run away while you still can

wednesday: worked on yearbook unti 11:30pm.
thursday: worked on yearbook until 2am.
friday: worked on yearbook until 4am.
saturday: work on yearbook through the night (no sleep).
sunday: after 5.5 hours printing proofs, pass out at 6pm.
monday: ward rounds at 7am. full day at uni. will be working on yearbook tonight. again.
the feeling when we get the yearbooks off to the printers and can finally STUDY: priceless.

yes, when studying seems like a reward, you know you're losing the plot. but that's the way it goes... exams are less than two weeks around the corner. and looking at the chaos that enveloped the ward this morning when the new interns started on the job (one even had a cheat sheet about bowel anatomy), i know january 16 next year will be a day of sheer panic. one patient in outpatients this afternoon asked me "are you sure you still want to do this job?" after she finished crying about her bowel problems. i said, "maybe i'll become a writer". yeah, right, maybe i still have time to quit med and run away from next year.

and the feeling i'll get when i finally get a copy of the yearbook in my hands? it's called an anti-climax.

a patch of green

come on baby blue
shake up your tired eyes
the world is waiting for you
may all your dreaming fill the empty sky

but if it makes you happy
keep on clapping
just remember i'll be by your side
and if you only go, it's gonna pass you by
- oasis

there is a patch of green in my backyard. it suddenly appeared over a week or two, with the warm breezes and the dusty rain telling me it's spring. there are the large hands of the potato leaves, the grasses waving their arms towards the sky, and the very first flower of spring, a little yellow thing, daring to stand out against the sea of greenness.

we are all waiting. the end is coming. i am excited and scared. it'll be alright, i tell myself. just look at the patch of green. they are oblivious to what is happening to me. they only grow, as is in their nature, and everything else is not their fault.

this dying business, part three

Later on that morning, after the consultant ward round, while I’m waiting for my new friend Mohammed to organise my discharge paperwork, an eager and very pretty fourth year med student found me. The lucky girl got her long case in half an hour. I even helped her with the lymph node examinations. I wonder if it’s unethical for a patient to ask their medical student out. What am I thinking – of course it’s unethical!

I ask her (nicely) to get my file so we could read it together. Mohammed’s writing is terrible. There is nothing to see on my X-ray but I get Sarah (the medical student) to talk me through it anyway, just for practice. She is better than I was when I was in fourth year, that’s for sure. Before she leaves she asks me a few interesting questions.

‘Is it weird being a patient?’

‘Yeah. Although, they treat me a bit better because I’m supposed to be on their side. But no one tells you anything. The nurses have no idea what’s going on. The residents have no idea either, unless they read my file. The reg is nice but I hardly see him. And the consultants have even less time. You lose all your privacy. You can’t sleep properly at night. And the food is bad.’

‘What does it feel like being diagnosed with cancer?’

‘It’s really strange. For a while it was like, no way! I was supposed to be finishing med school and doing my internship this year. But then the shock kinda hit me about half way through my first consultation, and I didn’t really hear what else the doctor told me after that. They booked me in for chemo and all that, but I just kinda went along with it. I didn’t even though if I wanted chemo. Hadn’t thought about it at all.’

‘What do you mean? Why wouldn’t you want to have chemo?’

‘Well… I don’t know. People always assume you want to live. I wasn’t sure about that. I mean, living is such a chore, sometimes. But I was like, okay, I have cancer. What the fuck do I do now?

‘But it forces you to re-think everything. I mean, you know how you have to get up by a certain time because you had to come into the hospital by a certain time and sit through tutes you didn’t want to go to because you are afraid you might miss something? Or you watch a movie or go out with your friends and you feel guilty because you should be studying?

‘Well, all of a sudden I didn’t have to worry about any of that any more. I didn’t have to worry about passing exams and moving house. I didn’t have to worry about eating bad food and losing weight and quitting smoking. I could read whatever I wanted, and watch movies or play computer games all day long. It was great. I might die! I might only have a few months or years left! What am I going to do with the time I have left? What do I really want to do right now?

‘And I found I was noticing things more: the colours, the feeling of the sun on your face and arms; the sound of trees swaying in the wind; the people around me, strangers and friends, the colours of the clothes they were wearing, their body language; the smell of food and perfume; music! It was absolutely fantastic!

‘I didn’t think I was going to miss anyone. I mean, other people might miss me, but dying is a very personal thing. It’s the only time when I feel that my time truly belongs to me. I’ve never seen death as a bad thing. Yeah, I know I’m weird.’

‘But you are having chemo now?’

‘Yeah, eventually I came around. My parents and my friends made me go along with it. I was already booked in for the day centre anyway. And, I mean, I know the survival rate of Hodgkin’s is pretty good with chemo. It’d be a bit silly not to give it a go, really. I think I was just toying around with the idea of dying. I didn’t really want my mum to feel sad!

‘But this experience has definitely been a positive one. I know what it’s like being a patient now. I know how much it sucks being in a public hospital. I know what it feels like to be told bad news, not just to tell it. And it’s changed the way I see things and live my life. It’s like I’ve only just started to live.

‘This dying business, you should try it sometime.’

I grinned and winked. I think she thought I was crazy and made a hasty retreat. Ah well, ethical dilemma resolved!

this dying business, part two

Next to me is Mr Beswick, a retired plumber. He is a 78 year old man with lung cancer who’s been on the ward for four days. He presented with worsening shortness of breath and weight-loss of twenty kilograms over seven months. The GP did a chest X-ray, which showed a pretty big pleural effusion around his left lung. So he sent Mr Beswick into hospital straight away to have the fluid drained. One smart intern thought about sending it for cytology and it came back positive for malignant cells. Score one for the team! They did a CT and found the primary cancer in the left upper lobe (of the lung) with enlarged mediastinal lymph nodes, but no metastases in the usual places. So now he’s waiting for a biopsy to obtain some tissue for histology, and a pulmonary function test to see if he has enough pulmonary reserve for the surgeons to remove one lung.

Of course, getting all this information hasn’t been entirely straightforward. Mr Beswick himself isn’t quite sure why he still has the chest tube in place or why he’s having the pulmonary function test. I don’t think they’ve even broached the subject of surgery yet. All he knows is he has cancer and the doctors are “running some tests”. The story had unfolded over a few hours on Sunday afternoon, in dribs and drabs, between visitors coming and going, and a lot of guess work and piecing the pieces together. It’s very frustrating that I can no longer just go behind the nursing station and read his file.

I myself have been here for two days. I felt a bit crook on Friday, coughing and sputtering and a bit sinusy, and woke up hot and sweaty on Saturday. I measured my temperature and it was 38, so I had to come into emergency. Luckily my mate Baz was doing a shift, so I didn’t have to hang around for that long. They really do need to rebuild the whole department – its tiny cubicles and narrow corridors and the cramped fishbowl area really makes it an awfully uncomfortable place for both patients and doctors alike. Anyway, they took some bloods and my neutrophils (which help the body fight infections) were a bit low. So Baz made some calls and worked the system and I made it up to the ward by mid-afternoon, admitted for observation. Just my luck – stupid neutrophils!

I was donating more blood to the nurse (her badge said Silvia) when a dude with a stethoscope marched in. The fact he is a doctor is a no-brainer, and I guessed he was the resident by his brisk walk. Registrars walk a bit slower, and they dress nicer, too. Medical consultants walk even slower. Besides, they never round this early. And they wear suit jackets. You used to be able to tell them apart by their age, but with all the postgraduate students around these days, you just can’t tell any more.

‘Good morning Mr Li. I’m Mohammed, one of the doctors on the team who will be looking after you. How’re you feeling today?’

‘Yeah, good thanks. How was your weekend?’

Mumble-mumble. He is flipping through my file and obs chart.

‘I see you have come in over the weekend with a temperature. Have you had any more fevers or chills?’

‘Not since yesterday, no.’

‘Well, your X-rays came back negative. We’ll see what your blood test shows this morning and if they’re good we can probably send you home today.’

He looks up and grins. He thinks he’s saved my life. Wonderful. I decide to really make his day.

‘Mr Beswick next door is a bit worried about what’s going on though. He’s not sure about this lung biopsy thing so maybe you should have a chat to him. And he wants to know if he needs to have surgery. I don’t think anyone has told him.’

Mohammed looks at me quizzically, and then at Mr Beswick, who is struggling to wake up for Silvia, and then back at me again.

‘Ah right.’

this dying business

last night i didn't feeling like studying, so i decided to take the night off and do something i really enjoyed: daydreaming and writing it down as a story. so here it is, the first of three parts of a short story: this dying business.

*
Ward 2C at the Western Hospital Footscray is a rather dimly-lit place. There is a decided lack of natural lighting, and the only windows open out to the orange-brown bricks on the other side of the hospital. In the small courtyard of synthetic green in between the buildings, under the dusty Coffex umbrellas, patients and visitors are smoking and drinking coffee, with the grey Melbourne sky hanging heavily overhead. This rather drab scenery outside may explain why, more often than not, the blinds are drawn down in the patients’ rooms, which makes the ward even gloomier. Inside, the corridors are pink and orange, the furnishings are blue and grey – pretty standard décor for a hospital last refitted sometime in the last century.

It is seven o’clock in the morning on a Monday in June. Outside it’s a nippy four degrees and the city is struggling to awaken in the midst of a cold front. Inside it’s a more comfortable twenty-four degrees, thanks to the efficient (and at times rather overzealous) hospital heating system. Most of the patients are still asleep, but at the nursing station there is a bustle of bags and coats as the new shift of nurses come in for handover. Orderlies are starting to arrive with the breakfast trolleys filled with cereal and fruit for those who can still eat, and jellies and yoghurt for those that can still swallow. For those who can do neither, well, I suppose the bags of liquid goo or 5% dextrose will have to do.

Sitting up in my bed, I’ve been awake for an hour and half. I’m listening to Neil Young on my Discman and reading about sarcoidosis from my beautiful new edition of Harrison’s. No one knows what causes sarcoidosis, but it is related to an overly enthusiastic T cell response to unknown antigens. These antigens must be pretty ubiquitous, because these T cells and their recruits (mononuclear macrophages and other inflammatory cells) form granulomatous lesions in pretty much every organ around the body. However, unlike things like chest infections or asthma, which will let you know that they’re around, these lesions are often clinical silent, and only cause problems when they become bigger and distort the normal structures of organs. It’s a fascinating disease to read about when you don’t have to worry about memorising the long list of possible clinical presentations.

My breakfast arrived but I give it a miss because I’m not feeling particularly hungry. Hospital food is notoriously unappetising, but I think that’s confounded in a large part by the fact that when you’re sick you usually lose your appetite. As a poor and hungry medical student, I remembered looking at the patient food trolleys and thinking about “liberating” a few trays for the “advancement of medical knowledge”. I never did, of course, so I never found out what they tasted like, until now. But the patients have been right all along – they do taste rather bland, and are usually cold by the time the land on your table. No wonder the inpatients always take so long to get better – how can the body heal itself when you don’t feed it with yummy things like stir fries and Indian food and cold beers?

I Corinthians 13

Though I speak with the tongues of men and of angels, but have not love, I have become sounding brass or a clanging cymbal.

And though I have the gift of prophecy, and understand all mysteries and all knowledge, and though I have all faith, so that I could remove mountains, but have not love, I am nothing.

And though I bestow all my goods to feed the poor, and though I give my body to be burned, but have not love, it profits me nothing.

Love suffers long and is kind; love does not envy; love does not parade itself, is not puffed up;

Does not bahave rudely, does not seeks its own, is not provoked, thinks no evil;

Does not rejoice in iniquity, but rejoices in the truth;

Bears all things, believes all things, hopes all things, endures all things.

Love never fails. But whether there are prophecies, they will fail; whether there are tongues, they will cease; whether there is knowledge, it will vanish away.

For we know in part and we prophesy in part.

But when that which is perfect has come, then that which is in part will be done away.

When I was a child, I spoke as a child, I understood as a child, I thought as a child; but when I became a man, I put away childish things.

For now we see in a mirror, dimly, but then face to face. Now I know in part but then I shall know just as I also am known.

And now abide faith, hope, love, these three; but the greatest of these is love.

the end of the beginning

today i turn 23. the age at which I will graduate from uni and begin full time work. i've never been one for big birthday celebrations. it is simply another day, although perhaps one on which people tend to reflect more on their existence, like new years day. a moment to pause, to consolidate the past and plan for the future. some would say it is a cause for celebration (kind of like funerals, really). for after all the only true currency we possess is time, granted by this spark that inhabits my body and distinguishes it from a cadaver. but i feel too weary to celebrate anything today. it's been a busy few weeks of uni and yearbook things, and i'm not looking forward to the early starts and late finishes of the surgical block. and lately, i have been feeling quite sedated. it seems as if i have been waiting for something to jolt me into action, to inspire me to attempt great deeds. but there are so many daily distractions that crowd my thoughts that maybe i've missed the call to arms.

when i was little i used hate sleeping. i used to feel indignant that i had to go to bed before the saturday night movies came on. mum used to use the delaying tactic on me: when you're at uni, you can stay up as long as you like, rent and watch as many videos as you want. so i waited impatiently for that time to arrive. but now, the bed constantly calls my name, and only rarely do i have the energy or time to sit in front of a movie. there isn't enough hours in a day to do everything, and the only thing i seem to be able to skip is sleep. my coffee in the morning is getting blacker, my heartburn and palpitations getting worse from the caffeine, and my concentration wanders more and more...

so perhaps i shouldn't underestimate the power of a birthday. it is time for action. it is time for sleep. it is time to cultivate that spark of life. thank you everyone who's messaged me and sent me cards. you guys are the only other true currency i possess and treasure.

"now this is not the end. it is not even the beginning of the end. but it is, perhaps, the end of the beginning."
- winston churchill, november 10, 1942.

the hello kitty version of christianity

- He wants us to love Him, because He loves us.
- so basically he wants love, just like everyone else. to love and be loved in return. that's fair enough.
- Yes. God created us in the image of Him. He made us with a purpose for us. He made us to share his creation with him. But he also gave us free will.
- so he's got all these things going for him, but he felt a bit lonely, so he made us to get a bit of loving happening.
- well he really stuffed up didn't he. why give us free will?
- well, so that we're different to robots, i guess.
- if we all just obeyed without questioning, wouldn't that be easier?
- i suppose that wouldn't be love...
- well, isn't it just like between people, then? if you loved someone and they don't love you, what can you do about it?
- not much. so if god keeps falling in love with all these people, he's bound to get disappointed now and then.
- oh he gets disappointed yes. every day. every second.
- he's got to learn to let go. just like me.
- yet he waits and never gives up on us.
- sounds like a pretty big crush.
- it's much more than a crush.
- okay, say he's like my mum, then.
- yup
- but i know my mum. i have all this memories of my mum. i have no memories of god.
- well, i guess it's difficult to have memories of someone you never knew
- mm... this crush that he has on you... so much so that he sacrificed his only son to die for you
- right. so i need to understand the story of jesus. so i should read the bible?
- it's a bit of a roundabout way, though. why doesn't he just come into my dream and say, hey, i'm the creator. i love you. i find you really attractive. want to go out?
- he's waiting for you to ask him out.
- far out.
- part of the free will deal. although, i guess i'm his wingman. he's a bit shy
- right. i was going to say, he creates me and then goes all shy on me.
- and technically, you're not his wingman. because that would mean you have to chat up my ugly friend. you're more his mate who puts in a good word for him to help him score.
- right right. i'm that one
- well, this is an interesting concept of god, anyway. a girl that did some fantastic thing for me (fantastic thing as in, created the world and me), in the hope i'd be interested to find out more.
- well i still figure god should have some guts and ask me out.
- but then i suppose it's a hard thing to do, if i don't appear to be interested.
- and it's not a crush, so god can't just let go.
- *sigh* sounds like asking for trouble, really... hope i'm worth it
- if we get together and god finds i'm terrible... the breakup would be really messy

and i'm still not convinced about the omnipotence bit. if she was all that, then why would she let little kiddies die? and what about all the other gods? are they the same? feeling a bit lonely and trying to find someone to love them? anyway, i found my little green gideon bible. hopefully the new testament has as many cool stories as the old.