Dream: neonatal resuscitation

In this dream I'm sitting in Outpatients Area 2 at Royal Darwin, where I usually have my clinics. Somehow I know that this is an ICU outpatients clinic, which is a bit of an oxymoron..

I pick up the next file from my usual maroon box of files and call the patient. No-one answers but there's a baby in front of me. I pick him up and take him into my office, and no parents seem to be with the baby. It's a happy gurgly chubby baby of about 9-10 months, and I bounce him up and down on my lap, whilst reading through his file. All I can see are normal antenatal records, and there's no mention of why this baby is in my ICU clinic.

Suddenly my boss Tsin comes into the room.

"Nancy! What are you doing? What's wrong with his baby?" He demands angrily (very unusual as he's usually such a mild man).

"I don't know why this baby is here, I'm just trying to figure out what's wrong with it."

The baby starts smiling and laughing on my lap, then it suddenly falls to the left of me and hits the ground with a thud.

I panic and look down. The baby is having a generalised tonic-clonic seizure and appears to be frothing at the mouth.

My head runs through A...B...C... but I'm frozen in action. I crouch down on the ground and try to turn the baby on its side.

"What are you waiting for? Start CPR!" Tsin shouts at me.
"But.. but.. he's still breathing and has a pulse.." I protest feebly.
"I don't know what you're thinking, just hurry up." He glares at me so I put my hands around its skinny little chest and start compressing its chest.

All of a sudden he stops seizing and looks almost peaceful in my hands. For a brief moment I wonder if he's dead. Then Tsin says "Where's the drill? We need it now!"

As I'm thinking "what drill? why do we need a drill?" He pulls a big green drill that looks like something from Bunnings out of his back pocket, and snatches the baby from my hands.

He puts his hands over the baby's skull and feels for the fontanelle. Then he drills directly into the fontanelle and the baby screams as clear CSF runs out..

Then I wake up, horrified.

The importance of being thankful

Is the world really coming to an end?

Starting with the Queensland floods, which were in progress as I was driving up to Darwin, there's been such a spate of disasters. Cyclone Yasi, the volcanic eruption in Indonesia that postponed my Bali trip, then Cyclone Carlos, and now the Japanese disaster. One can't help but feel like the world is really falling apart. When I was young one hardly ever heard about natural disasters. Sure they happened, but always somewhere far away and so removed from our lives that they hardly seemed real. Now everything's instantly available, and thus we are constantly reminded of what terrible shape the world is in.

I feel so awful for the people of Japan, many of whom probably never thought that a nuclear disaster of such a scale could happen in their technologically advanced country. The bombings of Hiroshima and Nagasaki were so horrific but somehow it was easier to accept psychologically, as there was an "enemy", someone to blame. There's no-one to blame for this disaster - nature chose that place to strike, and it so happens that the nuclear reactors are involved. I wonder if the scientists in the nuclear plants ever projected what would happen in this situation - did they predict that this could be possible? It would be chilling if things were just left the way they were, even if people were aware that this could happen.

If the world really is coming to an end, I must say I feel grateful for what I have been through in this lifetime. There is no time better than now to recapitulate all the things I appreciate in life -
... delicious food (this list would be too long)
... philosophical conversations with strangers
... really wonderful books that transport one to another world
... my piano and violin
... the music of Chopin and so many other great composers (a few current favourites: Meditation by Tchaikovsky, the G major violin concerto by Mozart, Clair de Lune, Salut d'amour by Elgar, the Dvorak violin concerto)
... amazing vistas I have seen - sunsets in Darwin, the Himalayas, Tibetan monasteries with their yak butter lamps and prayer flags, the salt plains of Bolivia.all the crazy experiences I've had while travelling
... frangipani trees
... all the people that have supported me in my studies and career (special mention to my Yr 12 German and chemistry teachers, and to the truly inspirational doctors I have met - Dr Roach, Dr Ong, Dr Kliman & Dr Collins)
... all my pets - Ashley who was with me for 15 years, and Kody who has brought so much joy to our family in the last few months
... let me try the food list now - cookies & creme ice cream... red bean sticky rice dumplings.. ayam goreng at Mamak.. hand made taro balls... cendol, faluda, ais kacang and all other icey drinks.. durians.. fried stinky tofu.. 1000 year eggs.. Rapid creek markets.. green papaya salad.. pad thai man in Krabi.. fresh tuna sashimi... freshly baked bread.. gorgonzola.. smoked salmon.. Campos coffee.. Bees Knees coffee.. kim chi pajeong.. unagi don.. fresh salads at Bagan.. whole fried snapper with lemongrass and chilli at Chat Thai.. ricotta pancakes with honeycomb butter and caramelised banana... fresh edamame.. tomatoes from the garden.. eggplant curry.. coconut oothapam... pongal, dear pongal... paper masala dosas.. besan laddoo... rice with curd and pickles.. mango lassi.. larb... black glutinous rice pudding.. I could probably fill up a whole page with food, but I'll stop now.

... and finally, my family and friends. Thank you all for being there for me at different stages of my life - so many people have passed through, some have stayed for a long time, others just for a little while. Whatever little contribution you have made to my daily life or overall life, whether we laughed or cried together, shared a life changing experience or an ice-cream.. it all matters, and I wouldn't be who I am without you.

This sounds like some sort of acknowledgement at the end of a book (except the food list is too long to be in one), but really I am just thankful on this day that I am alive and healthy, and that I've had such a great life so far. Let's hope the world keeps it together for a while longer, so I get to travel to a few more places and eat a lot more food!

Dream in Bali

This is the dream I had on my 3rd night in Bali.

The dream starts inside Coles, where I'm standing at the fridge to the side of the fruit & veg section, usually full of cold drinks. I'm looking up and down the display and there's the usual coke, red bull, iced tea etc. My eyes settle on the top shelf where there is a row of NT-unique iced coffee (I think it's called Territory's Own?).

As usual I'm amazed at the selection, standard iced coffee, skim, double shot, chocolate etc. There's a big sign underneath one end of the row, advertising "Special! IV salbutamol, $3.49 per bottle."

I'm puzzled and look around for someone to explain why the iced coffee is advertised as salbutamol. Then a short squat Indonesian woman grabs my arm in a vice-like grip and hisses "Be quiet! This is not how we do things in Bali!"

I'm startled and allow her to drag me away from the drinks fridge. She pushes me down a few aisles till we come to an entire aisle filled with kaya of all different colours in different sized jars. She says, "Quickly! Choose one!" I look around, not sure what the differences between all the jars are. As I hesitate, she grabs one off the shelf and gives it to me. It's filled with luridly green kaya (the colour of radioactive stuff on the Simpsons). The jar itself is a weird shape, with a very narrow neck and I wonder in the dream how I could possibly put a spoon down the neck to get the kaya out.

"What are you doing? Now you must choose a tart shell!" She points to the opposite side, which is full of tart shells in different shapes and sizes. I grab one and it's so crispy it shatters in my hand, scattering crumbs all over the floor.

Silently she drags me away from the kaya / tart aisle and we head towards the checkout. As we get there I look to the right and see the IV salbutamol again.. then I wake up.

Eating places

Sari Rasa

A modest little Indonesian joint inside one of the malls on Cavenagh St, Sari Rasa might be the only Indonesian "restaurant" in town. There's plenty of places to get satay, lontong and such at the markets, but this is a nice place to sit down. The food is padang style (pre-cooked and ready to serve in bain maries) and one makes a selection from the variety on offer.

At my last visit I tried beef rendang which had a delicious sauce but the meat was slightly dry, not quite falling apart at the prod of a fork; fish curry, which was made with chunks of unidentifiable white fish in a broth with strong notes of chilli, lemongrass and tamarind; and sambal eggplant, whole grilled baby eggplants which are then halved and served with a mild chilli paste. There was also on offer chicken curry, spicy chicken, a green bean dish, twice cooked eggs and a lamb curry, and the usual suspects of fried rice and fried noodles.

The inside is a bit dark, and the plastic tables rather reminiscent of a cafeteria, but the serving ladies were so nice and the food adequately delicious, it was well worth the trip into the city.


My friend's kitchen

My first thought was, what a strange name for a Vietnamese restaurant! The logo is an evil looking smiley face, and dazzlingly bright flower patterned melamine bowls and plates make the place even a little weirder. The position is great though, with the tables look out onto busy Mitchell St, making it a perfect people watching spot. 

The menu is pretty standard and reminds me of those really old style Chinese restaurants catering to Western tastes. There aren't any really dishes that I usually love to eat at Vietnamese restaurants - spicy Hue style beef noodles, rice noodle salad, grilled lemongrass pork, prawns on sugar cane, etc.. Instead there was like the same "satay beef, curry beef, beef with black bean sauce", followed by "satay chicken, curry chicken, chicken with xyz sauce", which was a bit disappointing.  Pho was the only "authentic" thing on the menu but we decided to share a few dishes instead.

The fish with chilli and lemongrass was reasonable - a huge plate of pan-fried fish simmered in a spice paste along with red capsicum and celery hearts. The vegetables & tofu dish was a bit boring but perfectly edible, with the fried tofu being the highlight (slightly sweet exterior with a soft silken centre), which made me wonder where they got such delicious tofu in Darwin.

With no drinks other than the standard cans and bottles, I was left wanting my three coloured ice...


Boatshed cafe 

This is a funky cafe on the Cullen Bay main street, considered a "posh" area in Darwin. As one drives into the Cullen Bay precinct, there are all these new-looking modern apartments that just look so out of place in Darwin (especially when I live in the slightly decrepit northern suburbs!) The cafe is decorated like the inside of a boat, the high ceilings lending an airy feel. The tables spill out onto a verandah overlooking the marina, and it's all very cosmopolitan (would not be at all out of place in Sydney).

The coffee came in a large cradle-worthy bowl, which reminded me of the bowls I used to drink at La Petit Creme in Darlinghurst. It was very decent coffee too (Grinders), among the best I've had in Darwin. I had the big breakfast, which really was big enough for two with a pile of bacon, two sausages, scrambled eggs, a whole grilled field mushroom, two halves of roast tomato, a handful of baby spinach and two massive slices of toast. I think that was enough protein to last me for the next week!

The end of nights

Life is always like this - when it's happening everything seems to be in slow motion, yet when it's over it seems to have gone too quickly. Finally, I've finished my six weeks of nights, and will have no more nights for the rest of the year!

Most of my nights were long and painful, and I struggled with not only hunger and fatigue, but with unfamiliar diseases, cultural and language barriers, and the sheer volume of work to be done. I did feel desperate a few times, and it wasn't pretty. Sometimes I wanted to scream "There's five of you (ED doctors) and one of me! Can't you do a better job so I can have an easier time?". Often I was given a completely useless story by a completely clueless person, and have to start from square one, which drove me to the brink of exasperation.

Morning handover was also unpleasant at times. Though most consultants tried to make it a neutral environment, I often felt like I was on trial. I called it the solo standup show of Nancy, and it really was like that, facing a whole room of up to 30 people. One time I started giggling uncontrollably when I relayed that the patient had been hit on the head by his wife wielding a mango stick, and not a single other soul laughed along. All I could hear in the big quiet room was my own loud giggles rising like sobs out of me, fraught with such physical and mental exhaustion. I was so frustrated when I felt like I was being criticised, and sometimes it was just the last thing I needed to make me slouch home like a walking corpse and collapse into bed, unconscious for the next 10 hours.

So in conclusion, it was tough. This job is so different from my last that I am still learning the ropes, and six weeks of nights was the worst way to start. But I have to put that behind me now, see all the positives (all the amazing stories I heard and crazy cases I saw), and look forward to my next job, starting tomorrow.

Three mini-dreams

These three dreams arose quickly in succession after I finally got to sleep in my own bed after a two hour restless snooze on the Bali - Darwin flight.

One

I was in a multi-storey carpark, on the bottom level which appeared to be below ground as it was very dark and illuminated only by a few odd lightbulbs dangling from the ceiling. It's not a carpark that I recognise as having been to before.

I'm looking everywhere for the exit when I suddenly see Eric (as in Nowra ICU nurse) and another girl across the carpark. I walk over to them with the thought to ask Eric how to leave, when I realise he had her draped and prepped for a spinal anaesthetic, sitting over the edge of a little plastic stool.

He's holding a 2mL syringe and about to inject when I ask him (incredulously), why in the world are you doing this in the carpark?

He says "she's made a grave mistake and must be punished". As he injects she screams and I start running away as quickly as I can, and soon I see a lift. Breathlessly I jump into the lift and press a random bunch of buttons.

When the lift door opens I'm in the handover room at Darwin, and everyone's sitting there waiting for me. I grab the first consultant I see (James) and tell him "There's someone trying to murder a girl in the basement, we have to help them!"

He groans and rolls his eyes, "Oh, all right",and gets up reluctantly.

He retrieves a motorbike from behind the lockers in the handover room and we set off into the carpark. When we get there the girl is gone, but Eric is still standing here, and as we approach he chuckles evilly "You'll never get me!"

James says quietly, I'll drive by as closely as possible and you try to kick his head...
but when he does I totally miss and almost fall off the bike.

We try again and again, I try to punch and kick and pull at Eric, every time we are nearby, but he yields a little tiny knife which he keeps cutting my feet and legs with.

Just as I start to feel despair, James runs the bike up a straight part and up onto the ceiling of the carpark. As we are driving along upside down I look down and catch the shining gleam of Eric's knife in the dark.. and that's how I wake up.


Two

I'm sitting at my desk in ED when someone comes up to me and says "Excuse me, I'm just needing a bit of help with the inotropes, could you possibly come and help me?" I don't recognise the girl, who looks about 18, but I assume she's another ICU registrar I haven't met.

I say "Sure, I'll be over as soon as I'm finished here." On the screen I'm reading some food blog about how to make chicken satay sticks; I close the browser and stand up.

Suddenly the alarm goes off and there are flashing red lights everywhere. I wonder briefly if it's my vision going funny as the world flashes bright red.

I walk over to the patient and see that she is completely grey. A nurse stands by staring at the monitor, which is showing a row of flat traces including an arterial BP of 50 / 01. I shout "start CPR", then "get the arrest trolley!" "prepare adrenaline!"

The girl comes rushing up to me and says, I wasn't sure how to make up the noradrenaline and dobutamine infusions, so I started all of them at 1mg/min, is that ok?

The blood rushes to my head as I think about the ramifications of this bizarre situation, then I hear the patient groaning and realise she' s come back to life.

Then I realise she is one of the patients that I lost last year.. and wake up in a sudden fright.


Three

In this dream I am in my own kitchen back at home, and there are lots of plates full of food all around me, as if there had just been a party.

The plate in front of me has a large turkey breast, stuffed with pesto and crushed nuts, rolled and then roasted. It looks and smells delicious, though it has clearly gone cold. I'm wondering whether to heat it up or put it away, when my friend star walks through the doorway.

"I was wondering what happened to the turkeys! Now I know, you've eaten them all!" He says accusingly.

"I didn't have anything to do with this." I protest, "I just walked in and all this food was already here."

He starts shoving plates into the fridge angrily and says "I thought you were vegetarian, but obviously I'm wrong. There's the other turkey breast here, do you want to eat that too?"

Then my grandma shuffles into the kitchen and says "kids, kids, stop arguing, the turkey is already dead." She smiles at us, "I'm going to sleep now, you'd better clean all this up."

I make a cup of tea and sit at the table, wondering which pile to clean up next. There's no more room in the fridge and despite looking through all the cupboards the only containers I can find are a carved wooden box I bought in India (previously containing spiced tea) and an old mobile phone cardboard box, with an old sim card in it.

I'm just wondering which bits of food I can put into these random boxes, then my dad comes into the kitchen and says "What are you doing? It's 6am now! Have you been up all night eating?"

"No, no, I've been trying to clean up, but.." I protest weakly but my dad loses interest and instead drags my friend off into the living room. I overhear him asking "What city are you from? What do your parents do? Where do you work? How much money do you earn?"

I groan in my head and wake up.


(Even for me, this many vivid dreams in a night is too many, my head felt like it was going to explode at the end..)

Dream: crocodile drystroke

So I start this dream standing outside some sort of tourist office advertising "New crocodile tours!". Soon this ranger looking like Steve Irwin (in khaki shorts and sunnies) comes out and takes a group of us into a white van.

We drive out of Darwin on a beautiful sunny day, down the Stuart highway heading towards Katherine. Suddenly the guide brakes and pulls over, parking the van in a clump of grass.

We get out and stand by the side of the road. There's no water around for miles, and I start to wonder where the crocodiles would be.

"Are we supposed to cross the road now?" I asked the guide.
"No, just wait and the crocodiles will come."

I stand there watching sceptically while cars, 4WDs, trucks and road trains hurtle down the Stuart highway, sending little clouds of gravel into our midst.

Just as I was about to laugh at the ridiculousness of this all, I saw a huge looming grey shadow on the horizon, slowly coming towards us. As it gets closer I see that it is about 10 times the size of a normal crocodile, about 50m long with a humongous tail. It looks like some sort of reptilian dinosaur, steadily trudging towards us. Its feet make thunderous plops as they land on the road, like something out of a horror movie.

One of the girls in the group starts screaming, and the guide says "shhh... these are non vegetarian crocodiles, they'll eat you if you make too much noise!" The adrenaline starts to run in me and I shout at the guide "shouldn't we run away? this looks too dangerous!"

But the guide calmly says "These crocodiles have evolved to incorporate a new style of swimming on land, called the drystroke. Please don't be afraid of them because they are Olympic champions in drystroke and would be very upset if you ran away from such a master performance of this art".

So I stand there wide eyed as the crocodile comes closer and closer, when it passes by us I see that it is indeed swinging its arms & legs in a strange awkward fashion like a flapping drowning duck. It gets so close that I can see all its scales..

Then I smell that distinct smell of blood, my heart is filled with horror and I wake up.