Hog thoughts

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

Musings from the back of a motorbike:

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

Month

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

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

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

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

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

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.

Neurosis alert

Current stressors:

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

Ok feeling better now.

Who's got the map?

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

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

New Year's resolutions

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

Ok. Resolutions.

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

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

Oy navel gazing again.

Mountains

It's 4am and I just had to purge my brain of the thought that has been clanging about for weeks. The idea is this: the task of becoming a good doctor is a lifetime's work, and an honourable aspiration. It is also something I am still not sure I can accomplish, because to be a good doctor is to juggle mountains (to use a totally obvious metaphor).

On one hand, you must master the vast body of scientific knowledge, numerous disparate fields of both ancient and developing knowledge. Anatomy, biochemistry, embryology, physiology, pharmacology, pathology, genetics, microbiology, immunology, histology. Whole careers are dedicated to subspecialties in these domains; you have to know them all, at least to a basic level. Many things make sense, others must be hammered into your memory by sheer bloody-minded force. You need an almost obsessive thirst for facts and an innate logical wiring. In first year I thought that medicine was in some ways less intellectually rigorous than the humanities which require critical thinking, generating ideas. That's still true, but now I have greater respect for the many fat detailed books that have to be crammed into my small head with its penchant for big-picture intuitive concepts.

On the other hand, there are clinical skills, that ambiguous art of learning from touch and hearing and observation, distinguishing and integrating subtle signs, recalling obscure connections between them, matching them to the sciences, keeping your mind open to rare possibilities while honing in on the most probable, decision-making in the face of uncertainty based on epidemiology and evidence and experience. At the moment I don't trust myself; it all seems so subjective.

Finally, there is the human side. All the above facts and skills must be internalised so that you can see the individual patient as a whole, not a cluster of symptoms but as nothing less than a fellow human being with all the dignity and vulnerability that term implies. You must connect, empathise, reassure, instruct, question, attempt to understand the landscape of their lives. You must see them clearly with both objectivity and compassion, and respect them. What's more, acknowledge your own weaknesses and fears. You have to keep an eye on ethics and its scarier big brother, Teh Law. You have to maintain humility while projecting and indeed having self-confidence. You are privileged to have contact with people in extremis and experience a broad spectrum of the human condition. This is the bit of doctoring that convinced me to take the blind leap from BA/LLB to BMed. We'll have to see if it's good enough.

It is a rare doctor who manages to keep all three aspects in the air at the same time, even in the higher echelons of the profession. Common in our tutorial rooms are the well-intentioned doctors, certainly caring, but a little sloppy with factual details. In our lecture theatres and in hospitals, often you find doctors who have conquered those first two mountains and even create new knowledge - but who lose sight of the person behind the clinical problem. There is also a thread of self-pity among medical students and doctors, I've noticed. Hell, I've been guilty of it myself. The training is difficult and long, the price of mistakes are high...but all the same, as I read elsewhere, it's nothing compared to being on the cold end of the stethoscope or scalpel. And it's an honour to be trusted with someone's health or even life.

I have seen doctors I can admire, though. The latest is a professor I am crushing at the moment (intellectually only!). He teaches eloquently - it's not grandiose, just lucid and precise - and has dry understated humour, but most of all has that indefinable humane quality. It manifests itself in the way he talks to, and not merely about, a patient in a clinical presentation; how he touches her arm gently instead of manipulating her like a lump of meat. I have learned to identify good doctors. Becoming one? I still have many doubts and fears, but insha'allah that's what aquackening will chronicle.

Course, there will also be posts consisting of lists, rants, annoying alliteration, navel-gazing, swearing, pretentious rhetoric, indecision, woe-is-me whining, groanworthy jokes, and abuse of the English language (et français o español si j'en ai envie, porque tengo que les practiquer), etc. Just so you're warned.