders from him to the sign describing each floor. 1st & 2nd: wedding restaurant. 3rd: stock market company. 4th & 5th: hotel floors. 6th: massage parlour. 7th: sunset cafe.

I see the 6th floor button lit up, look back to the grinning man, remember the night-time clip-clops...and totally crack up in his face. Heh.

Lost in interpretation

How could I forget this one? It's from Flynnie.

Dr (to nurse): You know, we really shouldn't take drug samples.
Rep: Why??
Dr: There's no such thing as a free lunch.
Rep: I'll bring some next time!
Dr: That's not what I...sigh. *takes drugs anyway*

There was more lost in translation at the conference I was just at. I died several times in lectures when Vietnamese audience-members would ask questions in heavily accented English, and the Australian or American lecturers would be totally "wtf?" but gamely give a detailed answer about a completely different topic and then say "did I answer your question?" and everyone ended up completely confused. I was tempted to offer my services as a Vietglish to English interpreter, but it was more fun silently cracking up. Heh. Bilingualness is so worth it for those moments. And then there was the hilarity of the simultaneous interpretation, with two waves of reaction to every joke, one delayed by half a minute, like an in-person satellite delay. The UN must be a barrel of laughs.

Broken hearts &c

No, not dead, arrested or deported! I'm in HN now attending this regional cardiology conference. No extremes of life and death to report - my days are now filled with lectures about things like the electrophysiological diagnosis of atrial flutters (who knew there were so many types?). Apart from bits of extreme detail about randomness such as Takotsubo "Broken Heart Syndrome" Cardiomyopathy, the main messsages I've gotten are: smoking bad. Fat bad. Exercise good, immobility bad. Vegetables and fruit good. Diabetes bad. Hypertension bad. Prevention is better than cure. Not a whole lot different from cardio week. It's weird, because some of the new research they're presenting seems to basically confirm the same old conclusions about risk factors rahrahrah. Surely the problem is WHAT TO DO about it.

Anyway, I was mentally drafting a post about discovering a whole new branch of my family tree for the first time ever but then I was distracted by someone else's family (Jerry is enbumped again! hehe awww). I'm related to a guy who's an instructor in the VC army, a paediatrician and an artist who moved to Germany and married Aryan. I bonded more with my grandfather's sister in one day than I have with him for my whole life, and now he's not well. And I have all these people looking out for me in VN, including my new aunt who's not the man-eating "I use you for citizenship! ha! ha!" she-devil we all automatically assume Vietnamese brides are.

Sleep now. More later maybe.

Lost in translation

Scene: conversation with a mumbly patient with a jacket covering up her mouth.

Her: Doctor, I have pains / a fever / seizures / am pregnant with octuplets.
Me: You want a blanket?
Her: ???
Me: WANT. BLANKET?
Her: ???
Me: ???
(Both: Weirdo.)

*****
Scene: friendly, nerdy (does Vietnam make them otherwise?) and extremely loquacious Viet student accosts less friendly, less nerdy, taciturn Oz-Viet student. Note that he'd already talked to (= at) me about a) the cathedral in Dalat, b) his goldfish, c) how his parents met, d) how to read an abdominal ultrasound (appreciated) and e) domestic violence in VN. And asked what my religious convictions are and whether I was sad at my parents' divorce. Boundaries already! He got my e-mail and mobile number, mis dios.

Him: Talking to you, it's like honey is melting in my mouth.
Me: Errrr what?
Him: Like honey, you give nourishment to my voice.
(Me: But all I did was nod....twenty minutes ago!)

*****
Scene: a discussion about how (un)likely it is my children will speak Viet.

Five Foot Nothing Ortho Surgeon: You probably will marry a Westerner, right?
Me: Maybe, but possibly an Australian-born Vietnamese like me.
FFNOS: Not a Vietnamese-born Vietnamese?
Me: Most only come up to my shoulder. [forgetting his stature, as we were seated]
Others: LOL!
FFNOS: Some of history's greats were short! Napoleon said that a man's stature should be measured from his head to the sky, not from the ground to his head. Napoleon! Who else?
Others: Hitler?
FFNOS: Hitler! And Charlie Chaplin.
Me: I'm not really looking to marry Hitler or Charlie Chaplin.

*****
Scene: a man lying in bed, bored.

Me: So, what's wrong?
Him: Nothing.
Me: I mean, why are you in hospital?
Him: No reason. Nothing at all.
Me: ... You're here for a rest?

*****
Another time I thought that weedkiller - "thuoc co", literally "grass drug" - was some kind of herbal medicine. And I puzzled for ages about a lady with a presentation suggestive of gall stones, but who'd just had her gallbladder removed recently...until I realised that she'd said she'd just had her pancreas out, not her GB. Same difference right?

We had an Aussie in today and basically I was the language monkey, which I was happy to be. Me with my crapola Viet! It was a good day. Learned a few things, got the same provisional diagnosis as the doctor a few times, was useful to at least one person ("the toilet's outside on the right"...heh), didn't witness any more dust to dust, talked to people. Had delicious variation on bubble tea. And my new tailored pants fit well, MOST importantly. Still secretory though. Are lungs really that necessary? Can I just do away with mine?

Going to the enemy capital tomorrow. Yes, where they captured and tortured John McCain! Except I don't get to stay at the Hilton.

All in a day's work

Meals eaten in the last 48 hours: 2.
Sleep in the last 48 hours: 13. (3 + 10)
Self-medication (opiates! wheee!): lost count.
Dead people seen: lost count.
Open heart surgeries witnessed: 2.

I got up - note, not woke up - this morning. Showered. Put on my pants. Took off my pants because they had a dead woman's blood on them. Rummaged the laundry basket for my relatively cleaner white coat, the one that's not also contaminated by bodily fluids (at least not visibly). Swallowed codeine. Jumped on a taxi.

I was wrong, or unconsciously taking poetic license, because the floor and walls of ED are not white, but light grey, though they are indeed reflective. When I first came in the room was quite empty. God must've wanted to punish me for thinking so because before 9am there were already at least two brain-dead (I checked their pupils), a swathe of old people, five or so parties involved in a stabbing, an emaciated 30-something with massive cirrhosis, a maybe renal colic and more. One of the patients was about to be certified dead until he started breathing on his own! But I think he was still gone. All that before breakfast.

I haven't learned enough about death. I mean the clinical side of it. There was probably a learning target in first year that I pooh-pooh'd as fluff, but it's critical. When to stop CPR. When there's no hope of return. This is something that happens daily here. The first few days I just walked by the mini-ICU in ED a few times, not really knowing what was going on, but now I realise that the air pumping and chest thumping is most likely to be fruitless. My PBL training leads to determining causes, mechanisms and solutions, but leaves me high and dry when it comes to The End. As for the personal side....seeing the relatives grieving shook me up a bit, but the thing is, when someone's brought in barely alive, the transition to mostly dead isn't that obvious.

There wasn't a whole lot for me to do and I think Mr Intern wanted to give me a break from, yknow, death and destruction, so he took me upstairs to the cardiac surgery department. So, c'est vrai, surgery is just cutting stuff up then sewing it back together...but when the "stuff" is a LIVING BEATING HEART....dude, that is wicked rad. The heart guys are cooler than the ortho surgeons as well - the professor (God Himself) joked with me in excellent English and another one explained the repair of a Fallot's Tetralogy. When I started hacking up my lungs and swaying, I thought that was time to retreat.

My intern is becoming a friend. Imagine a small, deft, fine-fingered fellow with blinky myopic eyes behind thick glasses, square-cut hair, conscientious, finicky with hygiene at mealtimes and in surgery as befits an open heart surgeon to be. He spends his spare time studying (I KNOW!) and playing soccer and stuff with his friends, sometimes martial arts. He's so cute and gentlemanly - took me to the coughfakebookshopcough today and even offered to pay, and then drove me home. And he's a role model now too. He actually cares for his patients, in a setting where that's hard to do, and he is always seeking to learn more. Now I go around stage-whispering "he's a darling!". I sense he's got a little in reserve but I don't think this idol will turn out to have clay feet.

You know what I've been thinking about? Here doctors are really poorly remunerated, yet patients can still get an excellent standard of care. I have to give Mr Ortho props for the six gruelling hours he spent on that thumb...it only garnered him about 75 000 VND, which is about $7 AUD. The buying power isn't a lot either, given that a hospital lunch is about 30 000 VND. He could've just stitched the thumb on for aesthetic purposes, but instead took great care in connecting each tiny vessel and nerve. And Mr Intern probably gets paid even worse, but he stays overtime to make sure that his patients survive the handover and is meticulous in examining them. I've been taught (brainwashed) to think that a nation without rule of law must be corrupt and collapsing, each man for himself - and indeed there are horror stories about doctors giving sloppy care or sending patients for unnecessary operations because they have side deals with specialists. But there remains the integrity of individuals, the drive to excel at one's work and do good. It's heartening.

Unbearable whiteness of being

Home from my first ever graveyard shift in ED. It was a warzone last night. The combination of weekend drink-driving, rain and a motorbike nation is deadly. The room was full of head injuries, people vomiting and seizing and yelling and moaning and banging on their stretchers, many crudely restrained with their limbs tied to the the bed. Ears ripped off, partly severed fingers dangling, faces disfigured from swelling. Twice, power failures plunged us all into darkness. Patients and relatives kept clutching at me, "doctor, my arm is so sore, what can you do doctor", "doctor, help my son, please doctor", "doctor, the drip doesn't work". I don't know why they chose me out of the other students there - maybe because I look older, or because I'm not wearing the blue-striped coat that Viet students wear, or maybe because I haven't learnt the art of ignoring yet and still make eye contact. I felt helpless before such need, not having any answers, not knowing who to tell - just starting to get to recgonise the staff here. I didn't know whether to pass on their pleas or not? To my shame, in some cases I didn't do anything. But in the end I decided this was cowardice; it cost me nothing to ask. I napped a few fitful hours in the nurses' change room and wondered at how they could wake up immediately, get themselves impeccably neat, and head back into the fray at ungodly o'clock. It's practically heroic.

I did CPR for the first time on a real person. She was a middle-aged Jane Doe, with hair and skin tone revealing that she was probably a daughter of the war, half GI, half Vietnamese. Her feet were already blue. She had blood coming from her face; I couldn't tell if her upper lip was still there or not. The contents of her pockets were thrown on a tray: a wad of paper money, some silver jewellery, but no ID. I got some of her blood on my coat. When I returned from getting a scrub top from theatre as replacement, she was under a white sheet. Another first.

If this sounds emotionally flat, it is because I am. I'm washed out from the flu and from...I dunno, what's the noun for overwhelming? That. I'm curiously untraumatised. The glaring clinical whiteness of the ED - white-uniformed nurses, blinding white lights, reflective white floor, white walls, white doctors' coats - contrasts weirdly with the broken bodies lying there in pools of their own blood. It contributes to a sense of removal. Sure, I connected to a few people I interviewed and examined, but the innumberable semi-conscious head-injured started to blend in to each other, an undifferentiated mass of Them.

I'd like to say I feel that I've lost something, but I'm just tired.

Bones and groans

Well I had a long rant yesterday that is Saved As Draft, and there shall it remain. Long story short: morning spent wrangling with bureaucracy. Brief period of awesome when I finally got things sorted and was introduced to ED (English speaking! program for international students! assigned to people who are keen to teach!). Invited to "dinner" by a young gentleman - actually lunch at about 10.30 in the morning. Nerdy, nice, semi-weird (check check check) but alas, a foot shorter than me. Then I was hauled off by Mr Ortho to see hand surgery. Ok, so seeing a thumb COMPLETELY SEVERED cleanly like an anatomical diagram, with the loose bit covered in ants, was pretty cool/gross. And the patient semi waking up mid-surgery was...interesting. But most of the SIX HOURS was watching someone poke at something invisible with something invisible - microsurgery. And then the rest of the night was also spent in ortho feeling like a useless sack because I can't for the life of me understand mask-muffled franglovietnamese instructions. Didn't help that the flipside of Mr Ortho's Alpha qualities (decisiveness, vigour) is impatient assholicness that rears its fugly head in theatre. At the end - 11pm, because I was going to stay with him on 24 hour call but threw in the towel - he said "the best thing I've seen you do all day is holding legs". A job a block of wood can do! Could've been more useful with a five minute tutorial on what's expected of me and what the bits and pieces are called, but no, I'm sure letting people know they're tards is a better way of getting things done. Well screw you, Mr Ortho, and screw your specialty. It's a waste of intelligence - glorified carpentry. After something like twelve hours, I'd be happy never to see any ortho surgery again in my life. I came home pissed off and depressed.

Did I say short? Heh. Still had some rant left in me.

However, today was fantastico. Worked the 2.30-9pm shift in ED, which meant yay extra sleep! But really, I heart ED. Instead of cursing my lack of Viet abilities, for once I was glad of what little I have, as I was able to take pretty decent histories. Really don't know how international students cope here, when history is like 80% of diagnosis, and so much learning requires explanation. (Not to discourage anyone who's planning to come here! depends on the program, staff and department I guess). I got to do a few procedures like blood-taking, IV cannulation (1/2 tries - better than my 1/6 record in Armi) and suturing, which is always funzies. And saw stuff like a pneumothorax, CPR, CVP measuring, emergency intubation, acute glaucoma and paraquat poisoning. ED is where the medicine is: a bit of everything, fresh patients, mysteries to figure out. A thrillion times better than bones bones bones!

Hog thoughts

This blog is going to be more of a pressure valve than ever, given that it's one of the only links to the English-speaking world I've got here. Translation: aquackening will be even more wanktastic than usual! I find when I'm isolated for too long I get all self-loathing and angsty. Will ask training dude about international students to befriend.

Musings from the back of a motorbike:

• From the Idiot's Guide to Idiocy: riding a motorbike just after you've come from a ward full of people with pins and contraptions on their limbs, and surgery where you saw hammers, chisels, screwdrivers, power drills, pliers and nails applied to a HUMAN BODY - most as a result of motorbike accidents. Own damn fault if anything happens. But taxis are hard to catch back from hospital and slow and you don't get to ZOOMZOOM with the wind in your face.
  
• Orthopaedics is just like mechanics except you're not allowed to scratch your nose. Ohmygod. The no-scratch thing should be used in Gitmo, it is serious torture. I'm going to invent a surgical itch stick.
• Finally I know why everyone always think my name is Thuy Tien instead of Thao - for some reason Thuy Tien is the preferred name for dozens and dozens of restaurants here. FYI people: I do not serve pho.
  
• Are you supposed to lean into bends or against them?! I reckon the former, but that's based on a half-remembered bit from The History Boys where the smarmy new teacher gets paralysed because he's unused to riding on the back of Mr History's bike (on which Mr History takes boys and feels them up). Um. I think. Alan Bennett: my life is in your hands.
• My Viet is sometimes taken for native, and yet at other times entire sections of conversation whizz over my head because I don't understand key words, or I misunderstand and answer some totally different question. In the Romance languages, even those I don't know well, at least educated guessing is possible, but in Viet the etymology is often from Chinese, so all that's possible is a dopey Huh?! face. Serious damper on personality.

Crushes

My saviour has come. I should have known, he makes the lame walk! He is an orthopaedic surgeon at Choray, a ginormous hospital in Saigon town. He is tall and quick-eyed and is a man of action, which you can tell from his gait - I practically have to run to keep up with him. He's married and is, um, "friends" with my mum's (also married) cousin. Is coveting thy neighbour's (wife's) ass genetic?! My family is McWeird.

BUT, the good news is....drumroll, ladies and gentlemen...Mr Ortho has agreed to be my new supervisor!!! Get this. My old supervisor tells me to come in at 8am. I drag myself out of bed and go by xe om to the hospital, only to find out he's out at breakfast. So I pull out my laptop (having learned that long waits are to be expected). Finally he comes back, only to sit there twiddling his thumbs, deep in thought. So I sit there doing more laptop crap, breathing in more iatrogenic smoke, waiting til he decides to do something with me. Finally it clicks when he starts folding up his white coat...he's actually quitting his job TODAY! He takes me home again.

Compare this to Mr Ortho. Once I get back, we call him at around 10am. At 11.30, we meet him at the hospital. He asks what I want to do. On the spot I decide on Emergency, since that's where you get a bit of everything, plus I'm sure to see crazy stuff that I never would in Oz. He takes me there, introduces me to a guy who I'll follow around in ED, asks the lady in charge for permission, and takes me to the staff caf for an iced tea (yeah, I didn't follow my own advice about the ice and will probably pay for it! DIY oral rehydration, woot) while we wait for the training office to re-open. By about 1.15pm, it's all set, I just have to get an introduction letter from uni. Three hours after we started the ball rolling. You can understand why I walked around stage-whispering "I LOVE HIM!" and grinning.

This means I have accommodation, I have exciting stuff to do, I have a trustworthy supervisor, I don't have to breathe in any more slack doctor smoke, and I'm far away from a certain Shakespearean crackpot. I get to stay in the comfortably uncouth South, with the familiar accents and frank manners and plenty of contacts to rescue me if anything happens. All because Mr Ortho fancies my second cousin! Heh.

This is a REAL VN hospital, unlike the cushy semi-private one I was at previously. We arrived by taxi and could hardly even get off - it took ages to get to the curb because of the throng of motorbikes, bikes, pedestrians, peddlers, officials and other sundry bodies. Across the street, there's a booming side trade in quick meals to feed the hungry relatives (and indeed patients, because they often rely on outside food - not sure if they're even fed in hospital). You walk in and there are people on almost every available horizontal surface - there was a woman lying down on some newspaper right at the entrance, centimetres from being stepped on by the entering and departing crowds. It's often hard to tell the patients from the relatives. When trying to find Mr Ortho, we went on the scenic tour of the hospital as we were directed and misdirected all over the place. On the ortho clinic side, patients sit or lie in the coridoors, surrounded by anxious relatives, clutching whatever limb they've damaged. To go up or down a level, you have to brave the chaos of the elevators - the battle between wheelchairs, stretchers and doctors in a rush - or else take the stairs, which are also packed with people. In the ED, there aren't six beds as in Barmy or twelveish as at the hospital I was at previously - there are dozens and dozens of beds in rows like those shots of maternity wards, except instead of gurgling babies there are people in various states of silent distress. My home for the next seven weeks. Scary? Hell the frick yeah. Am I up to it? Errr....probably not. But who cares. Bring it on.

Sham-fricking-bolic

Ok, so Plan A was this: 2 weeks in Saigon, 6 weeks in Hanoi. However, after the Othello explosion, I was debating whether to continue with the original plan to go to HN, what with the risk of him going spazz at the thought of DevilSpawn (yours truly) working with Des. My presence cramps Des' style - she can't get out in case he tries some shit with me. Plus there's the added inconvenience of not having anywhere to stay - we do have some distant contacts (my mum's brother's soon-to-be-ex-wife's cousin twice removed or something) but a) I'm not keen to share a room and b) it's a big ask to have me for almost 2 months. Could stay in a hotel, but transport is a bit tricky.

Thus, Plan B was to stay in Saigon. Here, the doctor I'm with is my great-uncle's friend. Their family has a nice big house with room for me, plus kids to play with, and they have an English school which I could help with. I was only hemhawing about going here because we didn't know them well and because he's less in the loop about what the purpose of the placement is. The time here so far has been patchy: long periods of waiting around doing nothing, but then again yesterday I went with him on call and got to do some cool things, like take part in laparoscopic surgery, sew people up, test for appendicitis. Even got a case of subcutaneous emphysema (air under the skin from a broken rib stabbing a lung...the guy seriously looked and felt like a squishy balloon!). This kind of stuff convinced me that it'd be ok to stay here after all. Last night I was preparing to do the paperwork with the uni and hospital to make it official. I like the South, despite the heat, cos the people are straightforward and easygoing, as opposed to the Northerners' veneers and status games. But wait, there's more! Today we find out that this supervisor is resigning his job. He handed in his letter just this morning.

To think I went to VN partly because it'd be easier to organise. What a country. It's got an unique ability to drive one nuts. I think the problem is that we're entangled in a web of obligations, debts and favours here, at the mercy of others, and there are all these unwritten rules and traps. Bearshit is the inevitable result. In Oz we have atomised lives, not relying on anyone except nearest friends and family. Perhaps it's lonelier, but it's a hell of a lot more peaceful.

Vietnam travel tips

• Go to Saigon, Hanoi, Ha Long Bay, Sapa, Nha Trang, Hue and Dalat if at all possible. Take the train from Saigon to Hanoi, there's great scenery of rice paddies and hills and buffalos.
  
• Don't drink the water or anything with ice, for this will end up with you hugging the toilet bowl, or worse, the squat toilet on the side of the road where the plumbing is a hole running down the mountain. FYI, a litre of water with one teaspoon of table salt and eight of sugar plus lime for flavour makes for a decent rehydration solution. Says Wikipedia, so it must be true.
  
• Speaking of which, always bring your own supply of tissues and toilet paper. And work on your thigh and ankle muscles, you'll need em for squatting.
  
• Do buy one of those face-mask type things that everyone wears. Helpful if you want to take a ride on a xe om ("hug taxi" - hop on the back of a motorbike and hold on for dear life. Quickest, cheapest, funnest, most lung-blackening and dangerous mode of travel). Also helpful if you're in the doctor's lounge in a hospital, and a senior surgeon is chain smoking in this small closed room with the windows shut, and you're too polite to leave. (PS. ERECTILE DYSFUNCTION!) If you're a smoker, this is your paradise.
  
• Avoid raw vegetables and seafood if you're careful. Do try some of the street foods like sticky rice and noodle soups.
  
• If you're on a tour and stop at a beach resort, remember to bring get your bathers from your suitcase, especially if the bus is parking 20 minutes away. Otherwise, an XXXL men's souvenir t-shirt will suffice, though beware of transparency and cling when wet. Whether you wear knickers with this ensemble is up to you - you need to make the choice between modesty in the ocean vs sitting on a bus for the next five hours with a wet bum - or commando. (hint: breezy!)
  
• If you're an Asian girl, be prepared to be stared at like you're some kind mutant freak because of your Australian Weetbix-and-Vegemite-fed height ("are you a basketballer?" at 165cm!) - and, alas, girth.
  
• If you're white, be prepared to be stared at like you're some kind of mutant freak...just because. And be prepared to be ripped off by every friendly-seeming local. There are actually different price lists printed for "international guests", and that's when they're being nice. Travel with a trusted local if you can. Take Vinasun taxis, they're the most reliable.
  
• When you're feeling like a stranger in a strange, busy, hot, dirty land full of skinny little people who speak a language that's half familiar and half gobbledegook (racistpunlol), whose culture seems alien, and you are reduced to nodding and smiling like a dimwit bobblehead doll...be reassured that some things are the same everywhere. Anatomy. Hospital politics. The fact that surgeons wear those bandanna-like caps in theatre, while nurses and others wear the much less badass, but much more hygienic shower caps. The questions general surgeons always ask post-op: "have you been eating? pooing? peeing?".
  
• If you're working in a hospital and you thought you knew Vietnamese, you don't. Buy a medical English-Viet dictionary. Curse yourself for learning a dead language for six years (no, not French! heh) instead of something useful. (ahh it was fun though)
  
• You may want to reconsider going to Vietnam for a rotation if your patership is a very visible dissident in exile, because your host's pathologically jealous and delusional husband may follow her to a (chaste) nocturnal meeting with your uncle and accuse him of bringing news from patership with whom she's (falsely) alleged to be having an affair. Othello may then raid all of his wife's emails and mobile phone, call up her family and colleagues to badmouth her, change all the phone numbers in the house so no one can contact her, and forbid you to stay with them for you are the spawn of That Man. Worst of all, poor Des can't leave because if she does, he threatens to denounce her to the cops for her (non-existent) political connection with said armchair revolutionary - and people have been imprisoned for less in this land of justice and freedom for all (*cough*). Seriously, one of patership's colleagues - an Australian citizen! - was recently hauled in for questioning. Consider writing to the Australian embassy to explain the situation in case Grand Frere decides to mess with you or Des for shits and giggles.
  
• An iPod or similar is a must if you're touring in a bus in which the driver plays Vietnamese folk music at full blast. Earplugs are recommended if you're staying in Saigon, because the blast of motorbike horns never stops, even in the middle of the night.
  
• Wear sunscreen. Don't wear any precious jewellery or carry a handbag - try putting your stuff in a strong shopping bag. Keep a sharp eye on your belongings when on the move.