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.
Showing posts with label ward stories. Show all posts
Showing posts with label ward stories. Show all posts
Saturday, April 25, 2009
Friday, February 13, 2009
Gastro updates
The score so far:
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.
- 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?
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.
Wednesday, November 12, 2008
It's a....squalling purple thing!
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.
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.
Monday, October 13, 2008
All in a day's work
Meals eaten in the last 48 hours: 2.
Sleep in the last 48 hours: 13. (3 + 10)
Self-medication (opiates! wheee!): lost count.
Dead people seen: lost count.
Open heart surgeries witnessed: 2.
I got up - note, not woke up - this morning. Showered. Put on my pants. Took off my pants because they had a dead woman's blood on them. Rummaged the laundry basket for my relatively cleaner white coat, the one that's not also contaminated by bodily fluids (at least not visibly). Swallowed codeine. Jumped on a taxi.
I was wrong, or unconsciously taking poetic license, because the floor and walls of ED are not white, but light grey, though they are indeed reflective. When I first came in the room was quite empty. God must've wanted to punish me for thinking so because before 9am there were already at least two brain-dead (I checked their pupils), a swathe of old people, five or so parties involved in a stabbing, an emaciated 30-something with massive cirrhosis, a maybe renal colic and more. One of the patients was about to be certified dead until he started breathing on his own! But I think he was still gone. All that before breakfast.
I haven't learned enough about death. I mean the clinical side of it. There was probably a learning target in first year that I pooh-pooh'd as fluff, but it's critical. When to stop CPR. When there's no hope of return. This is something that happens daily here. The first few days I just walked by the mini-ICU in ED a few times, not really knowing what was going on, but now I realise that the air pumping and chest thumping is most likely to be fruitless. My PBL training leads to determining causes, mechanisms and solutions, but leaves me high and dry when it comes to The End. As for the personal side....seeing the relatives grieving shook me up a bit, but the thing is, when someone's brought in barely alive, the transition to mostly dead isn't that obvious.
There wasn't a whole lot for me to do and I think Mr Intern wanted to give me a break from, yknow, death and destruction, so he took me upstairs to the cardiac surgery department. So, c'est vrai, surgery is just cutting stuff up then sewing it back together...but when the "stuff" is a LIVING BEATING HEART....dude, that is wicked rad. The heart guys are cooler than the ortho surgeons as well - the professor (God Himself) joked with me in excellent English and another one explained the repair of a Fallot's Tetralogy. When I started hacking up my lungs and swaying, I thought that was time to retreat.
My intern is becoming a friend. Imagine a small, deft, fine-fingered fellow with blinky myopic eyes behind thick glasses, square-cut hair, conscientious, finicky with hygiene at mealtimes and in surgery as befits an open heart surgeon to be. He spends his spare time studying (I KNOW!) and playing soccer and stuff with his friends, sometimes martial arts. He's so cute and gentlemanly - took me to the coughfakebookshopcough today and even offered to pay, and then drove me home. And he's a role model now too. He actually cares for his patients, in a setting where that's hard to do, and he is always seeking to learn more. Now I go around stage-whispering "he's a darling!". I sense he's got a little in reserve but I don't think this idol will turn out to have clay feet.
You know what I've been thinking about? Here doctors are really poorly remunerated, yet patients can still get an excellent standard of care. I have to give Mr Ortho props for the six gruelling hours he spent on that thumb...it only garnered him about 75 000 VND, which is about $7 AUD. The buying power isn't a lot either, given that a hospital lunch is about 30 000 VND. He could've just stitched the thumb on for aesthetic purposes, but instead took great care in connecting each tiny vessel and nerve. And Mr Intern probably gets paid even worse, but he stays overtime to make sure that his patients survive the handover and is meticulous in examining them. I've been taught (brainwashed) to think that a nation without rule of law must be corrupt and collapsing, each man for himself - and indeed there are horror stories about doctors giving sloppy care or sending patients for unnecessary operations because they have side deals with specialists. But there remains the integrity of individuals, the drive to excel at one's work and do good. It's heartening.
Sleep in the last 48 hours: 13. (3 + 10)
Self-medication (opiates! wheee!): lost count.
Dead people seen: lost count.
Open heart surgeries witnessed: 2.
I got up - note, not woke up - this morning. Showered. Put on my pants. Took off my pants because they had a dead woman's blood on them. Rummaged the laundry basket for my relatively cleaner white coat, the one that's not also contaminated by bodily fluids (at least not visibly). Swallowed codeine. Jumped on a taxi.
I was wrong, or unconsciously taking poetic license, because the floor and walls of ED are not white, but light grey, though they are indeed reflective. When I first came in the room was quite empty. God must've wanted to punish me for thinking so because before 9am there were already at least two brain-dead (I checked their pupils), a swathe of old people, five or so parties involved in a stabbing, an emaciated 30-something with massive cirrhosis, a maybe renal colic and more. One of the patients was about to be certified dead until he started breathing on his own! But I think he was still gone. All that before breakfast.
I haven't learned enough about death. I mean the clinical side of it. There was probably a learning target in first year that I pooh-pooh'd as fluff, but it's critical. When to stop CPR. When there's no hope of return. This is something that happens daily here. The first few days I just walked by the mini-ICU in ED a few times, not really knowing what was going on, but now I realise that the air pumping and chest thumping is most likely to be fruitless. My PBL training leads to determining causes, mechanisms and solutions, but leaves me high and dry when it comes to The End. As for the personal side....seeing the relatives grieving shook me up a bit, but the thing is, when someone's brought in barely alive, the transition to mostly dead isn't that obvious.
There wasn't a whole lot for me to do and I think Mr Intern wanted to give me a break from, yknow, death and destruction, so he took me upstairs to the cardiac surgery department. So, c'est vrai, surgery is just cutting stuff up then sewing it back together...but when the "stuff" is a LIVING BEATING HEART....dude, that is wicked rad. The heart guys are cooler than the ortho surgeons as well - the professor (God Himself) joked with me in excellent English and another one explained the repair of a Fallot's Tetralogy. When I started hacking up my lungs and swaying, I thought that was time to retreat.
My intern is becoming a friend. Imagine a small, deft, fine-fingered fellow with blinky myopic eyes behind thick glasses, square-cut hair, conscientious, finicky with hygiene at mealtimes and in surgery as befits an open heart surgeon to be. He spends his spare time studying (I KNOW!) and playing soccer and stuff with his friends, sometimes martial arts. He's so cute and gentlemanly - took me to the coughfakebookshopcough today and even offered to pay, and then drove me home. And he's a role model now too. He actually cares for his patients, in a setting where that's hard to do, and he is always seeking to learn more. Now I go around stage-whispering "he's a darling!". I sense he's got a little in reserve but I don't think this idol will turn out to have clay feet.
You know what I've been thinking about? Here doctors are really poorly remunerated, yet patients can still get an excellent standard of care. I have to give Mr Ortho props for the six gruelling hours he spent on that thumb...it only garnered him about 75 000 VND, which is about $7 AUD. The buying power isn't a lot either, given that a hospital lunch is about 30 000 VND. He could've just stitched the thumb on for aesthetic purposes, but instead took great care in connecting each tiny vessel and nerve. And Mr Intern probably gets paid even worse, but he stays overtime to make sure that his patients survive the handover and is meticulous in examining them. I've been taught (brainwashed) to think that a nation without rule of law must be corrupt and collapsing, each man for himself - and indeed there are horror stories about doctors giving sloppy care or sending patients for unnecessary operations because they have side deals with specialists. But there remains the integrity of individuals, the drive to excel at one's work and do good. It's heartening.
Unbearable whiteness of being
Home from my first ever graveyard shift in ED. It was a warzone last night. The combination of weekend drink-driving, rain and a motorbike nation is deadly. The room was full of head injuries, people vomiting and seizing and yelling and moaning and banging on their stretchers, many crudely restrained with their limbs tied to the the bed. Ears ripped off, partly severed fingers dangling, faces disfigured from swelling. Twice, power failures plunged us all into darkness. Patients and relatives kept clutching at me, "doctor, my arm is so sore, what can you do doctor", "doctor, help my son, please doctor", "doctor, the drip doesn't work". I don't know why they chose me out of the other students there - maybe because I look older, or because I'm not wearing the blue-striped coat that Viet students wear, or maybe because I haven't learnt the art of ignoring yet and still make eye contact. I felt helpless before such need, not having any answers, not knowing who to tell - just starting to get to recgonise the staff here. I didn't know whether to pass on their pleas or not? To my shame, in some cases I didn't do anything. But in the end I decided this was cowardice; it cost me nothing to ask. I napped a few fitful hours in the nurses' change room and wondered at how they could wake up immediately, get themselves impeccably neat, and head back into the fray at ungodly o'clock. It's practically heroic.
I did CPR for the first time on a real person. She was a middle-aged Jane Doe, with hair and skin tone revealing that she was probably a daughter of the war, half GI, half Vietnamese. Her feet were already blue. She had blood coming from her face; I couldn't tell if her upper lip was still there or not. The contents of her pockets were thrown on a tray: a wad of paper money, some silver jewellery, but no ID. I got some of her blood on my coat. When I returned from getting a scrub top from theatre as replacement, she was under a white sheet. Another first.
If this sounds emotionally flat, it is because I am. I'm washed out from the flu and from...I dunno, what's the noun for overwhelming? That. I'm curiously untraumatised. The glaring clinical whiteness of the ED - white-uniformed nurses, blinding white lights, reflective white floor, white walls, white doctors' coats - contrasts weirdly with the broken bodies lying there in pools of their own blood. It contributes to a sense of removal. Sure, I connected to a few people I interviewed and examined, but the innumberable semi-conscious head-injured started to blend in to each other, an undifferentiated mass of Them.
I'd like to say I feel that I've lost something, but I'm just tired.
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.
Saturday, October 11, 2008
Bones and groans
Well I had a long rant yesterday that is Saved As Draft, and there shall it remain. Long story short: morning spent wrangling with bureaucracy. Brief period of awesome when I finally got things sorted and was introduced to ED (English speaking! program for international students! assigned to people who are keen to teach!). Invited to "dinner" by a young gentleman - actually lunch at about 10.30 in the morning. Nerdy, nice, semi-weird (check check check) but alas, a foot shorter than me. Then I was hauled off by Mr Ortho to see hand surgery. Ok, so seeing a thumb COMPLETELY SEVERED cleanly like an anatomical diagram, with the loose bit covered in ants, was pretty cool/gross. And the patient semi waking up mid-surgery was...interesting. But most of the SIX HOURS was watching someone poke at something invisible with something invisible - microsurgery. And then the rest of the night was also spent in ortho feeling like a useless sack because I can't for the life of me understand mask-muffled franglovietnamese instructions. Didn't help that the flipside of Mr Ortho's Alpha qualities (decisiveness, vigour) is impatient assholicness that rears its fugly head in theatre. At the end - 11pm, because I was going to stay with him on 24 hour call but threw in the towel - he said "the best thing I've seen you do all day is holding legs". A job a block of wood can do! Could've been more useful with a five minute tutorial on what's expected of me and what the bits and pieces are called, but no, I'm sure letting people know they're tards is a better way of getting things done. Well screw you, Mr Ortho, and screw your specialty. It's a waste of intelligence - glorified carpentry. After something like twelve hours, I'd be happy never to see any ortho surgery again in my life. I came home pissed off and depressed.
Did I say short? Heh. Still had some rant left in me.
However, today was fantastico. Worked the 2.30-9pm shift in ED, which meant yay extra sleep! But really, I heart ED. Instead of cursing my lack of Viet abilities, for once I was glad of what little I have, as I was able to take pretty decent histories. Really don't know how international students cope here, when history is like 80% of diagnosis, and so much learning requires explanation. (Not to discourage anyone who's planning to come here! depends on the program, staff and department I guess). I got to do a few procedures like blood-taking, IV cannulation (1/2 tries - better than my 1/6 record in Armi) and suturing, which is always funzies. And saw stuff like a pneumothorax, CPR, CVP measuring, emergency intubation, acute glaucoma and paraquat poisoning. ED is where the medicine is: a bit of everything, fresh patients, mysteries to figure out. A thrillion times better than bones bones bones!
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!
Friday, October 3, 2008
Crushes
My saviour has come. I should have known, he makes the lame walk! He is an orthopaedic surgeon at Choray, a ginormous hospital in Saigon town. He is tall and quick-eyed and is a man of action, which you can tell from his gait - I practically have to run to keep up with him. He's married and is, um, "friends" with my mum's (also married) cousin. Is coveting thy neighbour's (wife's) ass genetic?! My family is McWeird.
BUT, the good news is....drumroll, ladies and gentlemen...Mr Ortho has agreed to be my new supervisor!!! Get this. My old supervisor tells me to come in at 8am. I drag myself out of bed and go by xe om to the hospital, only to find out he's out at breakfast. So I pull out my laptop (having learned that long waits are to be expected). Finally he comes back, only to sit there twiddling his thumbs, deep in thought. So I sit there doing more laptop crap, breathing in more iatrogenic smoke, waiting til he decides to do something with me. Finally it clicks when he starts folding up his white coat...he's actually quitting his job TODAY! He takes me home again.
Compare this to Mr Ortho. Once I get back, we call him at around 10am. At 11.30, we meet him at the hospital. He asks what I want to do. On the spot I decide on Emergency, since that's where you get a bit of everything, plus I'm sure to see crazy stuff that I never would in Oz. He takes me there, introduces me to a guy who I'll follow around in ED, asks the lady in charge for permission, and takes me to the staff caf for an iced tea (yeah, I didn't follow my own advice about the ice and will probably pay for it! DIY oral rehydration, woot) while we wait for the training office to re-open. By about 1.15pm, it's all set, I just have to get an introduction letter from uni. Three hours after we started the ball rolling. You can understand why I walked around stage-whispering "I LOVE HIM!" and grinning.
This means I have accommodation, I have exciting stuff to do, I have a trustworthy supervisor, I don't have to breathe in any more slack doctor smoke, and I'm far away from a certain Shakespearean crackpot. I get to stay in the comfortably uncouth South, with the familiar accents and frank manners and plenty of contacts to rescue me if anything happens. All because Mr Ortho fancies my second cousin! Heh.
This is a REAL VN hospital, unlike the cushy semi-private one I was at previously. We arrived by taxi and could hardly even get off - it took ages to get to the curb because of the throng of motorbikes, bikes, pedestrians, peddlers, officials and other sundry bodies. Across the street, there's a booming side trade in quick meals to feed the hungry relatives (and indeed patients, because they often rely on outside food - not sure if they're even fed in hospital). You walk in and there are people on almost every available horizontal surface - there was a woman lying down on some newspaper right at the entrance, centimetres from being stepped on by the entering and departing crowds. It's often hard to tell the patients from the relatives. When trying to find Mr Ortho, we went on the scenic tour of the hospital as we were directed and misdirected all over the place. On the ortho clinic side, patients sit or lie in the coridoors, surrounded by anxious relatives, clutching whatever limb they've damaged. To go up or down a level, you have to brave the chaos of the elevators - the battle between wheelchairs, stretchers and doctors in a rush - or else take the stairs, which are also packed with people. In the ED, there aren't six beds as in Barmy or twelveish as at the hospital I was at previously - there are dozens and dozens of beds in rows like those shots of maternity wards, except instead of gurgling babies there are people in various states of silent distress. My home for the next seven weeks. Scary? Hell the frick yeah. Am I up to it? Errr....probably not. But who cares. Bring it on.
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.
Wednesday, September 17, 2008
Overheard
In the waiting room:
"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.
"I've been having trouble with Bubba - he throws a tantrum and cries and spits when I try to breastfeed him!"More from Doc:
"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?"
"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.
Monday, September 15, 2008
Teo and tangents
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.
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?".
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 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.
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...
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?".
Tuesday, September 9, 2008
Ritual
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.
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.
Tuesday, May 6, 2008
Candles and other obvious metaphors
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.
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.
Monday, December 31, 2007
Nam
Sweet jeebus it's great to be home. So, so many stories to tell, I'm a bit overwhelmed by it all. Never fear, trusty unordered listage to the rescue!
The Good
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 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.
- 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):
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.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.
Monday, October 15, 2007
Juggling mountains, real time
(This is from before the hols, forgot to post it)
So often you come across a list of symptoms and signs in a book, dot points to memorise for the exams. Receptive aphasia = Wernicke's area, expressive = Broca's, conductive = arcuate fasciculus. Easy enough. Wernickes are Wordy without making sense. Brocas have Broken speech. And then you find yourself at the bedside, running over the longwinded neuro exam in your head and launching into your well-rehearsed introductory "hi Mr X I'm a 2nd year med student and would it be ok if my friends and I asked you some questions everything you say is confidential and of course please let us know if you're uncomfortable at any time" speech....only to find that Mr X, though awake, isn't even looking at you or appearing to listen. Sudden panic. What about consent? how are you meant to proceed without a history? this isn't how it's meant to go! Then you collect your wits and think what this might mean. Is he deaf? Is he unable to understand? Does he have psychiatric problems? You try verbal and written questions, "could you close your eyes? what is your name?". Unblinking, he doesn't reply, despite several attempts. You notice his face is drooping on the right and lightbulbs start flashing. Mixed aphasia, facial paralysis...left hemisphere stroke. Lateral cortex, maybe middle cerebral artery? What next, coma scale score?
The registar comes with the answers, and shows you the physical exam tests you should be doing. Heaps of positive results. So, spasticity is when you bend his arm and it comes to a sudden stop. Hyperreflexia is when the lightest tap makes his arm jerk. Hemianopia is when he doesn't notice your fingers wiggling in one bit of his visual field. Inattention is why he didn't respond to you at all from the right side of the bed, but reacted a bit more from the left. The reg leaves. You're pretty proud you came up with a correctish diagnosis, plus seeing these signs in real life is frankly darned cool- things are starting to click. The panic has subsided, thanks to the comforting jargon and procedures.
Well, almost. You're still uneasy about what to make of this man. It doesn't seem right to speak about him as if he wasn't there. He's unable to understand you or say a word. Still, he's awake, can shift the blankets to warm himself, and seems to register your voice if not its meaning. How much does he understand? Is all communication lost to him, or just verbal language? If it is all language, can he even think? Is he trapped inside his mind, unable to express his indignation at being unceremoniously poked at by three young women? Can he be depressed? Does he retain his personality? Should you explain what you're doing, even though it seems to be useless? Some of these questions come much later when there is time for reflection, because on the spot you are preoccupied with figuring out what on earth is going on. Feeling a bit ridiculous, you look him in the eye to say "thank you Mr X" and pat his hand. Your friend snorts.
Outside, you look at his notes. He came to hospital for an elective operation, in decent shape albeit with some of the generic risk factors for stroke, cholesterol and blood pressure and all that. He didn't recover from the procedure as expected, and somehow - you're not sure if it's related or not - he ended up with this stroke, locked within himself. Among the pages and pages, a note from a social worker. It says how his wife was informed about how he will be severely disabled and would be best in professional care. She refused. He could be cared for at home in their back room. It is a few words embedded amongst measures of his vitals and physical exam results. Suddenly he's no longer a clinical puzzle, or a collection of cool signs, but a husband whose wife loves him enough to keep him by her though communications is impossible. Now you understand why there is a photo at the foot of his bed, a portrait of him with his dog, the man he was before he became a patient.
So 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.
Tuesday, September 25, 2007
Like an ACTUAL dumb blonde
Sometimes stereotypes are true! Quotes from our clinical tutor:
1) "There are only two people who can make the blind see and the lame walk. One's a neurosurgeon and the other you see on the Sabbath".
2) "Did you see that black car out the front? Anyone? The black turbo Merc bzzbzzbzzbzz 0-to-100kph-in-3.7-sec bzzbzzbzzboycartalkbzzz? Yep, that's mine."
3) "Oh, you guys are still in the caring phase. We neurosurgeons leave the caring to less qualified people."
!!
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."
!!
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