aquackening

A void

2011-12-20T04:20:00.000+11:00

Two years since I last posted on this blog. In that time, I've graduated med school. The end of internship is coming fast and with it, the prospect of more career planning. Yet, in what are meant to be my most productive, most ambitious, most passionate years, I find myself tired, stagnant and adrift.Don't get me wrong. I'm enjoying my job. ED at the moment is always varied, learning comes in increments and painful leaps. I enjoy most of my colleagues. I'm often surprised to find myself returning home more cheerful than when I left.I just feel like I've lost track of who I am. I'm unrecognizable to my 17yo self. Work has brought on this crushing myopia. Each shift is a race to the finish line and at the end I collapse and feed myself and numb my mind with games or TV.I fear the creep of apathy. I fear I am living in spiritual poverty. Where I once loved reading, now I glance at headlines. Where I once defined myself by love of languages and music, these interests now decay from neglect. But even worse, I fear a disengagement with the world. This year has been a momentous one. Harrowing disasters like the Japan earthquakes, tectonic shifts in geopolitics like the Arab Spring, the death of dictators and terrorist bogeymen, the end of the Iraq War, the famine in East Africa - events that mark a generation, events which once would have impassioned me and kept me up nights. Now they barely skim the surface of my concern. I have lost that altruistic drive to make my mark on the world. At 25, somehow, I find I've given up on myself. I've talked myself into believing that a quiet country general practice will suit me fine, where once I dreamed of the United Nations, striving for Peace, Justice and other capitalized pipe dreams. Being the change. It stings that some of the people in my year at school are actually living these dreams while I trudge onwards in the medical career rut. It is a taboo to admit, in this profession which in the public's eye is a vocation, an avocation akin to taking the cloth, that it is not mine. I strive for competence but I will never excel. This is not modesty, merely plain truth. So the years ahead look dark, if I let myself continue in the status quo. I cannot wake up 40, alone, merely surviving.I'm feeling vulnerable to evangelism at the moment. I envy people of faith their centre of gravity. I'm not talking the hypocrisy and bombast of religion; I mean the private, heartfelt faith which i have seen transform others. It brings serenity and purpose. What's next, then? Where to from here? The blueprint is easy: find one's intersection of belief and talent, direct that towards an area of need. It's the specifics that's the killer. I feel a deja vu, like I've said all this before. Existential ennui, lather rinse repeat. Carry on.

Ways to skin a cat

2009-07-10T22:01:00.005+10:00

Tutor (neonatologist): What do you guys know about Toxoplasmosis?
Student A: Um...you get it from cats or something?
Student B: Yeah, so being pregnant's a great excuse not to take out the kitty litter.
Tutor: For sure. But I really think cats should be banned during pregnancy. In fact, just shoot them all beforehand. You could make all sorts of things, nice scarves, hats, coats...
Student C: ...stirfry....
[pause]
Tutor: If anyone else said that, we'd be in trouble!

Guess who C is? Auto-racism all the way.

Starting Paediatrics at the moment. On day one, we were taken on a 1.5hour tour by a DOCTOR around the Paeds areas. We're not in surgery any more, Toto! There's a games room, where we were officially welcomed by the Starlight Foundation peoples to come and play Guitar Hero. Hell yes. And there are all these secret things I never knew existed in the hospital. Like playgrounds, a small school, and, I shit you not, a fairy garden.

There's a palpably different vibe among paeds folks as well. There's laughter at Grand Rounds, rather than the tense one-upsmanship of the internal med one. They are nice to students. They care about patients. I want to marry a paediatrician dammit! Not so sure if I could be one. At this point, kids are still like a foreign country. To put it delicately, it seems like paeds = geriatrics = vet. heh. (*ducks*) Nah, the kiddies are cute, but it's challenging enough doing grownup clinical exams, let alone with a 3yo kid trying to burrow into his mum's lap.

In other news, I'm getting on the exercise bandwagon at long last. So many times I've heard, in PBL or in GP clinics, people glibly advise "diet and exercise". Easy to say, a bit trickier to do. For doctors, as well as patients. I was looking around the tute today, and at least five of nine of us in the room, including the tutor, were at least on the "moderate to high risk" side of the BMI scale. One of my GPs in rurality was full on obese, with diabetic foot and everything. She'd tell the tall skinny guys to put on weight, and say nothing to the metabolic syndromic patients who rather resembled herself. Blind spot much?

All these years I've thought that I'm just not a gym-junkie type, but it's finally clicked that everyone has to become one, sooner or later. Either before or after you have a heart attack. There's also a concrete incentive: my dad and I are doing a Biggest Loser challenge. If he wins, I get $2k towards my Eurotrip budget, while if he wins, I have to get him a present worth up to $500. Game on! We're txting each other progress updates. Example: "Watch out, Loser: 1kg in <1wk already! Go comfort urself w some chocolate." Heh. Such love.

My method is pretty straightforward: gym pass + calorie/fat/sugar cutting + daily logging. I'm using SparkPeople to track progress. Another handy resource is CalorieKing, which has Aussie-based nutritional info.

It's only day 4 so far, but it feels sustainable. I find myself actually looking forwards to the gym, which is just weird. All this motivation just came out of nowhere! And the diet part isn't too onerous. I'm not anal about the calories, just trying to up the fruit and veg, cut down portions, limit naughties, that sort of thing. I've discovered that really thin slices of apple are handy, as it takes so long to eat them that by the time you're halfway through, you're not even hungry any more.

The only question is why I didn't start this before! It's so simple: move more, eat less. I think I was scared off by the beautiful people at the uni gym, but luckily at my present one it's a mix of HeartMoves oldies, athlete types and the unfit young like moi, so it's not too intimidating. I am scoping out the classes to see if I'm fit enough for them though, cos it'd be pretty demoralising to be overtaken by some 59yo with a triple bypass!

Open letter

2009-04-25T01:52:00.003+10:00

There's an article about your accident in the local paper. If you look online, you can see there all the dozens of comments from you friends, family and colleagues. They talk about your heroism and humour and what they loved about you. I didn't know about this before. I wasn't sure of your name until now.

The last time I saw you, you were on the operating table. I'd followed you from ED to the theatre. You know, you've gained some fame in the hospital, because of how the trauma guy made your heart start again in ED by clamping your aorta! That was a small miracle in itself. We were all full of hope then, and I can tell you that there was a frantic effort to save you. The surgeons worked with fierce attention, I could tell even from outside the window. When they left, the intensivists took over the business of trying to keep you alive. They tried everything in the book and few things beyond. And then, finally, they stopped.

We watched as the monitor slowed and slowed and finally came to a flat line. It's the first time I've ever seen it happen that clearly. The cause of death was exsanguination, we were told by the anaesthetist. Bleeding out, bleeding in...blood in your belly and blood on the floor. It was an ugly way to go. I remember thinking, I hope those movies are wrong, the ones where the spirit hovers over the body immediately after death. I hope you didn't have to see yourself exposed, bloated, blue and bloody.

But you're probably wondering why I'm writing. It's out of remorse. I'm sorry I was a voyeur, along with so many others. It was a circus. I'm sorry I was pumped with adrenaline from the drama of the moment, because it made me callous. I examined my feelings in those early stages and it scares me that I couldn't find much sympathy for you. There was only a competitive desire to see what was going on, looking for a good vantage point. You were anonymous to me. I'd met your partner and the boy in the ED as well, but it hadn't clicked that you were part of the same accident...and when it did, I still couldn't feel their loss. I'm sorry that even as you were dying, I was fascinated and even a little thrilled to see how it happened. I'm sorry that the other students and I stood not even two feet from your body and chatted and laughed as though you weren't there. I don't even know if dignity in death is absurd or what, but your body was you not so long ago, and we should have respected that. I felt the wrongness but didn't act. I'm sorry that I've told your story to so many, as though you were my first battle scar. Even this is an example of that. I'm sorry it's taken so long for the meaning to sink in for me.

I've read that you too saw violence and death in your line of work. Did you ever imagine someone would be looking upon you as you looked upon the broken bodies of others? I guess the watchers must all eventually become the watched, in the end. I still can't quite connect what I know about you now, the dad and mate and husband you were, to what I saw that day. It's funny, because compared to everything you did before that day, your death was the smallest, least important event of your life. But it's become significant in mine.

What is there left to say? I never knew you. I'll remember you. RIP.

The Motherlode

2009-02-16T23:22:00.005+11:00

PS. I had the wrong link before, fixed now! Here.

Entire This American Life archives + DownloadThemAll (for Firefox) + uni broadband = never, ever being bored again. If you download that program, a shortcut is

http://audio.thisamericanlife.org/jomamashouse/ismymamashouse/[1:374].mp3

which brings you all the way to the latest episode. Yes, I am an audio glutton.

PS. For the guilt: support the show. I will do so when I locate my credit card.

Gastro updates

2009-02-13T00:26:00.008+11:00

The score so far:

Runaway patients: 1
Birthday cakes eaten on ward: 1 (yay Woolies)
Practice long cases done: 0 (arghhhh final week soon!! where did the month go?!)
Ascitic taps done by me: about 3-4, lost count
Traumatic ascitic taps done by me: 1 (so not my fault, patient was sat up....)
Ascitic taps removed by the patient themselves: 1 (see: runaway)
IV cannulas inserted: 1
IV cannulas attempted: 3
Patients presenting with alcoholic livers, GI haemorrhages, or combination of the above: ALL OF THEM, it feels like.
Liver biopsies seen: 2
Colonoscopies seen: 2
Colonoscopies in which patient semi woke up: 1
Emergency gastroscopies in which patient melaena'd on bed and had to be held down by three people: 1 (too many)
Attempts taken to do a MMSE on a grumpy old lady: 2, with much cajoling.
Patients successfully discharge-counselled: 1 (take your drugs, go to your appointments, stop that drinking, limit fluids)
Longest stretch without seeing consultants: 1 week
Pathology forms filled out: 127836987236874 (we are the intern's bitch)
Items carried at one time: too many. OHCM, clipboard, notebook, steth, pen, mini handbag, charts
Free food: less than expected. WTF, hospital?

So, acclimatised to ward life now. Got a decent rapport going with the team, who are quite friendly - gastro dudes are definitely nice, none of the (overt) personality disorders seen elsewhere. My main problem is that we've become too useful to the JMOs, so the time's been a bit heavy on scut and minor procedural stuff and light on hardcore pimping (also known as learning). Just did a shitty short case today. Not because it was difficult, because I suck. What is it with med and my brain? Oil and water, sans surfactant. I blame vivas...what, they expect me to think without pen and paper?! It's not that I'm slacking either, probably am more motivated than usual for this point in the semester. I dunno. Feeling dumb is not fun. Chris and I were reminiscing about high school when we felt smart the majority of the time. Where did that go? I think the prob is that I STILL have not figured out "learning widgets" for med...processes to churn and integrate the info. Whereas for, say, French - even at uni level - it was relatively simple: memorise vocab, practise both by writing and speaking, expose self to francophone sources. Lather, rinse, repeat. Badabing.

Despite the moaning and nervous breakdowns, I'm nostalgic for last year. Armidale was awesome, VN quite fun, and even academic semester was satisfying cos I was knowledgable for a whole three minutes there before it all drained out the other ear. This year hasn't been bad so far, but there's the vague undercurrent of DESPERATE PANIC from being in 4th year and expected to, er, know stuff. Somehow 4th year sounds so much more almost-doctor than 3rd year, just as being 23 is uncomfortably close to "mid 20's" and ensuing QUARTER LIFE CRISIS (part the umpteenth).

But all is well. I now know how to stop a nosebleed in a sheep. We had an ENT session with decapitated sheep heads (is that redundant?) at the morgue - this involved practising stuffing gauze up their noses. Should come in handy in rurality one day.

First day of school

2009-01-27T21:00:00.002+11:00

Sorry for the temporary break in programming! Ah, summer holidays, we hardly knew you. School started today already. TOO. SOON. It was a weird day. The morning was spent in (dis)orientation: fire safety, vaccination check, infection control. Then we were unceremoniously kicked off the branch and told to fly. No timetable, wrong contact details for supervisor, and instructions vaguely to "attach yourself to the team". Er. Even though I've done Armidale and Vietnam and have been at this hospital before during years 1-3, it still feels like I'm going to kindy for the first time and need mummy to hold my hand. Vietnam ED was different, there was only one place to go and what to do was pretty obvious. Armidale was tiny and everyone knew who we were. Here: big pond, small fish. Not even, more like a small anemone. How is one meant to fill the days?! It seems a bit "rock up to whatever you want to".

Anyhow. A bit too sleepy for full sentences, so here comes random listiness galore. What I Did On the Holidays:

Bought myself an iPod. And hence....
...listened to all 7 Harry Potter audiobooks. American version + British reader = things like "jello" and "sweater" read in a British accent. Just...no. Still, it was awesome and I'm having the same pangs I had when I was 4 and really really into Alice in Wonderland: dammit why can't it be real! I wanna fly on a broom.
Listened to a crapload of podcasts. This American Life, Enough Rope, TED.
Went to the Gold Coast. Tanned a lot. Beached some more in Sydney.
Saw Cate Blanchett et al in an 8-hour Shakespeare play, War of the Roses. I heart her.
Went to Jazz in the Domain (Gypsy Kings and Queens) and Festival First Night (Grace Jones) and camped out at Milson's Point for the fireworks. Sorry Melbourne, Sydney wins in summer.
Stressed out from last-minute house-hunting. Currently in a literal granny flat (a granny's upstairs) near hospital. On the plus side, I have it all to myself. On the minus, I have it all to myself.
Spent Chinese New Year / Australia Day alone, shopping at Aldi to stock up the new place. SAD.
Quickly cycled through several phases: musical (guitar, ukulele), DVDs (The Office, Blackadder, some Sopranos, West Wing again)
Shopped far too much. Not buying that much, just being dragged by mothership and stepdorkship. Talk about a consumerist rut.
Did buy a haul of books. That new orange-covered Penguin modern classics series is so tempting. Only 10 dollar, lah! I'm partway through half a dozen books. Attention span of a....hmm?
Avoided doing lots of things I should've. Like studying.
Had a wisdom tooth out

See, not that exciting.

Met a few interesting characters lately. My landlady is one of those people one can only call "decent" - you know, good in an uncomplicated way. She brought me juice and bus timetables with bits highlighted and a tin of cookies. Come to think of it, I should bake something for her, right? That's neighbourly. She's a 60something widow, formerly a nurse. Her sons, who came over to move the fridge in for me, are of that hardy, handy, decent stock of Real Aussie Bloke, tempered with a bit of 21st century snagginess - one of them is a yoga teacher. There's also a blond, angelic 2yo grandson who talked to me about the circus. How do these people exist in the world? A family where the sons come over to cut trees for their mum on the weekend?

Then one of the patients I met today was an incredibly sweet woman. Seriously, you only need look at her and she smiles this great big infectious grin at you that exudes genuine warmth. She's also an alcoholic with decompensating liver failure. Huh?

Too tired to make a point. Fingers crossed the net works.

Two tongues = handy

2008-11-23T21:33:00.005+11:00

My cardiologist "aunt" from Hanoi came to visit for the weekend. It was entertaining. She took me to an exorbitant but mind-blowingly awesome buffet at a 5 star hotel yesterday. Srsly, there was like foie gras cooked on demand and a chocolate fountain. Then today we ended up at a "binh dan" restaurant. It was hilarious cos she was visibly, like, "holy shit this place is SO LOW CLASS". Whereas to me, a place with chairs that are more than stools 10cm off the ground and tablecloths is woah break the bank already. I've been eating at pavement stalls. She said it was the first time ever she'd been to one - having spent her whole life in Vietnam! I'm not sure whether she knows she's in the 1%. I wouldn't say she's a snob, just...removed. I'm still fascinated by her, though. Such a dynamic, complicated yet endearing modern woman in a society that's not really caught up yet - the stuff heroines of novels are made of. Her family's interesting too. Her mum was a ballet dancer, then joined the army's arts corps (who knew such a thing existed!), then switched into medicine and later Eastern medicine. She knows Portuguese fluently, having worked in Africa for some time. Her dad was a famous architect, and went to Cuba and France to work. Like, wtf, I didn't know there were people like that in Vietnam.

So I was farewelling her today when I got into a conversation with a xe om driver. He's a good bloke. Then one of his regulars came round, an Aussie. So began one of the funniest, most disjointed conversations in my life because while neither party could understand the other, I got both ends.

Dramatis personae:
1) Aussie: 61yo, Vietnam Vet, big, bluff, rough-house Queenslander with tatts and a beer gut. Doesn't speak any Vietnamese and probably thinks everyone should understand English. Likes giving the driver punches in the arm, the only way he can communicate.
2) Driver: 40ishyo bone-skinny, chain-smoking, gap-toothed. Doesn't speak English except for "yes", "no". Ducks when Aussie comes, having been smacked too many times.
3) Me: bemused and amused, in PJ shorts because wasn't planning to stay downstairs for long.

Snippets.

Driver: I have no idea where he wants me to take him! And he never pays me enough. He only pays 70 000 for a whole day's driving, I barely break even with the cost of petrol these days. I might as well stay at home. It's no holiday, being his driver.
Aussie: He keeps taking me in circles and asking for more money, the greedy bastard. I always shout him meals and cigarettes. It costs me 150 000 a day!

Driver: There was this girl who kept wanting money from him...she wanted him to buy her a motorbike! I tried to tell him to stay away.
Aussie: There was this girl - she's 38 but looks lots younger. Isn't she cute? *whips out phone*

Driver: I feel sorry for him despite his cheapness, because without me he'd have to take taxis everywhere. He's a good bloke.
Aussie: I'd punch the lights out of anyone who tried to lay a finger on him. He's a good bloke.

Driver: Did you see the powdered pills he put in his coffee? Can you ask what it is?
Me: Shit, I hope they didn't give me the wrong cup! I'm scared! I don't want to ask. He wants me to come up to his room to "fix his computer". I don't know what to do!
Driver: Oh my god. He loves flirting with girls. Don't go!
Aussie (oblivious): Can you ask him how I can buy some fairy lights, like up on that tree there?

Yes, I did drink from a cup potentially with white powder in it AND went to his room. I KNOW!!! I can feel the disapproval coming down the mother-daughter psychic connection line as we speak! But he left the door open in his room, and I poked my keys between my fingers as makeshift brass knuckles just in case. Nothing happened, thank Jeebus...I'd have no one to blame but myself. Fortune favours the extremely stupid sometimes.

Cambodge

2008-11-19T06:04:00.006+11:00

(drafted a few days ago)

Apparently I've been tagged for a meme. Too uncool and blog-orphaned to tag anyone else. Does Not Play Well With Other Children here! heh. But anywho...

The instructions:

Grab the nearest book.
Open it to page 56.
Find the fifth sentence.
Post the text of the sentence in your journal along with these instructions.
Don’t dig for your favorite book, the cool book, or the intellectual one: pick the CLOSEST.

I was hoping it'd be some random Viet book, but sitting here on my dining table / dumping ground (along with socks, a surgical masks, souvenir koalas, toilet paper, a Shins CD, my CV and Keo Mon Sua) is Jonathan Harley's Lost in Transmission. You may know him as the husband of the chick who wrote Holy Cow, or the ABC's South Asia correspondent. The book's about his travels - he was in Afghanistan on September 11th and such. Eh, worth the $4 it cost me as part of a travelogue box set (do I hear a "hell yeah!").

"On both sides of the divide, more than fifty thousand Kashmiris have fled their villages and the raining shells."

Meanwhile, just back from Le Cambodge. Angkor totally deserves the hype. I travelled with my ex-PBL-groupmate and another Aussie student, and collectively we decided Cambodia wins at temples and city architecture. Phnom Penh is a classy joint. Vietnam is bogan in comparison, but at least we win at food! Bun bo hue shits all over your amok! (er) That said, Cambodia is definitely more developing world - complete with the trademark Pong of Asia stinky markets, vehicles overloaded with cargo and people (today we saw a guy clinging for dear life on the boot of a car as there was no space inside), and undernourished, unbelievably cute half-naked children begging for money. Guilt. Trip. As a rule I don't give money to beggars, but sometimes I forget why that's a rule. Well, if you give a man a fish, you feed him one day. If you give an international charity $40 a month, 20% of which goes to glossy advertising and Administrative Costs, and they teach a man to fish, then you feed him for a lifetime. Or something.

In Phnom Penh we visited the Genocide Museum and the Killing Fields. The latter is really just a field, with ominous ditches and signs saying "Please don't walk over the mass grave!", and a monument filled with skulls. The museum is at the school that the Khmer Rouge took over and used as a prison. There are no tastefully lit cardboard placards, few glass cases in this museum, no multimedia whizzbangs - quite a contrast from the Holocaust museum in Washington DC. That's not a political statement...it's just that this shabby place doesn't allow you much historical distance at all. The first thing you walk into is a series of cells. It was late afternoon when we got there, and the cells were unlit. In these dark, bare rooms, there's nothing but a metal bed frame on which sit iron shackles and other sinister implements. On the wall, a picture of the victim found there. Dead or alive, it's hard to tell. No words of explanation. There's only a sign in Khmer outside, with a drawing of a smiling man crossed out. We couldn't figure out what it meant..."no photos"? "No smiling"? I think it's perhaps "no smiling and posing for photos in this place where people were tortured and killed". The next building is the gallery of the dead, photographs of the prisoners at arrest, and sometimes after being beaten. It's the "befores" that were especially haunting, though. Rarely do they show fear or cry, some even half-smile for the camera.

For some reason we decided we'd go see the war museum today upon our arrival back in Saigon. I wrestled with a lifetime's worth of indoctrination. See, the version of the VN War I got as a descendant of soldiers and refugees, was vastly different from the Western notion - all that stuff about guilt, quagmires, good old hippy days, "Communism roolz (in theory)", American imperialists interfering with the nationalist struggle by the valiant VC, etc etc. It blew my 14-year-old mind, that the story we were taught in Year 9 History differed so much from the story I got at home.

So yeah, the museum is an obvious propaganda tool. Captions say things like "American GIs [grinning] after beheading Vietnamese patriot". And yeah, there's a Hanoi Hilton-sized elephant in the room... indeed all the exhibits are of American weapons and their consequences - I didn't see any VC artefacts. But, man, the pictures. Napalm, Agent Orange, land mines... bodies, burns, birth defects, dead kids. "They did it too" is no answer. There are no answers.

West Winging it

2008-11-13T06:44:00.005+11:00

The West Wing totally called the US election. Matt Santos, token ethnic president based on Obama, campaigning on a message of change, wins against maverick Republican partly based on John McCain - check. Chooses Josh Lyman, based on Rahm Emanuel, as chief of staff - check. The only thing that's missing is the theme song.

I had a post-election squee post but my wifi died and I lost the nerve to press "publish" afterwards. Luckily for you: I was kinda delirious after 150 hours of election coverage. Gotta admit, this Australian shed a little tear. Democracy in action, yknow? And hope in the face of one screwed up world.

Been obsessively following the news, far more than is healthy for someone who's NOT AMERICAN. SMH, Huffington Post, New York Times, New Yorker, Guardian, Washington Post, Politico. This real time thing is too slow, I wanna know what happens in the next episode NOW! Where's the DVD box set?

For your perusal:

The rise and fall of John McCain. New Yorker.
An oldie but an of coursie: a conversation between Jeb Bartlett of WW and Obama. NYT.
Tears along with the joy. NYT blogger.
Can Obama be the next FDR? New Yorker.

(what, you got something against New Yawk?)

It's a....squalling purple thing!

2008-11-12T01:07:00.004+11:00

So I've been pretty crap at blogging Vietnam! I blame the shitbox wifi in my room. Sitting downstairs now glaring at my battery meter.

GUESS WHAT. Today I went to an obstetrics hospital. Borrowed scrubs and a student ID so I wouldn't look too conspicuous. What, that's totally legit!

It was awesome! And a little bit icky. But mostly awesome. I saw four births: one immediately afterwards (placenta still on the way), one C-section and two from start to finish. That is, we had a look of them before the "pushpushush!! HARDER! you can do better than that!!!" started. I even, ahem, assisted on one. That's to say, I felt the belly to see when it was taut, and was meant to yell at the mother to push and tap on the belly to help the contractions, except I was kinda shy and didn't fully understand the instructions.

The actual process of childbirth looks, um, kind of painful. When it's my turn, give me the frigging drugs already! And the cutting and sewing bit - only under lidocaine here - seems like torture. Eww. And the delivery suite wasn't very friendly. Women just lying there with their legs open, no one paying much attention to them. Is that the way to welcome a new life into the world? I entertained notions of having a hippie, birthing centre, water-birth, midwife type of thing, but then I can't be a doctor and forsake western medicine entirely hey. Maybe a hippie birthing centre next door to a major tertiary hospital. Also, yknow what? Newborns are so not cute. Maybe after they're cleaned up and oxygenated, not so much when cone-headed and purple and covered with dodgy slime and being held upside-down by the legs by a midwife who's suctioning said dodgy slime from its nose, mouth, and anus by the same apparatus (yes IN THAT ORDER, thank god).

My Viet student friend ultrasounded another woman's belly and after mucking around for a while trying to find it, we finally got the heartbeat. The mother's face lit up, as no doubt mothers' faces everywhere light up. My "omfg that rocks!!" grin was reflected in her face.

Indecision 08

2008-11-04T18:13:00.002+11:00

A German and an Aussie med student in a Vietnam triage room.

German: What day is it today?
Aussie: Umm let's see...tomorrow is the election. I mean, The Election.

and previously

Aussie 1: I haven't been following the elections recently, but yesterday I went on a mad spree and stayed up til 2am looking up the candidates on Wikipedia and reading the blogs.
Aussie 2: Dude. ME. TOO.

Conclusion: don't fuck it up for everyone, America! Kthanx.

I've had a bit of election fever for a while actually. Huffington Post is my drug of choice, although it's funny how it's so overtly Obamamania. Reminds me of how my Flynnie mentor only watches Fox. All the cognitive bias you need in one place!

CNN and BBC don't work here properly, with only sound but fuzzy wuzzy pictures. I would like to attribute that to Our VC Overlords, but it's more likely due to crappy reception. So my options for fulfilling my "WOOO! WEST WING SEASON FINALE!" excitement are listening to the news (so retro! cf people in WWII listening to the wireless to see whether their city's going to get bombed) or obsessively surfing the blogosphere.

We sing with one voice

2008-11-03T17:56:00.005+11:00

Remember how I was feeling like a stranger here? I've discovered these really are My People. See, in Australia, people look at me like I'm a weirdo whenever I randomly burst out singing in the street. Haven't they seen musicals?! But here in the motherland, EVERYONE does that. Bus drivers, roadside stall owners, cleaners, doctors in ED or surgery - elbow deep in someone's belly. They'll just be working then suddenly break into folk song mode and no one blinks an eye.

A genetic excuse!

(and a one, two, one two three four...jazz hands!)

Roxanne

2008-10-31T04:45:00.003+11:00

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

2008-10-22T03:48:00.002+11:00

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

2008-10-20T03:49:00.004+11:00

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

2008-10-15T02:06:00.006+11:00

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

2008-10-13T20:36:00.005+11:00

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

2008-10-13T01:22:00.005+11:00

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

2008-10-11T01:47:00.006+11:00

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

2008-10-08T20:34:00.003+11:00

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

2008-10-03T19:10:00.009+10:00

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

2008-10-03T03:36:00.004+10:00

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

2008-10-01T18:20:00.006+10:00

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.

Just because I'm paranoid

2008-09-29T00:41:00.003+10:00

...doesn't mean that the television isn't watching me!

For serious. Day 5 in VN and I'm wondering whether I'll have to get out by those same rickety boats. Man! All I wanted from this trip was to a) never enter a VN hospital lying down (and you thought the Australian public hospital system was bad...) and b) no melodrama of the hair-tearing variety.

One of the above is going well: I'm still standing, though mothership is currently undergoing the South (East Asia) Beach Diet...that's to say, massive gastro.

The other thing, not so great. My placement plans are in shambles due to a shitstorm that is some bizarre variation on Othello complete with misguided accusations of adultery and political intrigue. I'll write more when I can figure out how to protect the innocent. So far Desdemona hasn't copped it yet, but it's a possibility, and I could get dragged in as well.

Jetsetter

2008-09-24T08:52:00.003+10:00

Hello from Sydney Airport, waiting for the plane to Vietnam. Yes, already! I barely got off the plane from Airlie Beach!

Too brain-dead at the moment to think. More later from the behind the high walls of state-controlled internet! Woohoot. Can you believe I"m going back to the country from which my relatives had to flee in rickety boats, only thirty years ago? And am going to be living in the enemy capital? Then again I also learned the language of the foreign devil colonialists to tertiary level...while barely speaking my alleged mother tongue. Irony lives!

Before and after

2008-09-19T00:10:00.014+10:00

One thing I've been noticing lately is that I have to stop and concentrate hard to remember what it was like being a layperson. Did I know what a clavicle or myocardial infarction was? How lungs work? What viruses and bacteria are? A lady recently asked the doctor how you get oxygen into your blood, and a guy asked whether you can trace the source of bacteria from a swab. Certainly the fact that antibiotics are for bacteria only clicked in med school for me.

It goes further than just knowledge, though. It's being grossed out - or not - by certain things. I don't blink an eye at blood or guts or vaginas, but purulent wounds still make me go ick. Can't remember if I used to be affected by such things. It's how I feel about hospitals nowadays. For normals, they can be a place of fear and grief. The feelings of claustrophobia, displacement and unease from when my grandma was sick occasionally come back to me: all those depressing neon lights, haggard faces and barely masked smells. After Armidale though, I feel at home in hospitals - even theatre is now familiar and cool. They've become a place of learning, where we seek out interesting and fun experiences - and some of those interesting and fun things are other people's illnesses. Kinda twisted really. I've never been an inpatient before (except as a hairy-backed preemie), and I imagine it's got to be disorienting. I remember, in law we read some Foucault, about the parallels between hospital and prison. You're stripped of power, put in a uniform, your movement is restricted, you live by others' schedules, people do things to you which you mightn't fully understand or consent to, and you're surveyed day and night.

In politics one of my lecturers talked about how it's difficult for democracies to fight in asymmetrical wars because citizens generally aren't happy to send their sons off to commit the brutalities that are often unavoidable when you're fighting unconventional forces (NB: much is debatable there bien sur). Obviously, this theory was derived from Vietnam-type conflicts. The way around this is professional standing armies, as opposed to concripts. You separate citizens from civil society to a boot camp in the bush, teach them loyalty to each other and the institution, show them how to function in extreme circumstances.

I find this an apt analogy for med school, in particular clinical rotations. Besides the teaching of facts and skills, they help to transform us from wet-eared civvies into hard-assed troops. You learn the ethos, conventions, secret language, and see and perform things that would be considered horrors in other settings. Sticking a needle in someone's back or a finger in their bum. Cutting them open, exposing organs, then shoving everything back in again. Kinda absurd if you think about it. What's amazing is that this sort of initiation isn't uncommon. Nurses, undertakers, cops, firemen, carers, social workers, vets, soldiers, hell even dunny cleaners! Entire classes of otherwise normal people to whom weird-to-Joe-Average things are routine.

Some of the hardening is necessary of course. You can't have a doctor getting disgusted or freaked out every time they come across an anal abscess or something. But it's also a bit dehumanising, because dodging the discomfort of the situation also disconnects you from the patient's experience. I reckon it's a good thing to stand back once in a while and think, yeah, to normal people, this here is weird, embarassing, absurd, scary or gross. Like taking your own pulse, it tethers you back to your own humanity, the kid who lurks behind the professional.

Overheard

2008-09-17T16:05:00.004+10:00

In the waiting room:

"I've been having trouble with Bubba - he throws a tantrum and cries and spits when I try to breastfeed him!"
"Really? I've heard of babies that couldn't latch on well, but never one that actually hates breastfeeding..."
"Do you reckon it predicts whether he'll be a boob or butt man when he's grown up?"

More from Doc:
"All the Muslims want to take over the world and kill everyone....you're not Muslim are you?"

He also wants to invade Mexico and to tell his friend Malcolm Turnbull (our new Liberal [actually conservative] opposition leader, FYI non-Aussies) to scrap "socialised medicine" cos it creates too much paperwork.

We also had a patient today who was a former SAS officer (the CIA apparently wanted to recruit him once). His theory is that Muslim society is afflicted by inbreeding and the recessive genes make tards who are recruited as martyrs.

Teo and tangents

2008-09-15T22:20:00.013+10:00

So I just finished watching the Enough Rope interview with Maverick Neurosurgeon Charlie Teo. Thought-provoking stuff. If you don't know his background, read on at Australian Story and Enough Rope.

The name Charlie Teo first crossed my consciousness this year, when I met one of his patients during my rural GP week. She'd had a tumour on her spinal cord and was handballed between various surgeons who told her it was impossible to remove. None of them mentioned Teo, the surgeon who was willing to operate on the inoperable. They were finally referred to him when the tumour was far advanced. They got to him just in time to save her life, but she was already a quadriplegic at that point. This lady and her husband were fair dinkum Aussie Battlers, and I say that without irony. Her husband had his own health problems - chronic severe back pain, multiple injuries from past car accidents, and was visiting the GP with pneumonia, requiring hospitalisation - but still managed to care for her full time. Despite their ordeals, they were philosophical, not at all self-pitying, and deeply committed to each other in an unsentimental, no-nonsense way.

To me, the Outcast Teo vs Medical Fraternity fracas highlights the contradictions in our noble profession. Questioning the validity of Teo's techniques is justifiable, but the visceral hatred he seems to evoke from the establishment goes far beyond the scientific. It comes from something baser, something like insecurity and jealousy and resentment.

See, on one hand there are the bright lights - doctors who inspire with their integrity, passion, intellectual precision, curiosity, compassion, humility, dedication and conscientiousness. I've seen these qualities in doctors at all levels, from humble residents, to GPs, to consultants (ie. Gods). I see the potential in many of my fellow students. The docs I had in Armidale were awesome. Being a small hospital, the structure was really flat - consultants actually deigned to talk to us lowly students and treated us as really really really junior colleagues. And they could teach, hallelujah!

On the other hand, I'm always wondering what patients would think if they really knew what doctors are like backstage. They are given so much trust, and abuse of that trust is so commonplace. Not so much the Dr Evil "mutilating genitals during surgery for kicks" kind of thing, but insidious, small betrayals. Using big words to take advantage of patients' ignorance. Never, ever saying "I don't know". Making referrals to specialists who've been nice to you, or not making referrals to specialists who've slighted you once. Putting on a façade of professional reassurance, only to talk crap about them behind their back. Using bias-based, not evidence-based medicine. Blaming patients for depression or addiction. Being careless with infection control. Doing tests or procedures that aren't strictly necessary to cover your own ass or make a bigger buck. Never admitting mistakes. Writing off some patients as basket cases, too hard, or not worth the bother. Aiming for "good enough not to be sued" rather than best care. I could go on and on. And the personalities, god, the personalities. Impenetrable vanity, arrogance, selfishness, apathy, laziness, bullying. I mean, I'm sure these things occur in all professions - petty rivalries and so forth. But people's LIVES aren't at stake in other professions, people's lives don't depend on whether Dr X's pride has been wounded or not.

I'm on Flynnie placement yet again, and in moments of particularly brain-numbing boredom I fantasise about the scathing portrait of my boss' foibles I'm going to write. A by-product of observing him for most of my waking hours. Let me try to capture some of his flavour. Our protagonist is a late-40's American ex-surgeon, a footballer who injured himself out of a career in college, dressed in all-American blue jeans and polo shirts. Adopts a folksy straight-shooting manner but bullshits his way around questions he can't answer ("What's idioventricular mean? It's something that's not working like it's supposed to. Like idiopathic, idiosyncrasy, one of those old Greek word things"). FoxNews devotee, son of a blue-collar worker, now multi-millionaire, casually racist ("Med school was so hard back in the day that two guys from my class killed themselves. Just couldn't hack the pace. They were both Arabs from Pakistan or something. Good thing too. Those people are all terrorists in the making"). He's threatened by and contemptuous of anyone who dares question his authority by showing any knowledge about their condition or using alternative therapies . Starts lots of sentences with "In medicine...", eg. "In medicine, this is called a puritic [sic] rash". Writes referral letters with really bad spelling and grammar. Asks "guess what I'm thinking!" kinds of questions to show off his knowledge or exert his power rather than actually discussing or teaching. Is impervious to student's eyes glazing over during his lengthy Pearls O' Homegrown Wisdom About Medicine - which he repeats. A lot.

A recent consultation went like this. A gentle, child-of-hippies type of woman comes in with diarrhoea and constipation.

Her: I had a look on the internet...and I know I shouldn't try to self-diagnose, but I was wondering if it could possibly be IBS?
Doc: Impossible. Can't believe anything on the internet. Inflammatory Bowel Disease is a very serious condition and it is very unlikely you have it...(etc etc etc etc)
Me: Um. Didn't she mean Irritable Bowel Syndrome?
Her: Yes, that's it. So I tried some natural medicines they recommended at the shop over there...

Doc instantly bristles, patronises her ("Cactus extract? What kind of cactus? There are many many kinds of cactus"), contradicts everything she says, and boots her out. After she leaves, he launches into lecture mode.

That there was a good lesson for you. What they don't teach you nowadays in medical school, which they did back in the days when I was training, is that you should never, ever let the patient take control. You'll see. When you've had 30 years of experience like me, you find out all patients want to use and abuse you. They'll come in with some scrap they've found off the Google and try to sell you some bullshit. Like that girl just then, she just flung piles and piles of bullshit all over the room. I picked it up right away, as soon as she came in - I've got my observations honed to perfection, it'll take you 30 years to get that kind of skill. Cactus extract! You saw how she tried to get her agenda on, but no way, I don't stand for that shit. You gotta learn that you're the doctor and you're the boss. She's a massage therapist - probably flunked out of high school - and she wants to tell YOU what to do! (etc etc etc etc)

Somewhere, an artsy-fartsy tie-died hippy-dippy anatomy-sucks ethics-roolz Newie lecturer is weeping. To be fair, I don't want to completely vilify him. He's got his charm and is great with babies. He works up his patients really thoroughly and goes the extra mile for them...at least the ones he likes. I can tolerate him...and occasionally learn a thing or two, though I now take whatever he says with a fistful of salt - he's quite capable of making up facts.

Praps I have this impossible ideal of Perfect Doctor - one that others, and no doubt I myself, will constantly fall short of. But the standard's got to be at least: "how would I like to be treated? what if it was my grandma?".

Ritual

2008-09-09T21:17:00.005+10:00

First you have to get through the negotiations. You introduce yourself as a student and exchange pleasantries and nervous jokes. You put on your shiniest Bedside Manner, perky and polite. Almost invariably, they consent with self-deprecating good nature. Everyone's got to learn some time, right? I'm happy to help if I can. Yes, thank you so much - I really appreciate it. If you feel uncomfortable at any time, please let me know and I'll stop. Your group and tutor are standing around you, sometimes participating in this exchange, but often just silent spectators at the show.

It's a shifting of power. Once you have given them the semblance of control, you proceed to command them to perform all sorts of bizarre manoeuvres. Could you take off your shirt, please? And would you mind if I pulled your pants down a little further? Is it ok if I put my hand here in your groin? This is someone who could be your grandmother's age, or your father's. In everyday life, you would perhaps nod at each other on a sidewalk, or if you met, you would defer to them as your elder and better. Now, circumstances have contrived that you both meet here, in this place of delicately balanced vulnerabilities. You have to get past your own anxious voices. Am I doing it wrong? Do they all think I'm a tard? Am I making it up, or do I really feel this? Am I hurting them? This is embarassing.

But when you're in the zone, when you've passed all the awkwardness and anxiety and come to focus, finally the physical examination becomes an oasis. The laying on of hands, the strict order of the tests and the calm solemnity recall the rituals of the ancients. Feel a pulse - make sure it is not your own. Put your hand on a heart. Listen. The room is quiet, the clatter of the hospital fades into the background, and all you can hear is the heart beat and breathing. A steady rhythm, almost music. One-two, one-two. It is a moment of strange intimacy.

Month

2008-07-23T16:12:00.002+10:00

Was that really less than a month ago that I was considering failure and running away and hiding? Btw I PASSED I PASSED I PASSED!!!! Victory is a little diminished by the suspicion that they wanted to pass us all because of the change in the curriculum. Whatever. The hell of academic semester is over.

Global Health Conference was full on. I can't remember the detailed stats about climate change and AIDS and the exact Millennium Development Goals, but I'm left with the troubling sense of the enormity of the challenges facing our generation, and the necessity of finding out how my own small life can fit in with the solutions. Nelson Mandela, that old fella, has a nice turn of phrase. It's all a bit overwhelming really...fuel crises, food crises, global warming, conflict, epidemics. It'd be easy to throw up your hands and succumb to fatalism, but as one of our speakers said, "we cannot afford the luxury of despair".

After that was Convention...a little ironic, after the heady inspirational rhetoric of global responsibility, to spend a week in drunken stupor and mindless hedonism. You know those Clubbing Montages in movies with the DUBDUBDUBDUBDUBDUB music and the flashy lights and jam-packed semi-naked bodies writhing rhythmically and making out and you go "pffft I'd rather be reading Jane"? Yeah. A week of that. Don't get me wrong, those nights were a blast in a "what inhibitions?!" kind of way (slightly afraid of and slightly looking forward to what photos surface on Facebook), but it's definitely a one-off for me.

There were other things. GP week was good. I didn't want to stab myself in the eye, the work of a rural GP is actually interesting and the area is one I can envision myself working in one day...although occasionally I do panic at the thought of the vast as-yet-unexplored wider world out there, countries I've never seen, whole classes of people I've never come in contact with. The peaceful country life appeals, but so too the call of adventure and worldliness that once made me want to be a languages, politics and law major aiming for DFAT or the UN or whatever the pipe dream of the moment was.

Anyway. My grandma is wise. Whether or not 2008 is actually celestially destined to be a good year, telling me that makes me determined to make it so.

Brainhack

2008-06-19T05:08:00.003+10:00

So my brilliant idea of cramweek, aka insantorium, was simply this: a blog about learning. One thing that I was procrastinating about leading up to these Exams O' Doom was how to do learn more efficiently and I came across heaps of different approaches - photoreading, memory pegs, holistic learning, etc, but there was no one resource collating all this. There are blogs for students, but I'd like to focus on the principles of learning and not crap like "sleep before the exam" (pshaw! overrated!). Interesting to me at least, and I'd hope to make it practical.

Will it actually happen? Perhaps. I'll check it out more carefully, see what's already in the field. Been reading up how to monetise blogs as well, and if I do venture out and do this, I want to start if off properly...and that involves learning about SEO (Search Engine Optimisation) and blog techie stuff (CSS and server management crapola) and marketing and all that.

I've recently realised that if I ever do write a book, it'd probably be non-fiction as, alack, I cannot plot and my visual imagination is pretty crap. This is a potential topic. And I've decided that writing a book is one of my life's goals. It doesn't even have to be published. I just want to have the satisfaction. That's the liberating thing about non-fic - it's not a matter of talent. Beyond being able to string sentences together and structuring things, which I believe I can do, it's just perseverance and discipline and finding the right questions to answer.

Damn it's uncomfortable to air ambitions in public, even with, what, 2 readers? This is idle speculation at this stage.

66.66% done!

2008-06-17T20:41:00.002+10:00

Today I...

Had 3 hours sleep before my exam
Sat one of my first OSCAs where I had to actually TALK to PEOPLE which I was scared about because a) I have not talked to humans for like a whole week and b) my sex counselling video was a total disaster and c) hello I'm an INTP! I hate people! hehe
Was so nervous at some points I wanted to spew my Weetbix
Counselled a fake patient about their herpes test results. I am in love with my tutor right now, because she STRONGLY HINTED that Breaking Bad News would be on the exam, so I actually looked up how to do it and had a framework for what to talk about and was practising "sorry, I'm afraid the HIV test is positive" last night in fact (aloud to myself). It went better than I thought it would. Was grinning all the way out, probably just the adrenaline. But it was like....maybe I'm not actually not as inept as I'd thought. I can do this stuff. I can do people. I listened reflectively! I empathised! And it didn't feel too fake!
Completely blanked on how tiredness would relate to indigestion. Well actually the question was, "how would this change your thinking?" but I was too stuck on reflux to expand to cancer and systemic diseases and haemorrhage. STUPID!
Had to scurry from the main exam room to the counselling rooms twice. Felt so sorry for the year manager because it's a huge logistics nightmare..they had to shuffle students up and down the corridoor like ten times, and sometimes people were too dumb to realise it was their turn, or went over time. There were walkie talkies involved and they had to co-ordinate timing and stuff.
Took lollies from a stranger
Took free tea
Got into a car with an acquaintance on a whim, cos he asked if we wanted to go to lunch. The food was semi ok though we did have "what meat is this?" *taste* "I still can't tell" issues, but it was fun talking to people I don't know well.
Told a guy he reminded me of my seedy uncle. hahahaaha he so does. He's our The Todd...a wannabe beefcake, real Alpha Macho "I like beer and cars and guys who don't are faggots" type. So closeted. Hilarious though. He smokes! We just did lung cancer, emphysema, ERECTILE DYSFUNCTION, diabetes and osteoporosis, and he smokes!
Had to amuse myself on blank OSCA stations. I did half a sudoku and some word thing, but that somehow made me more stressed when I couldn't think of a three-letter colour ending in e, so gave up. Then I made a paper plane which I really wanted to fly, but that would probably be against the rules or something. So lots of the time I sat with my eyes closed and played air piano. That was calming. Also this breathing technique I learned from Mind Performance Hacks...you take deep tummy breaths in for 3 counts, hold for 3, out for 3. Stops the hyperventilation.
Surprised myself at being slightly disappointed that this guy I know has a girlfriend. I never thought of him as potential! Not that he's that attractive, he's just the nerdy semi-weird but nice type I'll probably end up with.
Wondered if the faculty made the questions less demanding this year because they don't want to fail anyone since they're changing the curriculum next year. They're dropping the Regional Rotation would you believe?! This is "We Need YOU to be a rural GP!" Newie we're talking about! And it's entirely for logistics not educational rationale. What a shame. The clinical stuff is, I hope, what will make us think of ourselves as Doctors to Be for the first time, and prepare us more for the real world than this "sit in a room for a week and cram" bit. Shame on you, Newie! This is partly a result of government policy I think. Making new places in med school sells well politically - "look, new doctors on the production line = totally the solution to the shortage!" - but there's the small matter of the hospital system accommodating for the extra training that we wide-eyed wet-behind-the-ears types need. And seriously? GP community placements won't cut it.
Practically danced out of the exam. Such a weight off my chest. The written parts were ok, and regardless, having the two OSCAs out of the way means this hell is almost over.
Asked someone how they coped with failing last year. I'm surprised at who fails. Some of them are obvious slacker "I accidentally got into medicine" types, but then there are also the really studious and serious Malaysians, as well as the outgoing and at least verbally impressive types who teach anatomy and stuff.

Ahhh. Such a turnaround from last week. Some of the conclusions I drew then are still true, but I'm on less of an emotional hair trigger now. There is hope. There is life beyond Wednesday. This career is not a trap.

Holyfuckingshit, if I pass these exams, I am HALF A DOCTOR. Or at least half an intern. Dr T-Dizzle. Snort.

Rosebush

2008-06-15T20:45:00.005+10:00

A portrait of a nervous breakdown. In the past week, I....

Attempted to cram: dermatology, ophthalmology, diabetes, endocrinology, hepatology, nephrology, orthopaedics, immunology, infectious diseases, cardiology, neurology, respirology, rheumatology
Burst into tears multiple times, including weeping at the piano
Seriously contemplated skipping the joint and running away to do volunteer English teaching in South America, to Find Myself and fucking rebel for once.....to the point of wondering how I can get a debit card and what kind of camping gear I need
Stayed up til 6-7am
Studied in bed, in the bathroom, in the kitchen, on the dining table
Did not do any exercise beyond going downstairs for food
Read about 1000000 pages of notes and realised just how many lectures I napped in...the handwriting would start off impeccable and then deteriorate to scribbles by the end, heh
Relived some of my and Ru's intra-lecture exchanges via our margin graffiti
Thought about what I wish I'd told my first-year self: 1) from the beginning approach med as if you were gearing up for the physician's exam, to be a Real Doctor...rather than studenty "I just wanna know enough to pass" or "this isn't on the curriculum" attitude, 2) COLOURFUL PENS and highlighters make a world of difference to how much you feel like studying....typed notes in table format are boring, 3) reading up BEFORE the week starts makes you feel smart and feeling smart makes you study more and studying more actually makes you smarter.
Drank a LOT of Irish Breakfast, English Afternoon and Earl Grey tea
Obviously peed a lot
Wondered if I should take the USMLE boards just to solidify my knowledge in the basic sciences
Learned that apparently bee venom is good for fatigue in MS
Wore the same clothes for about 4 days straight
Undressed to go to shower only to realise that my mum had set the house alarm and had to run downstairs, redressing on the way, to turn it off
Practicised that Granados Oriental piece a bazillion times. Still got to do the middle bit, but am getting pretty good at the first bit except for that fiddly trill
Did not leave the house for an entire week
Drank about 12 boxes of lactose free chocolate milk (not that I'm intolerant, it was just free at the GP convention)
Hit my head against desk
Snapped at my mother
Talked to myself, a lot
Ate a lot of mandarins and bagels
Wondered if Jerry blogging was a three-year cry for help
Invented retarded mnemonics like "quatre femmes sit on your lap doing high kicks" (quadriceps, femoral nerve, anterior thigh, extension) (ok, I'm actually proud of that one. the stupid ones are the ones that I make up and then promptly forget)
Realised that I hate medicine and the only things stopping me from ditching it are 1) debt - this bonded thing is a MORTGAGE ON MY SOUL, 2) all these textbooks going to waste, 3) my grandma would be really sad
Realised I actually enjoy some of medicine and want to be good at it and in my dream "running away to S. America" scenario I'd bring my OHCM
Discovered that I like pathology (though not the microscope aspects, the mechanisms) and microbiology (cos bugs have identities) and immunology (very logical, fits warfare metaphors well). I hate rote rote rote learning anatomy and drug names
Went outside at 5am, thought about jumping in the pool with my pyjamas on
Considered my extra-academic marketable skills and came up with...diddly squat. Well I can type, write ok, speak French halfarsedly.
Prayed to, and railed at, god...who, by the way, hates humanity, going by some of the horrendous diseases I've seen
Did nothing but eat, drink, poo, pee and study for days on end
Told myself I'm a fucking idiot because I'm 22 and all I've done is study and I'm going to fail at that which means I fail at life
Realised that failure could be liberating and motivating and a Life Experience because I've had it all my way til now...a test of character
Napped on the floor of my study
Decided I need a life: closer friends, diverse interests, a job, LOVE SWEET LOVIN'
But decided I'm not really ready for the latter til I'm totally happy with who I am, which is not yet
Realised that I have never strayed from the path of least resistance in my life -- never made an autonomous choice, never acted against the destiny set out by my milieu (school, uni, make money, consume)
Was cheered by reading silly forum posts on the internet
Helped a friend do her job application letter
Wondered, in the darkest depths of 5am self-pity, who I could call for Listen&Support at such an insane hour...but as always, kept myself to myself
Got really excited about a potential new blogging project and procrastinated for a bit drafting up ideas and posts and thought about how I could even maybe turn it into a book
Woke up the next day and reconsidered it and thought it's probably stupid
Wrote half a post about how my family is totally fucked - >80% divorce rate, some multiple. Also realised I have no blood aunts! Well only one, but she's estranged.
Tried to meditate
Realised that this is all bloody self-indulgent and melodramatic because I have had it so damn easy: parents and grandparents who love me, money, education, health, opportunity...a giant big fat cushion of privilege...not that it was much comfort at the time
Realised that one day I'd look back and laugh in disdain at myself for thinking that THIS was stress
Was told by my grandma that according to astrology this year is meant to be a good one for me....hahahahaahahahaha right.

Phew. Catharsis.

Earworm

2008-05-16T05:04:00.003+10:00

And possibly fingerworm as well, I just spent an age digging up a free score for this piece. Tis Granados, Danza Española No. 2, Oriental. It kills me.

Piano: the first one I found was by this 11 year-old girl. While it's prolly a bit less polished than this other woman's version, I love how she's really into it. Also, dudes, 11.

Geetar:

It's great being able to compare versions on different instruments. I reckon the guitar one is more romantic and soulful, cos they make up for the instrument's relatively limited dynamic range with sensitive phrasing and flexible timing. Or something. I'm only just beginning to work on my classical ear after x million years/dollars of music tuition. The slides on the guitar make it more lyrical as well. Sigh.

Why is this piece so familiar and haunting? I have a feeling it's from a movie. Godfather? I've definitely heard it before. Only came upon the title by chance, listening to ABC Classic FM: Up Insanely Late. Digging that channel lately. In my car I've got it programmed along with Triple J and Today FM. In company the cooler ones are chosen; alone I wind down the windows and blast me some harp action.

PS for Chris: I SAW A MOUSE IN MY ROOM!!! The first time it was exiting. The second time it was coming in. Errrr.

Candles and other obvious metaphors

2008-05-06T20:06:00.006+10:00

So, radio silence.

What I haven't been saying here, or rather what I've been saying by not saying anything here (are we following?), is how I'm terrified that med is not my One True Vocation and that I'm going to turn out to be a incompetent doctor, bitter and resentful at how it's taken up my life.

I think it's partly because of our lack of clinical stuff this year so far, with hardly any patient contact. Buried beneath the books, the weekly grind of Working Problems, it's easy to lose sight of where it's all leading. I fear that I still don't own medicine; being a student doctor isn't part of my identity. Compare this with learning French- it is a part of me, it was my passion (at least for a while). Whereas with med, part of me is standing to the side, half amazed at what knowledge I have managed to pick up, half bemused and terrified at the thought of one day being Dr Tina. Who, me? What a ridiculous notion. With my heart not really in it, I was afraid that I would be a half-ass doctor, knowing just enough to get by, fooling the less critical of my patients. And that's just not what I want out of life; I want to be brilliant at what I do, passionate, absorbed. Sure there are doctors who can do other things at the same time, like my hero Oliver Sacks, the great neurologist who's written about things as diverse as music and botany. But I don't have that kind of protean genius; I know that just getting to grips with the mountains of med knowledge will take up most of my efforts, leaving my other interests by the wayside.

Also, med frustrates my desire for creativity and Making a Difference. You're at the coal face, applying other people's technologies and research, with your impact being limited to the patient in front of you, basically working as an algorithm-churning machine. Yes, it is a noble and important job and satisfying in its way, too. But it's constrained. The scientist who invents a new vaccine, the politician who brings in universal health care, the teacher who shapes a class-full of young minds...that's how you multiply your impact. Yeah I realise how grandiose and naive that sounds. I know my limitations, but I want to use what I've got for the greatest effect and satisfaction.

In short, I felt trapped. Trapped by the 5 years I've already spent at uni, the $100k debt, the expectations of family, the 5 years of Bonded practice and at least 7 years of advanced training awaiting me. So I've been idly surfing for alternative lives. An English-for-foreigners teaching diploma, a correspondence course for a Grad Dip Psychology.

These worries have been sloshing around for months now, and I never thought to speak them to anyone. It's taboo. Then yesterday had a chat with Chris. A light of hope! She told me that she too has doubts about clinical med being her life's work. I'm not alone. She's interested in business, finding a niche to fulfill future healthcare needs. Now that is exciting stuff, where new ideas are possible. She wants a non-profit branch to her biz too, and suggested that I be part of that, doing some kind of travelling medico-journalism kinda thing. What a pipe dream, what perfection! It's so obvious. One of my main objections to Being a Writer (ooh la la) is that I'm crap at making up stories. But lo, there are many stories in med. As I was reminded today- we had a palliative care placement, and oh how it was lovely talking to a patient. With 10 years of cancer but still seemingly well, he told us about his love for the bush and his career as a forrester, his worldwide travel, his passion for Schubert and art. In fact he's going to Sydney tomorrow to buy a Schubert CD of the most beautiful piece ever, he says. So among my notes about his medical history of hip replacements and diabetes is a citation for Piano Sonata in B flat, D960. Have a listen (I downloaded the Lipkin one). I dunno about "best evah", but it sure is beautiful, especially the second movement. For Friday I've volunteered to be the one quizzing him about the psychospiritual stuff (what a silly term for "what do you think about dying?").

Whether or not these are impossible dreams, suddenly the trap seems less deathly tight. The inevitable bitter end - haggard repressed half-assed GP - doesn't have to be that. There's something to work towards and hope for. I'm reminded how I convinced myself to get into med in the first place and it doesn't seem quite so self-delusional- that people and their stories are pretty damn awesome.

Now for the "study and pass" bit.

Neurosis alert

2008-04-29T14:57:00.005+10:00

Current stressors:

EXAMS IN 7 WEEKS. 10 weeks' work to catch up on. Motivation level: subterranean. The exams are on 3 consecutive days which translates to: pass the razor. Small consolation is that I get to see Phantom after all- accidentally booked it during exam period, but luckily we will have finished by then.
Recurring doubts about What The Flying Fluck I am doing in this course. Why did I ever say I wanted a challenge? How did I ever convince myself this was my vocation when as a kid my ambitions included psychology, anthropology, journalism, language teaching, &c &c but NEVER EVER medicine?! How did I even get admitted? Still waiting for the letter that says "Just kidding. *BOOT*".
HES project. I've got a supervisor lined up, but he's a frigging big shot lecturer and epidemiological researcher. His field is exactly what HES is meant to be about. Seems like a nice guy too. One problem. He wants me to do publication-level research! Which is cool except for the fact that the last time I did field research was...........NEVER. Know jackshit about it.
HES in Vietnam. I'll be staying with a family friend previously mentioned. I'm stressed out about all the etiquette and language barriers cos this is in the very politesse-conscious North. I'm afraid I will use the wrong honorific for some Head Honcho, thus condemning my host to social exile and and bringing SHAME AND HELLFIRE upon seventeen generations of my ancestors and progeny who will spit on my grave!! I will also be a small lonesome English-speaking island wanting my mummy, in an ocean of streetsmart Vietnamese who eat Australian-Vietnamese Traitors for breakfast. Why oh why didn't I go to Viet school? Should've known. Blood will out. And how come at 22 I'm still not self-sufficient or confident or grown up yet? Hurry up already.

Ok feeling better now.

The Seed

2008-03-31T01:05:00.007+11:00

The things I suffer for other people's art. On Saturday, I had to wake up in the MORNING (gasp! 9am) to take the 2.5 hour train to Central station. From there I had to lug my overstuffed bright green backpack like a studious turtle over to the Belvoir St Theatre. All this to see the second-last performance of an Australian play, my first without any Big Names or familiar authors as risk-mitigation.

Totally. Freaking. Worth it.

It was The Seed by Kate Mulvany, a semi-autobiographical play about an Australian ex-journo-turned-aspiring-writer-(the-real-kind), Rosie, who goes to Ireland with her Vietnam veteran father to meet her ex-IRA grandfather. The playwright is also the lead actress playing her barely-fictional self. This isn't a big-R review, so go elsewhere for the plot synopsis. There are several spoilers that aren't included there...watch out, cos I'm going to blow it for you. Basically, the dad got hit with Agent Orange which meant that he and the mum had four miscarriages before Rosie...who was born with kidney cancer, the treatment for which made her unable to have children. Her fiancé's just left her because of that. The other big reveal is about the grandpa. Throughout the play he paints himself as a devoted bomb-maker for the IRA, regaling them with stories of how many English pigs he's killed. But in the end it turns out that it was all a myth, that the "meetings" were just drinks at the pub with his mates and that the fundraised money was spent on the bookies. His lifelong lie had sown a (lo!) seed of guilt in his son for deserting his family and The Cause, driving him to Vietnam to prove himself. Dominoes and reverberations.

I laughed, I was sucked into the story, I blinked a whole damn lot. Kinda embarrassing when you're in the front row and one of the actors seems to be staring right at you. The emotion lingered for hours afterwards and I'm still thinking about it today - that's how I measure the impact of a play. Wanted to give a standing ovation at the end but, well, again with the self-conscious front-row squirmies.

Of course being a INTP equivocator type, I had to find some flaws with it as well. Can't let pure emotion go unchallenged by nitpicky thought! The "VN war = bad....just like IRAQ" thing was a little heavyhanded. You don't need to convince me that war is bad, you only have to do it elegantly. "What the fock is Agent Orange?!" and the list of PTSD symptoms were like being hit on the head with a giant expository hammer. The drama of the final confrontation flagged a bit - can't put my finger on the reason - and a reference to old and new, literal and figurative scars was a tad obvious at the end.

On the other hand, most of the writing was gorgeous. Occasionally in between the segments of family reunion dialogue, there are bits of monologue by the author-as-herself about a crayfishing trip with her father as a kid. There was a moment about how her father pulled the ropes to lift the pot as if he were dancing with himself. Mulvany's reading is dream-like as she acts out the hypnotising motion...omg. I won't forget that soon. What did Tom Stoppard say about moments that transcend text? That was one of them, even though it was so verbal. The other bit that made me sniffle like crazy was when Rosie tells her grandfather she can't have children (after his long spiel about how Malloney women are made to be mothers). She says maybe she doesn't deserve them and rips into this speech about the envy, rage and desire that she has when she sees pregnant women and soon-to-be fathers and babies. The violence and spite shock you, the wrenching yearning draws the blinkage. It is so painfully raw, made more so by the realisation that maybe this is the actress/writer speaking from her own experience. Chills, man. It takes real balls to put yourself on the line like that, and everybody appreciated it.

It's definitely nudging the top ranks on my "Theatre Bests" list, even accounting for recency bias. See if I was a real reviewer I'd end this with a crappy extension of the seed metaphor, blooms and trees or something, but instead I'm just going to brush my teeth and go to bed.

PS. I have this ultra-sexist crackpot theory that while men may be better at writing about great ideas and the sweep of history &c, women, even authors of teen fiction and other low-brow genres, are better at psychological and emotional realism. I mean much as I revere Sir Tom, with his piercing, crystalline turns of phrase, sometimes his characters' changes in mood are abrupt and seem contrived. Victor Hugo was one of my favourites as a teen, but a couple of dudes in Les Mis are impossibly saintly or heroic or villainous. Michael Ondaatje's English Patient is beautifully poetic but strange; people do inexplicable things and they all talk in this oblique manner. For shiz this is gross over-generalisation - Henry James' Washington Square was a masterpiece in minutely detailed character development. Emphasis on the "crackpot" part of the theory.

PPS. AMSA, you suck.

PPPS. My grammer and speling also suck. Fer shame.

Who's got the map?

2008-03-21T23:35:00.003+11:00

"We need wit and courage to make our way while our way is making us."
- Salvage, Stoppard

Spoken about historical necessity, but also conveniently applicable to this one small life. Not blogging lately because everything comes out in angst. Who am I? Where am I going? Who stole my socks?

Cut-loss week

2008-02-28T12:35:00.003+11:00

My second "shouldn't have gotten out of bed this morning" day this week. On Tuesday I was going to go swimming so drove to uni instead of walking, only to circle the campus for half an hour in fruitless search for a parking spot with the petrol meter already in the red. Then decided to screw it and went to find fuel. The first place I went to, as bad luck would have it, was completely out, so had to cross the suburb to fill up. The punchline? Couldn't have gone swimming anyway, because there was a school carnival on that day at the pool. I managed to tun the day around by treating myself to an icecream - panacea! - and it was actually quite productive study-wise.

Today we had a derm clinic: utter waste of time. There were about two patients in two hours. We ended up getting taught stuff off the internet, no joke. And got my first taste of hardcore pimpage from this toolish Viet reg who quizzed us on all the obscure immunomodulator drugs you can use on BCC's while he cut one out of a lady's neck. The other reg, on the other hand, was the one who had given us a lecture yesterday, and he only expected us to know how to identify macules, papules, etc etc. when we split up I made sure to be in the latter's group! Har.

Luckily we got to leave early so did a bit of study in the library and got a gross but cheapo lunch from the subterranean caf. Whose idea was it, by the way, to put the poor paeds wards underground, circles-of-hell style? Then left to drive to the city where they randomly scheduled two lectures. Foiled by bearshit again, this time in the form of a frigging monsoon. Guess who didn't bring an umbrella? And wore a white shirt? And got soaked down to her unmentionables? Gah. The car was no refuge either as could hardly see through the fogged-up windows and had to drive illegally sans glasses because they made my vision even worse. Was gung-ho at first and was going to soldier on to the lectures but finally decided that listening to two dudes read off Powerpoint slides wasn't worth indecent exposure, pneumonia, or a ten car pileup.

IV icecream please.

Why there will never be Grey's Anatomy: The Med School Years

2008-02-27T01:52:00.004+11:00

Actual conversation today.

R: So what did you do yesterday?
Me: Mmmm nothing much. Studied. You?
R: Meh, same.

[5 minutes later]

Me: Any plans for tonight?
R: Study probably. You?
Me: Yeah, gotta cram for derm tute tomorrow.

The glamorous lives of medkids, ladies and gentlemen. Where is the sex in anatomy labs I was promised?!

This is just in case you were wondering why the posts about the actual process of aquackening are rather sparse here. Want to hear about, um, the textbook I read yesterday? Ophthalmology Made Ridiculously Simple, if you must know. Don't mock, it covered 90% of the stuff we got in lectures today. I bite my thumb at fat textbooks. Why get bogged down in detail when a skinny book with cartoons can tell you the basic essentials like: don't press on a possibly burst eyeball, for that will make the goo come out. Good to know.

Ophthalmology week has been pretty interesting actually. I like the anatomy and physiology of it, probably because we did heaps of vision stuff in psychology so it mostly makes sense. Briefly wondered why I didn't do optometry and then remembered that their whole job seems to be "now which lens is better, one or two? two or three? three or four? four or should I go with the gas oven or the razor blades?". Wouldn't mind ophthalm as a job except for the apparently crazy competition to get in...who's got that much ambition? The ophthalm lecturers we've seen so far seem cool. I've decided that I will probably choose my specialty based on whether I like the type of people who are in it. So...surgery it is!

(cut to: Satan getting frostbite)

Why this blog is like safety scissors

2008-02-25T23:27:00.006+11:00

It has no point.

(Do I see eyes rolling?)

Anywho. So there's been this story/play idea rumbling around ever since Vietnam, based on a family I met. I've talked about the wife (H) a bit before here, she's the doctor and "family friend" who saved us from evil Bac Q's house in Hanoi. She won us all over, including my mum, who isn't the easiest to please, with her sweet disposition and gracious hosting. I was intrigued by her.

On the surface, especially in public settings with parents and elders around, she's the perfect well-bred Vietnamese lady. Considerate to a fault, always tends to other people's needs, says all the right things- lavish with praise, slow to criticise, self-deprecating. For example, my dad mentioned once or twice that he had trouble sleeping, so she bought him some herbal sleeping tablets for me to bring back to Australia. I found myself taking everything she said with a grain of salt because she took so much care not to hurt anyone's feelings that white lies weren't beyond her, like saying how much she loved our crappy presents.

Besides this Jane Bennet aspect, there's some Lizzy as well, in her quick-eyed observation, an instantaneous understanding of people and situations. The first time she came to meet us, my mum grabbed her in the alley moments after she arrived and told her to pretend to be my aunt to simplify things with Bac Q's family. Once inside, she understood immediately how to play along, and how her Specialist Doctor Aunt label would give us a boost in that status-conscious household/hell-hole where we were lower than dirt. Also Lizzyish is her lively, occasionally cheeky wit. I got to see more of this the day we went to hospital together. In our halting half-English half-Viet we managed to joke around a bit- I teased her for being so paranoid that she made me call my (pro-democracy shitstirrer) dad from a phone booth instead of from home, for fear of Big Brother; she jokingly asked whether I wanted to shoot her for being a puppet of the Commie state, as a government-employed doctor. That day was strange, because we kept shifting from egalitarian English to tortuous etiquette-bound Viet, from student-teacher roles to guest-host to joshing equals. Stressful but interesting. Though I appreciate observant and sharp-minded people, it's so much easier dealing with the thickheaded ones who don't notice all your gaucheness!

The comme-il-faut manners, the gentle tact, the lively eye and humour - these are still the outer layers of the onion. As the day progressed and she grew more tired and strained, I noticed impatience, though of course not with me. With her housekeeper, daughter, husband and mother she had a quietly sharp tongue. In this setting she's no longer the demure hostess, but the exacting head of the household. Underlying these contradictions - or are they really? - there is a deep sadness.

See, the reason we know her is through my uncle L. She came to Australia for a 6 month study visit last year and somehow befriended L. It was a weird relationship. He was estranged from his unfaithful wife at the time. H too was apparently in an unhappy marriage. According to my grandma, husband and wife lived on different floors, just staying in the same house for appearance's sake, and for their 7 year-old daughter TH. When H and L came over to my grandparents' house, they acted like lovers, flirting and joking. I assumed she was his girlfriend. Everyone accepted that. Although before we went to Vietnam L's wife had returned - somewhere in the bargain a new car was included! their sorry story will have to be told another time - the understanding was that H was still kindasorta his girlfriend. I admit I judged them a bit for that, she had a little kid and husband, he a wife, what were they thinking?! Though the "internally separated" explanation on her part seemed fair enough, and the husband and kid were only abstract concepts.

It was seeing H in her world that made the tragedy and complexity of the situation more real to me. They live in this perfect display-room house, with modcons and luxuries impressive even by Western standards, staff to take care of everything. Her husband T is a high-level engineer for the state. A sophisticated, soft-spoken, gentle-mannered man, he would appear to be a good match for H. Their daughter TH is precocious, whip-smart, destined to follow in her parents' high-achieving footsteps. From the outside they look like a model upper bourgeoisie family. The only thing missing in this picture? Love. Well it is there, but only for the daughter, which is probably why she's spoiled rotten. I think TH may not even know that her parents are semi-separated; they still go on family outings together and everything. You have to squint to spot the cracks. It's in how H and T call each other "Mother" and "Father" instead of the standard "Anh/Em" endearments, how they never touch or joke or speak to each other except about practical matters- Stepdork and mum looked like lovebirds in comparison, holding hands, feeding each other, scolding. But this is on close observation; otherwise, it's an unnervingly smooth pretense.

I see now why H went for my uncle, with his boyish mischievous charm and rough romance. It's also clear why she likes my family and is in regular contact with my grandma and dad. Despite our Bac Ky origins, we've adopted the frank and direct style of the South, so different from the frigid Northern politesse that rules in her house. At our dinner table everyone talks and debates politics and jokes, food is passed to and fro, and even with my crazy grandpa stirring trouble and my uncle's abrasive teasing it's warm and lively. In contrast, I imagine meals are a lonely time for H and T, as TH eats alone with her nanny and the parents both work late.

My grandma said that H's parents had divorced and she had suffered greatly for it, which is why she won't split with T. Grandma has advised her that she's doing the right thing by staying with him for TH's sake, giving her a stable environment. I don't agree. My uncle in Canada did the same thing - stayed in the same house with his ex until his kids were in uni. The last time I met him he was bitter and disillusioned. At 50-odd, he had nothing: no one to grow old with, kids he thought ungrateful and disobedient, his assets chipped away by a war-of-attrition divorce settlement case. And who's to say that having two parents in the house is going to make the kid any better adjusted? Bearing the burden of guilt later on, not having an example of a happy relationship, being stifled by love that has no other conduit...that can't be good for a kid. For all the dark twistyness and slow-healing scars, both parents and I are better off after their divorce I reckon. Look at how normal and well-adjusted I am! (spluttersnort). No but according to grandma, there are other barriers to H and T's divorce as well - something to do with losing face and lessening of a woman's worth. Even worse reasons, to my banana mind...though I can see how divorce would seem an ugly black mark and a failure to H, who's worked so hard for perfection or at least the appearance of it.

It's vaguely obscene to plunder someone's life for a story, but I can't help imagining how it'd play out - it's so inherently dramatic and tragic. Our layered heroine in her tangled dilemma - mother vs woman; an apparently idyllic family that is a sham; two lovely, lonely people seemingly so well suited, unable to live happily together, unable to break away to make their own lives. Is a happy ending even possible? In literature the poor woman always seems to shoot herself or go under a train or something. But just as terrible would be the more realistic end: long years of status quo, resignation, unfulfillment, bitterness. They both deserve more.

Today is history

2008-02-13T16:12:00.005+11:00

It is so weird having a government I agree with for the first time in my adult life.

Onya Rudd. Go now and read the Sorry speech.

Nelson's response isn't so bad in text...I'm a bit puzzled at the "fury" it provoked. That article has people talking about inaccuracies and stuff, but I think his real crime was going against the spirit of the day. I thought the collective turning of backs on him was pretty cool in a groupthink sort of way though.

New Year's resolutions

2008-02-12T23:21:00.001+11:00

Yeah yeah yeah, it's February. Well the lunar new year just passed, along with my 22nd birthday. I swore to myself I wouldn't be one of those women who are insecure/coy/precious about their age but OMFGIAMOVERTHEHILLANDWILLENDASPINSTER!!!!111!

Ok. Resolutions.

Read non-med stuff every day. Went book-crazy on my birthday and bough like $60 worth of fun books including Musicophilia by Oliver Sacks (two loves in one), Phillip Pullman's Northern Lights omnibus (Nicole Kidman made me) and The Odyssey (to see what all the millennia-long fuss is about).
Do some study every day.
Make exercise a habit. Already some progress: got a swim pass and swum 1.5k today.
Eat less crap. Helped by swimming cos calories have more meaning when counted in laps.
Write. Stop being in denial, apply ass to chair and ink to paper. Doesn't have to be any good.

But most of all, take no one's shit. After Vietnam and to some extent Airlie, I'm sick of being patronised and put down by men with planet-sized egos and presumably diminuitive....feet. One thing I've learnt is that there's an steel shard of self-respect buried beneath the tons of insecure neurotic baggage. Who'dathunk. This resolution is tempered by two others however: pick my battles and be kinder. Cos not taking shit can manifest in churlishness and defensiveness and that's hardly better than being a doormat.

Oy navel gazing again.

Grumbles from paradise

2008-01-25T19:12:00.000+11:00

Of all the medical centres in all the towns in all the world...why did I have to get a Texan mentor who works 8am-6pm every day? Why god why?!

Heh. Ok he's not that bad. It's just I'm not used to working hours after waking in the pm for a month.

On the plus side, I've already cut stitches, taken more blood pressures than I have in my entire life to date, listened to some pneumonia lungs, heard a foetus' heart and am learning to suture. Also seen numerous skin surgeries and naughty parts of both genders. Tomorrow I'm going to a Whitsunday island and snorkelling and I have a long weekend. Huzzah!

My hotel has $10/day net so I'm stuck using net cafes - this is free cos of booking above tour. Yknow what sucks, whenever I have stuff to blog I have net, and when I have net (ie. in Newie) my life is dead boringo. Some weird 21st century variation on Murphy's law or summut.

Off to collapse now.

Desperate and netless

2008-01-14T10:05:00.000+11:00

So the home monitor has blown for the second time - no blogging goodness til Airlie Beach or Newcastle. Play among yourselves dears.

New year, old crap

2008-01-02T17:10:00.002+11:00

Two days into 2008 and I've already seen one play (Blackbird - the one directed by Cate Blanchett) and gotten a parking fine (didn't read the "rear to curb" bit of the sign, dammit! 79 big ones).

Was just sorting through the enormous piles of crap in my study and came across all sorts of relics from my past life. Listened to a CD or two from our old school magazine Patchwork - good god the choir was crap! All my paths not taken were there: ANU scholarship letter, Melbourne law acceptance letter, Sciences Po exchange forms. And the paths taken but then U-turned. A nice assessment note from my French Popular Culture class, a letter inviting me to do Economics honours (wtf, I know), Spanish homework exercises, a now-incomprehensible Contracts essay, notes on International Security in handwriting that doesn't even look like mine but actually is. Leaflets for the smorgasbord of academic delights available to BA's: linguistics, a fistful of Romance languages, history, politics. Reminds me of the delicious sense of opportunity of first first year, fresh from slaying the VCE dragon, with wonderful delusions of the greatness awaiting me.

Nam

2007-12-31T19:15:00.000+11:00

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

2007-12-10T11:40:00.001+11:00

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

2007-12-01T02:45:00.000+11:00

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

2007-11-27T17:30:00.000+11:00

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...

2007-11-25T00:19:00.000+11:00

...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

2007-11-24T01:15:00.000+11:00

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

2007-11-20T00:59:00.000+11:00

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

2007-11-18T21:15:00.000+11:00

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

2007-11-16T02:56:00.000+11:00

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....

2007-11-14T15:45:00.001+11:00

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

Quack hacks

2007-11-13T16:02:00.000+11:00

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

2007-11-11T17:14:00.001+11:00

(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

2007-11-11T16:39:00.000+11:00

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...

2007-11-05T00:25:00.000+11:00

...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

2007-11-02T23:35:00.000+11:00

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

2007-10-31T14:36:00.001+11:00

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

2007-10-24T23:41:00.000+10:00

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

2007-10-20T23:01:00.000+10:00

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:

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.
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.
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.
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.
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.
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

2007-10-19T23:09:00.002+10:00

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

2007-10-18T20:42:00.000+10:00

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

No brainer

2007-10-17T21:07:00.001+10:00

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

2007-10-17T16:18:00.000+10:00

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

2007-10-15T22:22:00.000+10:00

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

2007-10-15T01:13:00.000+10:00

(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

2007-10-05T09:34:00.000+10:00

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!

2007-09-29T14:13:00.000+10:00

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

2007-09-28T11:36:00.002+10:00

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.

2007-09-26T22:40:00.001+10:00

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

2007-09-25T22:40:00.000+10:00

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!

2007-09-24T21:29:00.000+10:00

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,

2007-09-20T22:58:00.000+10:00

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

2007-09-20T18:23:00.000+10:00

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

2007-09-19T18:46:00.000+10:00

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

2007-09-16T01:10:00.000+10:00

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

2007-09-15T04:00:00.000+10:00

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.