A void

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

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

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

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

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

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

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.