a matter of faith

i'm glad i made the effort to byron's birthday party last night, because i had a chat with tanya (who was also celebrating her birthday). my little spiritual dilemmas, my loss of faith in the world, my cynicism - it's all a case of been-there, done-that for tanya. she's met people who radiate wisdom and contentment from their shoulders and fingers and in everything they do. and she didn't mean psychiatrists either - she chuckled at my suggestion and said "they're so cognitive about everything". i want to meet these people. i want to have faith. i want to be sure of my actions, to act with purpose and not self-doubt.

i guess lou was right once again. *worships worships* i need to get out more. it seems answers are found in life as they are written down in books.

no woman no cry

louise, my midwife for the soul, helped me come to this conclusion last night: finding myself a girlfriend is not really a priority for me right now. having never had someone i can truly call a girlfriend, someone whose irritating habits i not only tolerate, but treasure; and having never been in love, as far as i know, i suppose i have no idea whether or not it'd be something i want. i'd much rather sit around with my mates playing cards, talking shit and drinking beer, than making myself go out and meet new people. true, observing those of my friends who are in relationships or are looking to be in relationships, i can see the inevitable trend of groups splitting into couples towards our thirties; true, sometimes i wonder if it might be worth all the trouble, in order to hold loneliness at bay; and true, sometimes i have even been tempted by someone.

perhaps i am still too immature; maybe it is because i am afraid; perhaps i am simply looking for excuses; or maybe i can't be bothered because it is in my nature to be lazy. whatever it may be, there are other things on my mind right now that interest/bother me more.

pyschosocial = root of all evil

developmental psychology, personality disorders, post-traumatic stress disorder - it is amazing what clues you can dig up from the dim dark past that seems to shed light on someone's present condition, if only you know where to look and persist long enough. maternal depression leads to dysfunctional attachment, rolling into separation anxiety, becoming oppositional defiant disorder, developing into conduct disorder, culminating in antisocial personality disorder, an entire catalogue of forensic histories, domestic violence and abuse. the vicious cycle continues. faced with a patient across the desk, at the tender age of twenty-something, against the backdrop of all of the above, the overwhelming psychosocial burden would seem to snuff out any hope of change before it can flicker. our arsenal of management options suddenly feels like a box of useless toys. what can medication, psychotherapy or social agencies hope to achieve against such a formidable fortress of human tragedy and maladaptive coping? years of psychodynamics therapy will merely peel away layers after layers of misery, anger and guilt, only to uncover more failed developmental tasks. it seems futile.

a patient presenting with any medical condition can be approached in a similar way. a middle-aged man presenting with angina - a seemingly typical problem to be managed in a matter-of-fact manner, working through the modifiable risk factors, shopping for the latest pharmaceutical miracles. but in addition to the bad genes, ailing heart, and a whole vascular system choked with atheroma, there might be a person, stressed from the demands of work; coming to terms with his own developmental tasks; coping with the responsibilities and fading dreams of young adulthood. around this person, a partner, children, relatives, friends, and a whole society revolves. how much can a doctor know and do? it can never be enough.

we had dinner with dr greenberg and his wife yvonne tonight at soulmama. the food and the restaurant was very decent; the mood from the table reflective and hopeful, looking to the past and the future. i glimpsed the bay outside and couldn't help but wonder at the mass of humanity that the bay had witnessed passing by its shores: all the dreams, emotions and lives that were, are and will be. we are all children; wonderful, ridiculous, oblivious children. the bay does well to laugh at us, at our silliness. it will still be there when we are gone.

the trouble with human beings is we can grasp the idea of eternity and a sense of our mortality at the same time. it is our gift, and our curse.

at last - found my turkish delight! 

lost and happy

today i spent the day with the cat team at broadie, where i met maria the worldly czechoslovakian psych reg, noel and alan the wizened cynical road-weary psych nurse-warriors, and angela the young intelligent idealistic nursing student. i am of course sterotyping outrageously here. it was a fairly quiet day, and i spent the most time talking to maria. she raved on about psychotherapy and got me excited and even suggested i go and see a psychotherapist myself, just to satisfy my curiosity, to cultivate my inner awareness, to explore issues that are ingrained in my subconscious, so i can become a mature and better person and doctor. this lady obvious knew how to push my buttons because i spent the whole afternoon absolutely certain that i wanted to become a psychiatrist. we also chatted about psychiatry training, subspecialties, spending more time in the hospitals gaining exposure to medicine versus streamlining into specialty training, the ridiculousness of diagnosing using DSM-IV criteria, the mental state examination, the new medical curriculum, share housing accommodation, the pros and cons of driving, whether a patient visiting prostitutes is a symptom of mania or simply a lifestyle choice, and whether it is the role of a case manager or the public housing commissioner to clean up a psychiatric patient's flat. i even scored a ride back into town with her in her flashy silver chrysler - sure beats catching the train!

you know i'm not one to conform to social norms; in fact, i like rebelling agains them, sometimes because i see through them, other times just to get a response out of people. but often it's purely accidental (i swear!) - i'm just as lost and confused as the next person, only i like to think i have insight. anyway, today's experience confirmed my belief that being lost can be a good thing. i enjoy being lost. when you have no idea where you are and where you are heading - it's liberating. knowing exactly where you want to go can give you tunnel vision; you forget to look around and enjoy the scenery; you close your heart to the world.

so i say to myself: fuck trying to finish my training as soon as possible. i don't even know if i want to get there. i'm lost and i'm happy. i'm just gonna enjoy the ride, baby! get to know myself; try out all the things that interest me; and go book myself an appointment with a good-looking private psychotherapist!

just another sunday

today i let myself sleep in, feeling my body coming down with yet another cold, closing my eyes to resist the brightness outside. eventually i gave in, got up, made some coffee, warmed up a bowl of oats with extra honey, and ate in front of video hits. moped around the house and on the internet until thommo suggested we go to the vic market to grab some meat and veges. i decided it was time to ditch my disgraceful five-dollar k-mart slippers and upgrade to sheepskin. thommo even let me drive his car there although it took me twenty minutes to parallel park. for once, the colour and noise and activity of the crowds was interesting rather than annoying, and we wandered past random stalls, comparing prices of slippers, capsicums and lamb chops. on the way back to the car we complained about our sore arms from the heavy plastic bags filled with goodness, but we were smiling and joking. packing our shopping away at home has always been associated with warm fuzzy feelings and boyish excitement, deciding what to eat first, what to save for later, gazing at our bulging fridge and pantry with satisfaction. powernapped after lunch and sneaked in a cigarette. it's been another lazy, uneventful sunday - perfect.

i suspect i may even be happy without realising it.

it's hard work being good

i know psychiatry agrees with me. i found this out when we first encountered it during psychogeriatrics. delving into someone else's life story interests me like nothing else i've come across so far, finding out where they've been, why they are as they are, building up a rapport with them until i become a node for change in their lives - these are my addictions. and yet the scare tactics over the years must have worked. the idea of actually being a practicing psychiatrist is something i instinctively, irrationally reject. i know i could do it, i know i'd love it once i get into it, but i am holding myself back. at least part of it is i simply can't be bothered: with all the other things happening right now, learning med is the last thing on my mind - even if the long case is worth 50% of the block assessment. i should give it a good go, but swimming up is such hard work... *sigh*

bureaucracy is bullshit

i know baz will agree with me on this one. stupid UHT people.

bureaucracy is the bane of the intelligent common man and woman. it's purposes for existing is to take something simple and make it as complicated as possible, to multiply inefficiencies, to flood the world with bullshit and frustration, and fill our heads with things we'd like to do to the incompetent little shit's skull.

case in point, this ridiculous timetable i have in front of me spanning nine pages, which i have to wade through to figure out where i'm supposed to be in the next few weeks. why couldn't the course coordinator have put the time, the place, and the person i'm meeting all on the same piece of paper?

internship applications is the same. why do we have to apply to pmcv and the hospitals separately? why do we have to go through this bullshit process of sending CV's, filling in application forms, writing cover letters and doing interviews many different times? why the useless referee reports? if we're all guaranteed intern jobs, why can't we just send one copy to the faculty, fill out our preferences like we did for clinical schools, and just do one interview with an independent interview panel rating us according different desirable qualities requested by the hospitals?

the answer: because it'd make sense! it'd mean unemployment for people doing useless jobs! oh no we can't have that! we'd actually be able to concentrate on our clinical experience and learn about medicine and not waste time and energy worrying about other peoples incompetencies! that would never do!

*sigh* just another annoying thing we are confronted with, every morning we wake up...

just what to do with myself?

the emergency block is unofficially over, as we have no more scheduled tutorials, each of us with just a handful of shifts left before our time in the ED is done. most of us have found it a wonderful 180-degree turn from "rural health", to hit the ground running, to be doing things with our hands. the docs and the nurses have mostly been awesome - going out of their way to fit us into their busy shifts, allowing us opportunities to learn if simply because we were there. this i'm sure has changed a few peoples future career leanings. it's strange how much meeting one good consultant or registrar can play a part in our decisions on how we live our life. for example, after doing oncology (ahh my hero dr ding) at the western, half our group were thinking about becoming oncologists; after general surgery at ballarat (debbie, mr deutscher, mr stewart) even i thought surgery wouldn't be so bad; and now, even though i still detest the idea of shift work, and all the blood and wow-factor of major trauma doesn't really excite me, i'm thinking about doing some emergency rotations in my future training. how impressionable we medical students are! it only makes me more excited about working as a doctor in the public system - i can shape generations of malleable bright young virgin minds with little more than free coffee or a few half-hour tutes. *rubs hands with glee*

most of us have been preoccupied with the process of applying for internship this week. much of our talk revolve around where we want to go and how we can get there. and while it feels like our lives will be in limbo until july 19, it's interesting to read lou's musings: "while decisions regarding internship seem overwhelming, whichever hospital, whichever city, there is really no devastating option". this is so true. so many times when i've been in a introspective mood (which is too often, i might add), i've told myself - if i hadn't come down to melbourne, if i hadn't lived at jch for a couple of years, if i hadn't done my clinical years with group a - think of all the great people i would've missed out on knowing, all the friends that i care about that simply wouldn't exist for me. but the truth is, i would've simply met other people, made other friends, and that's all. i wouldn't be a worse person - just different. so it is with internship - wherever i end up next year doesn't really matter as much as it seems right now. as long as i seize the day, try to squeeze the marrow out of life, swim up to the surface as often as i can - then there can nothing more a person can ask for.

mother's day

had a long chat with mum today on the phone. we talked about a lot of things such as whether it's good or not to be religious; where i want to go with my medical career; if i should be reading so many books on philosophy; why i always seem to get really bad colds; people in my beloved group a; how the takeaway shop is going; my little brother; my dad. i love talking to mum for hours and hours, even though it doesn't happen very often (mostly my fault), and i know she always looks forward to my calls (and misses me a lot) because she doesn't really 'chat' with my dad or my brother. i really should talk to my mum more often!

right now i've got a terrible cold and it's really annoying as the day outside is clear and sunny and i should be going for a walk and be content and be enthusiastic about doing another shift at the emergency department this afternoon with catherine. but instead i'm miserable with a sniffly nose and constant fruity coughing, wondering if i really should be going into the hospital spreading my virus around already sick people - i guess i shouldn't. *sigh*

last night min was on msn and she appeared to be rather stressed about the whole internship application process. of course, i started looking around the web for information myself and naturally became slightly stressed myself. thanks minnie! :-p there's like a hundred things i have to do before the month is up: CV, applications, contacting referees, going to the career expo and hospital information evenings... etc etc. luckily i've pretty much decided where i want to go: rmh, austin, western, ballarat - sticking mostly with what i know. hopefully i'll get a job at one of those four places, trying hard to resist the fear that i might not and applying to more hospitals that i don't really know anything about nor do i want to find out. i lasted until about 11pm, my head heavy with viral goodness, passing out somewhere between my computer and my pillow...

existentialist angst in true absurdist tradition 

no more black hole

i'm sick of my mood swings. they've become a big problem recently, occurring more frequently and with greater intensity, interfering with my life. talking to min helped me clarify things in my mind: when people irritate me, i bristle and confront rather than reason or tolerate; when i'm in a bad mood, i seek attention by antagonising others around me; when i disgust myself i want other people to hate me too, so i can feed my negative thoughts; indulging in the darker emotions of my personality makes it contagious, contaminating others around me. after reading one of the posts on lou's blog, i've realised what this all means: i'm hurting my friends and isolating myself from people i care about. i've got to fight it, brave the stormy waves a bit rather than sinking to the bottom. i don't want to be a "fucking ray of sunshine" - i just don't want to be a black hole.

turning over a new leaf

the second day of a new beginning. let's see how long this period of reinvention lasts. after the hiatus that was the rural health module, i must admit i feel excited to be back at the royal melbourne hospital, with the promise of seeing real patients and learning about real medicine again in the emergency department. with exactly seven months until graduation, there is no better time than now to shift gears. there is so much to learn and relearn until i can feel comfortable enough to step into the role of an intern, whereever i end up in january next year. my pristine 16th edition of harrison's looks more inviting now than it ever has - i'm sure that will wear off in about two minutes. on a personal level, having decided to move on from the momentary giddiness of the last few days, i need distractions - lots of it, whereever i can find it. any ideas?

both lou and baz have recently started new blogs online. i love discovering new things about people i thought i had pigeonholed. they're both intelligent people with a great deal of common sense - probably two of the most with it people i know, who seem to have things together and under control, comfortable with their intrapersonal and interpersonal relationships. how refreshing it is to find that they too subject themselves to barrages of self-criticism and doubt. i suppose it means i'll have to give up these habits as excuses for my uncontrollable mood swings. no more excuses for sinking down to the bottom. bummer!

there's a new home for the shrine, kids: http://shrinetogroupa.blogspot.com/

a brush with love

well my outburst a couple of days ago certainly got a me a few raised eyebrows. talking to a number of mates i've allowed them to talk sense into my befuddled thinking, point out the obvious, and show me where the shovel is. all that's left to do is to dig a big hole and bury these feelings deep deep inside. ooh i wonder what kind of neurosis will it surface as in thirty years? *rubs hands in anticipation* but it is the easiest thing to do; it may even be the best thing to do (i'm steering away from right/wrong here as they are concepts fraught with danger); and i guess the bitter taste in my mouth is to be expected. after all, love is the only emotion we have to fight our fear of death, or so they say, so one can't expect to come out of a brush with love unscathed. what did surprise me was baz saying that he was surprised that i was so open about it. apparently i give the impression that i keep things close to my chest. well, i suppose that is a fair call given i'd never talked about my feelings for a particular person before (mainly because there aren't that many people to talk about). usually i just talk about my preoccupation with death and suicide. but i reckon these are pretty personal subjects too. maybe he is just used to me moaning and whining about my bad moods and generally me being terrible company. what an absolute champ he is to put up with me for the last four weeks. actually, that goes for everyone of my friends over the last few years. cheers kids, you're all lifesavers.